Drug treatment of obesity – current situation and perspectives
Authors:
Vojtěch Hainer
Authors‘ workplace:
Endokrinologický ústav Praha, Centrum pro diagnostiku a léčbu obezity
Published in:
Čas. Lék. čes. 2010; 149: 513-519
Category:
Review Article
Farmakoterapie obezity by měla být integrální součástí komplexního léčebného programu u obezity, který zahrnuje dietu, pohybovou aktivitu a kognitivně behaviorální intervenci. Léky k léčbě obezity (antiobezitika), které máme v současnosti k dispozici, navozují pouze nevelký hmotnostní pokles, který je však provázen redukcí kardiometabolických zdravotních rizik. V minulosti byla řada antiobezitik stažena z trhu vzhledem k výskytu závažných nežádoucích účinků (psychostimulačních, kardiovaskulárních, plicní hypertenze, chlopenních vad, deprese, návykovosti atd.).
Overview
Pharmacotherapy of obesity should be an integral part of the comprehensive obesity management program which includes diet, exercise and cognitive behavioural intervention. Currently available antiobesity drugs result in only modest weight loss, however it is still accompanied by reduction of cardiometabolic health risks. In the past several antiobesity drugs were removed from the market because of serious adverse effects (psychostimulatory, cardiovascular, pulmonary hypertension, valvular disease, depression, addiction etc.). Such situations led some investigators and clinicians to nihilistic approaches to the drug treatment of obesity. This paper aims to review the data on clinical efficiency and safety of currently available antiobesity drugs and to summarize our knowledge on the recently discovered antiobesity agents which underwent clinical trials (such as lorcaserin, tesofensine, cetilistat, combination drugs, gut hormone analogues etc.). Approaches with two drug combination of decreased doses were recommended to increase both safety and efficacy of antiobesity treatment. However, previous experiences that antiobesity drug combinations (e.g. fenfluramine/phentermine) may also potentiate adverse events should be carefully considered in the evaluation of recently tested compounds. Administration of physiological doses of gut hormones - derived appetite regulating agents seems to be a promising, efficient, specific and thus, low side-effect approach in the treatment of obesity. To confirm the strong role of antiobesity drugs in the treatment of obesity and its complications further long-term studies evaluating their effect on morbidity and mortality end points in appropriate target populations are needed.
Key words:
obesity, drug treatment, efficiency, safety, orlistat, sibutramine, lorcaserin, tesofensine, cetilistat, combination drugs, gut hormone analogues.
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