The place of central-acting drugs in the algorithms of treatment of primary obesity

Logvinova, Oksana V.; Викторовна, Логвинова Оксана; Galieva, Marina; Олеговна, Галиева Марина; Mazurina, Natalia V.; Валентиновна, Мазурина Наталья; Troshina, Ekaterina A.; Анатольевна, Трошина Екатерина

doi:10.14341/omet2017218-23

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“…Орлистат является блокатором желудочно-кишечных липаз, за счет чего снижает расщепление и всасывание жиров в желудочно-кишечном тракте. Эффект сибутрамина основан на ингибировании им обратного захвата серотонина и норадреналина, что приводит к увеличению содержания данных нейротрансмиттеров в синапсах нейронов, способствует увеличению чувства насыщения, уменьшает количество потребляемой пищи и усиливает расход энергии благодаря влиянию на термогенез [4]. Лираглутид представляет собой агонист рецепторов глюкагоноподобного пептида-1 (ГПП-1), который первично был зарегистрирован в дозе 1,2-1,8 мг для лечения сахарного диабета 2 типа (СД2), а затем -для терапии ожирения (в том числе без нарушений углеводного обмена) в суточной дозе 3,0 мг.…”

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Prediction of early response to liraglutide therapy in patients with obesity

et al. 2020

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BACKGROUND: The main goal of treating obesity is to reduce the risk of developing its complications and comorbid diseases, which requires a steady decrease in body weight by at least 510%. In Russia in 2016, the list of drugs for the treatment of obesity was supplemented by a glucagon-like peptide 1 receptor agonist (GLP-1) liraglutide . There is evidence that about one third of patients do not achieve a clinically significant decrease in body weight during treatment with liraglutide, while the factors that predict the so-called early response to treatment are currently unknown. AIM: To identify prognostic factors of an early response to complex therapy of exogenously constitutional obesity, including agonist of GLP-1 receptors liraglutide, and to evaluate the effect of this therapy on the dynamics of levels of endogenous peptide bioregulators of eating behavior (IB). MATERIALS AND METHODS: The study included 42 patients with exogenously constitutional obesity, which were divided into 2 groups, comparable by sex, age and body mass index (BMI). The first group (n=22) received treatment recommendations for the correction of nutrition and physical activity, as well as liraglutide 3.0 mg for 3 months. The second group (n=20) received only recommendations for the correction of nutrition and physical activity. At the start and after 3 months, anthropometric characteristics and laboratory parameters were evaluated in all patients, including the levels of endogenous peptide bioregulators of IB (leptin, ghrelin, obestatin and GLP-1), their dynamics was compared between groups. Depending on the therapeutic effect, the 1st group was divided into two subgroups: those who achieved (n = 14) and did not achieve (n = 8) a clinically significant decrease in body weight. In both subgroups, baseline characteristics were analyzed as possible prognostic factors for the effectiveness of complex therapy. RESULTS: To predict an early response to complex therapy, including liraglutide, a mathematical model has been developed that is implemented as a calculator in MS Excel and contains a combination of initial body weight and fasting plasma ghrelin. The dynamics of body weight and BMI in the group of complex therapy was statistically significantly higher than that in the group of isolated lifestyle modifications (ILM). CONCLUSIONS: The proportion of individuals with an early response to 3.0 mg liraglutide therapy is comparable to that of data from randomized clinical trials. The mathematical model, which includes a combination of initial body weight and plasma ghrelin, allows predicting the likelihood of a clinically significant decrease in body weight after 3 months of using liraglutide 3.0 mg in combination with ILM with a sensitivity of 86% [65%; 97%] and prognostic value of a positive result of 80% [60%; 95%].

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Prediction of early response to liraglutide therapy in patients with obesity

et al. 2020

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Obesity as a Reflection of Psycho-Emotional Disorders: Focus on Pharmacotherapy

Shishkova¹

2022

Farm. farmakol. (Pâtigorsk)

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Obesity is a vivid example of a multifactorial disease. In its development, not only the discrepancy between the energy intake and its expenditure but also various neurohumoral mechanisms, as well as external socio-economic and psychosocial factors, play important roles. One of the frequent options for combining psychoemotional disorders with obesity is the development of certain types of eating disorders in a patient. In this regard, the actual problem is to find the optimal therapeutic and prophylactic strategy in the management of such patients.The aim of the work is to analyze the literature data on the features of the pathogenetic mechanisms of the obesity development against the background of psychoemotional disorders that are realized through eating disorders, and to identify the possibilities of using sibutramine to carry out a pharmacological correction of these pathological conditions.Materials and methods. In the process of selecting materials for writing a review article, the following databases were uses: PubMed, Scopus, Web of Science, Google Scholar, ScienceDirect, etc. The search carried out, was based on the publications for the period from 2009 to 2020. The following words and phrases were chosen as parameters for the literature selection: obesity, psycho-emotional disorders, eating disorders, sibutramine.Results. This review summarizes the main pathogenetic aspects that unite both the development of psychoemotional and metabolic disorders. A modern classification of obesity, taking into account the latest domestic and international recommendations of professional communities, is given. Eating disorders are considered in detail, their socio-psychological and psychiatric classifications are given. The prospect of choosing a therapeutic and prophylactic strategy for managing such patients is assessed, depending on the presence of psycho-emotional and eating disorders.Conclusion. Thus, the combined drug containing sibutramine and metformin registered in the Russian Federation is effective, safe and can be used in patients with alimentary obesity and eating disorders, taking into account contraindications.

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Experience of using sibutramine in combination with microcrystalline cellulose in clinical practice

et al. 2020

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For many years, interest in the issue of obesity has not faded, as obesity is now one of the most common pathologies in the world that directly affects quality of life and lifespan. Even a slight weight loss (5-10% of baseline values) in obese patients is known to improve metabolism and reduce the risk of a range of comorbidities. The article reflects the importance of comprehensive treatment of obesity, presents positive experience of using Reduxin (sibutramine in combination with microcrystalline cellulose) to reduce body weight and risk factors for cardiovascular disease in a specific clinical example in a patient with exogenous-constitutional obesity and eating disorders. The case of obesity in a young man of 24 years old is presented, when other components of the metabolic syndrome (except for arterial hypertension) were not formed. Thus, following the results of 24-week complex treatment, clinically significant reduction of body weight (by 21.7% of initial values) was observed in the patient. The data of psychological researches have shown that the patient has no increase of anxiety and depression level during treatment, but at the same time the indicators of quality of life according to the results of health questionnaire testing have improved. This clinical case corresponds to the results of the PrimaVera program and demonstrates that weight loss during sibutramine therapy in combination with microcrystalline cellulose has a positive impact on the overall health and emotional status of patients and leads to improved quality of life. Therefore, successful treatment of obesity and the maintenance of other outcomes are key to preventing cardiovascular disease.

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The place of central-acting drugs in the algorithms of treatment of primary obesity

Cited by 3 publications

References 17 publications

Prediction of early response to liraglutide therapy in patients with obesity

Prediction of early response to liraglutide therapy in patients with obesity

Obesity as a Reflection of Psycho-Emotional Disorders: Focus on Pharmacotherapy

Experience of using sibutramine in combination with microcrystalline cellulose in clinical practice

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