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New medications for treatment of obesity: metabolic and cardiovascular effects
Canadian Journal of Cardiology, 11/25/14
Pucci A, et al. – The management of obesity remains a major challenge. While hard clinical outcome benefit has yet to be established obesity pharmacotherapy may soon offer to address many of the challenges in the clinical management of obesity, although newer and better drug combinations, and more evidence of benefit from appropriately designed outcome trials, is needed.

  • Dietary therapy often fails, while bariatric surgery although successful, is demanding and applicable to a limited number of patients.
  • Drug therapy has had many setbacks over the past twenty years because of serious adverse effects; however several new drugs for the treatment of obesity are either licensed in some parts of the world, submitted for registration, or completing phase 3 trials.
  • These include combinations (at low dose) of existing drugs e.g. bupropion + naltrexone (Contrave), phentermine + topiramate (Qsymia), higher doses of existing drugs licensed for other indications (liraglutide 3mg) and new entities (lorcaserin).
  • Here, the authors discuss the challenges and opportunities for obesity pharmacotherapy, and review in detail the efficacy of the new drugs in terms of weight loss, and both desirable and potential undesirable cardiovascular and metabolic risk factors.
  • Substantial barriers remain, even if the drugs are approved, in successfully integrating these agents into weight management practice, largely related to cost, patient acceptability and clinician willingness to be engaged in obesity treatment.

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