Lu Ting-Ting, Liu Bin, Ge Long, Liu Ya-Li, Lu Yu
Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China.
NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor, Gansu Provincial Hospital, Lanzhou, China.
Int J Obes (Lond). 2025 Mar;49(3):464-477. doi: 10.1038/s41366-025-01719-3. Epub 2025 Jan 26.
Multiple meta-analyses (MAs) have demonstrated that six pharmacotherapies, including orlistat, liraglutide, phentermine/topiramate, naltrexone/bupropion, semaglutide, and tirzepatide, improve weight loss and weight maintenance. However, few studies have synthesized and evaluated the quality of this evidence.
To identify the relevant MAs of randomized clinical trials (RCTs) that explored the association between the six pharmacotherapies and obesity-related health outcomes and adverse events (AEs).
A comprehensive search was conducted across PubMed, Embase, Cochrane Library, and Web of Science from database inception up to January 2024. We calculated the effect size as the mean difference and risk ratio using the random-effects model. The quality of MAs was evaluated using "A Measurement Tool to Assess Systematic Reviews 2".
Sixteen MAs comprising 235 RCTs that described 115 unique associations between the six pharmacotherapies and various health outcomes were included. Overall, 101 statistically significant associations (88%) had beneficial outcomes on body weight, weight loss, waist circumference, body mass index, total cholesterol, triglycerides, both low-density and high-density lipoprotein cholesterol, blood pressure, and glycemic profile. The pharmacotherapies were associated with significant weight loss and partial improvements in the lipid profile, blood pressure, and glycemic control among individuals with overweight or obesity. Notable AEs were associated with liraglutide, naltrexone/bupropion, semaglutide, and orlistat. The methodological quality of the included MAs requires improvement.
This umbrella review identified significant beneficial associations between pharmacotherapies and anthropometric measures, lipid profile, blood pressure, glycemic profile, and quality-of-life outcomes in individuals with overweight or obesity. In addition, the umbrella review highlighted safety considerations. The findings affirm the efficacy of the six pharmacotherapies in promoting weight loss in this demographic. Further clinical trials with long-term follow-up are essential to evaluate the effects of these pharmacotherapies on clinical outcomes, including cancer, cardiovascular events, and mortality.
多项荟萃分析表明，包括奥利司他、利拉鲁肽、苯丁胺/托吡酯、纳曲酮/安非他酮、司美格鲁肽和替尔泊肽在内的六种药物疗法可改善体重减轻和体重维持情况。然而，很少有研究对这一证据的质量进行综合评估。
识别探索六种药物疗法与肥胖相关健康结局及不良事件（AE）之间关联的随机临床试验（RCT）的相关荟萃分析。
从数据库建立至2024年1月，在PubMed、Embase、Cochrane图书馆和科学网进行了全面检索。我们使用随机效应模型将效应量计算为平均差和风险比。使用“系统评价评估测量工具2”评估荟萃分析的质量。
纳入了16项荟萃分析，包括235项RCT，这些RCT描述了六种药物疗法与各种健康结局之间的115种独特关联。总体而言，101项具有统计学意义的关联（88%）对体重、体重减轻、腰围、体重指数、总胆固醇、甘油三酯、低密度和高密度脂蛋白胆固醇、血压以及血糖谱具有有益结局。这些药物疗法与超重或肥胖个体的显著体重减轻以及脂质谱、血压和血糖控制的部分改善相关。显著的不良事件与利拉鲁肽、纳曲酮/安非他酮、司美格鲁肽和奥利司他有关。纳入的荟萃分析的方法学质量需要改进。
这项伞状综述确定了药物疗法与超重或肥胖个体的人体测量指标、脂质谱、血压、血糖谱和生活质量结局之间存在显著的有益关联。此外，伞状综述强调了安全性考量。这些发现证实了六种药物疗法在该人群中促进体重减轻的疗效。进一步的长期随访临床试验对于评估这些药物疗法对包括癌症、心血管事件和死亡率在内的临床结局的影响至关重要。
