肥胖的药物治疗原则课件.ppt

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PrinciplesofPharmacotherapyintheManagementofObesity

DrugsApprovedbyFDAforTreatingObesityGenericNameTradeNamesDEAScheduleApprovedUseYearApprovedOrlistatXenicalNoneLong-term1999SibutramineMeridiaIVLong-term1997DiethylpropionTenulateIVShort-term1973PhentermineAdipex,lonaminIVShort-term1973PhendimetrazineBontril,Prelu-2IIIShort-term1961BenzphetamineDidrexIIIShort-term1960

EffectofContinuousandIntermittentPhentermineTherapyonBodyWeight0Time(weeks)82428MunroJFetal.BritMedJ1:352,1968WeightLoss(lbs)36412162032AlternatePhentermineandDummyContinuous

PhentermineContinuousDummy

EffectofOrlistatDoseonFecalFatExcretionZhietal.ClinPharmacolTher1994;56:82.FecalFatExcretion(%intake)OrlistatDailyDose(mg)020040060080010001200

EffectofLong-termOrlistatTherapyonBodyWeight0Weeks52Torgensonetal.DiabetesCare2004;27:155ChangeinWeight(kg)104156208P0.001vsplacebo-4.1kg-6.9kgPlaceboOrlistat

Meta-analysisofRCTsEvaluatingEffectofOrlistatTherapyonWeightLossat1-YearStudy

orSub-categoryWMD(random)

95%CIHollander1998*Sjostrom1998Davidson1999Finer2000Heuptman2000Lindgarde2000Rossner2000Bakris2002Broom2002Kelley2002*Miles2002*Total(95%CI)Padwaletal.IntJObes2003;27:1437*Allsubjectshadtype2diabetesWMD=weightedmeandifferenceFavours

TreatmentFavours

Control-10-50105

IndependentEffectofOrlistatonPlasmaLDL-CholesterolWeightLossCategory(%initialbodyweight)Changein

Plasma

LDL-Cholesterol

Concentration

(mmol/L)Segaletal.FASEBJ.1999;13:A873.*P0.01vsplacebo.

Datapooledfrom5trials(N=1773).0-55–1010–1515PlaceboOrlistat****

GastrointestinalSideEffectsofOrlistatTherapyYear1Year2PlaceboOrlistatPlaceboOrlistatFatty/oilystool53118Increaseddefecation72022Liquidstools101358Fecalurgency31023Flatulence3723Flatuswithdischarge0701Fecalincontinence0702Oilyevacuation1605Lowplasmavitaminconc:VitaminA0.60.30.80VitaminD0.65.

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