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Vest AR, Schauer PR, Rodgers JE, Sanderson E, LaChute CL, Seltz J, Lavie CJ, Mandras SA, Tang WHW, daSilva-deAbreu A. Obesity and Weight Loss Strategies for Patients With Heart Failure. JACC. HEART FAILURE 2024:S2213-1779(24)00506-7. [PMID: 39093256 DOI: 10.1016/j.jchf.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 08/04/2024]
Abstract
Obesity is a common comorbidity among patients with heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF), with the strongest pathophysiologic link of obesity being seen for HFpEF. Lifestyle measures are the cornerstone of weight loss management, but sustainability is a challenge, and there are limited efficacy data in the heart failure (HF) population. Bariatric surgery has moderate efficacy and safety data for patients with preoperative HF or left ventricular dysfunction and has been associated with reductions in HF hospitalizations and medium-term mortality. Antiobesity medications historically carried concerns for cardiovascular adverse effects, but the safety and weight loss efficacy seen in general population trials of glucagon-like peptide 1 (GLP-1) and gastric inhibitory polypeptide/GLP-1 agonists are highly encouraging. Although there are safety concerns regarding GLP-1 agonists in advanced HFrEF, trials of the GLP-1 agonist semaglutide for treatment of obesity have confirmed safety and efficacy in patients with HFpEF.
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Affiliation(s)
- Amanda R Vest
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Philip R Schauer
- Metamor Metabolic Institute, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Jo E Rodgers
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Emily Sanderson
- Friedman School of Nutrition Science and Policy at Tufts University, Boston, Massachusetts, USA
| | - Courtney L LaChute
- Department of Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Jessica Seltz
- Frances Stern Nutrition Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Carl J Lavie
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana, USA; University of Queensland Ochsner Clinical School, University of Queensland, New Orleans, Louisiana, USA
| | - Stacy A Mandras
- Transplant Institute, AdventHealth Orlando, Orlando, Florida, USA
| | - W H Wilson Tang
- Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Adrian daSilva-deAbreu
- Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Wu Y, Li D, Vermund SH. Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:757. [PMID: 38929003 PMCID: PMC11204233 DOI: 10.3390/ijerph21060757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
Obesity reflects excessive fat deposits. At-risk individuals are guided by healthcare professionals to eat fewer calories and exercise more, often using body mass index (BMI; weight/height2) thresholds for screening and to guide progress and prognosis. By conducting a mini-narrative review of original articles, websites, editorials, commentaries, and guidelines, we sought to place BMI in the context of its appropriate use in population health, clinical screening, and monitoring in clinical care. The review covers studies and publications through 2023, encompassing consensus reviews and relevant literature. Recent consensus reviews suggest that BMI is a valuable tool for population surveys and primary healthcare screening but has limitations in predicting the risk of chronic diseases and assessing excess fat. BMI can guide nutritional and exercise counseling, even if it is inadequate for reliable individual risk prediction. BMI cut-offs must be reconsidered in populations of varying body build, age, and/or ethnicity. Since BMI-diagnosed overweight persons are sometimes physically and physiologically fit by other indicators, persons who are overweight on BMI should be more fully evaluated, diagnosed, and monitored with combined anthropometric and performance metrics to better clarify risks. The use of combined anthropometric and performance metrics involves integrating measurements of body composition with assessments of physical function and fitness to provide a more comprehensive evaluation of an individual's health and fitness status. Eligibility for bariatric surgery or semaglutide satiety/appetite-reduction medications should not be determined by BMI alone. Awareness of the advantages and limitations of using BMI as a tool to assess adult obesity can maximize its appropriate use in the context of population health and in rapid clinical screening and evaluation.
