Farmacoterapia de la obesidad: revisión de revisiones sistemáticas / Pharmacotherapy of obesity: an umbrella review

Resumen Introducción: los cambios de estilo de vida son los pilares fundamentales del tratamiento de la obesidad. Estos anteceden y acompañan al tratamiento farmacológico cuando correspondiera su indicación. Objetivos: describir la evidencia disponible a través de revisiones sistemáticas (RS) sobre la eficacia y seguridad de los fármacos aprobados para el tratamiento de la obesidad en adultos en Argentina. Materiales y método: se realizaron búsquedas en cinco bases de datos electrónicas, en idioma español, inglés y portugués, donde se seleccionaron RS con o sin metaanálisis, publicadas entre enero 2015 y marzo 2021. La calidad de la evidencia se analizó con la herramienta AMSTAR 2. Resultados: se identificaron 183 RS potencialmente relevantes, incluyendo finalmente a 7 (6 con metaanálisis). A los 12 meses de tratamiento, se observó un rango de pérdida de peso adicional por el uso de medicación vs. placebo: con orlistat de 2,12 a 3,07 kg a una dosis de 360 mg/día; con liraglutida de 5,15 a 5,8 kg a una dosis de 3 mg; y con naltrexona-bupropión de 2,53 a 4,95 kg a una dosis de 32/360 mg o 16/180 mg. Entre los efectos adversos (EA) predominaron los gastrointestinales (GI) en todos los fármacos. Conclusión: los fármacos fueron superiores al placebo en relación a la pérdida de peso, a los 12 meses de intervención, sin embargo es necesario evaluar el costo beneficio de su uso y los resultados a largo plazo. Su implementación en el marco de tratamientos multicomponente e intervenciones intensivas de cambios en el estilo de vida, considerando el fenotipo de conducta alimentaria, entre otros factores influyentes, permitiría optimizar los resultados.

Abstract Introduction: lifestyle changes are the cornerstones of obesity treatment. These precede and go along with pharmacological treatment when indicated. Objectives: to describe the evidence available through systematic reviews (SR) on the efficacy and safety of drugs approved for the treatment of obesity in adults in Argentina. Materials and methods: searches were carried out in five electronic databases, in Spanish, English and Portuguese, in which SRs with or without meta-analysis were selected, published between January 2015 and March 2021. The quality of the evidence was analyzed through AMSTAR2 tool. Results: 183 potentially relevant SRs were identified, finally including 7 (6 with meta-analysis). At 12 months of treatment, a range of additional weight loss from medication use vs. placebo: with orlistat from 2.12 to 3.07 kg at a dose of 360 mg/day; with liraglutide from 5.15 to 5.8 kg at a dose of 3 mg; and with naltrexone-bupropion from 2.53 to 4.95 kg at a dose of 32/360 mg or 16/180 mg. Gastrointestinal (GI) symptoms predominated among adverse effects (AEs) in all drugs. Conclusion: drugs were superior to placebo in relation to weight loss, at 12 months of intervention; however, it is necessary to evaluate the cost benefit of their use and long-term results. Its application in the framework of multicomponent treatments and intensive lifestyle change interventions, considering the eating behavior phenotype, among other influencing factors, would allow optimization of results.

Pharmacological Management of Obesity in Patients with Type 2 Diabetes: An Update

Type 2 diabetes is closely linked with obesity. Obesity is associated with risk of both development and progression of type 2 diabetes, as well as cardiovascular disease. Although lifestyle modifications aimed at prompting weight reduction are cornerstone therapies in managing type 2 diabetes, weight reduction remains challenging for overweight and obese patients with type 2 diabetes. A shift in the approach to weight management in patients with type 2 diabetes is clearly needed. Pharmacotherapy should be considered as a realistic treatment option for patients with type 2 diabetes who cannot lose weight with health behavior modification alone. This review is focused on current pharmacotherapies for obesity to support the glycemic and weight loss goals of obese people with type 2 diabetes.

16 Cases of Anti-obesity Drug Intoxication Experienced in 4 Emergency Departments

PURPOSE: In Korea, few studies have examined the acute toxicity of anti-obesity drugs. The purpose of this study is to analyze the general characteristics and clinical aspect of acute anti-obesity drug intoxication. METHODS: We retrospectively investigated patients admitted to the emergency department after anti-obesity drug intoxication between March, 2004 and February, 2012. The medical records of these patients were reviewed for demographic data, toxicologic history, time elapsed to presentation, clinical symptoms and signs, treatment, and outcome. RESULTS: There were a total of 18 anti-obesity intoxication cases during the study period; of 16 which were included in our study. The purchasing route of the anti-obesity drug was mainly through a doctor's prescription (68.8%), however, some were obtained through the internet and the pharmacies. The mean time to The most commonly ingested anti-obesity drug was sibutramine (31.3%) and many of the cases (62.5%) were multi-drug ingestions. The most common clinical manifestations were gastrointestinal symptoms (94%), but, CNS symptoms (75%) and cardiovascular symptoms (75%) were almost equally present. 13 patients (81%) were discharged after clearance of toxic symptoms and signs with a mean observational period of 7.0 hours. 3 patients were admitted for observation and treatment; of which 1 patient died due to fatal complications. CONCLUSION: Most anti-obesity intoxications show mild toxicity and a nonfatal clinical course. However, the recent trend toward prescribing psychostimulant anti-obesity medication, which can be fatal after an acute overdose, calls physicians' attention to treating of anti-obesity intoxications.

Treatment of Obesity with Drugs

Oesity is a major global health problem. However, current therapeutic strategies for obesity are limited. Obesity results from an imbalance between energy intake and energy expenditure, and the treatment of obesity is based on the correction of this metabolic imbalance. Anti-obesity drugs can shift this balance in a favorable way by reducing food intake, altering metabolism, and by increasing energy expenditure. There is a growing consensus that pharmacotherapy is appropriate for many individuals who are unable to lose weight through less intensive measures. However, side effects may ensue phamacotherapy for obesity. Only two drugs (sibutramine and orlistat) are currently approved for the long-term treatment of obesity. Sibutramine inhibits the reuptake of serotonin and norepinephrine. Orlistat works by blocking the pancreatic lipase. However, phamarcotherapy may not be the ultimate resolution for obesity management. Because the underlying pathophysiology in each individual varies in many aspects, it is recommended to provide individualized and tailored medication in addition to other antiobesity supportive treatments.