Drug Therapy For Obesity Research Articles

Modern strategies for the treatment of childhood obesity

The prevalence of obesity and related metabolic disorders in children and adolescents in the Russian Federation is steadily increasing, which requires healthcare professionals to search for new methods of treatment and prevention. The treatment of childhood obesity should be based on a comprehensive approach, including diet therapy, increased physical activity, behavioral therapy and psychological support. To increase the effectiveness of the formation of new eating habits and proper eating behavior, as well as to increase the adherence of children and adolescents to treatment, drug therapy of obesity is used, aimed primarily at reducing appetite. Considering the efficacy and safety of glucagon-like peptide 1 analog (Liraglutide) in adolescents, as well as a small number of gastrointestinal side effects, this drug is promising in the complex treatment of childhood obesity. This review presents an analysis of the literature on non-medicated and drug-based methods of treatment of childhood obesity.

Drug therapy for obesity in the Russian Federation: pharmacoepidemiological study

Objective: аssessment of orlistat, liraglutide and sibutramine consumption in the Russian Federation as drugs recommended by the Russian clinical guidelines for the pharmacotherapy of obesity.Material and methods. From IQVIA database, the information was selected on retail sales and procurement of the specified drugs at the expense of the federal and regional budgets in the period of 2011–2021. The consumed volumes of each drug were recalculated into the number of defined daily doses (DDDs) for each international nonproprietary name in accordance with the World Health Organization methodology.Results. It was demonstrated that over a 10-year period there was a tendency to reduce the consumption of drugs for the treatment of obesity from 83.03 million DDDs in 2011 to 71.7 million in 2021. Sibutramine consumption dominated throughout the observation period: its share ranged from 76% to 84%. The proportion of people receiving obesity pharmacotherapy in the Russian Federation was about 0.5%. Herewith 58–66% of DDDs sales took place in 3 regions: Moscow, Moscow Region and Saint Petersburg.Conclusion. Low efficacy, high frequency of adverse effects, frequent weight gain after therapy termination, as well as low orientation of doctors to the need for pharmacotherapy are probably the main factors determining the low prevalence of using drugs for the treatment of obesity in Russia.

Pharmacological Management of Obesity: A Century of Expert Opinions in Cecil Textbook of Medicine

Innovations in drug therapy for obesity have had a limited impact on the body mass index, prevalence of medical complications, quality of life, and work potential of a substantial majority of affected persons. What are the milestones of the changes in the expert approach to the pharmacological management of obesity in the past century? To determine the changes in the experts' approach to the management of obesity, as presented in a widely used textbook in the United States. The primary sources were chapters describing the management of obesity in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. Secondary sources were publications retrieved from Medline that clarified technical issues related to the development, regulatory approval, and use of the drugs mentioned in the Cecil Textbook of Medicine. Pharmacological interventions aimed at increasing caloric expenditures through thermogenesis were recommended from 1927 through 1943. Thyroid extracts were prescribed even in the absence of demonstrated hypothyroidism or decreased basal metabolic rate throughout this period. Dinitrophenol was mentioned in 1937, but was banned soon thereafter. Appetite suppression with amphetamine was considered useful from 1943 through 1988, after which the drug was replaced with other centrally acting molecules, such as fenfluramine in 1988, sibutramine in 2000, and rimonabant in 2008, which were in turn withdrawn because of major adverse effects. In the past decade, obesity has been treated with the appetite suppressants phentermine-topiramate, bupropion-naltrexone, lorcaserin, and liraglutide, and with orlistat, a drug promoting fat malabsorption. The change in weight produced by these drugs is generally modest and transient. The pharmacological management of obesity has remained frustratingly inefficient. The reasons for the relative lack of success may reside in the ever-growing access to dense, palatable, and relatively inexpensive food, coupled with the decrease in energy expenditure created by a sedentary lifestyle.

