Obezitenin Medikal Tedavisinde Liraglutide Etkinliğinin Araştırılması

Yıl 2023, Cilt: 13 Sayı: 3, 334 - 339, 30.09.2023

Mustafa Altınkaynak Yağmur Göksoy Solak Naci Şenkal Yavuz Burak Tor Timur Akpınar Murat Kose

https://doi.org/10.31832/smj.1320355

Öz

Amaç Glikagon benzeri peptit-1 (GLP-1) analoğu olan liraglutidin diyabetten bağımsız olarak obezite tedavisinde kullanımı onaylanmıştır. Çalışmamızda liraglutidin obezite tedavisinde etkinliğini araştırıldı.
Yöntem ve Gereçler 2018-2021 yılları arasında genel dahiliye polikliniğine başvuran fazla kilolu ve obez, 18 yaş üzeri hastaların dosyaları incelendi. Tıbbi beslenme tedavisi ve egzersiz programına ile liraglutide 3 mg/gün en az bir ay alan hastalar çalışmaya alındı. Hastalar liraglutide kullanım sürelerine göre ayrılarak vücut kitle indeksi (VKİ), ilaç etkinliği ve yan etkileri her ay değerlendirildi.
Bulgular Çalışmamıza 201 kadın ortalama 40,9±10,5 yaş 303 hasta alındı. Hastaların VKİ dağılımına bakıldığında 80 hasta (%26,4) aşırı kilolu, 128 hasta (%42,2) evre 1 obezite, 61 hasta (%20,1) evre 2 obesite, 34 hasta (%11,2) ise evre 3 obezite olarak değerlendirildi. Liraglutide tedavisini 233 hasta 1-4 ay, 59 hasta 5-8 ay ve 11 hasta ise ≥9 ay süre ile kullandı. Bu grupların ortalama ortalama yaşı sırasıyla 41,2±10,5; 39,8±10,9 ve 40,2±10,4 ortalama VKİ’si 34,3±2,4 kg/m2; 33,9±4,2 kg/m2 ve 39,5±5,1 kg/m2 saptandı. Ortalama kilo kaybı ise sırasıyla 6,4 kg; 12,5 kg ve 21 kg saptandı. Her üç grupta da başlangıç kilosuna göre anlamlı kilo kaybı gözlendi (p<0,001). Hastaların ilk bir ayda %5 kilo kaybı hedefine ulaşma oranı %46, ilk 2 ayda %86, ilk 3 ayda ise %90 saptandı. En sık görülen etki bulantıydı.
Sonuç Liraglutide fazla kilolu ve obez hastalarda diyet ve egzersizle kombine olarak verildiğinde özellikle 6 ay ve üzeri kullanımda %20’lere varan kilo kaybı sağlamaktadır. Obezite tedavisinde GLP-1 analoglarının kullanımına ait uzun vadeli diğer çalışmalar ile mortalite üzerine etkileri orta koymakta fayda vardır.

Anahtar Kelimeler

Obezite, tedavi, liraglutid, Glikagon benzeri peptit-1 (GLP-1)

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

Yok

Investigation of the Effectiveness of Liraglutide in the Medical Treatment of Obesity

Öz

Introduction This study investigated the efficacy and safety of liraglutide, a glucagon-like peptide-1 (GLP-1) analogue, in the treatment of obesity.
Materials and Methods The study enrolled 303 patients over 18 years of age with overweight or obesity (201 female, mean age 40.9 years). The records of patients admitted from the Internal Medicine Outpatient Clinic between 2018 and 2021 were retrospectively reviewed. Patients taking liraglutide (3 mg) daily in combination with diet and physical activity were included. Body mass index (BMI), drug efficacy, and side effects were evaluated once monthly.
Results Participants' BMI was evaluated; 80 of them were overweight, 128 of them were obese stage 1, 61 of them were obese stage 2, and 34 of them were obese stage 3. Patients were divided into 3 groups according to the duration of liraglutide intake (1-4 months for 233 patients, 5-8 months for 59 patients, and ≥ 9 months for 11 patients). Mean age was 41.2±10.5, 39.8±10.9, and 40.2±10.4; mean BMI was 34.3±2.4 kg/m2, 33.9±4.2 kg/m2, and 39.5±5.1 kg/m2; and mean weight loss was 6.4 kg, 12.5 kg, and 21 kg, respectively. All groups experienced significant weight loss compared with their baseline weight (p<0.001). The percentage of patients achieving weight loss goal was 46% at month 1, 86% at 2 months, and 90% at 3 months. In addition, the most common side effect was nausea.
Conclusion In combination with lifestyle modification, liraglutide was well tolerated and resulted in significant weight loss, especially using for more than 6 months.