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Affiliation(s)
- Yilun Wu
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA;
| | - Dan Li
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA;
| | - Sten H. Vermund
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA;
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Chen W, Cai P, Zou W, Fu Z. Psychiatric adverse events associated with GLP-1 receptor agonists: a real-world pharmacovigilance study based on the FDA Adverse Event Reporting System database. Front Endocrinol (Lausanne) 2024; 15:1330936. [PMID: 38390214 PMCID: PMC10882716 DOI: 10.3389/fendo.2024.1330936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/02/2024] [Indexed: 02/24/2024] Open
Abstract
Background Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used due to their profound efficacy in glycemic control and weight management. Within real-world contexts, the manifestation of certain psychiatric adverse events (AEs) has been observed, which is potentially linked to the administration of GLP-1 RAs. The objective of this study was to undertake a comprehensive investigation and characterization of the psychiatric AEs associated with GLP-1 RAs. Methods We retrieved reports of AEs associated with treatment with GLP-1 RAs during the period from the first quarter (Q1) of 2004 to Q1 2023 from the FDA Adverse Event Reporting System (FAERS) database. Descriptive analysis was performed to examine the clinical characteristics and time to onset of the psychiatric AEs caused by GLP-1 RAs. Moreover, disproportionality analyses were performed using the reporting odds ratio (ROR) to identify GLP-1 RA-related psychiatric AEs. Results A total of 8,240 reports of psychiatric AEs were analyzed out of 181,238 AE reports with treatment with GLP-1 RAs. Among these cases, a higher percentage was represented by women compared to men (65.89% vs. 30.96%). The median age of these patients was 56 years, with an interquartile range (IQR) of 48-67 years, based on data available in 286 case reports. This study showed that the median time to onset of the overall GLP-1 RA-related AEs was 31 days (IQR = 7-145.4 days), which varied among GLP-1 RA regimens. Specifically, exenatide had a significantly longer onset time at 45 days (IQR = 11-213 days), with statistically significant differences from the onset times of the other five GLP-1 RAs (p< 0.0001). Moreover, eight categories of psychiatric AEs, namely, nervousness (ROR = 1.97, 95% CI = 1.85-2.11), stress (ROR = 1.28, 95% CI = 1.19-1.38), eating disorder (ROR = 1.57, 95% CI = 1.40-1.77), fear of injection (ROR = 1.96, 95% CI = 1.60-2.40), sleep disorder due to general medical condition-insomnia type (ROR = 2.01, 95% CI = 1.60-2.52), binge eating (ROR = 2.70, 95% CI = 1.75-4.16), fear of eating (ROR 3.35, 95% CI = 1.65-6.78), and self-induced vomiting (ROR = 3.77, 95% CI = 1.77-8.03), were defined as GLP-1 RA-related psychiatric AEs through disproportionality analysis. Conclusion Our findings demonstrate a significant association between GLP-1 RAs and the development of specific psychiatric AEs. Despite the observational nature of this pharmacovigilance study and the inherent limitations of the FAERS database, our preliminary findings in this work could provide a better basis for understanding the potential psychiatric AEs that may occur with GLP-1 RA treatment, assisting clinicians to focus on these AEs and provide early intervention for optimal risk management.
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Affiliation(s)
- Wei Chen
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Peishan Cai
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenbin Zou
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhiwen Fu
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Carmina E, Longo RA. Semaglutide Treatment of Excessive Body Weight in Obese PCOS Patients Unresponsive to Lifestyle Programs. J Clin Med 2023; 12:5921. [PMID: 37762862 PMCID: PMC10531549 DOI: 10.3390/jcm12185921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
In spite of the widespread use of lifestyle modifications programs, many patients with PCOS are obese and prevalence of obesity in PCOS remains high. In this study, we present the data on the use of semaglutide, an incretin mimetic drug, in obese PCOS patients who were unresponsive to a lifestyle modification program. Twenty-seven obese patients with a diagnosis of PCOS, who did not reduce their body weight by a lifestyle modification program, were included in this study and treated by semaglutide, 0.5 mg subcutaneously once a week. After three months of treatment, an improvement in body weight with a mean decrease in body weight of 7.6 kg and a mean BMI loss of 3.1 was observed, while very few side effects were reported. Almost 80% of the studied obese PCOS patients obtained at least a 5% decrease in their body weight. Only a few patients (22%) obtained a decrease in body weight lower than 5% and were considered non-responsive to semaglutide, at least at the used doses. These patients presented a more severe obesity than responsive patients. Independently of results on body weight, and in patients who did not obtain a 5% decrease in their body weight, insulin basal values decreased, and HOMA-IR improved. Fasting blood glucose normalized in 80% of semaglutide-treated IFG PCOS women. In patients who were responsive to semaglutide (weight loss > 5%), the treatment was continued for additional three months. Weight loss slowed but continued and, at the end of the six months of therapy, the mean body weight loss was 11.5 kg and mean BMI reduced from 34.4 to 29.4. A total of 80% of responsive patients normalized menstrual cycles. In conclusion, treatment with semaglutide, at low doses, significantly reduces body weight in almost 80% of obese PCOS patients who were unresponsive to a previous lifestyle plan. It is often associated with the normalization of menstrual cycles, and these important results are obtained with very few side effects.