Efficacy of sibutramine in different types of eating behavior in obese patients

Introduction. One of the key factors contributing to the development and progression of obesity is impairment eating behavior (EB). Therefore, drug therapy for obesity should not only reduce hunger, contributing to weight loss, but also reducing the severity of EB disorders.Aim. Assess the representation of different types of EB in obese patients, the effect of sibutramine therapy on dynamics EB by The Dutch Eating Behavior Questionnaire (DEBQ) and for hunger/satiety on a visual analog scale (VAS). Quality life of patients, adherence to treatment of obese patients and their weight dynamics in different types of EB during therapy with sibutramine was also assessed.Materials and methods. The study included 36 obese patients (30 women and 6 men), mean age 38.7 ± 10.8 years, mean body weight 102.8 ± 16.4 kg, body mass index (BMI) 36.8 ± 4.6 kg/m2, receiving therapy with sibutramine at a dose of 10 mg per day once in the morning before meals in combination with hypocaloric nutrition.Results and discussion. The study showed the prevalence of the emotiogenic type of eating disorders in patients. However, it was pointed out that sibutramine therapy combined with hypocaloric nutrition proved its efficacy in any type of eating disorders. Positive dynamics anxiety/depression in subclinical conditions during treatment with sibutramine was also revealed.Conclusion. Sibutramine treatment may be recommended for the development of a new EB model in obese patients because it is effective in reducing weight in any type of EB disorder.

Utility of an experimental medicine model to evaluate efficacy, side-effects and mechanism of action of novel treatments for obesity and binge-eating disorder

Obesity and Binge-Eating Disorder (BED) are prevalent conditions that are associated with increased risk of morbidity and mortality. There is evidence that the use of pharmacotherapy alongside behavioural treatments can improve quality of life and reduce disease risk for patients with these disorders. However, there are few approved drug therapies for obesity, and these are limited by poor efficacy and/or side effects and only one drug has been approved for the treatment of BED. There is considerable potential to use experimental medicine models to identify new drug treatments for obesity and BED, with greater efficacy and an improved side effect profile, at an early stage of development. Here, we present a model developed in our laboratory that incorporates both behavioural and neuroimaging measures which can be used to facilitate drug development for obesity and BED. The results from validation studies conducted to date using our model suggest that it is sensitive to the effects of agents with behavioural, neurophysiological and neuropharmacological mechanisms of action known to be associated with weight loss and reductions in binge eating. Future studies using the model will be valuable to evaluate the potential efficacy and side-effects of new candidate drugs at an early stage in the development pipeline for both obesity and BED.

The Fight Against Obesity Escalates: New Drugs on the Horizon and Metabolic Implications.

There is currently a steep rise in the global prevalence of obesity. Pharmaceutical therapy is a valuable component of conservative obesity therapy. Herein, medications currently in the phase of preclinical or clinical testing are reviewed, along with an overview of the mechanisms that regulate energy intake and expenditure. In addition, the current and potential future directions of obesity drug therapy are discussed. Although the current arsenal of obesity pharmacotherapy is limited, a considerable number of agents that exert their actions through a variety of pharmacodynamic targets and mechanisms are in the pipeline. This expansion shapes a potential near future of obesity conservative management, characterized by tailored combined therapeutic regimens, targeting not only weight loss but also improved overall health outcomes. The progress regarding the elucidation of the mechanisms which regulate the bodily energy equilibrium has led to medications which mimic hormonal adaptations that follow bariatric surgery, in the quest for a "Medical bypass." These, combined with agents which could increase energy expenditure, point to a brilliant future in the conservative treatment of obesity.

US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity.

Obesity is now the most prevalent chronic disease in the United States, which amounts to an estimated $147 billion in health care spending annually. The Affordable Care Act (ACA) enacted in 2010 included provisions for private and public health insurance plans that expanded coverage for lifestyle/behavior modification and bariatric surgery for the treatment of obesity. Pharmacotherapy, however, has not been included despite their evidence-based efficacy. We set out to investigate the coverage of Food and Drug Administration-approved medications for obesity within Medicare, Medicaid and ACA-established marketplace health insurance plans. We examined coverage for phentermine, diethylpropion, phendimetrazine, Benzphentamine, Lorcaserin, Phentermine/Topiramate (Qysmia), Liraglutide (Saxenda) and Buproprion/Naltrexone (Contrave) among Medicare, Medicaid and marketplace insurance plans in 34 states. Among 136 marketplace health insurance plans, 11% had some coverage for the specified drugs in only nine states. Medicare policy strictly excludes drug therapy for obesity. Only seven state Medicaid programs have drug coverage. Obesity requires an integrated approach to combat its public health threat. Broader coverage of pharmacotherapy can make a significant contribution to fighting this complex and chronic disease.

New drug therapies for obesity: Do they work?

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Pharmacotherapy of Obesity: Clinical Trials to Clinical Practice.

