Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis.
Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis.
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DOI：
10.1001/jama.2016.7602
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发表时间：
2016-06-14
期刊：
影响因子：
--
通讯作者：
Singh S
中科院分区：
文献类型：
--
作者：
Khera R;Murad MH;Chandar AK;Dulai PS;Wang Z;Prokop LJ;Loomba R;Camilleri M;Singh S
五种药物已被批准用于治疗肥胖，但比较有效性的数据有限。使用系统评价和网络荟萃分析来比较肥胖药物治疗的体重减轻和不良事件。 MEDLINE、EMBASE、Web of Science、Scopus 和 Cochrane Central（从成立到 2016 年 3 月 23 日）；临床试验注册处。在使用美国食品和药物管理局批准的长期减肥药（奥利司他、氯卡色林、纳曲酮安非他酮、芬特明托吡酯或利拉鲁肽）治疗至少一年的超重和肥胖成年人中进行的随机临床试验，与另一种活性药物或安慰剂进行比较。两名研究人员使用预定义的方案确定研究并独立提取数据。进行了贝叶斯网络荟萃分析，并使用累积排名（SUCRA）概率下的表面来评估代理的相对排名。使用 GRADE 标准评估证据质量。 1 年时体重减轻至少 5% 和至少 10% 的患者比例、体重减轻幅度以及因不良事件而停止治疗的患者比例。纳入了 28 项随机临床试验，涉及 29018 名患者（中位年龄 46 岁；74% 女性；中位基线体重 100.5 kg；中位基线体重指数 36.1）。中位 23% 的安慰剂参与者体重减轻至少 5%，而服用芬特明-托吡酯的参与者为 75%（比值比 [OR]，9.22；95% 可信区间 [CrI]，6.63–12.85；SUCRA，0.95），服用利拉鲁肽的参与者为 63%（OR，5.54；95%CrI， 4.16–7.78； 0.83），55% 服用纳曲酮安非他酮（OR，3.96；95%CrI，3.03–5.11；SUCRA，0.60），49% 服用氯卡色林（OR，3.10；95%CrI，2.38–4.05；SUCRA，0.39），44% 服用奥利司他（OR，2.70；95%CrI，2.34–3.09； 苏克拉，0.22）。与安慰剂相比，所有活性药物在 1 年时均与显着过度体重减轻相关——芬特明-托吡酯，8.8 kg（95% CrI，-10.20 至 -7.42 kg）；利拉鲁肽，5.3千克（95％CrI，-6.06至-4.52千克）；纳曲酮-安非他酮，5.0 kg（95%CrI，-5.94至-3.96 kg）；氯卡色林，3.2千克（95%CrI，-3.97至-2.46千克）；和奥利司他，2.6千克（95％CrI，-3.04至-2.16千克）。与安慰剂相比，利拉鲁肽（OR，2.95；95%CrI，2.11-4.23）和纳曲酮-安非他酮（OR，2.64；95%CrI，2.10-3.35）与不良事件相关治疗终止的几率最高。高流失率（所有试验中为 30%–45%）与较低的估计可信度相关。在超重或肥胖成人中，与安慰剂相比，奥利司他、氯卡色林、纳曲酮-安非他酮、芬特明-托吡酯和利拉鲁肽均与 52 周时体重减轻至少 5% 相关。芬特明-托吡酯和利拉鲁肽与实现至少 5% 体重减轻的最高几率相关。
Five medications have been approved for the management of obesity, but data on comparative effectiveness are limited. To compare weight loss and adverse events among drug treatments for obesity using a systematic review and network meta-analysis. MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane Central from inception to March 23, 2016; clinical trial registries. Randomized clinical trials conducted among overweight and obese adults treated with US Food and Drug Administration–approved long-term weight loss agents (orlistat, lorcaserin, naltrexone-bupropion, phentermine-topiramate, or liraglutide) for at least 1 year compared with another active agent or placebo. Two investigators identified studies and independently abstracted data using a predefined protocol. A Bayesian network meta-analysis was performed and relative ranking of agents was assessed using surface under the cumulative ranking (SUCRA) probabilities. Quality of evidence was assessed using GRADE criteria. Proportions of patients with at least 5%weight loss and at least 10% weight loss, magnitude of decrease in weight, and discontinuation of therapy because of adverse events at 1 year. Twenty-eight randomized clinical trials with 29018 patients (median age, 46 years; 74%women; median baseline body weight, 100.5 kg; median baseline body mass index, 36.1) were included. A median 23%of placebo participants had at least 5%weight loss vs 75%of participants taking phentermine-topiramate (odds ratio [OR], 9.22; 95%credible interval [CrI], 6.63–12.85; SUCRA, 0.95), 63%of participants taking liraglutide (OR, 5.54; 95%CrI, 4.16–7.78; SUCRA, 0.83), 55%taking naltrexone-bupropion (OR, 3.96; 95%CrI, 3.03–5.11; SUCRA, 0.60), 49%taking lorcaserin (OR, 3.10; 95%CrI, 2.38–4.05; SUCRA, 0.39), and 44%taking orlistat (OR, 2.70; 95%CrI, 2.34–3.09; SUCRA, 0.22). All active agents were associated with significant excess weight loss compared with placebo at 1 year—phentermine-topiramate, 8.8 kg (95%CrI, −10.20 to −7.42 kg); liraglutide, 5.3 kg (95%CrI, −6.06 to −4.52 kg); naltrexone-bupropion, 5.0 kg (95%CrI, −5.94 to −3.96 kg); lorcaserin, 3.2 kg (95%CrI, −3.97 to −2.46 kg); and orlistat, 2.6 kg (95%CrI, −3.04 to −2.16 kg). Compared with placebo, liraglutide (OR, 2.95; 95%CrI, 2.11–4.23) and naltrexone-bupropion (OR, 2.64; 95%CrI, 2.10–3.35) were associated with the highest odds of adverse event–related treatment discontinuation. High attrition rates (30%–45%in all trials) were associated with lower confidence in estimates. Among overweight or obese adults, orlistat, lorcaserin, naltrexone-bupropion, phentermine-topiramate, and liraglutide, compared with placebo, were each associated with achieving at least 5%weight loss at 52 weeks. Phentermine-topiramate and liraglutide were associated with the highest odds of achieving at least 5%weight loss.
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DOI：
10.1038/ijo.2011.158
发表时间：
2012-06
期刊：
International journal of obesity (2005)
影响因子：
--
作者：
Astrup A;Carraro R;Finer N;Harper A;Kunesova M;Lean ME;Niskanen L;Rasmussen MF;Rissanen A;Rössner S;Savolainen MJ;Van Gaal L;NN8022-1807 Investigators
通讯作者：
NN8022-1807 Investigators
影响因子：
168.9
作者：
Greenway, Frank L.;Fujioka, Ken;Dunayevich, Eduardo
通讯作者：
Dunayevich, Eduardo
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
5.8
作者：
Hanefeld, M;Sachse, G
通讯作者：
Sachse, G
影响因子：
2
作者：
Hartung, J;Knapp, G
通讯作者：
Knapp, G