Comparison of the effects of liraglutide and sibutramine in obese patients

Abstract

Background: Obesity is a global noncommunicable pandemic. The low effectiveness of treating obesity is associated with the difficulty of maintaining weight loss due to the reaction of the appetite regulation system. Drugs with central mechanisms of action can help overcome this problem.Aim: The aim of our study was to compare the effects of liraglutide and sibutramine (Reduxin) on the dynamics of weight and cardiometabolic parameters in obese patients without cardiovascular diseases.Materials and methods: We estimated the dynamics of the main metabolic parameters (BMI, glucose, lipid metabolism, blood pressure), the level of hormones involved in the regulation of fat metabolism (leptin, adiponectin, insulin), the ­HOMA-IR index, markers of oxidative stress and inflammation during therapy with liraglutide in comparison with reduxin for 6 months in obese patients.Results: 64 obese patients were included in the study: 25 patients — in the “Liraglutide” group, 39 patients — in the “Sibutramine” group in accordance with the declared inclusion / exclusion criteria. The included patients were young, average body mass index (BMI) (37.92 ± 5.45 kg / m2), average glycemic level was 5.47 ± 0.81 mmol /l, HOMA-IR was 6.01 ± 4.25, blood pressure was at inclusion was within the normal range, but 21.8% of patients received antihypertensive therapy.Both treatment options provided a comparable decrease in body weight (-10.28% vs -9.47%, p = 0.13)., Leptin level (-32.12% vs -41.77%, p = 0.77) and myeloperoxidase (-33.33% vs -19.91%, p = 0.2). The blood pressure level did not change significantly on liraglutide, while on reduxin the level of diastolic blood pressure (dBP) increased significantly (6.87%, p = 0.006). There was a more pronounced decrease in insulin levels compared to the baseline level (-46%, p = 0.005), as well as a decrease in the HOMA-IR index (-50.08, p = 0.005) on liraglutide therapy.An increase in adiponectin levels (+ 45.36% vs 14.01%, p = 0.0045) and a decrease in low density lipoprotein(LDL) cholesterol were significantly more pronounced on reduxin therapy (-15.03% vs -9.4%, p = 0.006).36% of the participants completed their participation in the study ahead of schedule due to the lack of effect in the form of weight loss in the «Liraglutide» group. Side effects in the “Liraglutide” group were observed in 16% of patients. 48% of patients took part in the study within 6 months. In the «Sibutramine» group 33.4% of patients completed the study ahead of schedule for reasons unrelated to the drug intake, the side effects were observed in 20.5% of patients. 46.1% of participants in the «Sibutramine» group received therapy for 6 months.Conclusions: This study confirms the previous findings that both liraglutide and reduxin therapy provide effective weight loss. We found a positive trend in markers of inflammation, atherogenesis and oxidative stress, and leptin levels. Liraglutide therapy was accompanied by a more pronounced effect on the state of carbohydrate metabolism, and reduxin therapy provided a more pronounced dynamics of lipid disorders and adiponexin. Both groups were characterized by a rather low adherence to therapy, but the incidence of side effects requiring stopping therapy was higher in the Sibutramine group.

Tissue and Circulating MicroRNAs 378 and 142 as Biomarkers of Obesity and Its Treatment Response

“…Thus, according to Formichi et al, 19.2% of patients dropped out of the study of glucagon-like peptide 1 receptor agonists (GLP1ra) therapy because of side effects [42]. According to our data in real clinical practice, 46.1% of patients fully received a 6-month course of sibutramine therapy (20.5% dropped out due to side effects, 33.4%-due to unsatisfactory price/effect ratio), and 48% of patients received GLP1ra liraglutide (16% of patients dropped out due to side effects, 36%-due to unsatisfactory price/effect ratio) [43]. In a study by Formichi et al [42], as in our study, a block of miRs involved in metabolism processes, not AT but glucose and differing in expression levels in diabetes mellitus type 2 with obesity, was selected based on literature data and the miR dynamics in plasma during GLP1ra therapy was evaluated.…”

Semaglutide — effectiveness in weight loss and side effects when used according to studies by SUSTAIN, PIONEER, STEP

“…В Российской Федерации зарегистрированным и рекомендованным к использованию у пациентов с ожирением является сибутрамин [ 47 ]. На сегодняшний день отсутствуют исследования, посвященные прямому сравнению эффективности семаглутида с сибутрамином, однако имеются данные сравнения с другими АР ГПП-1, включая лираглутид [ 48 ][ 49 ]. Было показано, что через 6 мес терапии снижение массы тела >5% отмечено у 91% пациентов группы лираглутида и у 88% группы сибутрамина [ 49 ].…”

“…На сегодняшний день отсутствуют исследования, посвященные прямому сравнению эффективности семаглутида с сибутрамином, однако имеются данные сравнения с другими АР ГПП-1, включая лираглутид [ 48 ][ 49 ]. Было показано, что через 6 мес терапии снижение массы тела >5% отмечено у 91% пациентов группы лираглутида и у 88% группы сибутрамина [ 49 ]. Спектр побочных эффектов сибутрамина включает нарушения со стороны ЖКТ (5,1% случаев), сердечно-сосудистой системы (10,5% случаев), нервной системы (5,1% случаев), что обусловлено присущими ему симпатомиметическими свойствами [ 48 ][ 49 ].…”

“…Было показано, что через 6 мес терапии снижение массы тела >5% отмечено у 91% пациентов группы лираглутида и у 88% группы сибутрамина [ 49 ]. Спектр побочных эффектов сибутрамина включает нарушения со стороны ЖКТ (5,1% случаев), сердечно-сосудистой системы (10,5% случаев), нервной системы (5,1% случаев), что обусловлено присущими ему симпатомиметическими свойствами [ 48 ][ 49 ]. Напротив, семаглутид может оказывать кардиопротекторное действие, что важно для пациентов с ожирением [ 16 ].…”