Obesity pharmacotherapy – update 2023

Czech version

Authors: Martin Haluzík ¹; Dana Müllerová ²; Petr Sucharda ³; Jan Boženský ⁴; Pavol Holéczy ⁵; Martin Fried ⁶; Vojtěch Hainer ⁷; Marie Kunešová ⁷; Iva Málková ⁸; Šárka Slabá ⁹; Petra Šrámková ⁶; Radka Taxová Braunerová ⁷
Authors‘ workplace: Centrum diabetologie IKEM, Praha ¹; Ústav hygieny a preventivní medicíny a 1. interní klinika LF UK a FN Plzeň ²; 3. interní klinika – klinika endokrinologie a metabolismu 1. LF UK a VFN v Praze ³; Dětské oddělení Nemocnice AGEL Ostrava-Vítkovice ⁴; Chirurgické oddělení Nemocnice AGEL Ostrava-Vítkovice ⁵; OB klinika, Praha ⁶; Endokrinologický ústav, Praha ⁷; STOB, Praha ⁸; Gynekologicko-porodnická klinika 1. LF UK a VFN v Praze ⁹
Published in: Čas. Lék. čes. 2023; 162: 19-31
Category: Guidelines

Overview

The increasing prevalence of obesity and its associated complications leads to the need to intensify its prevention and treatment. The treatment of obesity is currently based on lifestyle modification, which often fails in the long term. For the next decade, the long-term administration of anti-obesity drugs, i.e. drugs that have a positive effect not only on the reduction of excess weight but also on the health risks associated with obesity, seems to be a necessary part of obesity treatment, along with surgical approaches.

This text provides an overview of the current options for the pharmacotherapy of obesity, including their indications, appropriate patient selection and adverse effects of treatment. It also provides an overview of studies that demonstrate the long-term efficacy and safety of these treatments. Although effective and safe anti-obesity drugs are currently available, it is not even partially covered by general health insurance. However, the cost of treatment is unaffordable in the long term for a large proportion of the obese. The virtual unavailability of effective antiobesity drugs for indicated patients has serious health-economic consequences.

Failure to take advantage of effective therapeutic options, confirmed by evidence-based medicine, results in a high prevalence of obesity-related diseases, which are even more costly to treat economically and, in the case of type 2 diabetes, even less effective. We consider at least partial reimbursement of antiobesity drugs from general health insurance for cooperating patients under clearly defined conditions to be a necessary step towards improving the situation, and clearly cost-effective in its consequences.

Keywords:

diabetes – obesity – pharmacotherapy – antiobesity – complications of obesity

Sources

Měřinská S.Životní podmínky českých domácností. Český statistický úřad, 2. 2. 2023. Dostupné na: www.czso.cz/documents/10180/205587887/csu_tk_silc_2022_prezentace.pdf/dc9e03bb-375c-432f-9d7a-d8a0a51f1f72?version=1.0
Vážná A, Vignerová J, Brabec M a kol. Vliv restrikcí spojených s onemocněním COVID-19 na prevalenci nadváhy a obezity u českých dětí. Čs. pediatrie 2023; 78 [v tisku].
König HH, Lehnert T, Brenner H et al. Health service use and costs associated with excess weight in older adults in Germany. Age Ageing 2015; 44: 616–623.
Specchia ML, Veneziano MA, Cadeddu C et al. Economic impact of adult obesity on healthsystems: a systematic review. Eur J Public Health 2015; 25: 255–262.
Tremmel M, Gerdtham UG, Nilsson PM, Saha S. Economic burden of obesity: a systematic literature review. Int J Environ Res Public Health 2017; 14: 435.
Flegal KM, Panagiotou OA, Graubard BI. Estimating population attributable fractions to quantify the health burden of obesity. Ann Epidemiol 2015; 25: 201–207.
Hebebrand J, Holm JC, Woodward E et al. A proposal of the European Association for the Study of Obesity to improve the ICD-11 diagnostic criteria for obesity based on the three dimensions etiology, degree of adiposity and health risk. Obes Facts 2017; 10: 284–307.
Yumuk V, Tsigos C, Fried M et al.; Obesity Management Task Force of the European Association for the Study of Obesity. European guidelines for obesity management in adults. Obes Facts 2015; 8: 402–424.
Greenway FL. Physiological adaptations to weight loss and factors favouring weight regain. Int J Obes (Lond) 2015; 39: 1188–1196.
Sumithran P, Prendergast LA, Delbridge E et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med 2011; 365: 1597–1604.
Jensen MD, Ryan DH, Apovian CM et al.; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol 2014; 63 (25 Pt. B): 2985–3023.
Lean ME, Leslie WS, Barnes AC et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 2018; 391: 541–551.
Durrer Schutz D, Busetto L, Dicker D et al. European practical and patient-centred guidelines for adult obesity management in primary care. Obes Facts 2019; 12: 40–66.
Hainer V. a kol. Základy klinické obezitologie (3., zcela přepracované vyd.). Grada, Praha, 2021.
Sjöström L, Rissanen A, Andersen T et al. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. European Multicentre Orlistat Study Group. Lancet 1998; 352(9123): 167–172.
Leblanc ES, O'Connor E, Whitlock EP et al. Effectiveness of primary care-relevant treatments for obesity in adults: a systematic evidence review for the U. S. Preventive Services Task Force. Ann Intern Med 2011; 155(7): 434–447.
Torgerson JS, Hauptman J, Boldrin MN, Sjöström L. Xenical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 2004; 27: 155–161.
Davidson MH, Hauptman J, DiGirolamo M et al. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: a randomized controlled trial. JAMA 1999; 281: 235–242.
Kelley DE, Bray GA, Pi-Sunyer FX et al. Clinical efficacy of orlistat therapy in overweight and obese patients with insulin-treated type 2 diabetes: a 1-year randomized controlled trial. Diabetes Care 2002; 25: 1033–1041.
Tonstad S, Pometta D, Erkelens DW et al. The effect of the gastrointestinal lipase inhibitor, orlistat, on serum lipids and lipoproteins in patients with primary hyperlipidaemia. Eur J Clin Pharmacol 1994; 46: 405–410.
Henness S, Perry CM. Orlistat: a review of its use in the management of obesity. Drugs 2006; 66: 1625–1656.
McNeely W, Benfield P. Orlistat. Drugs 1998; 56: 241–249.
Greig SL, Keating GM. Naltrexone ER/Bupropion ER: a review in obesity management. Drugs 2015; 75: 1269–1280.
Caixàs A, Albert L, Capel I, Rigla M. Naltrexone sustained-release/bupropion sustained-release for the management of obesity: review of the data to date. Drug Des Devel Ther 2014; 8: 1419–1427.
Greenway FL, Dunayevich E, Tollefson G et al. Comparison of combined bupropion and naltrexone therapy for obesity with monotherapy and placebo. J Clin Endocrinol Metab 2009; 94: 4898–4906.
Hollander P, Gupta AK, Plodkowski R et al. Effects of naltrexone sustained-release/bupropion sustained-release combination therapy on body weight and glycemic parameters in overweight and obese patients with type 2 diabetes. Diabetes Care 2013; 36: 4022–4029.
Wadden TA, Foreyt JP, Foster GD et al. Weight loss with naltrexone SR/bupropion SR combination therapy as an adjunct to behavior modification: the COR-BMOD trial. Obesity (Silver Spring) 2011; 19: 110–120.
