肥胖的药物治疗原则PPT课件.ppt

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1、PrinciplesofPharmacotherapyintheManagementofObesityDrugsApprovedbyFDAforTreatingObesityGenericNameTradeNamesDEAScheduleApprovedUseYearApprovedOrlistatXenicalNoneLong-term1999SibutramineMeridiaIVLong-term1997DiethylpropionTenulateIVShort-term1973PhentermineAdipex,lonaminIVS

2、hort-term1973PhendimetrazineBontril,Prelu-2IIIShort-term1961BenzphetamineDidrexIIIShort-term1960EffectofContinuousandIntermittentPhentermineTherapyonBodyWeight0Time(weeks)82428MunroJFetal.BritMedJ1:352,1968WeightLoss(lbs)36412162032AlternatePhentermineandDummyContinuousPhe

3、ntermineContinuousDummyOrlistatPreventsFatDigestionandAbsorptionbyBindingtoGastrointestinalLipasesTG=triglyceride;MG=monoglyceride;FA=fattyacid.MucosalCellIntestinalLumenOrlistatTGLIPASELIPASELIPASEBileAcidsMicelleMGFAEffectofOrlistatDoseonFecalFatExcretionZhietal.ClinPhar

4、macolTher1994;56:82.FecalFatExcretion(%intake)OrlistatDailyDose(mg)020040060080010001200EffectofLong-termOrlistatTherapyonBodyWeight0Weeks52Torgensonetal.DiabetesCare2004;27:155ChangeinWeight(kg)104156208P<0.001vsplacebo-4.1kg-6.9kgPlaceboOrlistatMeta-analysisofRCTsEvaluat

5、ingEffectofOrlistatTherapyonWeightLossat1-YearStudyorSub-categoryWMD(random)95%CIHollander1998*Sjostrom1998Davidson1999Finer2000Heuptman2000Lindgarde2000Rossner2000Bakris2002Broom2002Kelley2002*Miles2002*Total(95%CI)Padwaletal.IntJObes2003;27:1437*Allsubjectshadtype2diab

6、etesWMD=weightedmeandifferenceFavoursTreatmentFavoursControl-10-50105IndependentEffectofOrlistatonPlasmaLDL-CholesterolWeightLossCategory(%initialbodyweight)ChangeinPlasmaLDL-CholesterolConcentration(mmol/L)Segaletal.FASEBJ.1999;13:A873.*P<0.01vsplacebo.Datapooledfrom5

7、trials(N=1773).0-55–1010–15>15PlaceboOrlistat****OrlistatInhibitsDietaryCholesterolAbsorptionCholesterolAbsorbed(%ingested)*P<0.05vsbaseline.Mittendorferetal.ObesRes2001;9:599.BaselineOrlistat*GastrointestinalSideEffectsofOrlistatTherapyYear1Year2PlaceboOrlistatPlaceboOrli

8、statFatty/oilystool53118Increaseddefecation72022Liquidstools101358Fecalurgency31023Flatul