Pharmacological interventions for the management of children and adolescents living with obesity—An update of a Cochrane systematic review with meta-analyses

IF 2.7 3区医学 Q1 PEDIATRICS Pediatric Obesity Pub Date : 2024-03-07 DOI:10.1111/ijpo.13113

Gabriel Torbahn, Andrew Jones, Alex Griffiths, Jamie Matu, Maria-Inti Metzendorf, Louisa J. Ells, Gerald Gartlehner, Aaron S. Kelly, Daniel Weghuber, Tamara Brown

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Abstract

Importance

The effectiveness of anti-obesity medications for children and adolescents is unclear.

Objective

To update the evidence on the benefits and harms of anti-obesity medication.

Data Sources

Cochrane CENTRAL, MEDLINE, ClinicalTrials.gov and WHO ICTRP (1/1/16–17/3/23).

Study Selection

Randomized controlled trials ≥6 months in people <19 years living with obesity.

Data Extraction and Synthesis

Screening, data extraction and quality assessment conducted in duplicate, independently.

Main Outcomes and Measures

Body mass index (BMI): 95th percentile BMI, adverse events and quality of life.

Results

Thirty-five trials (N = 4331), follow-up: 6–24 months; age: 8.8–16.3 years; BMI: 26.2–41.7 kg/m². Moderate certainty evidence demonstrated a −1.71 (95% confidence interval [CI]: −2.27 to −1.14)-unit BMI reduction, ranging from −0.8 to −5.9 units between individual drugs with semaglutide producing the largest reduction of −5.88 kg/m² (95% CI: −6.99 to −4.77, N = 201). Drug type explained ~44% of heterogeneity. Low certainty evidence demonstrated reduction in 95th percentile BMI: −11.88 percentage points (95% CI: −18.43 to −5.30, N = 668). Serious adverse events and study discontinuation due to adverse events did not differ between medications and comparators, but medication dose adjustments were higher compared to comparator (10.6% vs 1.7%; RR = 3.74 [95% CI: 1.51 to 9.26], I² = 15%), regardless of approval status. There was a trend towards improved quality of life. Evidence gaps exist for children, psychosocial outcomes, comorbidities and weight loss maintenance.

Conclusions and Relevance

Anti-obesity medications in addition to behaviour change improve BMI but may require dose adjustment, with 1 in 100 adolescents experiencing a serious adverse event.

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管理肥胖儿童和青少年的药物干预--科克伦系统回顾与荟萃分析的更新。

重要性：抗肥胖药物对儿童和青少年的疗效尚不明确：数据来源：Cochrane CENTRAL、MEDLINE、ClinicalTrials.gov 和 WHO ICTR：数据来源：Cochrane CENTRAL、MEDLINE、ClinicalTrials.gov 和 WHO ICTRP（1/1/16-17/3/23）：数据提取和综合：筛选、数据提取和质量评估一式两份，独立进行：身体质量指数（BMI）：第95百分位数BMI、不良事件和生活质量：35项试验（N = 4331），随访时间：6-24个月；年龄：8.8-16.3岁；体重指数：26.2-41.7 kg/m2。中度确定性证据显示，BMI 降低了-1.71（95% 置信区间 [CI]：-2.27 至-1.14）个单位，不同药物之间的降低幅度从-0.8 至-5.9 个单位不等，其中以塞马鲁肽的降低幅度最大，为-5.88 kg/m2（95% 置信区间：-6.99 至-4.77，N = 201）。药物类型解释了~44%的异质性。低确定性证据显示，BMI 第 95 百分位数减少了：-11.88 个百分点（95% CI：-18.43 至 -5.30，N = 668）。药物与对比药之间的严重不良事件和因不良事件而中止研究的情况没有差异，但药物剂量调整率高于对比药（10.6% vs 1.7%；RR = 3.74 [95% CI：1.51 to 9.26]，I2 = 15%），与批准情况无关。有改善生活质量的趋势。在儿童、社会心理结果、合并症和体重减轻维持方面存在证据缺口：除了改变行为外，抗肥胖药物还能改善体重指数，但可能需要调整剂量，每100名青少年中就有1人发生严重不良事件。

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来源期刊

Pediatric Obesity PEDIATRICS-

CiteScore

7.30

自引率

5.30%

发文量

117

审稿时长

6-12 weeks

期刊介绍： Pediatric Obesity is a peer-reviewed, monthly journal devoted to research into obesity during childhood and adolescence. The topic is currently at the centre of intense interest in the scientific community, and is of increasing concern to health policy-makers and the public at large. Pediatric Obesity has established itself as the leading journal for high quality papers in this field, including, but not limited to, the following: Genetic, molecular, biochemical and physiological aspects of obesity – basic, applied and clinical studies relating to mechanisms of the development of obesity throughout the life course and the consequent effects of obesity on health outcomes Metabolic consequences of child and adolescent obesity Epidemiological and population-based studies of child and adolescent overweight and obesity Measurement and diagnostic issues in assessing child and adolescent adiposity, physical activity and nutrition Clinical management of children and adolescents with obesity including studies of treatment and prevention Co-morbidities linked to child and adolescent obesity – mechanisms, assessment, and treatment Life-cycle factors eg familial, intrauterine and developmental aspects of child and adolescent obesity Nutrition security and the "double burden" of obesity and malnutrition Health promotion strategies around the issues of obesity, nutrition and physical activity in children and adolescents Community and public health measures to prevent overweight and obesity in children and adolescents.