Addition of orlistat to conventional treatment in adolescents with severe obesity

Özkan, Behzat; Bereket, Abdullah; Turan, Serap; Keskin, Sabiha

doi:10.1007/s00431-004-1534-6

Cited by 107 publications

(54 citation statements)

References 12 publications

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“…51 These approaches, explored in therapy for both adult and pediatric NASH, include (1) diagnosis and treatment of related metabolic disturbances such as diabetes and hyperlipidaemia (2) targeting IR by weight loss (healthy lifestyle: diet and exercise) or pharmacotherapy and (3) control of the secondary processes promoting to oxidative stress, inflammation, apoptosis and hepatic fibrosis by using hepatoprotective agents such as antioxidants. 6,26,[130][131][132][133][134][135][136][137][138][139] However, it is important to exclude secondary causes for hepatic steatosis. Treatment in these cases differs and revolves around correcting the underlying cause.…”

Section: Treatmentmentioning

confidence: 99%

“…130 Table 5 has shown the list of pharmacological agents attributed to the treatment of NAFLD-NASH. [131][132][133][134][135][136][137][138][139][140][141][142][143][144][145][146][147] Only metformin 135 and vitamin E 140 have been used until now in clinical trials, but there is some evidence because of efficacy in adult and safety in children for other groups such as antiobesity (orlistat), 129,131 angiotensin-converting enzyme inhibitor 132 and stations. 133,138 These evidences in parallel to other novel therapies [141][142][143][144][145][146][147] must be considered in designing future clinical trials for treatment of pediatric fatty liver.…”

Section: Treatmentmentioning

confidence: 99%

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Nonalcoholic fatty liver disease: a challenge for pediatricians

Widhalm

Ghods

2010

Int J Obes

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Background: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of pediatric liver disease. Its prevalence is related to the growing epidemic in childhood obesity during the past decades. At present, NAFLD and nonalcoholic steatohepatitis (NASH) are increasingly recognized worldwide. In spite of alarming trend in the epidemiology in pediatric field and growing risk of end stage liver disease, there is no significant advance in its diagnosis and treatment. Aim: To provide a detailed review for diagnosis and management of NAFLD and NASH. Methods: By using Pubmed to find review articles and relevant research. Results: The prevalence ranges from at least 3% in children overall to about 50% in obese children. The noninvasive biomarkers can be used to identify NAFLD/NASH patients. Diagnostic criteria based on biochemical and immunological indicators in the high-risk group of children could prevent about half of cases from receiving an invasive test. The pharmacological and surgical interventions have shown a growing role in pediatric NAFLD. Novel treatment modalities, such as probiotics, have hardly been studied. Conclusion: Early diagnosis by using noninvasive screening methods in high-risk groups is the most effective strategy against the NAFLD. The biology of early growth and development, including hepatic metabolism, may hold the key to pediatric NAFLD. Prevention of overweight children and childhood obesity is undoubtedly the best strategy for treating NAFLD.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Nonalcoholic fatty liver disease: a challenge for pediatricians

Widhalm

Ghods

2010

Int J Obes

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“…A detailed study of the tolerability of taking orlistat together with a comprehensive behavioural and dietetic programme in 20 adolescents over 3 months found that 85% completed 3 months on orlistat, but that 50-60% reported a combination of unpleasant gastrointestinal side-effects [17]. In an early small open-label randomized controlled trial, gastrointestinal side-effects were reported in all 22 adolescents receiving orlistat, of whom seven (32%) dropped out of the trial during the first month of the trial due to side-effects attributable to orlistat [20].…”

Section: Comparison With the Literaturementioning

confidence: 99%

Rise in antiobesity drug prescribing for children and adolescents in the UK: a population‐based study