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Affiliation(s)
- Enrico Carmina
- Endocrinology Unit, University of Palermo School of Medicine, 90144 Palermo, Italy
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George M, Balachandran K, Jinson J. Fathoming the Role of Semaglutide in Obesity Therapeutics. Clin Ther 2023; 45:804-805. [PMID: 37442659 DOI: 10.1016/j.clinthera.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/07/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Melvin George
- Clinical Pharmacology, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India.
| | - Karthik Balachandran
- Endocrinology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Juanna Jinson
- Clinical Pharmacology, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India
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Alorfi NM, Alshehri FS. Usage of Glucagon-Like Peptide-1 for Obesity in Children; Updated Review of Clinicaltrials.gov. J Multidiscip Healthc 2023; 16:2179-2187. [PMID: 37547806 PMCID: PMC10402718 DOI: 10.2147/jmdh.s419245] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/07/2023] [Indexed: 08/08/2023] Open
Abstract
Background Obesity in both adults and children is a primary health concern that can lead to many complications at a young age, including insulin resistance, type 2 diabetes, and other diseases. Glucagon-like peptide-1 receptor agonists (GLP-1) are drugs utilized to treat diabetes, but they are also approved as an adjunct to a low-calorie diet to reduce body weight and to enhance the metabolic profile readings for diabetic and non-diabetic patients. However, their efficacy and safety in children have not been extensively examined. Aim To identify glucagon-like peptide-1 medications for obesity in pediatric participants (aged up to 17 years old). Methods Analysis of all clinical trials registered on ClinicalTrials.gov for obesity using GLP-1 as a treatment for children. Results As of January 26th, 2023, 10,828 clinical trials were found. The search included childhood obesity using GLP-1. The number of trials on the use of GLP-1 to treat childhood obesity is limited. The final number of analyzed trials was 19. GLP-1 has been shown to result in the effective management of body gain among children. Conclusion Exenatide, semaglutide, and liraglutide were the only GLP-1 medications used as the pharmacotherapy option. It has been studied in many circumstances eg, to treat children with severe obesity, PCOS, hypothalamic obesity, glucose tolerance, and as a complementary treatment alongside behavior-lifestyle change and surgery for obesity.
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Affiliation(s)
- Nasser M Alorfi
- Pharmacology and Toxicology Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Fahad S Alshehri
- Pharmacology and Toxicology Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
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Berman C, Vidmar AP, Chao LC. Glucagon-like Peptide-1 Receptor Agonists for the Treatment of Type 2 Diabetes in Youth. TOUCHREVIEWS IN ENDOCRINOLOGY 2023; 19:38-45. [PMID: 37313232 PMCID: PMC10258616 DOI: 10.17925/ee.2023.19.1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/20/2023] [Indexed: 06/15/2023]
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have gained traction for the management of type 2 diabetes and obesity. Unlike several classes of antidiabetic medications that contribute to weight gain, GLP-1RAs not only reduce haemoglobin A1c, but also promote weight loss. While there is a large body of evidence supporting its safety and efficacy in adults, paediatric clinical trial data have only emerged in recent years. This review will discuss the limited treatment options for paediatric type 2 diabetes and the mechanism of action of GLP-1RAs as it pertains to physiological pathways relevant for type 2 diabetes, obesity and their related comorbidities. The outcomes of paediatric trials evaluating liraglutide, exenatide, semaglutide and dulaglutide in paediatric type 2 diabetes and obesity will be closely examined, including differences compared with adult studies. Finally, potential barriers and strategies to expanding GLP-1RA access in adolescents will be discussed. Future studies are needed to determine if the cardio-and renal-protective benefits of GLP-1RAs apply to youth-onset type 2 diabetes.
