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Paper 4
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Concerning anti-obesity medication, which of the following is not a centrally acting drug? RitalinRimonabantSibutramined OrlistatThyroxine
Childhood Obesity
Published in James M. Rippe, Lifestyle Medicine, 2019
Jaime M. Moore, Matthew Allen Haemer
In combination with ongoing intensive lifestyle efforts, anti-obesity medications may be indicated for a subset of youth with obesity.12,13 A 2019 Opinion Statement provides a framework and practical considerations for the use of anti-obesity medications in adolescents with obesity.84 Pharmacotherapy for children and adolescents with obesity should be considered only after participation in an intensive lifestyle program for six to 12 months has been unsuccessful in either curbing weight gain and/or improving obesity comorbidities.14 Weight loss medications should be administered and monitored by a clinician experienced with their use and their potential adverse effects. In addition to monitoring for side effects, a planned assessment of the drug’s effectiveness and a decision to continue should be made within 12 weeks of starting the full dose. Weight loss medications should not be used in those younger than 16 who are overweight, but not obese. The only FDA-approved anti-obesity medication in pediatrics is the lipase inhibitor orlistat (for patients ≥ 12 years of age). Phentermine is FDA approved for short-term treatment of obesity in patients ≥17 years of age. Sibutramine was removed from the U.S. market in 2010 after clinical trial data in adults demonstrated an increased risk of adverse cardiovascular outcomes.85 It had previously been approved for weight loss in adolescents with obesity ≥ 16 years of age.
Q
Published in Alan Earl-Slater, Dictionary of Health Economics, 2018
Quality-adjusted survival time (QAST) is a measure of the change in quality of life multiplied by the change in life duration. For example, orlistat, an anti-obesity medication, in combination with a hypocaloric diet including 30% of calories in fat and multivitamin supplements, may enable an obese patient to live five more years than they would otherwise and at a lower weight (with concomitant improvements in their quality of life). To get the QAST, we would need to identify and measure the change in quality of life and then multiply it by the survival time of the patient. SeeHealthy years equivalent; QALY; Quality-adjusted time without symptoms or toxicity; Quality of life.
Integrating semaglutide into obesity management – a primary care perspective
Published in Postgraduate Medicine, 2022
Janine V. Kyrillos, Neil S. Skolnik, Bhasha Mukhopadhyay, Nicholas Pennings
If a patient is already on another anti-obesity medication, it may be beneficial to re-evaluate their existing treatment, taking into consideration weight loss progress and any negative side effects. If there has been inadequate clinical improvement (i.e. ≤4–5% reduction of baseline body weight) with their current anti-obesity medication after 12–16 weeks, then PCPs can consider dose adjustment or discussing alternative pharmacotherapeutic options with their patient [18]. Once-weekly semaglutide 2.4 mg may be a suitable alternative option for patients not achieving at least a ≤4–5% baseline body weight reduction on other anti-obesity medications, given the high proportions of participants achieving 5% and 10% reductions in clinical trials of once-weekly semaglutide 2.4 mg [42,49,55,56].
Pharmacological profile of once-weekly injectable semaglutide for chronic weight management
Published in Expert Review of Clinical Pharmacology, 2022
David C. W. Lau, Rachel L Batterham, Carel W. le Roux
Obesity is a progressive, relapsing, chronic disease that severely impairs health. People with obesity are at risk of developing concomitant diseases and many obesity-related comorbidities. Current obesity clinical practice guidelines recommend lifestyle interventions, such as a calorie-controlled diet and increased physical activity, as the cornerstone therapy for obesity, supported by behavioral and psychological therapy, pharmacotherapy, and bariatric surgery. The recent FDA approval of once-weekly injectable semaglutide 2.4 mg, as an adjunct to a calorie-controlled diet and increased physical activity, for chronic weight management provides HCPs with an additional option to consider when prescribing weight-loss drugs. The phase 3 STEP clinical development program, to date, has demonstrated that, among patients with overweight and obesity, with and without T2D, once-weekly injectable semaglutide 2.4 mg treatment induces greater weight loss from baseline, compared with placebo and once-daily liraglutide 3.0 mg. Semaglutide 2.4 mg treatment also demonstrates a tolerability profile that is similar to that for other GLP-1 RAs, with the most common AEs being gastrointestinal-related events. In addition to the efficacy and safety profile, HCPs should also consider the route and frequency of administration as well as the drug cost when choosing an anti-obesity medication. The cost of once-weekly injectable semaglutide 2.4 may constitute barriers for broad insurance coverage and limit patient access to this treatment option.
The risk of cardiovascular complications with current obesity drugs
Published in Expert Opinion on Drug Safety, 2020
Ariana M. Chao, Thomas A. Wadden, Robert I. Berkowitz, Kerry Quigley, Frank Silvestry
Guidelines for obesity treatment recommend a step-wise approach based on increasing BMI, as well as obesity-related comorbidities such as hypertension and type 2 diabetes [5,6]. Individuals with a BMI ≥30 kg/m2 (or ≥27 kg/m2 with obesity-related comorbidities) who have not successfully achieved weight loss with lifestyle modification alone are candidates for adjunctive treatments, including anti-obesity medication (AOM). Four medications currently are approved by the US Food and Drug Administration (FDA) for chronic weight management, when used as an adjunct to a reduced calorie diet and increased physical activity. They are orlistat, phentermine/topiramate, naltrexone/bupropion, and liraglutide. The European Medicines Agency (EMA) has approved all of these except phentermine/topiramate. Placebo-subtracted weight losses for these medications range from 2.6 to 8.8 kg at 1 year [7,8]. When combined with a program of structured lifestyle modification, all of these AOMs can help individuals obtain clinically significant weight losses of ≥5% of initial body weight [7,8]. However, prescription of obesity medications should balance benefits and risks. This review provides a history of AOMs and cardiovascular safety, and summarizes cardiovascular data from clinical trials of FDA-approved weight loss medications. We conclude with our expert opinion on the cardiovascular safety of AOMs.