Viner

Hsia

Neubert

et al. 2009

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • The antiobesity drugs sibutramine and orlistat are not licensed for use in children and adolescents in the UK or USA.• Clinical trials suggest antiobesity drugs are effective and well‐tolerated in obese adolescents. WHAT THIS STUDY ADDS • Prescribing of unlicensed antiobesity drugs in children and adolescents has increased significantly in the past 8 years.• Most prescribed antiobesity drugs in children and adolescents are rapidly discontinued before patients can see clinical benefit, suggesting they are poorly tolerated or poorly efficacious.AIMS The international childhood obesity epidemic has driven increased use of unlicensed antiobesity drugs, whose efficacy and safety are poorly studied in children and adolescents. We investigated the use of unlicensed antiobesity drugs (orlistat, sibutramine and rimonabant) in children and adolescents (0–18 years) in the UK.METHODS Population‐based prescribing data from the UK General Practice Research Database between 1 January 1999 and 31 December 2006.RESULTS A total of 452 subjects received 1334 prescriptions during the study period. The annual prevalence of antiobesity drug prescriptions rose significantly from 0.006 per 1000 [95% confidence interval (CI) 0.0007, 0.0113] in 1999 to 0.091 per 1000 (95% CI 0.07, 0.11) in 2006, a 15‐fold increase, with similar increases seen in both genders. The majority of prescriptions were made to those ≥14 years old, although 25 prescriptions were made for children <12 years old. Orlistat accounted for 78.4% of all prescriptions; only one patient was prescribed rimonabant. However, approximately 45% of the patients ceased orlistat and 25% ceased sibutramine after only 1 month. The estimated mean treatment durations for orlistat and sibutramine were 3 and 4 months, respectively.CONCLUSIONS Prescribing of unlicensed antiobesity drugs in children and adolescents has dramatically increased in the past 8 years. The majority are rapidly discontinued before patients can see weight benefit, suggesting they are poorly tolerated or poorly efficacious when used in the general population. Further research into the effectiveness and safety of antiobesity drugs in clinical populations of children and adolescents is needed.

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“…Although absolute concentrations of vitamins D and E and b-carotene decreased during orlistat treatment, only few individuals needed supplementation in the European Multicenter Orlistat Study. 17 Two studies in extremely obese adolescents 20,21 and one study in obese prepubertal children 22 demonstrated that orlistat significantly reduces body weight. Unfortunately, all these studies were short-term trials (3 months), and only few patients remained on orlistat treatment for 15 months.…”

Section: Digestive Inhibitorflipase Inhibitor (Orlistat)mentioning

confidence: 99%

“…Unfortunately, all these studies were short-term trials (3 months), and only few patients remained on orlistat treatment for 15 months. The number of patients investigated was low: twenty, 20 twenty two, 21 and eleven. 22 What is more disturbing is that none of these trials were randomised and placebo-controlled.…”

Section: Digestive Inhibitorflipase Inhibitor (Orlistat)mentioning

confidence: 99%

New drug policy in childhood obesity

Molnár

2005

Int J Obes

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OBJECTIVE: To update physicians, especially paediatricians, in the rapidly developing field of pharmacotherapy of childhood and adolescent obesity. METHODS: The paper reviews current and investigational antiobesity drugs. RESULTS: At present, there are only few drugs approved by the Food and Drug Administration (FDA) for the treatment of adult obesity. The most important ones are sibutramine and orlistat. The FDA in the USA approved the latter drug in 2003, and it has recently been approved by the European Union for the treatment of adolescents. There are several investigational antiobesity agents but only few new and promising substances like Rimonabant (a cannabinoid receptor antagonist) and axokine (ciliary neutrotrophic factor) are already at an advanced stage of development. CONCLUSION: In adults, it seems to be justified using drugs for long-term treatment of 'medically important' obesity. Strict guidelines concerning the treatment of obese adolescents with orlistat are needed. It is only hoped that double-blind placebocontrolled studies investigating the new and promising drugs will also include adolescents and provide sufficient scientific data to get them licensed for the treatment of obese adolescents.

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Addition of orlistat to conventional treatment in adolescents with severe obesity

Abstract: Orlistat could be a useful adjunct in the treatment of severe obesity in adolescents; however, gastrointestinal side-effects limit its usefulness in almost one in three adolescents.

Cited by 107 publications

References 12 publications

Nonalcoholic fatty liver disease: a challenge for pediatricians

Nonalcoholic fatty liver disease: a challenge for pediatricians

Rise in antiobesity drug prescribing for children and adolescents in the UK: a population‐based study

New drug policy in childhood obesity

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