Elif ERDOĞAN ERDEN, Zeynep Gül YAZICI, Cansu KILIÇ, Sule AYDIN, Fatma Sultan KILIÇ

Obezite Tedavisinde Farmakolojik Yaklaşımlar

Obezite; dünyada ve ülkemizde giderek artış gösteren bir salgın hastalık haline gelmektedir. Tedavi edilmediği durumlarda morbidite ve mortaliteye sebep olmaktadır. Obezite gelişiminde kişisel ve çevresel faktörler rol almaktadır. Nörolojik ve metabolik yolaklarla kontrol edilen enerji homeostazındaki bozulma obezite ile sonuçlanmaktadır. Obezite gelişimi sonrası tedavi sürecinde ilk basamak hayat tarzı ve diyet değişiklikleridir. Ancak çoğu zaman ikinci basamak tedavilere ihtiyaç duyulur. Bu aşamada obezite patofizyolojisi göz önünde bulundurularak farmakoterapi seçenekleri değerlendirilir. Kişinin genetik altyapısı, enerji homeostazındaki bozulma ve çevresel etkenler obezite oluşumunda rol oynamaktadır. Bu nedenle genetik mutasyonlar sonucu oluşan eksiklikler ve enerji homeostazında etkili yolaklar hedeflenerek farmakolojik yaklaşımlar kullanılır. Bunlar arasında hali hazırda kullanılan orlistat, cetilistat, liraglutid, lorkaserin, burpropion/naltrekson kombinasyonu, fentermin/topiramat kombinasyonu, metformin gibi seçenekler mevcutken, genetik mutasyonlar sonucu oluşan obezitede etkili metreleptin ve setmelanotid gibi obezite endikasyonu için onay almış ve endikasyon dışı kullanılarak obezitede fayda sağlanmış ajanlar mevcuttur. Obezite tedavisi için farmakolojik yaklaşımlar gün geçtikçe artmaktadır. Günümüzde obezite tedavisinde umut vadeden semaglutid, oksitosin, bromokriptin, resveratrol, β3 adrenerjik reseptör agonistleri ,velneperit, davalintide (AC2307), glukoz-bağımlı insülinotropik polipeptid (GIP) analogları, beloranib, tesofensin gibi birçok seçenek de mevcuttur. Bunların yanında obezitenin önlenmesine yönelik aşı çalışmaları da sürdürülmektedir. Obezite risk faktörlerini, gelişim sürecini bütüncül olarak ele aldığımızda obezitenin önlenmesi ve tedavisi için seçenekler artmakta olup obeziteye karşı mücadelede elimizi güçlendirmektedir.

Anahtar Kelimeler:

Obezite, Farmakoterapi, Aşı, İlaç

Pharmacological Approaches in Obesity Treatment

Obesity is becoming an increasing epidemic disease in the world and in our country. Unless it is treated it causes morbidity and mortality. Individual and environmental factors play a role in the development of obesity. The impairment in energy homeostasis, which is controlled by neurological and metabolic pathways, results in obesity. The first step in the treatment process of obesity is lifestyle and diet changes. However, second-line treatments are often needed. At this stage, pharmacotherapy could be an option considering the pathophysiology of obesity. The genetic background of the person, the impairment in energy homeostasis and environmental factors play a role in the formation of obesity. For this reason, pharmacological approaches are used by targeting deficiencies caused by genetic mutations and effective pathways in energy homeostasis. Among these, there are options such as orlistat, cetilistat, liraglutide, lorcaserin, burpropion/naltrexone combination, phentermine/topiramate combination, metformin, which are currently used, while meterleptin and cemelanotide, which are effective in obesity caused by genetic mutations, have been approved for the obesity indication and benefit in obesity by using off-label. agents are available. Pharmacological approaches for the treatment of obesity are increasing day by day. There are also many options being investigated such as semaglutide, oxytocin, bromocriptine, resveratrol, β3 adrenergic receptor agonists, velneperit, davalintide (AC2307), glucose-dependent insulinotropic polypeptide (GIP) analogues, beloranib, and tesofensin. In addition to these, there are also ongoing vaccine studies for prevention of obesity. When we consider the obesity risk factors and the development process holistically, the options for the prevention and treatment of obesity increase and strengthen our hand in the fight against obesity.

Keywords:

Obesity, Pharmacotheraphy, Vaccine, Drug,

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