Farmakoterapia otyłości — obecny stan wiedzy

Abstract

Obesity, which affects about 13% of the world population, results in significant deterioration of health and serious clinical, mainly meta-bolic and cardiovascular complications. Although the basis of therapeutic treatment is behavioural treatment, often non-pharmacological effects do not produce the desired effect. Currently there are several drugs with a safe action profile that improve the effect of treatment (5-10% weight reduction). The aim of the paper is to present the potential of modern pharmacotherapy in the treatment of obesity, in terms of mechanism of action, efficacy, and side effects, in order to individualise therapy. The drugs already registered include substances with a variety of mechanisms of action, including phentermine, orlistat, lorcaserin, and liraglutide. Compounded preparations (phenter-mine/topiramate, naltrexone SR/bupropion SR) are also available, which, by using low doses of active substances, have beneficial effects while reducing side effects. In addition, several drugs used to treat diabetes, such as metformin, SGLT2 inhibitors, GLP-1 agonists, and pramlintide, promote weight loss, although their use is reserved for diabetics, especially type 2 patients. Regarding the current alarm-ing epidemiological data there is a need for intensive prevention and treatment of obesity as well as the development of a new form of pharmacotherapy (new substances and treatment regimens) to develop effective, safe, and, above all, long-term effective therapy for the treatment of obesity.

Diagnosis and Non-Invasive Treatment of Obesity in Adults with Type 2 Diabetes Mellitus: A Review of Guidelines

“…Among the drugs used to treat T2DM is liraglutide, and in some countries semaglutide has also been officially approved for the treatment of obesity. It should be noted, however, that the dosage of GLP1-RAs in weight management is different than in T2DM management [ 14 , 19 , 82 ].…”

“…Additionally, GLP-1Ras exert a feeling of satiety by affecting POMC/CART (pro-opiomelanocortin/cocaine- and amphetamine-regulated transcript) neurons in the CNS (central nervous system) and delaying postprandial gastric emptying. These actions in tandem promote weight reduction [ 82 , 93 , 94 , 95 ]. GLP-1RAs can be readily subdivided into two groups: (1) short-acting, administered at least once a day (exenatide, lixisenatide, liraglutide) and (2) long-acting, administered once a week (dulaglutide, exenatide extended-release, semaglutide).…”

“…As mentioned earlier, liraglutide and semaglutide are the only GLP-1RAs (and the only antihyperglycemic agents for that matter) approved for weight management in patients without concomitant T2DM [ 82 , 110 ].…”

“…Adverse effects include insomnia, dry mouth, constipation, and dizziness [ 20 ]. An undisputed advantage of phentermine is its low cost (it is the cheapest drug approved for weight management) [ 14 , 82 ].…”

Pharmacotherapy for weight loss in adults with type 2 diabetes: a systematic review of randomised controlled trials

“…1,2 Although lifestyle modification remains the mainstay of all obesity treatment strategies, obesity pharmacotherapy can be a safe and effective adjunct to lifestyle modification. [3][4][5] To date, only seven drugs have been available for obesity treatment and three (sibutramine, rimonabant and lorcaserin) have been subsequently withdrawn for safety concerns. With the exception of orlistat available since 1998, remaining therapies have only recently become available within the last decade.…”