Drug combinations in the treatment of obesity: the past and present
Authors:
V. Hainer
Authors‘ workplace:
Centrum pro diagnostiku a léčbu obezity
; Ředitelka: doc. RNDr. Běla Bendlová, CSc.
; Endokrinologický ústav, Praha
Published in:
Prakt. Lék. 2017; 97(3): 109-116
Category:
Reviews
Overview
Withdrawal of several anti-obesity drugs from the market and inappropriate demands of drug regulating agencies with regard to the study protocol led to scepticism about the perspectives in the pharmacotherapy of obesity. Since 2010, only lipase inhibitor orlistat remained available for the long-term treatment of obesity in the Czech Republic. Nevertheless, recently developed anti-obesity medications such as gut hormone analogues and drug combinations provided encouraging results in terms of weight loss, improvement of cardio-metabolic health risks, safety and tolerability. The use of drug combinations in obesity management began in the eighties when two drug combinations (as ephedrine/caffeine mixture) in decreased doses were recommended to increase both the safety and efficacy of the treatment. However, it should be seriously considered that drug combinations may not only lead to increased efficacy but in some cases (as with fenfluramine/phentermine combination) also to enhancement of side effects. A short outline of anti-obesity drug combinations used or investigated in the past is provided. Curently two combination drugs are available for the long-term treatment of obesity: phentermine/topiramate in the United States (U.S.) and naltrexone/bupropion in both the U.S. and Europe, including the Czech Republic. Treatment with naltrexone/bupropion, used as indicated by the drug labelling and in combination with comprehensive lifestyle modification, leads to a significantly higher weight loss compared to diet and exercise intervention alone. Moreover, naltrexone/bupropion combination facilitates weight loss maintenance and improves lipid profile and glucose homeostasis as well as a quality of life in the treated overweight and obese patients. The drug is safe and well tolerated when indications and contraindications are taken into accout. It is emphasized that the treatment with anti-obesity agents should be interrupted in non-responders, i.e. in those who did not achieve weight loss ≥ 5,0% after 4-month of the drug administration.
Keywords:
combined anti-obesity agents – ephedrine/caffeine – fenfluramine/phentermine – phentermine/topiramate – naltrexone/bupropion – efficacy – safety
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