背景:如果生活方式改变失败,药物治疗为超重和肥胖的成年人提供了一种减少体重的选择。我们总结了有关减肥药的益处和危害的最新证据。
方法:本系统综述和网络荟萃分析包括对PubMed,Embase,和Cochrane图书馆(CENTRAL)从开始到2021年3月23日,用于超重和肥胖成人减重药物的随机对照试验。我们进行了频繁的随机效应网络荟萃分析来总结证据,并应用了建议评估的分级,发展,和评估框架,以评估证据的确定性,计算绝对效应,对干预措施进行分类,并提出调查结果。这项研究在PROSPERO注册,CRD42021245678。
结果:我们的搜索确定了14605条引文,其中132项符合条件的试验纳入48209例参与者.与单独改变生活方式相比,所有药物都降低了体重;所有随后的数字都是指与改变生活方式的比较。高度至中度确定性证据表明,苯丁胺-托吡酯在降低体重方面最有效(体重减少≥5%的比值比[OR]为8·02,95%CI5·24至12·27;体重变化百分比的平均差[MD]为-7·98,95%CI-9·27至-6·69),其次是GLP-1受体激动剂(OR6·33,95%CI500·79-5,纳曲酮-安非他酮(OR2·69,95%CI2·10至3·44),苯丁胺-托吡酯(2·40,1·68至3·44),GLP-1受体激动剂(2·22,1·74至2·84),和奥利司他(1·71,1·42至2·05)与导致停药的不良事件增加相关。在事后分析中,塞马鲁肽,GLP-1受体激动剂,在体重减轻5%或更高的可能性(OR9·82,95%CI7·09~13·61)和体重变化百分比(MD-11·40,95%CI-12·51~-10·29)方面,与其他药物相比,不良事件风险相似的药物显示出显著更大的获益.
结论:在超重和肥胖的成年人中,芬特明-托吡酯和GLP-1受体激动剂被证明是减轻体重的最佳药物;在GLP-1激动剂中,semaglutide可能是最有效的.
背景:1.3.5卓越学科项目,华西医院,四川大学。
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.
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.
14 605 citations were identified by our search, of which 132 eligible trials enrolled 48 209 participants. 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 -7·98, 95% CI -9·27 to -6·69) followed by GLP-1 receptor agonists (OR 6·33, 95% CI 5·00 to 8·00; MD -5·79, 95% CI -6·34 to -5·25). Naltrexone-bupropion (OR 2·69, 95% CI 2·10 to 3·44),
phentermine-topiramate (2·40, 1·68 to 3·44), GLP-1 receptor agonists (2·22, 1·74 to 2·84), and orlistat (1·71, 1·42 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 -11·40, 95% CI -12·51 to -10·29).
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.
1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University.