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Affiliation(s)
- Casey Berman
- Division of Endocrinology, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Alaina P Vidmar
- Division of Endocrinology, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Lily C Chao
- Division of Endocrinology, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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Leptin Increases: Physiological Roles in the Control of Sympathetic Nerve Activity, Energy Balance, and the Hypothalamic-Pituitary-Thyroid Axis. Int J Mol Sci 2023; 24:ijms24032684. [PMID: 36769012 PMCID: PMC9917048 DOI: 10.3390/ijms24032684] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/17/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023] Open
Abstract
It is well established that decreases in plasma leptin levels, as with fasting, signal starvation and elicit appropriate physiological responses, such as increasing the drive to eat and decreasing energy expenditure. These responses are mediated largely by suppression of the actions of leptin in the hypothalamus, most notably on arcuate nucleus (ArcN) orexigenic neuropeptide Y neurons and anorexic pro-opiomelanocortin neurons. However, the question addressed in this review is whether the effects of increased leptin levels are also significant on the long-term control of energy balance, despite conventional wisdom to the contrary. We focus on leptin's actions (in both lean and obese individuals) to decrease food intake, increase sympathetic nerve activity, and support the hypothalamic-pituitary-thyroid axis, with particular attention to sex differences. We also elaborate on obesity-induced inflammation and its role in the altered actions of leptin during obesity.
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Affiliation(s)
- Santiago Palacios
- Medical Director of Palacios's Institute, Madrid, Spain
- Director of the Menopause Chair of the HM foundation, Madrid, Spain
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Ozeki Y, Masaki T, Kamata A, Miyamoto S, Yoshida Y, Okamoto M, Gotoh K, Shibata H. The Effectiveness of GLP-1 Receptor Agonist Semaglutide on Body Composition in Elderly Obese Diabetic Patients: A Pilot Study. MEDICINES (BASEL, SWITZERLAND) 2022; 9:47. [PMID: 36135828 PMCID: PMC9502467 DOI: 10.3390/medicines9090047] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/25/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to investigate the changes in obesity severity, glucose metabolism, and body composition in patients with obesity and type 2 diabetes mellitus treated with glucagon-like peptide 1 receptor agonist (GLP1-RA) semaglutide. MATERIALS AND METHODS Body weight (BW), metabolic parameters, and body composition were examined before and 3 months after semaglutide administration. The mass of body fat (FM), fat weight percentage (%FM), mass of skeletal muscle (MM), skeletal MM percentage (%MM), and limb muscles were measured using the bioelectrical impedance method. RESULTS Semaglutide dramatically reduced the weight, the body mass index (BMI), and the levels of the glucose metabolic markers, including fasting blood glucose and hemoglobin A1c, and accelerated the loss of excess BW. FM, MM, and %FM after semaglutide treatment also decreased. Conversely, semaglutide had no effect on the %MM after 3 months. In limb muscle analyses, right upper and lower leg muscle percentages, left upper and lower leg muscles, and the ratios of the lower/upper muscles were maintained by semaglutide treatment. CONCLUSIONS These results suggest that the GLP1-RA semaglutide effectively reduces body adiposity while maintaining the MM in obese type 2 diabetic patients.
