利拉鲁肽在肥胖症治疗中的应用:真实世界的数据(葡萄牙)。

IF 2.5 Q3 ENDOCRINOLOGY & METABOLISM Minerva endocrinology Pub Date : 2024-07-16 DOI:10.23736/S2724-6507.24.04161-7
Carlos Tavares Bello, Inês Redondo Carvalho, Anabela Martins, Ana F Martins, Ana Wessling, Daniel Macedo, Diana Martins, Carlos Fernandes, Francisco Sobral DO Rosário
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引用次数: 0

摘要

背景:超重和肥胖是一个重大的公共卫生问题,其发病率和流行率不断上升,影响着发达国家 50%以上的人口。由于其复杂的病理生理学和多因素病因,人们对疾病的认识、诊断方法和管理仍未达到最佳水平。药物治疗与结构化营养干预和体育锻炼计划相结合,有可能放大体重减轻和与健康相关的益处。利拉鲁肽是最有效、最常用的减肥药物之一。其疗效和安全性已在随机临床试验中得到证实,但葡萄牙的实际数据却很少。作者报告了一家大学医院内分泌诊所在生活方式干预基础上使用利拉鲁肽治疗超重和肥胖症患者的经验。研究的目的是评估利拉鲁肽治疗超重和肥胖症的效果:方法:回顾性纵向观察研究。纳入标准为肥胖(BMI>30 kg/m2)或超重(≥27 kg/m2)且至少患有一种与肥胖相关的并发症(高血压、血脂异常、阻塞性睡眠呼吸暂停、非酒精性脂肪肝)、接受过至少三个月利拉鲁肽治疗的成年患者(大于 18 岁)。糖尿病诊断和曾接受过减肥手术为排除标准。研究包括人口统计学和临床变量,并记录了利拉鲁肽治疗至少 3 个月前后的体重:148名患者(85.8%为女性)接受了利拉鲁肽治疗,平均年龄为(48.7±11.9)岁。平均基线体重指数(BMI)为 33.8±5.2 kg/m2,中位随访时间为 13 个月。在最后一次就诊时,85.8%的患者仍在服用利拉鲁肽。在仍在服用利拉鲁肽的患者中,平均体重减轻了7.6千克(7.9%),治疗时间超过6个月的患者体重减轻幅度更大(8.6千克对6.2千克,P=0.016)。尽管治疗时间相似,但肥胖患者的体重减轻幅度明显高于超重患者(8.3 千克对 4.5 千克,P=0.028)。利拉鲁肽停药的原因包括胃肠道不耐受(7例)、药物费用(2例)、疗效不佳(10例)和医生指导(1例):本研究证实了利拉鲁肽治疗超重和肥胖症患者的长期疗效,且停药率低。平均体重减轻效果显著,而且从治疗的第 6 个月开始更加明显。利拉鲁肽与生活方式干预相结合,是大多数肥胖症患者控制体重的良好选择。
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Liraglutide in the management of obesity: real world data (Portugal).

Background: Overweight and obesity are major public health issues with increasing incidence and prevalence, affecting more than 50% of the population in developed countries. Due to its complex pathophysiology and multifactorial etiology, disease understanding, diagnostic approach and management remain suboptimal. Together with a structured nutritional intervention and physical activity plan, pharmacological treatment has the potential to magnify weight loss and health related benefits. Liraglutide is one of the most effective and frequently prescribed weight loss medication. Its efficacy and safety have been demonstrated in randomized clinical trials, however, real world data in Portugal is scarce. The authors report on the experience of a University Hospital Endocrine Clinic in the management of patients with overweight and obesity with liraglutide on top of lifestyle intervention. The aim of the study was to evaluate the effectiveness of liraglutide in the management of overweight and obesity.

Methods: Retrospective, longitudinal observational study. Inclusion criteria were adult patients (>18 years old) with obesity (BMI>30 kg/m2) or overweight (≥27 kg/m2) with at least one obesity related co-morbidity (hypertension, dyslipidemia, obstructive sleep apnea, non-alcoholic fatty liver disease) with at least three months of liraglutide treatment. Diabetes diagnosis and prior bariatric surgery were exclusion criteria. Demographic and clinical variables were included and weight was recorded before and after at least 3 months of liraglutide treatment.

Results: One hundred forty-eight patients (85.8% females) with a mean age of 48.7±11.9 years were treated with liraglutide. Mean baseline BMI was 33.8±5.2 kg/m2 and median follow-up was 13 months. At the last appointment, 85.8% were still taking liraglutide. Among patients still taking liraglutide, mean weight loss was 7.6 kg (7.9%), with significantly greater losses in patients treated for more than 6 months (8.6kg vs. 6.2 kg, P=0.016). Patients with obesity lost significantly more weight than overweight patients (8.3 kg vs. 4.5 kg, P=0.028), despite similar treatment duration. The reasons for liraglutide withdrawal were gastrointestinal intolerance (7), medication cost (2), inefficacy (10) and physician instructions (1).

Conclusions: The present study documents the long-term efficacy of liraglutide in the treatment of patients with overweight and obesity, with a low rate of drug withdrawal. Mean weight loss was significant and more evident from the 6th month of treatment on. Liraglutide, along with lifestyle intervention, is a good option for weight management in the majority of patients with obesity.

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