Nissen SE, Wolski KE, Prcela L et al. Effect of naltrexone-bupropion on major adverse cardiovascular events in overweight and obese patients with cardiovascular risk factors: a randomized clinical trial. JAMA 2016; 315: 990–1004.
Bode B. An overview of the pharmacokinetics, efficacy and safety of liraglutide. Diabetes Res Clin Pract 2012; 97: 27–42.
Jacobsen LV, Flint A, Olsen AK, Ingwersen SH. Liraglutide in type 2 diabetes mellitus: Clinical pharmacokinetics and pharmacodynamics. Clin Pharmacokinet 2016; 55(6): 657–672.
van Can J, Sloth B, Jensen CB et al. Effects of the once-daily GLP-1 analog liraglutide on gastric emptying, glycemic parameters, appetite and energy metabolism in obese, non-diabetic adults. Int J Obes (Lond) 2014; 38: 784–793.
Flint A, Kapitza C, Hindsberger C, Zdravkovic M. The once-daily human glucagon-like peptide-1 (GLP-1) analog liraglutide improves postprandial glucose levels in type 2 diabetes patients. Adv Ther 2011; 28: 213–226.
Horowitz M, Flint A, Jones KL et al. Effect of the once-daily human GLP-1 analogue liraglutide on appetite, energy intake, energy expenditure and gastric emptying in type 2 diabetes. Diabetes Res Clin Pract 2012; 97: 258–266.
Pi-Sunyer X, Astrup A, Fujioka K et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med 2015; 373: 11–22.
le Roux CW, Astrup A, Fujioka K et al. 3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial. Lancet 2017; 389: 1399–1409.
Davies MJ, D'Alessio DA, Fradkin J et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2018; 41: 2669–2701.
Wadden TA, Hollander P, Klein S et al. Weight maintenance and additional weight loss with liraglutide after low-calorie-diet-induced weight loss: the SCALE Maintenance randomized study. Int J Obes (Lond) 2015; 39: 187.
Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine Task Force. Sleep 1999; 22: 667–689.
Marso SP, Daniels GH, Brown-Frandsen K et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2016; 375: 311–322.
Bays H, Pi-Sunyer X, Hemmingsson JU et al. Liraglutide 3.0 mg for weight management: weight-loss dependent and independent effects. Curr Med Res Opin 2017; 33: 225–229.
Kolotkin RL, Fujioka K, Wolden ML et al. Improvements in health-related quality of life with liraglutide 3.0 mg compared with placebo in weight management. Clin Obes 2016; 6: 233–242.
Blackman A, Foster GD, Zammit G et al. Effect of liraglutide 3.0 mg in individuals with obesity and moderate or severe obstructive sleep apnea: the SCALE Sleep Apnea randomized clinical trial. Int J Obes (Lond) 2016; 40: 1310–1319.
Aroda VR, Bain SC, Cariou B et al. Efficacy and safety of once-weekly semaglutide versus once-daily insulin glargine as add-on to metformin (with or without sulfonylureas) in insulin-naive patients with type 2 diabetes (SUSTAIN 4): a randomised, open-label, parallel-group, multicentre, multinational, phase 3a trial. Lancet Diabetes Endocrinol 2017; 5: 355–366.
Pratley RE, Aroda VR, Lingvay I et al. Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial. Lancet Diabetes Endocrinol 2018; 6: 275–286.
Ahrén B, Masmiquel L, Kumar H et al. Efficacy and safety of once-weekly semaglutide versus once-daily sitagliptin as an add-on to metformin, thiazolidinediones, or both, in patients with type 2 diabetes (SUSTAIN 2): a 56-week, double-blind, phase 3a, randomised trial. Lancet Diabetes Endocrinol 2017; 5: 341–354.
Marso SP, Holst AG, Vilsbøll T. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2017; 376: 891–892.
Garvey WT, Mechanick JI, Brett EM. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract 2016; 22 (Suppl. 3): 1–203.

Labels

Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management

ÚVODEM

Current possibilities and risks of donating some tissues, cells, and organs from living donors

Adipose tissue in the treatment of androgenic alopecia

Hypercapnic respiratory failure – review

Syndrom křehkosti

Therapeutic effect of lymphography in the postoperative chylothorax – case reports and literature review

Protilátky získané po infekci koronavirem nás dlouhodobě chrání před opakovanou infekcí, pravil už i Lancet

Otakar Tardy, the founder of the ENT department in Litomyšl – commemoration on the 45th anniversary of his death

Zemřel profesor Karel Maršál

Odešel docent Jiří Ramba

Zemřel docent Petr Brandejský

Přednáškové večery Spolku českých lékařů v Praze (duben – květen 2023)