Abstract
The management of obesity remains a major challenge. Dietary therapy often fails,
whereas bariatric surgery, although successful, is demanding and applicable to a limited
number of patients. Drug therapy has had many setbacks over the past 20 years because
of serious adverse effects; however, several new drugs for the treatment of obesity
are either licensed in some parts of the world, submitted for registration, or completing
phase III trials. These include combinations (at low dose) of existing drugs, eg,
bupropion + naltrexone (Contrave), phentermine + topiramate (Qsymia), higher doses
of existing drugs licensed for other indications (liraglutide, 3 mg), and new entities
(lorcaserin).
We discuss the challenges and opportunities for obesity pharmacotherapy and review
in detail the efficacy of the new drugs regarding weight loss and both desirable and
potential undesirable cardiovascular (CV) and metabolic risk factors. Substantial
barriers remain, even if the drugs are approved, in successfully integrating these
agents into weight management practice, largely related to cost, patient acceptability,
and clinician willingness to be engaged in obesity treatment. Although hard clinical
outcome benefit (at least for CV outcomes) has yet to be established, obesity pharmacotherapy
may soon address many of the challenges in the clinical management of obesity, although
newer and better drug combinations and more evidence of benefit from appropriately
designed outcome trials is needed.
Résumé
La prise en charge de l’obésité demeure un enjeu majeur. La thérapie nutritionnelle
échoue souvent, tandis que la chirurgie bariatrique, malgré son succès, est exigeante
et praticable que chez un nombre limité de patients. La pharmacothérapie a subi plusieurs
revers au cours des 20 dernières années en raison d’effets indésirables sérieux. Cependant,
plusieurs nouveaux médicaments pour le traitement de l’obésité sont soit homologués
dans certaines parties du monde, soit soumis à l’homologation ou en cours d’achèvement
d’essais cliniques de phase III. De ce nombre, citons les combinaisons (à faible dose)
de médicaments existants, par exemple le bupropione + la naltrexone (Contrave), la
phentermine + le topiramate (Qsymia), des doses plus élevées de médicaments existants
homologués pour d’autres indications (le liraglutide, 3 mg) et de nouvelles substances
(la lorcasérine).
Nous discutons des enjeux et des possibilités de la pharmacothérapie contre l’obésité
et passons minutieusement en revue l’efficacité des nouveaux médicaments quant à la
perte de poids, aux facteurs de risque cardiovasculaire (CV) et métabolique désirables
et indésirables potentiels. Même si les médicaments sont approuvés, il reste d’importants
obstacles à surmonter pour réussir l’intégration de ces agents à la pratique pour
la prise en charge du poids, en grande partie liés au coût, à l’acceptabilité des
patients et à la bonne volonté du clinicien de s’impliquer dans le traitement de l’obésité.
Bien que les avantages tangibles des résultats cliniques (du moins en ce qui concerne
les résultats CV) n’aient pas encore été établis, la pharmacothérapie contre l’obésité
pourra bientôt relever les nombreux défis de la prise en charge clinique de l’obésité.
Cependant, de plus récentes et de meilleures combinaisons de médicaments et plus de
données probantes sur les avantages provenant d’essais cliniques bien conçus sont
nécessaires.
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Article info
Publication history
Published online: November 13, 2014
Accepted:
November 3,
2014
Received:
August 1,
2014
Footnotes
See page 149 for disclosure information.
Identification
Copyright
© 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
