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对肥胖的长期药物治疗:系统和临床审查
Susan Z Yanovski1, Jack A Yanovski2
1Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
JAMA
|November 16, 2013
概括
肥胖药物,当与生活方式的改变相结合时,提供显著的减肥益处. 临床医生应评估患者对治疗的反应,以优化结果并最大限度地降低风险.
科学领域:
- 药理学 药理学是指药理学的学科.
- 肥胖医学 肥胖医学
- 临床实践指南 临床实践指南
背景情况:
- 肥胖影响36%的美国成年人,许多人无法通过生活方式干预单独实现足够的减肥.
- 有效的体重管理策略对于改善公共卫生结果至关重要.
研究的目的:
- 系统地审查美国批准的成人治疗肥胖药物.
- 讨论非标签药物使用,并提供对肥胖药物治疗的临床考虑.
主要方法:
- 系统性审查PubMed文献 (2013年9月开始).
- 包括元分析,系统性审查和随机对抗肥胖药物的随机对照试验,持续时间≥1年.
- 研究要求≥50名参与者/组,≥50%的保留率,以及治疗意图分析.
主要成果:
- 经批准的肥胖药物在1年内,与安慰剂相比,增加了39%的体重减轻,而芬特明/托皮拉显示出最高的疗效.
- 3573%的患者在使用这些药物时实现了临床上有意义的体重减轻 (≥5%).
- 药物改善了心脏代谢风险因素,但没有证明降低了心血管发病率或死亡率.
结论:
- 长期的肥胖药物,作为生活方式干预的辅助,增强减肥和实现有意义结果的可能性.
- 在不响应患者 (缺少≥5%的体重减轻) 中停止药物治疗可以减少患者面临的风险和成本,但没有显著的益处.
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