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Canadian Journal of Cardiology

New Medications for Treatment of Obesity: Metabolic and Cardiovascular Effects

  • Andrea Pucci
    Affiliations
    Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, United Kingdom

    UCLH Centre for Weight Loss, Metabolic and Endocrine Surgery, University College London Hospitals, London, United Kingdom
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  • Nicholas Finer
    Correspondence
    Corresponding author: Dr Nicholas Finer, UCL Institute of Cardiovascular Science, 170 Tottenham Court Road, London W1T 7HA, United Kingdom. Tel.: +44-207-679-4411; fax: +44-203-447-9217.
    Affiliations
    Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, United Kingdom

    UCLH Centre for Weight Loss, Metabolic and Endocrine Surgery, University College London Hospitals, London, United Kingdom

    University College London Institute of Cardiovascular Science, London, United Kingdom
    Search for articles by this author
Published:November 13, 2014DOI:https://doi.org/10.1016/j.cjca.2014.11.010

      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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