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Affiliation(s)
- Yoshinori Ozeki
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu City 879-5593, Oita, Japan
| | - Takayuki Masaki
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu City 879-5593, Oita, Japan
| | - Akari Kamata
- Faculty of Medicine, Oita University, Yufu City 879-5593, Oita, Japan
| | - Shotaro Miyamoto
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu City 879-5593, Oita, Japan
| | - Yuichi Yoshida
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu City 879-5593, Oita, Japan
| | - Mitsuhiro Okamoto
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu City 879-5593, Oita, Japan
| | - Koro Gotoh
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu City 879-5593, Oita, Japan
| | - Hirotaka Shibata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu City 879-5593, Oita, Japan
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Arslanian SA, Hannon T, Zeitler P, Chao LC, Boucher-Berry C, Barrientos-Pérez M, Bismuth E, Dib S, Cho JI, Cox D. Once-Weekly Dulaglutide for the Treatment of Youths with Type 2 Diabetes. N Engl J Med 2022; 387:433-443. [PMID: 35658022 DOI: 10.1056/nejmoa2204601] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The incidence of type 2 diabetes mellitus is increasing among youths. Once-weekly treatment with dulaglutide, a glucagon-like peptide-1 receptor agonist, may have efficacy with regard to glycemic control in youths with type 2 diabetes. METHODS In a double-blind, placebo-controlled, 26-week trial, we randomly assigned participants (10 to <18 years of age; body-mass index [BMI], >85th percentile) being treated with lifestyle modifications alone or with metformin, with or without basal insulin, in a 1:1:1 ratio to receive once-weekly subcutaneous injections of placebo, dulaglutide at a dose of 0.75 mg, or dulaglutide at a dose of 1.5 mg. Participants were then included in a 26-week open-label extension study in which those who had received placebo began receiving dulaglutide at a weekly dose of 0.75 mg. The primary end point was the change from baseline in the glycated hemoglobin level at 26 weeks. Secondary end points included a glycated hemoglobin level of less than 7.0% and changes from baseline in the fasting glucose concentration and BMI. Safety was also assessed. RESULTS A total of 154 participants underwent randomization. At 26 weeks, the mean glycated hemoglobin level had increased in the placebo group (0.6 percentage points) and had decreased in the dulaglutide groups (-0.6 percentage points in the 0.75-mg group and -0.9 percentage points in the 1.5-mg group, P<0.001 for both comparisons vs. placebo). At 26 weeks, a higher percentage of participants in the pooled dulaglutide groups than in the placebo group had a glycated hemoglobin level of less than 7.0% (51% vs. 14%, P<0.001). The fasting glucose concentration increased in the placebo group (17.1 mg per deciliter) and decreased in the pooled dulaglutide groups (-18.9 mg per deciliter, P<0.001), and there were no between-group differences in the change in BMI. The incidence of gastrointestinal adverse events was higher with dulaglutide therapy than with placebo. The safety profile of dulaglutide was consistent with that reported in adults. CONCLUSIONS Treatment with dulaglutide at a once-weekly dose of 0.75 mg or 1.5 mg was superior to placebo in improving glycemic control through 26 weeks among youths with type 2 diabetes who were being treated with or without metformin or basal insulin, without an effect on BMI. (Funded by Eli Lilly; AWARD-PEDS ClinicalTrials.gov number, NCT02963766.).
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Affiliation(s)
- Silva A Arslanian
- From the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh, School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.A.); the Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children (T.H.), and Eli Lilly (J.I.C., D.C.) - both in Indianapolis; Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (P.Z.); Children's Hospital Los Angeles, Los Angeles (L.C.C.); the Department of Pediatric Endocrinology, University of Illinois Medical Center at Chicago, Chicago (C.B.-B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatric Endocrinology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris (E.B.); and the Diabetes Center of Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo (S.D.)
| | - Tamara Hannon
- From the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh, School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.A.); the Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children (T.H.), and Eli Lilly (J.I.C., D.C.) - both in Indianapolis; Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (P.Z.); Children's Hospital Los Angeles, Los Angeles (L.C.C.); the Department of Pediatric Endocrinology, University of Illinois Medical Center at Chicago, Chicago (C.B.-B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatric Endocrinology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris (E.B.); and the Diabetes Center of Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo (S.D.)