This review provides an overview of the current state of drug therapy for obesity, with a focus on four new drug therapies-lorcaserin, phentermine/topiramate, naltrexone/bupropion, and liraglutide 3.0mg-which have been approved by the US Food and Drug Administration (FDA) for long-term management of obesity since 2012. Topics discussed in this paper include rationale for pharmacotherapy, history of antiobesity drugs, and efficacy and safety data from randomized controlled trials with implications for clinical practice. Weight loss achieved by currently approved drugs ranges from approximately 3 to 9%, above and beyond weight loss with lifestyle counseling alone, after a year. Response and attrition rates in clinical trials indicate that the benefits of pharmacotherapy range from substantial for some patients, modest for others, and no benefits for others still. Decisions regarding selection of a suitable drug from the available pharmacotherapy options and duration of treatment should be based on the expected and observed benefit-to-risk balance and tailored to the needs of each individual patient using the principles of shared decision-making.

Obesity Context of Type 2 Diabetes and Medication Perspectives

Abstract Drug therapy of obesity has harsh antecedent that many earlier introduced drugs are withdrawn from market. The drugs in present use lack sufficient long-term efficacy and safety data. The difficulty of reversing changing dietary habits and decline in physical activity, however, offers major scope for anti-obesity therapeutics, implied in managing the epidemic chronic inflammatory maladies and cardiovascular sequel. Metabolic syndrome, pre-diabetes and type 2 diabetes mellitus, commonly associate with obesity. Weight reduction is crucial to prevent and control type 2 diabetes. This emphasizes rational choice of therapeutic regimens that do not themselves cause weight gain, and better promote weight loss. Such an aspect is addressed briefly focusing upon the available newer anti-obesity drug options, in particular.

The GLP-1 agonist, liraglutide, as a pharmacotherapy for obesity.

There is a global obesity epidemic that will continue to be a financial burden on healthcare systems around the world. Tackling obesity through diet and exercise should always be the first intervention, but this has not proved to be effective for a large number of patients. Pharmacotherapeutic options have been limited and many previously available drugs have been withdrawn due to safety concerns. Currently, only bariatric surgery has the capability to induce both substantial and durable weight loss. This article briefly reviews the history of pharmacotherapy for obesity before focusing on the clinical trial evidence for the use of the GLP-1 agonist liraglutide as a weight loss agent and comparing its efficacy with other emerging drug therapies for obesity.

The New Era of Drug Therapy for Obesity: The Evidence and the Expectations.

There is an urgent need for effective pharmacological therapies to help tackle the growing obesity epidemic and the healthcare crisis it poses. The past 3 years have seen approval of a number of novel anti-obesity drugs. The majority of these influence hypothalamic appetite pathways via dopaminergic or serotoninergic signalling. Some are combination therapies, allowing lower doses to minimize the potential for off-target effects. An alternative approach is to mimic endogenous satiety signals using long-lasting forms of peripheral appetite-suppressing hormones. There is also considerable interest in targeting thermogenesis by brown adipose tissue to increase resting energy expenditure. Obesity pharmacotherapy has seen several false dawns, but improved understanding of the pathways regulating energy balance, and better-designed trials, give many greater confidence that recently approved agents will be both efficacious and safe. Nevertheless, a number of issues from preclinical and clinical development continue to attract debate, and additional large-scale trials are still required to address areas of uncertainty.

Exenatide Response in an Adolescent’s Morbid Obesity

Adolescent obesity is a health problem worldwide. Drug therapy for obesity in children is only acceptable if done within the framework of a comprehensive weight loss, prevention of comorbidities, including health education, changes in lifestyles, diet and exercise. These pharmacological treatments indicate that mainly young patients did not respond to standard measures and developing complications. The role of bariatric surgery, with or without the use of drugs is subject to further research to elucidate its role among the various treatment options for these patients. Currently being studied a wide range of drugs to those included gastrointestinal hormones. Scientific information regarding the use of exenatide in obese patients without diabetes is still limited. The use of exenatide in adolescents with morbid obesity may represent a therapeutic complement invaluable, effective and free of complications, and prevents future bariatric surgery.

Pharmacy innovation across the nation

Pharmacy innovation across the nation

Pharmacological approaches to feeding behaviour and eating disorders

Pharmacological approaches to feeding behaviour and eating disorders

Drug Therapy for Obesity

Drug Therapy for Obesity

Bupropion plus Naltrexone for Weight Loss

The history of drug therapy for obesity is littered with compounds that were marginally effective for weight loss but had unacceptable side effects.

