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DOI: 10.1055/a-1118-2562
Abnehmen mit Arzneimitteln? Pharmakotherapie von Übergewicht und Adipositas
Body Weight Reduction with Anti-Obesity Medication? Drug Therapy of Overweight and ObesitySubject Editor: Wissenschaftlich verantwortlich gemäß Zertifizierungsbestimmungen für diesen Beitrag ist Prof. Dr. med. Christian Sina, Lübeck.
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Wichtigstes Ziel der Adipositastherapie ist die langfristige Senkung des Körpergewichts, um das Risiko assoziierter Folgeerkrankungen und die damit verbundene vorzeitige Sterblichkeit zu senken. Grundlage der Therapie sind Ernährungs-, Bewegungs- und Verhaltenstherapie. Da die dauerhafte Adhärenz zu Lebensstilmodifikation schwierig ist, erscheint eine Arzneimitteltherapie häufig als besonders geeignete und vermeintlich unbedenkliche Alternative.
Abstract
Drugs should never be the first choice in the treatment of obesity and should only be used after a critical risk-benefit assessment. Orlistat, liraglutide, naltrexone/bupropion and two amphetamine derivatives (amfepramone, norpseudoephedrine) are currently approved for weight loss in Germany. The current German obesity guideline only recommends the (adjuvant) use of orlistat, if the indication for drug therapy is given at all. Amphetamines, diuretics and hormones (HCG, testosterone, thyroxine, growth hormones) are explicitly not recommended for weight loss. Evidence of an improvement in cardiovascular risk factors is not sufficient to assess the effectiveness and safety of any anti-obesity medication. Clinically relevant endpoints remain the only meaningful basis for a responsible and evidence-based risk-benefit assessment.
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Arzneimittel sind in der Therapie der Adipositas nie Mittel der 1. Wahl und sollten nur nach kritischer Nutzen-Risiko-Abwägung ([ Tab. 2 ]) und unter Berücksichtigung spezifischer Grundsätze (s. „Hinweise zur medikamentösen Therapie in der S3-Leitlinie „Prävention und Therapie der Adipositas“) angewendet werden.
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Aktuell sind in Deutschland Orlistat, Liraglutid, Naltrexon/Bupropion und 3 Amphetamin-Derivate (Amfepramon, Norpseudoephedrin [Cathin], Phenylpropanolamin) zur Gewichtsreduktion zugelassen.
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Von der aktuellen deutschen Adipositas-Leitlinie wird ausschließlich die (adjuvante) Anwendung von Orlistat empfohlen („Wenn eine Adipositas medikamentös behandelt wird, soll nur Orlistat eingesetzt werden.“), wobei berücksichtigt werden muss, dass zum Zeitpunkt der Leitlinienpublikation weder Liraglutid noch Naltrexon/Bupropion in Deutschland zugelassen waren.
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Explizit sollen Amphetamine, Diuretika und Hormone (humanes Choriongonadotropin, Testosteron, Thyroxin, Wachstumshormone) nicht zur Gewichtsreduktion empfohlen werden.
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Auch für die Bewertung neuer Antiadiposita gilt: Der Nachweis einer Verbesserung kardiovaskulärer Risikofaktoren reicht für die Wirksamkeits- und Sicherheitsbeurteilung von Arzneistoffen nicht aus. Die einzig aussagekräftige Basis einer verantwortungsvollen und evidenzbasierten Nutzen-Risiko-Abwägung bleiben klinisch relevante Endpunkte.
Publication History
Article published online:
15 February 2021
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