Medikamentöse Adipositastherapie – Chancen und Perspektiven

Zusammenfassung

Medikamentöse Therapiestrategien sind dringend erforderlich, um Adipositas-assoziierte Begleiterkrankungen langfristig reduzieren und verhindern zu können. Mit einer Gewichtsabnahme um 10% kann bereits eine Reduktion kardiovaskulärer Endpunkte erreicht werden. Als medikamentöse Therapieoption stehen aktuell in Deutschland der Lipaseinhibitor Orlistat sowie der GLP-1 Rezeptor-Agonist (GLP-1RA) Liraglutid zur medikamentösen Langzeittherapie der Adipositas zur Verfügung. Perspektivisch könnten zukünftig noch weitere Therapieoptionen zur Verfügung stehen, mit denen eine effektive Gewichtsreduktion erzielt werden kann. Semaglutid ist bereits als GLP-1RA zur Therapie des Typ 2 Diabetes zugelassen und zeigt, neben einer effektiven HbA1c-Senkung, eine deutliche Gewichtsreduktion. Im Fokus aktueller Adipositasforschung stehen zudem die Multi-Agonisten auf GLP-1-Basis, die balanziert an Rezeptoren mehrerer gastrointestinaler Peptide binden. So zeigen klinische Studien bspw. mit einem dualen Agonisten aus GLP1 und GIP (Glucose-dependent insulinotropic peptide) vielversprechende Körpergewichts-reduzierende Effekte. Weitere Forschungsansätze medikamentöser Therapieoptionen zur Gewichtsreduktion basieren u. a. auf Glukagon-Analoga, PYY und Amylin, aber auch auf Kombinationstherapien wie Leucin-Metformin-Sildenafil. Neben einer Verringerung der Nahrungsaufnahme werden derzeit zudem Therapieansätze zur Steigerung des Energieumsatzes, z. B. über die Aktivierung des braunen Fettgewebes, intensiv beforscht. In diesem Übersichtsartikel werden aktuelle sowie mögliche zukünftige Therapieoptionen zur Gewichtsreduktion in der Therapie der Adipositas zusammengefasst.

Abstract

Therapy strategies are required to reduce and prevent obesity-associated comorbidities. Weight loss of 10% leads to a significant reduction in cardiovascular endpoints. In Germany, the lipase inhibitor orlistat and the GLP-1 receptor agonist (GLP-1RA) liraglutide are currently approved and available for long-term therapy of obesity. However, current research point to more oral and subcutaneous therapy options for effective weight loss in the future. Semaglutide is already approved as GLP-1RA for the treatment of type 2 diabetes and significantly reduces HbA1c-levels and body weigth. Current research also focuses on multi-agonists based on GLP-1, which are binding in a balanced way to receptors of gastrointestinal peptides. Further obesity research is based on glucagon analogues, gastrointestinal peptide hormones such as PYY and amylin, as well as on combination therapies such as leucine-metformin-sildenafil. In addition, increasing energy expenditure by activation of brown adipose tissue is in the focus of current research for weight reduction. This review summarizes current and possible future treatment options for obesity.

Schlüsselwörter

Pharmakotherapie - Adipositas - Gewichtsreduktion - GLP-1 Rezeptoragonisten

Keywords

Pharmacotherapy - obesity - weight reduction - GLP-1 receptor agonists

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