肥胖的药物治疗原则

Principles of Pharmacotherapy in the Management of Obesity,Drugs Approved by FDA for Treating Obesity,Effect of Continuous and Intermittent Phentermine Therapy on Body Weight,0,Time (weeks),8,24,28,Munro JF et al. Brit Med J 1:352, 1968,Weight Loss (lbs),36,4,12,16,20,32,Alternate Phentermine and Dummy,ContinuousPhentermine,Continuous Dummy,Orlistat Prevents Fat Digestion and Absorption by Binding to Gastrointestinal Lipases,TG=triglyceride; MG=monoglyceride; FA=fatty acid.,Mucosal Cell,Intestinal Lumen,Orlistat,TG,LIPASE,LIPASE,LIPASE,Bile Acids,Micelle,MG,FA,Effect of Orlistat Dose on Fecal Fat Excretion,Zhi et al. Clin Pharmacol Ther 1994;56:82.,Fecal Fat Excretion (% intake),Orlistat Daily Dose (mg),0,200,400,600,800,1000,1200,Effect of Long-term Orlistat Therapy on Body Weight,0,Weeks,52,Torgenson et al. Diabetes Care 2004;27:155,Change in Weight (kg),104,156,208,P0.001 vs placebo,-4.1 kg,-6.9 kg,Placebo,Orlistat,Meta-analysis of RCTs Evaluating Effect of Orlistat Therapy on Weight Loss at 1-Year,Padwal et al. Int J Obes 2003;27:1437,*All subjects had type 2 diabetesWMD=weighted mean difference,FavoursTreatment,FavoursControl,-10,-5,0,10,5,Independent Effect of Orlistat on Plasma LDL-Cholesterol,Weight Loss Category (%initial body weight),Change inPlasmaLDL-CholesterolConcentration(mmol/L),Segal et al. FASEB J. 1999;13:A873.,*P 15,*,*,*,*,Orlistat Inhibits Dietary Cholesterol Absorption,Cholesterol Absorbed (% ingested),*P5% weight loss.,Body Weight (lb.),Month,2,0,6,4,10,8,14,12,18,16,20,22,24,PlaceboSibutramine 10-20 mg/d,Weight Maintenance,Use of Sibutramine within a Health Maintenance Organization Enhances Weight Loss,0,Weeks,Porter et al. Am J Manag Care 2004;10:369,Weight Change (kg),26,52,No drug therapy,Sibutramine therapy,Meta-analysis of RCTs Evaluating Effect of Sibutramine Therapy on Weight Loss at 1-Year,Padwal et al. Int J Obes 2003;27:1437,All subjects had hypertensionWMD=weighted mean difference,Adverse Effects of Sibutramine Therapy,Meridia Package Insert, 2001.,Blood Pressure and Pulse Rate After 1 Year Sibutramine Therapy in Patients with Controlled Hypertension,McMahon et al. Arch Intern Med 2000;160:2185.,*P0.05 vs placebo.,Additive Effects of Behavior and Diet Therapy with Pharmacotherapy for Obesity,Weight Change (%),Wadden et al. Arch Intern Med 2001;161:218.,*P0.05 vs medication alone.,Time (months),0,2,