Фармакотерапия у взрослых с избыточной массой тела и ожирением: систематический обзор и сетевой мета-анализ рандомизированных контролируемых исследований

Перевод научной статьи Pharmacotherapy for adults with overweight and obesity: a systematic review and network meta-analysis of randomised controlled trials авторов Qingyang Shi, MM †; Yang Wang, MB †; Qiukui Hao, MD; Prof Per Olav Vandvik, MD; Prof Gordon Guyatt, MD; Jing Li, MD; Zhe Chen, MM; Shishi Xu, MD; Yanjiao Shen, MM; Prof Long Ge, MD; Prof Feng Sun, PhD; Ling Li, PhD; Jiajie Yu, PhD; Kailei Nong, MB; Xinyu Zou, MB; Siyi Zhu, MD; Cong Wang, MM; Shengzhao Zhang, BSc; Zhi Qiao, MS; Zhongyu Jian, MD; Ya Li, MS; Xinyi Zhang, MB; Kerun Chen, MS; Furong Qu, MB; Yuan Wu, MD; Yazhou He, PhD; Prof Haoming Tian, MM; Sheyu Li, MD

Источник: Articles| The LANCET Volume 403, ISSUE 10434, e21-e31, April 06, 2024 Published:April 06, 2024DOI:https://doi.org/10.1016/S0140-6736(24)00351-9

Перевод Г.Е. Заика (07.04.2024)

Аббревиатуры:
MD – mean difference – разность средних значений
OR – odds ratio – отношение шансов
Резюме

Предпосылки
Фармакотерапия предоставляет взрослым с избыточным весом и ожирением возможность снизить массу тела, если изменения образа жизни не помогают. Мы обобщили последние данные о пользе и вреде препаратов для снижения веса.

Методы
Этот систематический обзор и сетевой мета-анализ включали поиск в PubMed, Embase и Кокрановской библиотеке (CENTRAL) с момента начала до 23 марта 2021 года рандомизированных контролируемых исследований препаратов для снижения веса у взрослых с избыточной массой тела и ожирением. Для обобщения доказательств мы провели частотный сетевой мета-анализ со случайными эффектами и применили систему оценки оценок, разработки и оценки рекомендаций для оценки определенности доказательств, расчета абсолютных эффектов, категоризации вмешательств и представления результатов. Исследование зарегистрировано в PROSPERO, CRD 42021245678.

Результаты
В ходе нашего поиска было выявлено 14.605 цитирований, из которых в 132 испытаниях, отвечающих критериям отбора, приняли участие 48.209 человек. Все препараты снижали массу тела по сравнению только с изменением образа жизни; Все последующие цифры относятся к сравнениям с модификацией образа жизни. Данные с высокой и умеренной определенностью установили, что фентермин-топирамат является наиболее эффективным средством для снижения массы тела (отношение шансов [OR – odds ratio – ОШ] ≥5% снижения массы тела 8,02, 95% CI от 5,24 до 12,27; разность средних значений [MD – mean difference] процентного изменения массы тела от −7,98, 95% CI от −9,27 до −6,69) с последующими агонистами рецепторов GLP-1 (ОR 6,33, 95% CI от 5,00 до 8,00; MD −5,79, 95% CI от −6,34 до −5,25). Налтрексон-бупропион (ОR 2,69, 95% CI от 2,10 до 3,44), фентермин-топирамат (2,40, 1,68–3,44), агонисты рецепторов GLP-1 (2,22, 1,74–2,84) и орлистат (1,71, 1,42–2,05) ассоциировались с увеличением числа нежелательных явлений, приводящих к прекращению приема препарата. При анализе постфактум семаглутид, агонист рецепторов GLP-1, показал значительно большую пользу, чем другие препараты, с таким же риском нежелательных явлений, как и другие препараты, как в отношении вероятности потери массы тела на 5% или более (ОR 9,82, 95% CI от 7,09 до 13,61), так и в отношении процентного изменения массы тела (MD −11,40, 95% CI от −12,51 до −10,29).

Интерпретация
У взрослых с избыточной массой тела и ожирением агонисты рецепторов фентермин-топирамат и рецепторы GLP-1 оказались лучшими препаратами для снижения веса; из агонистов GLP-1 семаглутид может быть наиболее эффективным.

Финансирование
1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University.

