Non-surgical intervention for obesity

clearmind

In recent years, somewhat efficacious pharmacological
approaches (such as sibutramine and rimonabant)
received initial regulatory approval but were
subsequently withdrawn from the market because of
adverse effects such as depression or hypertension
resulting from their central actions on adrenergic, serotonergic
or cannabinoid mechanisms. Until recently,
the only approved medication was the pancreatic
lipase inhibitor, orlistat, which is associated with relatively
small changes in weight and GI adverse effects,
such as bloating and diarrhoea, which reduce compliance
with orlistat intake over the long term. New
pharmacological approaches, recently approved by
the FDA, decrease appetite and result in weight loss:
Lorcaserin (Belviq) is a serotonin 2c (5-HT2C) receptor
agonist that activates pro-opiomelanocortin
(POMC) neurons of the hypothalamic arcuate
nucleus, decreasing appetite7 and resulting in an average 5.8%
weight loss when compared with 2.1% in the placebo group.8 A
second, approved drug is the combination phenterminetopiramate
extended release (ER) (Qsymia) that produces mean 8–
10% weight loss in different trials when compared with 1.6%
weight loss in the placebo group.9 This degree of weight loss is
lower than that observed with bariatric surgery. In view of the
potential for central nervous system (CNS)-mediated and cardiovascular
adverse effects with these centrally-acting drugs, they
require close postmarketing surveillance. Lorcaserin has high affinity
and selectivity and is a full agonist for 5-HT2C receptors. By
virtue of its high selectivity for 5-HT2C receptors relative to
5-HT2A (18-fold) and 5-HT2B (104-fold) receptors,10 lorcaserin
avoids induction of hallucinations and cardiopulmonary toxicity,
12–14 respectively. Nevertheless, the FDA approved
phentermine-topiramate ER (Qsymia) with 10 postmarketing
requirements.

(Acosta A, et al. Gut 2014;63:687–695. doi:10.1136/gutjnl-2013-306235)

[ 本帖最後由 clearmind 於 2014-6-4 21:30 編輯 ]