| | - Philip Zeitler
- From the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh, School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.A.); the Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children (T.H.), and Eli Lilly (J.I.C., D.C.) - both in Indianapolis; Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (P.Z.); Children's Hospital Los Angeles, Los Angeles (L.C.C.); the Department of Pediatric Endocrinology, University of Illinois Medical Center at Chicago, Chicago (C.B.-B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatric Endocrinology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris (E.B.); and the Diabetes Center of Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo (S.D.)
| | - Lily C Chao
- From the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh, School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.A.); the Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children (T.H.), and Eli Lilly (J.I.C., D.C.) - both in Indianapolis; Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (P.Z.); Children's Hospital Los Angeles, Los Angeles (L.C.C.); the Department of Pediatric Endocrinology, University of Illinois Medical Center at Chicago, Chicago (C.B.-B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatric Endocrinology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris (E.B.); and the Diabetes Center of Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo (S.D.)
| | - Claudia Boucher-Berry
- From the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh, School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.A.); the Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children (T.H.), and Eli Lilly (J.I.C., D.C.) - both in Indianapolis; Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (P.Z.); Children's Hospital Los Angeles, Los Angeles (L.C.C.); the Department of Pediatric Endocrinology, University of Illinois Medical Center at Chicago, Chicago (C.B.-B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatric Endocrinology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris (E.B.); and the Diabetes Center of Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo (S.D.)
| | - Margarita Barrientos-Pérez
- From the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh, School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.A.); the Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children (T.H.), and Eli Lilly (J.I.C., D.C.) - both in Indianapolis; Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (P.Z.); Children's Hospital Los Angeles, Los Angeles (L.C.C.); the Department of Pediatric Endocrinology, University of Illinois Medical Center at Chicago, Chicago (C.B.-B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatric Endocrinology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris (E.B.); and the Diabetes Center of Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo (S.D.)
| | - Elise Bismuth
- From the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh, School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.A.); the Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children (T.H.), and Eli Lilly (J.I.C., D.C.) - both in Indianapolis; Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (P.Z.); Children's Hospital Los Angeles, Los Angeles (L.C.C.); the Department of Pediatric Endocrinology, University of Illinois Medical Center at Chicago, Chicago (C.B.-B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatric Endocrinology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris (E.B.); and the Diabetes Center of Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo (S.D.)
| | - Sergio Dib
- From the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh, School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.A.); the Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children (T.H.), and Eli Lilly (J.I.C., D.C.) - both in Indianapolis; Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (P.Z.); Children's Hospital Los Angeles, Los Angeles (L.C.C.); the Department of Pediatric Endocrinology, University of Illinois Medical Center at Chicago, Chicago (C.B.-B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatric Endocrinology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris (E.B.); and the Diabetes Center of Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo (S.D.)
| | - Jang Ik Cho
- From the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh, School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.A.); the Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children (T.H.), and Eli Lilly (J.I.C., D.C.) - both in Indianapolis; Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (P.Z.); Children's Hospital Los Angeles, Los Angeles (L.C.C.); the Department of Pediatric Endocrinology, University of Illinois Medical Center at Chicago, Chicago (C.B.-B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatric Endocrinology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris (E.B.); and the Diabetes Center of Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo (S.D.)
| | - David Cox
- From the Center for Pediatric Research in Obesity and Metabolism, Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh, School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.A.); the Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children (T.H.), and Eli Lilly (J.I.C., D.C.) - both in Indianapolis; Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (P.Z.); Children's Hospital Los Angeles, Los Angeles (L.C.C.); the Department of Pediatric Endocrinology, University of Illinois Medical Center at Chicago, Chicago (C.B.-B.); the Division of Pediatric Endocrinology, Hospital Ángeles Puebla, Puebla City, Mexico (M.B.-P.); the Department of Pediatric Endocrinology, Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Paris (E.B.); and the Diabetes Center of Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo (S.D.)