References

1. NCD Risk Factor Collaboration Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet. 2016; 387: 1377-1396 View in Article Scopus (3717) PubMed Summary Full TextFull Text PDFGoogle Scholar

2. Garvey WT Mechanick JI Brett EM et al.American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity.Endocr Pract. 2016; 22: 1-2*3View in Article Scopus (938)PubMedSummaryFull TextFull Text PDFGoogle Scholar

3. Bray G A Frühbeck G Ryan DH Wilding JPH Management of obesity.Lancet. 2016; 387: 1947-1956 View in Article Scopus (658)PubMedSummaryFull TextFull Text PDFGoogle Scholar

4. Wharton S Lau DCW Vallis M et al. Obesity in adults: a clinical practice guideline.CMAJ. 2020; 192: e875-e891 View in Article Scopus (459)PubMedCrossrefGoogle Scholar

5. Lemstra M Bird Y Nwankwo C Rogers M Moraros J Weight loss intervention adherence and factors promoting adherence: a meta-analysis. Patient Prefer Adherence. 2016; 10: 1547-1559 View in Article Scopus (211) PubMed Crossref Google Scholar

6. Arterburn DE Telem DA Kushner RF Courcoulas AP Benefits and risks of bariatric surgery in adults: a review. JAMA. 2020; 324: 879-887 View in Article Scopus (508) PubMed Crossref Google Scholar

7. Sarwer DB Ritter S Wadden TA Spitzer JC Vetter ML Moore RH Attitudes about the safety and efficacy of bariatric surgery among patients with type 2 diabetes and a body mass index of 30–40 kg/m2. Surg Obes Relat Dis. 2013; 9: 630-635 View in Article Scopus (34) PubMed Summary Full Text Full Text PDF Google Scholar

8. Bessesen DH Van Gaal LF Progress and challenges in anti-obesity pharmacotherapy. Lancet Diabetes Endocrinol. 2018; 6: 237-248 View in Article Scopus (219) PubMed Summary Full Text Full Text PDF Google Scholar

9. Sharretts J Galescu O Gomatam S Andraca-Carrera E Hampp C Yanoff L Cancer risk associated with lorcaserin—the FDA's review of the CAMELLIA-TIMI 61 trial. N Engl J Med. 2020; 383: 1000-1002 View in Article Scopus (85)PubMedCrossrefGoogle Scholar

10. Wilding JPH Batterham RL Calanna S et al.Once-weekly semaglutide in adults with overweight or obesity.N Engl J Med. 2021; 384: 989-1002View in Article Scopus (1277) PubMed Crossref Google Scholar

11. Davies M Færch L Jeppesen OK et al.Se maglutide 2·4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet. 2021; 397: 971-984View in Article Scopus (421)PubMedSummaryFull TextFull Text PDFGoogle Scholar

12. Wadden TA Bailey TS Billings LK et al.Effect of subcutaneous semaglutide vs placebo as an adjunct to intensive behavioral therapy on body weight in adults with overweight or obesity: the STEP 3 randomized clinical trial.JAMA. 2021; 325: 1403-1413 View in Article Scopus (374)PubMedCrossrefGoogle Scholar

13. Rubino D Abrahamsson N Davies M et al.Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial.JAMA. 2021; 325: 1414-1425View in Article Scopus (399) PubMed CrossrefGoogle Scholar

14. Hutton B Salanti G Caldwell DM et al.The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations.Ann Intern Med. 2015; 162: 777-784View in Article Scopus (4332) PubMedCrossrefGoogle Scholar

15. Page MJ McKenzie JE Bossuyt PM et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71View in Article Scopus (27158) PubMedCrossrefGoogle Scholar

16. Rücker G Network meta-analysis, electrical networks and graph theory. Res Synth Methods. 2012; 3: 312-324 View in Article PubMedCrossrefGoogle Scholar

17. Jackson D Bujkiewicz S Law M Riley RD White IR A matrix-based method of moments for fitting multivariate network meta-analysis models with multiple outcomes and random inconsistency effects.Biometrics. 2018; 74: 548-556View in Article Scopus (25) PubMed CrossrefGoogle Scholar

18. Rücker G Schwarzer G Resolve conflicting rankings of outcomes in network meta-analysis: partial ordering of treatments.Res Synth Methods. 2017; 8: 526-536 View in Article Scopus (44)PubMedCrossrefGoogle Scholar

19. Jackson D White IR Riley RD Quantifying the impact of between-study heterogeneity in multivariate meta-analyses. Stat Med. 2012; 31: 3805-3820 View in Article Scopus (453) PubMed Crossref Google Scholar

20. Krahn U Binder H König J A graphical tool for locating inconsistency in network meta-analyses. BMC Med Res Methodol. 2013; 13: 35 View in Article Scopus (309) PubMed Crossref Google Scholar

21. Dias S Welton NJ Caldwell DM Ades AE Checking consistency in mixed treatment comparison meta-analysis. Stat Med. 2010; 29: 932-944 View in Article Scopus (1577) PubMed Crossref Google Scholar

22. Schandelmaier S Briel M Varadhan R et al. Development of the Instrument to assess the Credibility of Effect Modification Analyses (ICEMAN) in randomized controlled trials and meta-analyses. CMAJ. 2020; 192: E901-E906 View in Article Scopus (236) PubMed Crossref Google Scholar

23. Sterne JAC Savović J Page MJ et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366l4898 View in Article Google Scholar

24. Puhan MA Schünemann HJ Murad MH et al. A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ. 2014; 349g5630 View in Article Scopus (1156) PubMed Crossref Google Scholar

25. Brignardello-Petersen R Bonner A Alexander PE et al. Advances in the GRADE approach to rate the certainty in estimates from a network meta-analysis. J Clin Epidemiol. 2018; 93: 36-44