Review Of NPY And NPY Receptor For Obesity

The prevalence of obesity continues to increase throughout the world and the burden of obesity and related co morbidities is large. However existing drug therapies for obesity are limited and agents with high efficacy, safety and tolerability are expected to meet patient needs and lead to more substantial commercial success. Contemporary consideration has focused on physiology of neuropeptides Y (NPY) and its role in the regulation of energy homeostasis. NPY stimulates food intake, inhibits energy expenditure, and increases body weight and increases anabolic hormone level by activating the NPY Y1 and Y5 receptors in the hypothalamus. Based on these findings, several NPY Y1 and Y5 receptor antagonists have been developed in last two decade as potential anti-obesity agents and transgenic mice model lacking NPY, the NPY Y1 receptor or the NPY Y5 receptor have been generated. The data obtained to date with these newly developed tools suggests that NPY receptor antagonists, particularly NPY Y1 and Y5 receptor antagonist, have potentiality to bless the obesity patients worldwide. However, the redundancy of the neurochemical systems regulating energy homeostasis may limit the effect of ablating a single pathway. In addition, patients in whom the starvation response is activated, such as formerly obese patients who have lost weight or patients with complete or partial leptin deficiency, may be the best candidates for treatment with a NPY receptor antagonist. New leads are under research by major pharmaceutical companies to limit the side effects and explore the area to meet clinical requirement.

Impact of Different Bariatric Surgical Procedures on Insulin Action and β-Cell Function in Type 2 Diabetes

The prevalence of obesity appears to have reached a plateau in the U.S. between 2003 and 2007 (1), but the obesity epidemic is still rampant in many other countries—especially in the developing world (2)—in adults as well as children (http://www.who.int/topics/obesity/en/). A recent analysis of a large prospective cohort of individuals 50–71 years old (3) has generated a precise dose-response gradient for the positive association of BMI and relative risk of death independent of other risk factors (especially smoking and preexisting disease, which cause weight loss). Yet, long-term observational studies have generally found that weight loss, whether spontaneous or intentional, is associated with increased, rather than decreased, overall mortality (rev. in 4). Lifestyle intervention (diet and exercise), behavioral management, and drug therapy for obesity deliver a degree of weight loss that is usually modest (and therefore unattractive to patients) and short-lived (6 months to 1 year at best) and carry considerable side effects. Moreover, despite the attenuation of risk factors such as diabetes and dyslipidemia, trial evidence for an effect of these weight-control approaches on reducing cardiovascular disease or mortality is still lacking (rev. in 5). On the other hand, and perhaps as a consequence, surgery for the treatment of severe obesity is gaining increasing favor. The annual U.S. frequency of hospital discharges that included bariatric surgery increased sevenfold (from 3.5 to 24.0 per 100,000) between 1996 and 2002 (6). According to a review of 85,048 morbidly obese patients (7), early (≤30 days) and late (30 days to 2 years) mortality rates for bariatric surgery trend downward (0.28 and 0.35%, respectively). Surgical treatment of massive obesity is being extended to adolescents, seemingly with similar success and risk rates as in adults (8–10). Recently, the 10.9-year follow-up of the Swedish Obese Subjects Study reported a 30% risk reduction for …

Nonviral Hepatitis

Chronic liver diseases are a significant cause of death worldwide. Cirrhosis is most frequently caused by hepatitis C or alcohol abuse, but other nonviral etiologies are now recognized as important contributors to the development of hepatitis. Nonalcoholic fatty liver disease, caused by abnormal accumulation of lipids in hepatocytes, can progress from simple steatosis to necroimflammation and cirrhosis. It is estimated to occur in up to 40% of the general population, and its pathophysiology is closely linked to features of metabolic syndrome. There is currently no proven treatment for nonalcoholic fatty liver disease. Management strategies largely address identification and treatment of associated risk factors and include drug therapy for obesity, insulin resistance (eg, metformin, thiazolidinediones), and dyslipidemia (eg, fibrates, HMG-CoA reductase inhibitors). Autoimmune hepatitis is characterized by necroinflammation mediated by autoantibody attack against liver antigens in genetically predisposed patients. It is considered a rare form of chronic liver disease but can progress to cirrhosis if unrecognized and untreated. Autoimmune hepatitis usually responds well to long-established immunosuppressive regimens with prednisone and azathioprine; however, new approaches are required for those patients who do not achieve or sustain desired outcomes or are intolerant to standard therapy.