Long term pharmacotherapy for obesity and overweight: updated meta-analysis
Long term pharmacotherapy for obesity and overweight: updated meta-analysis
复制标题
DOI：
10.1136/bmj.39385.413113.25
复制
发表时间：
2007-12-08
影响因子：
105.7
通讯作者：
Lau, David C. W.
中科院分区：
文献类型：
--
作者：
Rucker, Diana;Padwal, Raj;Lau, David C. W.
目的总结抗肥胖药物在减轻体重和改善健康状况方面的长期疗效。设计更新的随机试验荟萃分析。数据来源Medline，Embase，科克伦对照试验注册，当前科学对照试验荟萃注册，和已识别文章的参考列表。所有数据来源均检索自2002年12月（最后一次检索的结束日期）至2006年12月。研究回顾了批准用于成人的抗肥胖药物的双盲随机安慰剂对照试验结果30篇研究时间为1 ~ 4年的临床试验符合纳入标准：奥利司他16例（n= 10631例），西布曲明10例（n=2623例），利莫那班4例（n=6365例）。其中14项审判是新的，16项是以前确定的。平均发病率为30- 40%。与安慰剂相比，奥利司他减轻体重2.9 kg（95%置信区间2.5 kg至3.2 kg），西布曲明减轻体重4.2 kg（3.6 kg至4.7 kg），利莫那班减轻体重4.7 kg（4.1 kg至5.3 kg）。接受活性药物治疗的患者更有可能达到5%和10%的体重减轻阈值。奥利司他降低糖尿病的发病率，改善糖尿病患者的总胆固醇和低密度脂蛋白胆固醇浓度、血压和血糖控制，但增加胃肠道副作用的发生率，并略微降低高密度脂蛋白浓度。西布曲明改善了高密度脂蛋白胆固醇和甘油三酯的浓度，但提高了血压和脉搏率。利莫那班改善了糖尿病患者的高密度脂蛋白胆固醇和甘油三酯，血压和血糖控制的浓度，但增加了情绪disorders.Conclusions奥利司他，西布曲明，利莫那班适度减轻体重，对心血管疾病的风险有不同的影响，并有特定的不良反应。
Objective To summarise the long term efficacy of anti-obesity drugs in reducing weight and improving health status.Design Updated meta-anaiysis of randomised trials.Data sources Medline, Embase, the Cochrane controlled trials register, the Current Science meta-register of controlled trials, and reference lists of identified articles. All data sources were searched from December 2002 (end date of last search) to December 2006.Studies reviewed Double blind randomised placebo controlled trials of approved anti-obesity dugs used in adults (age over 18) for one year or longer.Results 30 trials of one to four years' duration met the inclusion criteria: 16 orlistat (n=10 631 participants), 10 sibutramine (n=2623), and four rimonabant (n=6365). Of these, 14 trials were new and 16 had previously been identified. Attrition rates averaged 30-40%. Compared with placebo, orlistat reduced weight by 2.9 kg (95% confidence interval 2.5 kg to 3.2 kg), sibutramine by 4.2 kg(3.6 kg to 4.7 kg), and rimonabant by 4.7 kg (4.1 kg to 5.3 kg). Patients receiving active drug treatment were significantly more likely to achieve 5% and 10% weight loss thresholds. Orlistat reduced the incidence of diabetes and improved concentrations of total cholesterol and low density lipoprotein cholesterol, blood pressure, and glycaemic control in patients with diabetes but increased rates of gastrointestinal side effects and slightly lowered concentrations of high density lipoprotein. Sibutramine improved concentrations of high density lipoprotein cholesterol and triglycerides but raised blood pressure and pulse rate. Rimonabant improved concentrations of high density lipoprotein cholesterol and triglycerides, blood pressure, and glycaemic control in patients with diabetes but increased the risk of mood disorders.Conclusions Orlistat, sibutramine, and rimonabant modestly reduce weight, have differing effects on cardiovascular risk profiles, and have specific adverse effects.