26. Brignardello-Petersen R Florez ID Izcovich A et al. GRADE approach to dView in Article Scopus (410) PubMed Summary Full Text Full Text PDF Google Scholar rawing conclusions from a etwork meta-analysis using a minimally contextualised framework. BMJ. 2020; 371m3900 View in Article Google Scholar

27. Hultcrantz M Rind D Akl EA et al. The GRADE Working Group clarifies the construct of certainty of evidence. J Clin Epidemiol. 2017; 87: 4-13 View in Article Scopus (401)PubMedSummaryFull TextFull Text PDFGoogle Scholar

28. Zeng L Brignardello-Petersen R Hultcrantz M et al.GRADE guidelines 32: GRADE offers guidance on choosing targets of GRADE certainy of evidence ratings.J Clin Epidemiol. 2021; 137: 163-175 View in Article Scopus (94)PubMedSummaryFull TextFull Text PDFGoogle Scholar

29. Heymsfield SB Wadden TA Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017; 376: 254-266View in Article Scopus (977) PubMed Crossref Google Scholar

30. Center for Drug Evaluation and Research Guidance for industry developing products for weight management. US Food and Drug Administration, Rockville, MD2007 View in Article Google Scholar

31. Crosby RD Kolotkin RL Williams GR An integrated method to determine meaningful changes in health-related quality of life. J Clin Epidemiol. 2004; 57: 1153-1160 View in Article Scopus (125) PubMedSummaryFull TextFull Text PDFGoogle Scholar

32. Wing RR Lang W Wadden TA et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011; 34: 1481-1486View in Article Scopus (1249)PubMed CrossrefGoogle Scholar

33. Hollander P Gupta AK Plodkowski R et al.Effects of naltrexone sustained-release/bupropion sustained-release combination therapy on body weight and glycemic parameters in overweight and obese patients with type 2 diabetes. Diabetes Care. 2013; 36: 4022-4029 View in Article Scopus (344)PubMedCrossrefGoogle Scholar

34. Guyatt G Montori V Devereaux PJ Schünemann H Bhandari M Patients at the centre: in our practice, and in our use of language. BMJ Evid Based Med. 2004; 9: 6-7 View in Article Scopus (16)CrossrefGoogle Scholar

35. Khera R Murad MH Chandar AK et al.Association of pharmacological treatments for obesity with weight loss and adverse events: a systematic review and meta-analysis.JAMA. 2016; 315: 2424-2434View in Article Scopus (519)PubMedCrossref Google Scholar

36. Khera R Pandey A Chandar AK et al.Effects of weight-loss medications on cardiometabolic risk profiles: a systematic review and network meta-analysis.Gastroenterology. 2018; 154: 1309-1319.e7 View in Article Scopus (53)PubMedSummaryFull Text Full Text PDFGoogle Scholar

37. Skrivanek Z Gaydos BL Chien JY et al. Dose-finding results in an adaptive, seamless, randomized trial of once-weekly dulaglutide combined with metformin in type 2 diabetes patients (AWARD-5). Diabetes Obes Metab. 2014; 16: 748-756 View in Article PubMed CrossrefGoogle Scholar

38. Harreiter J Just I Leutner M et al. Combined exenatide and dapagliflozin has no additive effects on reduction of hepatocellular lipids despite better glycaemic control in patients with type 2 diabetes mellitus treated with metformin: EXENDA, a 24-week, prospective, randomized, placebo-controlled pilot trial. Diabetes Obes Metab. 2021; 23: 1129-1139View in Article PubMedGoogle Scholar

39. Thieu VT Robinson S Kennedy-Martin T Boye KS Garcia-Perez L-E Patient preferences for glucagon-like peptide 1 receptor-agonist treatment attributes. Patient Prefer Adherence. 2019; 13: 561-576 View in Article Scopus (28)PubMedCrossref Google Scholar

40. Horowitz M Aroda VR Han J Hardy E Rayner CK Upper and/or lower gastrointestinal adverse events with glucagon-like peptide-1 receptor agonists: incidence and consequences. Diabetes Obes Metab. 2017; 19: 672-681 View in Article Scopus (54) PubMed CrossrefGoogle Scholar

41. Gallagher C Corl A Dietz WH et al. Weight can't wait: a guide to discussing obesity and organizing treatment in the primary care setting. Obesity (Silver Spring). 2021; 29: 821-824View in Article Scopus (11)PubMedCrossrefGoogle Scholar

42. Bonnet F Scheen A Understanding and overcoming metformin gastrointestinal intolerance.Diabetes Obes Metab. 2017; 19: 473-481View in Article Scopus (144)PubMedCrossrefGoogle Scholar

43. Li S Vandvik PO Lytvyn L et al.SGLT-2 inhibitors or GLP-1 receptor agonists for adults with type 2 diabetes: a clinical practice guideline.BMJ. 2021; 373n1091View in Article Google Scholar

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Published: 06 April 2024

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DOI: https://doi.org/10.1016/S0140-6736(24)00351-9

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