A systematic review and mixed treatment comparison of pharmacological interventions for the treatment of obesity
A systematic review and mixed treatment comparison of pharmacological interventions for the treatment of obesity
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DOI：
10.1111/j.1467-789x.2011.00981.x
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发表时间：
2012-06-01
期刊：
影响因子：
8.9
通讯作者：
Sutton, A.
中科院分区：
文献类型：
--
作者：
Gray, L. J.;Cooper, N.;Sutton, A.
该研究旨在比较单一证据合成框架中的抗肥胖干预措施。在电子数据库中检索奥利司他、利莫那班或西布曲明的随机对照试验，报告3、6或12个月时体重或体重指数（BMI）较基线的变化。采用混合治疗比较将联合收割机直接和间接试验证据结合起来。94项研究涉及24，808人; 83项试验包括体重变化的数据，41项包括BMI变化的数据。所有结果均与安慰剂进行比较。这些活性药物都能有效降低体重和BMI。在3个月时，奥利司他体重减轻了-2.65 kg（95%可信区间-4.00 kg，-1.31 kg）。对于西布曲明，12个月时，15 mg组的体重下降幅度大于10 mg组，分别为-6.35 kg和-5.42 kg。利莫那班在3个月时体重减轻了-11.23 kg，在12个月时减轻了-4.55 kg。单独的生活方式建议也可以在6个月和12个月时减轻体重，但效果不如药物干预。总之，所有药物干预均观察到适度的体重减轻。那些现已停止使用的干预措施（西布曲明和利莫那班）似乎是最有效的，这意味着如果可以避免副作用，类似药物在临床实践中可能有一席之地。
The study aims to compare anti-obesity interventions in a single evidence synthesis framework. Electronic databases were searched for randomized controlled trials of orlistat, rimonabant or sibutramine reporting weight or body mass index (BMI) change from baseline at 3, 6 or 12 months. A mixed treatment comparison was used to combine direct and indirect trial evidence. Ninety-four studies involving 24,808 individuals were included; 83 trials included data on weight change and 41 on BMI change. All results are in comparison with placebo. The active drugs were all effective at reducing weight and BMI. At 3 months, orlistat reduced weight by -2.65 kg (95% credibility interval -4.00 kg, -1.31 kg). For sibutramine, 15 mg gave a greater reduction than 10 mg at 12 months, -6.35 kg versus -5.42 kg, respectively. Rimonabant reduced weight by -11.23 kg at 3 months and -4.55 kg at 12 months. Lifestyle advice alone also reduced weight at 6 and 12 months, but was less effective than the pharmacological interventions. In conclusion, modest weight reductions were seen for all pharmacological interventions. Those interventions which have now been withdrawn from use (sibutramine and rimonabant) seem to be the most effective, implying that there may be a place in clinical practice for similar drugs if side effects could be avoided.