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Pharmakotherapie der Adipositas

Pharmacotherapy of obesity

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Die Diabetologie Aims and scope

Zusammenfassung

Die letzten Jahre markieren eine Revolution im Bereich der pharmakologischen Ansätze zur Adipositastherapie als direkte Antwort auf die weltweit zunehmende Prävalenz von Übergewicht und Adipositas. Die zugelassenen Substanzen der letzten Jahre konzentrieren sich v. a. auf inkretinvermittelte Wirkungen, die sowohl eine Regulierung von Appetit und Sättigung bewirken als auch gastrointestinale Effekte, wie eine Reduktion der Magenentleerung, aufweisen. Die Einführung neuer selektiver und dualer Koagonisten wie Semaglutid und Tirzepatid eröffnet besonders durch deren pleiotrope, kardiometabolische Effekte neue Perspektiven. Diese Substanzen finden nicht nur Anwendung in der Gewichtsreduktion, sondern spielen auch in der Therapie von Erkrankungen wie Diabetes mellitus Typ 2, MAFLD (mit metabolischer Dysfunktion assoziierte Fettlebererkrankung [„metabolic dysfunction-associated fatty liver disease“])/MASH (mit metabolischer Dysfunktion assoziierte Steatohepatitis [„metabolic dysfunction-associated steatohepatitis“]) und der Reduktion kardiovaskulärer Risikofaktoren bei Patient:innen mit Adipositas eine entscheidende Rolle. Mit der Markteinführung von Setmelanotid steht erstmals eine Substanz zur Verfügung, die zur Behandlung von seltenen, monogenetischen Adipositasformen eingesetzt werden kann. Ein neues Kapitel in der modernen Adipositastherapie ist eingeleitet, und die kommenden Jahre dürften aufgrund der stetig wachsenden wissenschaftlichen Evidenz, insbesondere im Hinblick auf die pleiotropen Effekte der neuen Substanzklassen, deren Bedeutung weiter stärken.

Abstract

Recent years have seen a revolution in pharmacological approaches to obesity therapy in direct response to the increasing prevalence of overweight and obesity worldwide. Approved agents of recent years have focused primarily on incretin-mediated effects that regulate appetite and satiety as well as having gastrointestinal effects such as reduction of gastric emptying. The introduction of new selective and dual co-agonists such as semaglutide and tirzepatide has opened up new perspectives, particularly because of their pleiotropic cardiometabolic effects. These agents are not only used for weight loss but also play a key role in the treatment of diseases such as type 2 diabetes mellitus, metabolic dysfunction-associated fatty liver disease/metabolic dysfunction-associated steatohepatitis (MAFLD/MASH), and in the reduction of cardiovascular risk factors in patients suffering from obesity. The introduction of setmelanotide marks a significant milestone, offering a treatment option for rare, monogenic forms of obesity. A new chapter in modern obesity therapy has begun, and it is likely to become even more important in the coming years as scientific evidence continues to accumulate, particularly with regard to the pleiotropic effects of new pharmacotherapeutic agents in the treatment of obesity.

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  1. III. Medizinische Klinik, Abteilung Endokrinologie und Diabetologie, Universitäres Adipositas-Zentrum des UKE, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    Pia Roser

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Correspondence to Pia Roser.

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P. Roser gibt an, Honorare für Vortrags- und Beratertätigkeit von Bayer, Boehringer Ingelheim und Rhythm Pharmaceuticals erhalten zu haben.

Für diesen Beitrag wurden von der Autorin keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

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Roser, P. Pharmakotherapie der Adipositas. Diabetologie (2024). https://doi.org/10.1007/s11428-024-01167-z

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