减肥手术后无应答者的药物治疗:现有证据综述。

IF 2.5 Q3 ENDOCRINOLOGY & METABOLISM Minerva endocrinology Pub Date : 2024-06-01 Epub Date: 2021-04-01 DOI:10.23736/S2724-6507.21.03311-3
Federica Vinciguerra, Luana M Romeo, Lucia Frittitta, Roberto Baratta
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引用次数: 0

摘要

导言肥胖症是一种复杂的慢性疾病,需要多学科的长期治疗。减肥手术是治疗肥胖症最有效的方法之一,但即使是接受了减肥手术的患者,也可能在成功完成初级手术后,体重减轻(IWL)低于预期(初级无反应者)或体重反弹(WR)(次级无反应者)。反应不佳是减肥手术面临的一个挑战,可能导致肥胖相关并发症的持续或复发,从而影响手术的效果。越来越多的证据表明,减肥药物是减肥手术后肥胖治疗的有效策略:本叙事性综述总结了有关抗肥胖治疗在初级减肥手术无反应者治疗中的应用的证据。考虑了有关利拉鲁肽(一项随机双盲安慰剂对照试验、三项前瞻性研究和三项回顾性研究)、纳曲酮/安非他明(三项回顾性研究)、奥利司他(一项病例对照前瞻性研究和一项回顾性研究)以及托吡酯和芬特明(五项回顾性研究)的现有数据:现有数据表明,在肥胖症的终生管理中,减肥药物可为生活方式和行为的改变提供显著的辅助益处:结论:包括使用抗肥胖药物在内的新治疗模式为患者和医疗服务提供者提供了更多选择,以治疗减肥手术后的不良反应。
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Pharmacological treatment of non-responders following bariatric surgery.

Obesity is a complex chronic disease and requires a long-term multidisciplinary management. Even patients undergoing bariatric surgery, one the most effective treatments for obesity, can have insufficient weight loss (IWL) than expected (primary non responder) or weight regain (WR) after a successful primary procedure (secondary non responder). A poor response represents a challenge of bariatric surgery that can induce persistence or recurrence of obesity-related comorbidities, prejudicing benefits of surgery. Increasing evidence suggests that weight loss medications represent a useful strategy in obesity care also after bariatric surgery procedures. This narrative review summarizes the evidence concerning anti-obesity therapy in the management of no-responders to primary bariatric surgery. Available data on liraglutide (one randomized double-blind placebo-controlled trial, three prospective and three retrospective studies), naltrexone/bupropion (three retrospective studies), orlistat (one case control prospective and one retrospective studies) and topiramate and phentermine (five retrospective studies) have been considered. Available data suggest that weight loss medications could offer a significant adjunctive benefit to lifestyle and behavioral modifications in the life-long management of obesity. Newer treatment modalities including the use of anti-obesity drugs provide patients and healthcare providers with more options in the management of poor response after bariatric surgery.

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