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Abstract(s)
A obesidade é definida pela Organização Mundial de Saúde (OMS) como uma acumulação anormal ou excessiva de gordura no corpo. A prevalência da obesidade tem aumentado exponencialmente e, atualmente, representa um grave problema de saúde pública no mundo. Esta é uma doença crónica que se não for prevenida ou tratada tem consequências graves nomeadamente, aumento do risco de doenças cardiovasculares, metabólicas e diversos tipos de cancro. As alterações de estilo de vida são o pilar na terapêutica não farmacológica, no entanto não são suficientes para induzir uma perda de peso sustentada a longo prazo. Assim deve-se considerar a terapêutica farmacológica como adjuvante da modificação do estilo de vida na indução e manutenção da perda de peso em indivíduos com um IMC ≥ 30 kg/m2 ou IMC ≥ 27 kg/m2 e comorbilidades associadas ao peso, segundo as guidelines atuais. Atualmente, existem seis medicamentos aprovados pela Food and Drug Administration (FDA) para a terapêutica a longo prazo da obesidade. Destes, a Agência Europeia de Medicamentos (EMA) aprovou apenas cinco, uma vez que a terapêutica combinada fentermina/topiramato foi rejeitada por falta de dados sobre os efeitos cardiovasculares da fentermina bem como efeitos adversos psíquicos e cognitivos do topiramato. O orlistato atua ao nível intestinal impedindo a absorção das gorduras, os agonistas do GLP-1 (exenatido, liraglutido, dulaglutido e semaglutido) atuam no sistema nervoso central induzindo uma sensação de saciedade e interferem na homeostasia da glucose, e outros fármacos como a naltrexona/bupropiona, fentermina/topiramato e setmelanotido interferem apenas com as vias do sistema nervoso central levando a redução do apetite. No caso das aminas simpaticomiméticas (fentermina, dietilpropiona), aprovadas para a redução de peso a curto prazo, não existem até hoje dados de segurança da sua utilização a longo prazo. Encontram-se atualmente em ensaios clínicos vários fármacos promotores de perda de peso. Neste contexto, o farmacêutico tem um papel muito importante na promoção de estilos de vida saudáveis (alimentação variada e prática de exercício físico) e na informação ao doente sobre a medicação, nomeadamente efeitos adversos e a necessidade de adesão à terapêutica.
Obesity is defined by the World Health Organisation (WHO) as an abnormal or excessive accumulation of fat in the body. The prevalence of obesity has increased exponentially and currently represents a serious public health problem worldwide. This is a chronic disease which, if not prevented or treated, has severe consequences namely, an increased risk of cardiovascular and metabolic diseases and several types of cancer. Lifestyle changes are the cornerstone of non-pharmacological therapy, but they are not enough to induce long-term sustained weight loss. Therefore, pharmacological therapy should be considered as an adjunct to lifestyle modification in inducing and maintaining weight loss in individuals with a BMI ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 and weight-related comorbidities, according to current guidelines. Currently, there are six drugs approved by the Food and Drug Administration (FDA) for the long-term obesity therapy. Of these, the European Medicines Agency (EMA) has approved only five, as phentermine/topiramate combination therapy was rejected due to lack of data on the cardiovascular effects of phentermine as well as psychiatric and cognitive adverse effects of topiramate. Orlistat acts at the intestinal level preventing fat absorption, GLP-1 agonists (exenatide, liraglutide, dulaglutide and semaglutide) act on the central nervous system inducing a feeling of satiety and interfere with glucose homeostasis, and other drugs such as naltrexone/bupropion, phentermine/topiramate and setmelanotide interfere only with the central nervous system pathways leading to appetite reduction. In the case of sympathomimetic amines (phentermine, diethylpropion), approved for short-term weight reduction, there are to date no safety data on their long-term use. Several drugs promoting weight loss are currently in clinical trials. In this context, the pharmacist has a very important role in the promotion of healthy lifestyles (varied diet and physical exercise) and in informing patients about the medication, including adverse effects and the need for adherence to therapy.
Obesity is defined by the World Health Organisation (WHO) as an abnormal or excessive accumulation of fat in the body. The prevalence of obesity has increased exponentially and currently represents a serious public health problem worldwide. This is a chronic disease which, if not prevented or treated, has severe consequences namely, an increased risk of cardiovascular and metabolic diseases and several types of cancer. Lifestyle changes are the cornerstone of non-pharmacological therapy, but they are not enough to induce long-term sustained weight loss. Therefore, pharmacological therapy should be considered as an adjunct to lifestyle modification in inducing and maintaining weight loss in individuals with a BMI ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 and weight-related comorbidities, according to current guidelines. Currently, there are six drugs approved by the Food and Drug Administration (FDA) for the long-term obesity therapy. Of these, the European Medicines Agency (EMA) has approved only five, as phentermine/topiramate combination therapy was rejected due to lack of data on the cardiovascular effects of phentermine as well as psychiatric and cognitive adverse effects of topiramate. Orlistat acts at the intestinal level preventing fat absorption, GLP-1 agonists (exenatide, liraglutide, dulaglutide and semaglutide) act on the central nervous system inducing a feeling of satiety and interfere with glucose homeostasis, and other drugs such as naltrexone/bupropion, phentermine/topiramate and setmelanotide interfere only with the central nervous system pathways leading to appetite reduction. In the case of sympathomimetic amines (phentermine, diethylpropion), approved for short-term weight reduction, there are to date no safety data on their long-term use. Several drugs promoting weight loss are currently in clinical trials. In this context, the pharmacist has a very important role in the promotion of healthy lifestyles (varied diet and physical exercise) and in informing patients about the medication, including adverse effects and the need for adherence to therapy.
Description
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2023, Universidade de Lisboa, Faculdade de Farmácia.
Keywords
Obesidade Perda de peso Terapêutica farmacológica FDA Adesão à terapêutica Mestrado Integrado - 2023