Zech Thomas J, Kirchweger Benjamin, Fürst Robert
Pharmazeutische Biologie, Department Pharmazie - Zentrum für Pharmaforschung, Ludwig-Maximilians-Universität München, Butenandtstr. 5, 81377, München, Deutschland.
Inn Med (Heidelb). 2025 Jun 13. doi: 10.1007/s00108-025-01918-0.
Obesity affects a growing number of people worldwide and is associated with severe metabolic, cardiovascular and oncological complications. Obesity not only represents an individual health burden but is also a socioeconomic challenge. With the incretin mimetics liraglutide, semaglutide and tirzepatide, a new class of drugs is now available that for the first time enables substantial and clinically relevant weight reduction.
The article sheds light on the efficacy, safety and prospects of obesity treatment based on glucagon-like peptide 1 (GLP-1). In addition to the results of key clinical trials, potential risks, limitations of use, typical side effects and drug interactions are discussed. Economic aspects are also explained.
Clinical trials show an average weight reduction of 15-20%, with tirzepatide in particular being highly effective. Positive side effects of the treatment mainly concern metabolism (prediabetes and type 2 diabetes regression) and cardiovascular diseases. The main side effects are the frequently occurring gastrointestinal disorders, such as nausea and vomiting. The long-term safety of the substances has not yet been conclusively proven. High costs, limited access and the potential for abuse pose additional challenges. Combination preparations and orally available drugs are currently under development.
Incretin mimetics represent a major advance in the treatment of obesity but require careful selection, close monitoring and long-term integration into lifestyle measures.
肥胖影响着全球越来越多的人，并与严重的代谢、心血管和肿瘤并发症相关。肥胖不仅给个人健康带来负担，也是一项社会经济挑战。随着胰高血糖素样肽-1（GLP-1）类似物利拉鲁肽、司美格鲁肽和替尔泊肽的出现，现在有了一类新型药物，首次实现了显著且具有临床意义的体重减轻。
本文阐述了基于胰高血糖素样肽-1（GLP-1）的肥胖治疗的疗效、安全性及前景。除关键临床试验结果外，还讨论了潜在风险、使用局限性、典型副作用及药物相互作用。同时也解释了经济方面的问题。
临床试验显示平均体重减轻15%-20%，其中替尔泊肽尤其高效。该治疗的积极副作用主要涉及代谢（糖尿病前期和2型糖尿病缓解）和心血管疾病。主要副作用是频繁出现的胃肠道紊乱，如恶心和呕吐。这些药物的长期安全性尚未得到确凿证实。高成本、获取途径有限以及滥用可能性带来了额外挑战。目前正在研发复方制剂和口服药物。
GLP-1类似物是肥胖治疗的一项重大进展，但需要谨慎选择、密切监测并长期融入生活方式措施中。
