首页 > 资讯 > Lancet：成人超重和肥胖的药物治疗：随机对照试验的系统回顾和网络荟萃分析

Lancet：成人超重和肥胖的药物治疗：随机对照试验的系统回顾和网络荟萃分析

泰然健康网
2025-09-16 12:05

本文由小咖机器人翻译整理

期刊来源：Lancet

原文链接：https://doi.org/10.1016/S0140-6736(24)00351-9

摘要内容如下：

背景

药物疗法为超重和肥胖的成年人提供了一种选择，如果生活方式改变失败，可以减轻体重。我们总结了减肥药物的益处和危害的最新证据。

方法

该系统综述和网络荟萃分析检索了PubMed、EMBASE和Cochrane Library（Central）从开始到2021年3月23日的关于超重和肥胖成人减肥药物的随机对照试验。我们进行了频率随机效应网络荟萃分析来总结证据，并应用建议评估分级、开发和评估框架来对证据的确定性进行评级，计算绝对效应，对干预措施进行分类，并展示研究结果。该研究在普洛斯彼罗注册，CRD 42021245678。

调查结果

通过我们的搜索确定了14605条引文，其中132个符合条件的试验招募了48209名参与者。与单独改变生活方式相比，所有药物都降低了体重；所有随后的数字都是指与生活方式改变的比较。高至中度确定性证据表明，芬特明-托吡酯在降低体重方面最有效（体重下降≥5%的比值比[OR]8.02，95%CI 5.24~12.27；体重变化百分比的平均差异[MD]为-7.98，95%CI为-9.27~-6.69），其次为GLP-1受体激动剂（OR为6.33，95%CI为5.00~8.00；MD-5.79，95%CI-6.34~-5.25）。纳曲酮-安非他酮（OR 2.69，95%CI 2.10~3.44）、芬特明-托吡酯（OR 2.40，95%CI 1.68~3.44）、GLP-1受体激动剂（OR 2.22，95%CI 1.74~2.84）和奥利司他（OR 1.71，95%CI 1.42~2.05）与导致停药的不良事件增加相关。在事后分析中，Semaglutide（一种GLP-1受体激动剂）在体重减轻5%或以上的可能性（OR 9.82，95%CI 7.09~13.61）和体重变化百分比（MD-11.40，95%CI-12.51~-10.29）方面显示出比其他药物更大的益处，不良事件风险与其他药物相似。

解释

在超重和肥胖的成年人中，芬特明-托吡酯和GLP-1受体激动剂被证明是最好的减肥药物；在GLP-1激动剂中，Semaglutide可能是最有效的。

英文原文如下：

Abstracts

BACKGROUND Pharmacotherapy provides an option for adults with overweight and obesity to reduce their bodyweight if lifestyle modifications fail. We summarised the latest evidence for the benefits and harms of weight-lowering drugs.

METHODS This systematic review and network meta-analysis included searches of PubMed, Embase, and Cochrane Library (CENTRAL) from inception to March 23, 2021, for randomised controlled trials of weight-lowering drugs in adults with overweight and obesity. We performed frequentist random-effect network meta-analyses to summarise the evidence and applied the Grading of Recommendations Assessment, Development, and Evaluation frameworks to rate the certainty of evidence, calculate the absolute effects, categorise interventions, and present the findings. The study was registered with PROSPERO, CRD 42021245678.

FINDINGS 14 605 citations were identified by our search, of which 132 eligible trials enrolled 48 209 participants. All drugs lowered bodyweight compared with lifestyle modification alone; all subsequent numbers refer to comparisons with lifestyle modification. High to moderate certainty evidence established phentermine-topiramate as the most effective in lowering weight (odds ratio [OR] of ≥5% weight reduction 8·02, 95% CI 5·24 to 12·27; mean difference [MD] of percentage bodyweight change -7·98, 95% CI -9·27 to -6·69) followed by GLP-1 receptor agonists (OR 6·33, 95% CI 5·00 to 8·00; MD -5·79, 95% CI -6·34 to -5·25). Naltrexone-bupropion (OR 2·69, 95% CI 2·10 to 3·44), phentermine-topiramate (2·40, 1·68 to 3·44), GLP-1 receptor agonists (2·22, 1·74 to 2·84), and orlistat (1·71, 1·42 to 2·05) were associated with increased adverse events leading to drug discontinuation. In a post-hoc analysis, semaglutide, a GLP-1 receptor agonist, showed substantially larger benefits than other drugs with a similar risk of adverse events as other drugs for both likelihood of weight loss of 5% or more (OR 9·82, 95% CI 7·09 to 13·61) and percentage bodyweight change (MD -11·40, 95% CI -12·51 to -10·29).

INTERPRETATION In adults with overweight and obesity, phentermine-topiramate and GLP-1 receptor agonists proved the best drugs in reducing weight; of the GLP-1 agonists, semaglutide might be the most effective.

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