Anahtar Kelimeler

Obese, treatment, liraglutide, glucagon-like peptide-1 (GLP-1)

Proje Numarası

Yok

Kaynakça

• Kaynaklar 1. GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, Lee A, et al. Health effects of overweight and obesity in 195 Countries over 25 Years. N Engl J Med 2017; 377: 13–27.
• 2. Noncommunicable diseases: risk factors. In: Global Health Observatory [website]. Geneva: World Health Organization; 2021 (https://www.who.int/data/gho/data/themes/topics/noncommunicable-diseases-risk-factors).
• 3. Obezite, T. E. M. D., and Hipertansiyon Çalışma Grubu. "Obezite tanı ve tedavi kılavuzu 2019, 8. baskı." Ankara, Türkiye Endokrinoloji ve Metabolizma Derneği. 2019: 59-62.
• 4. Kreymann B, Williams G, Ghatei MA, Bloom SR. Glucagon-like peptide-1 7-36: a physiological incretin in man. Lancet. 1987;2(8571):1300-1304.
• 5. Madsbad S, Krarup T, Deacon CF, Holst JJ. Glucagon-like peptide receptor agonists and dipeptidyl peptidase-4 inhibitors in the treatment of diabetes: a review of clinical trials. Curr Opin Clin Nutr Metab Care. 2008;11(4):491-499.
• 6. Montanya E, Sesti G. A review of efficacy and safety data regarding the use of liraglutide, a once-daily human glucagon-like peptide 1 analogue, in the treatment of type 2 diabetes mellitus. Clinical therapeutics 2009; 31: 2472-2488.
• 7. Nordisk N. Victoza package insert. Princeton, NJ, Novo Nordisk 2013.
• 8. Davies MJ, Bergenstal R, Bode B, Kushner RF, Lewin A, Skjøth TV, et al. Efficacy of Liraglutide for Weight Loss Among Patients with Type 2 Diabetes: The SCALE Diabetes Randomized Clinical Trial. Jama 2015; 314: 687–699
• 9. GRADE Study Research Group. Glycemia Reduction in Type 2 Diabetes - Glycemic Outcomes. The New England journal of medicine 2022; 387: 1063–1074.
• 10. Wadden TA, Hollander P, Klein S, Niswender K, Woo V, Hale PM, et al. Weight maintenance and additional weight loss with liraglutide after low‐calorie‐diet‐induced weight loss: the SCALE Maintenance randomized study. Int J Obes (Lond) 2013; 37: 1443–1451.
• 11. Pi-Sunyer X, Astrup A, Fujioka K, Greenway F, Halpern A, Krempf M, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med 2015; 373: 11-22
• 12. Wharton S, Haase CL, Kamran E, Mancini J, Neish D, Pakseresht A, et al. Weight loss and persistence with liraglutide 3.0 mg by obesity class in the real-world effectiveness study in Canada. Obes Sci Pract 2020; 6: 439-444.
• 13. Astrup A, Carraro R, Finer N, Kunesova M, Lean ME, Niskanen L, et al. Safety, tolerability and sustained weight loss over 2 years with the once-daily human GLP-1 analog, liraglutide. Int J Obes (Lond) 2012; 36: 843.
• 14. Salari N, Jafari S, Darvishi N, Valipour E, Mohammadi M, Mansouri K, et al. The best drug supplement for obesity treatment: a systematic review and network meta-analysis. Diabetol Metab Syndr 2021; 13: 1-12
• 15. Astrup A, Rössner S, Van Gaal L, Rissanen A, Niskanen L, Al Hakim M, et al. Effects of liraglutide in the treatment of obesity: a randomised, double-blind, placebo-controlled study. Lancet 2009; 374: 1606.
• 16. Pi-Sunyer X, Astrup A, Fujioka K, Greenway F, Halpern A, Krempf M, et al. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. N Engl J Med 2015; 373: 11.