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Dutta D, Kumar M, Shivaprasad KS, Kumar A, Sharma M. Impact of semaglutide on biochemical and radiologic measures of metabolic-dysfunction associated fatty liver disease across the spectrum of glycaemia: A meta-analysis. Diabetes Metab Syndr 2022; 16:102539. [PMID: 35709586 DOI: 10.1016/j.dsx.2022.102539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS No meta-analysis has analysed efficacy and safety of semaglutide in metabolic-dysfunction associated fatty-liver disease (MAFLD). METHODS Electronic databases were searched for RCTs involving people with MAFLD and/or type-2 diabetes (T2DM) receiving semaglutide. Primary outcome was to evaluate changes in alanine aminotransferase (ALT). Secondary outcomes were to evaluate alterations in other measures of NAFLD, glycaemia, lipids and adverse-events. RESULTS Data from 4 RCTs (2115 patients) was analysed. A greater lowering with injectable semaglutide 0.4mg/0.5 mg once weekly was seen with regards to ALT [MD -3.89U/L (95%CI: -5.41 to -2.36); P < 0.01; I2 = 0%; 2050 patients], liver stiffness (fibroscan®) [MD -3.19 kPa (95%CI: -3.26 to -3.12); P < 0.01; 162 patients], steatosis [MD -13.40 dB/m (95%CI: 20.56 to -6.24); P < 0.01; 162 patients], triglycerides [MD -21.43 mg/dl (95% CI: 41.63 to -1.23); P = 0.04; I2 = 99%; 2050 patients], total cholesterol [MD -5.53 mg/dl (95% CI: -8.45 to -2.61); P < 0.01; I2 = 0%; 1888 patients], LDL-cholesterol [MD -3.55 mg/dl (95% CI: -5.87 to -1.23); P < 0.01; I2 = 0%; 1888 patients], percent-weight [MD -8.99% (95%CI: -14.64 to -3.34); P = 0.002; I2 = 100%; 2115 patient] and HbA1c [MD -0.77% (95%CI: 1.10 to -0.45); P = 0.002; I2 = 100%; 2115 patients]. Number of patients inadequate to comment on histopathologic measures of MAFLD. Occurrence of treatment-emergent adverse-events [RR 2.31 (95% CI: 0.76-7.06); P = 0.14; I2 = 82%] and severe adverse events [RR 1.07 (95%CI: 0.69-1.65); P = 0.77; I2 = 33%] were comparable. Adverse-events leading to trial discontinuation [RR 2.37 (95% CI: 1.33-4.22); P = 0.003; I2 = 24%], diarrhea [RR 2.05 (95%CI: 1.17-3.60); P = 0.01; I2 = 66%], nausea [RR 4.98 (95%CI: 3.23-7.67); P < 0.001; I2 = 0%] and vomiting [RR 3.90 (95%CI: 1.75-8.68); P < 0.01; I2 = 54%] were higher with semaglutide. CONCLUSION This meta-analysis provides reassuring data on efficacy of low dose semaglutide injections in improving ALT and certain radiologic features in MAFLD. Current conclusions are limited by small number of patients evaluated. Urgent need remains for larger studies focussing on liver biopsy.
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Affiliation(s)
- Deep Dutta
- Department of Endocrinology, Center for Endocrinology Diabetes Arthritis & Rheumatism (CEDAR) Superspeciality Healthcare, Dwarka, New Delhi, India.
| | - Manoj Kumar
- Department of Endocrinology, CEDAR Superspeciality Healthcare, Zirakpur, Punjab, India.
| | - K S Shivaprasad
- Department of Endocrinology, CEDAR Superspeciality Healthcare, Bengaluru, Karnataka, India.
| | - Ashok Kumar
- Department of Endocrinology, CEDAR Superspeciality Healthcare, Panipat, Haryana, India.
| | - Meha Sharma
- Department of Rheumatology, CEDAR Superspeciality Healthcare, Dwarka, New Delhi, India.
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