The combat towards weight problems: Understanding mixture pharmacological remedies

August 02, 2022

3 min learn

Disclosures: Up to now 12 months, Bays’ analysis web site establishment has obtained analysis grants from 89Bio, Alon Altimmune, Medtech/Epitomee, Altimmune, Amgen, Boehringer Ingelheim, Eli Lilly & Co., Evidera, Novartis, NovoNordisk, Pfizer and Vivus; and he has served as a marketing consultant/advisor for 89Bio, Altimmune, and Amgen.

Weight problems is a multifactorial illness most successfully handled with a multifactorial strategy.

Whereas weight loss packages and commercials usually declare to supply fast fixes, profitable weight problems administration is often not achieved via a one-size-fits-all technique. As an alternative, long-term success is greatest achieved by way of a patient-centered strategy that makes use of a wide range of personalised, evidenced-based approaches.

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Supply: Harold E. Bays, MD, FOMA, FTOS, FACC, FACE, FNLA

As with remedy of different metabolic illnesses, anti-obesity treatment is a protected and efficient remedy possibility in our combat towards weight problems. Anti-obesity medications could scale back starvation, improve satiety and, in some circumstances, have an effect on how vitamins endure gastrointestinal absorption and metabolism. Nonetheless, the effectiveness of anti-obesity medicines is broadly variable. As such, sufferers obtain optimum well being advantages when anti-obesity medicines are utilized as an adjunct to healthful vitamin, routine bodily exercise, and favorable habits modification.

Given the fast analysis developments, it is crucial clinicians keep up-to-date on the most recent anti-obesity medicines and pharmacological remedy mixtures to offer sufferers with a holistic understanding of remedy choices that may assist sufferers with weight problems attain their well being targets.

An summary of anti-obesity medicines

Anti-obesity medicines are typically indicated for adults with a BMI of 30 kg/m2 or larger, or adults with a BMI of 27 kg/m2 or extra and having opposed penalties of weight problems, comparable to sort 2 diabetes, hypertension or dyslipidemia. Frequent anti-obesity medicines prescribed by clinicians embody phentermine, semaglutide, liraglutide, phentermine/topiramate mixture agent, naltrexone/bupropion mixture agent and orlistat.

Understanding pharmacological remedy mixtures

The quantity of medical trial information supporting mixture anti-obesity medicines is lower than the info relating to mixture remedy of different metabolic illnesses. The info are summarized in a 2022 Obesity Medicine Association Clinical Practice Statement, which offers an outline of FDA-approved anti-obesity medicines and investigational anti-obesity brokers in growth. Except already a mixture anti-obesity drug (e.g., phentermine/topiramate or naltrexone/bupropion), anti-obesity brokers often should not have particular indicated makes use of to prescribe as mixture remedy. However that’s not to say that such mixtures are contra-indicated. At present, pharmacological remedy mixtures fall into three classes:

Combining with different medicines

Anti-obesity medicines with indicated makes use of to deal with weight problems could be mixed with different medicines that, whereas not particularly indicated to deal with weight problems, promote weight discount. For instance, anti-obesity treatment comparable to a glucagon-like peptide 1 receptor agonists (liraglutide or semaglutide) have been mixed with medicine such metformin or sodium/glucose transporter 2 inhibitors.

Combining two anti-obesity medicines

One other strategy is using two completely different authorized anti-obesity medicines. As earlier than, whereas such an strategy is widespread for the remedy of diabetes, hypertension and dyslipidemia, the medical trial proof supporting such an strategy for weight problems is restricted.

Combining with bariatric surgical procedure

Some proof helps that anti-obesity medicines could mitigate weight regain after bariatric surgical procedure, which could be thought of a kind of mixture remedy for weight problems.

Concerns for combining remedies

Whereas BMI is the first criterion that helps decide who’s eligible to obtain anti-obesity medicines (i.e., in step with indicated use), BMI isn’t the only real consideration. The choice to make use of mixture anti-obesity therapies must be decided primarily based on everything of the affected person presentation, together with correct prognosis (i.e., performing physique composition analyses in sufferers with suspected improve in muscle mass or, conversely, sarcopenia); problems of weight problems; use of different prescription medicines; the anticipated security and efficacy of a specific mixture remedy; and affected person settlement.

Potential problems and dangers to contemplate

Selections relating to using mixture anti-obesity remedy, and the selection of mixture remedy, ought to embody the anticipated security and efficacy of a specific mixture remedy. For instance, the prescribing info for phentermine signifies that the protection and efficacy of its mixture with different anti-obesity brokers haven’t but been established. At a minimal, phentermine shouldn’t be used alone or together in sufferers with heart problems — for which phentermine is contraindicated. An exception could be using the phentermine/topiramate mixture agent, which isn’t contraindicated in sufferers with CVD.

Whereas extra information on pharmacological remedy mixtures are collected, clinicians ought to keep up to date on the most recent analysis relating to the protection and effectiveness of anti-obesity therapies, and thru a patient-centered strategy, select one of the best anti-obesity treatment for the person affected person.

Our information of anti-obesity medicines is quickly evolving. To entry the most recent weight problems analysis, assets, and instruments, change into a member of the Weight problems Drugs Affiliation (OMA). To be taught extra or be a part of, go to obesitymedicine.org and/or Obesity Pillars, the official publication of the OMA.

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