小柯机器人

四川大学华西医院李舍予团队对超重和肥胖成年人的药物治疗进行了系统回顾和网络荟萃分析。这一研究成果于2021年12月8日发表在《柳叶刀》杂志上。

药物治疗为超重和肥胖的成年人提供了一种选择，如果生活方式改变失败，他们也可以减轻体重。研究团队总结了有关减肥药利弊的最新证据。

研究组共确定了14605条文献，其中143个合格试验登记了49810名参与者。除左卡尼汀外，所有药物均比单独改变生活方式更能降低体重；所有后续指标均指与生活方式改变的比较。

在一项事后分析中，GLP-1受体激动剂塞马鲁肽在体重减轻5%及以上的可能性（9.82）和体重变化百分比（MD）方面，显示出比其他具有类似不良事件风险的药物更大的益处。

研究结果表明，对于超重和肥胖的成年人，芬特明-托吡酯和GLP-1受体激动剂被证明是最好的减肥药物；在GLP-1激动剂中，塞马鲁肽可能是最有效的。

附：英文原文

Title: Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials

Author: Qingyang Shi, Yang Wang, Qiukui Hao, Per Olav Vandvik, Gordon Guyatt, Jing Li, Zhe Chen, Shishi Xu, Yanjiao Shen, Long Ge, Feng Sun, Ling Li, Jiajie Yu, Kailei Nong, Xinyu Zou, Siyi Zhu, Cong Wang, Shengzhao Zhang, Zhi Qiao, Zhongyu Jian, Ya Li, Xinyi Zhang, Kerun Chen, Furong Qu, Yuan Wu, Yazhou He, Haoming Tian, Sheyu Li

Issue&Volume: 2021-12-08

Abstract:

Background

Pharmacotherapy provides an option for adults with overweight and obesity to reduce their bodyweight if lifestyle modifications fail. We summarised the latest evidence for the benefits and harms of weight-lowering drugs.

Methods

This systematic review and network meta-analysis included searches of PubMed, Embase, and Cochrane Library (CENTRAL) from inception to March 23, 2021, for randomised controlled trials of weight-lowering drugs in adults with overweight and obesity. We performed frequentist random-effect network meta-analyses to summarise the evidence and applied the Grading of Recommendations Assessment, Development, and Evaluation frameworks to rate the certainty of evidence, calculate the absolute effects, categorise interventions, and present the findings. The study was registered with PROSPERO, CRD 42021245678.

Findings

14605 citations were identified by our search, of which 143 eligible trials enrolled 49810 participants. Except for levocarnitine, all drugs lowered bodyweight compared with lifestyle modification alone; all subsequent numbers refer to comparisons with lifestyle modification. High to moderate certainty evidence established phentermine–topiramate as the most effective in lowering weight (odds ratio [OR] of ≥5% weight reduction 8·02, 95% CI 5·24 to 12·27; mean difference [MD] of percentage bodyweight change 7·97, 95% CI 9·28 to 6·66) followed by GLP-1 receptor agonists (OR 6·33, 95% CI 5·00 to 8·00; MD 5·76, 95% CI 6·30 to 5·21). Naltrexone–bupropion (OR 2·69, 95% CI 2·11 to 3·43), phentermine–topiramate (2·40, 1·69 to 3·42), GLP-1 receptor agonists (2·17, 1·71 to 2·77), and orlistat (1·72, 1·44 to 2·05) were associated with increased adverse events leading to drug discontinuation. In a post-hoc analysis, semaglutide, a GLP-1 receptor agonist, showed substantially larger benefits than other drugs with a similar risk of adverse events as other drugs for both likelihood of weight loss of 5% or more (OR 9·82, 95% CI 7·09 to 13·61) and percentage bodyweight change (MD 11·41, 95% CI 12·54 to 10·27).

Interpretation

In adults with overweight and obesity, phentermine–topiramate and GLP-1 receptor agonists proved the best drugs in reducing weight; of the GLP-1 agonists, semaglutide might be the most effective.

DOI: 10.1016/S0140-6736(21)01640-8

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01640-8/fulltext

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