Detalle Publicación

New advances and novel approaches in obesity pharmacotherapy
ISSN: 2451-9650
Volumen: 4
Páginas: 75 - 82
Fecha de publicación: 2019
Lugar: Scopus
Recently marketed antiobesity medications have improved the obesity therapeutic performance by promoting weight loss in patients treated with diet, physical activity and nutritional education. However, mean placebo-subtracted weight loss following treatment with phentermine, lorcaserin, liraglutide 3 mg or the combinations phentermine-topiramate and naltrexone-bupropion reaches 3¿10%. Although this weight reduction translates into significant benefits in obesity comorbidities management, more weight reduction is needed to reduce the gap between conventional treatment and bariatric surgery. The new weekly GLP-1 receptor agonist, semaglutide, exhibits a powerful effect on body weight reduction showing better performance when compared with other members of the same family in diabetic patients. Biochemical engineering has produced diverse unimolecular peptides displaying GLP-1, glucagon and GIP agonist action that are being investigated in preclinical models and clinical trials, showing encouraging results regarding weight loss and treatment of obese comorbidities such as diabetes, dyslipidemia and liver steatosis. Other medications such as amylin analogs, and different agonists and antagonists of satiating and orexigenic neuronal pathways offer new approaches. The possibility of conjugating peptides such as GLP-1 or glucagon with glucocorticoids, estrogens or triiodothyronine to deliver selectively these hormones to tissues expressing receptors involved in energy balance control opens a new era in obesity therapy. Preclinical studies show that this targeting strategy allows achieving selective hormonal actions with prevention of adverse effects in other organs. Peripheral pharmacological approaches including stimulation of thermogenesis, activation of bile acid receptors, lipolysis stimulation and manipulation of gut microbiota may also take part of this unlimited universe of pharmacological options. Drug combinations of compounds acting on different pathways and through diverse mechanisms represent an excellent option to increase efficacy and improve long-term results when compared with strategies based in monotherapy.