Expert Opinion on Drug Safety, Год журнала: 2025, Номер unknown
Опубликована: Апрель 26, 2025
Язык: Английский
Obesity Surgery, Год журнала: 2025, Номер unknown
Опубликована: Янв. 29, 2025
Язык: Английский
Процитировано
1
The Medical Journal of Australia, Год журнала: 2025, Номер unknown
Опубликована: Янв. 9, 2025
Originally introduced for type 2 diabetes mellitus, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have gained significant market traction the treatment of patients with obesity. There is global heterogeneity across health systems in how these agents are currently used and supplied, which patient cohorts eligible, whom they funded what duration. The deployment GLP-1 RAs obesity has potential to impact one-third Australians. This warrants due consideration planning future funding models, models care ensure equitable access. Australian system an important test bed strike a balance between addressing obesity-related concerns, while maintaining financial sustainability given uncertain economics represents timely case study on we design, develop implement new service delivery meet changing needs population. In 2022, 32% Australians were classified as obese.1 National Obesity Strategy 2022–2032 reported that cost $11.8 billion 2018, $5.4 was directly attributable costs.2 projected reach $87.7 Australia by 2032.3 been touted panaceas epidemic. Prescription significantly increased since 2014, largely driven off-label prescribing non-diabetic patients.4 These prescription volumes imply substantial ramifications users, adjacent industries once restoration scale up occurs. this perspective article, highlight clinical, logistical quandaries surrounding extending Australia. multiple RA formulations market. Only liraglutide (Saxenda) semaglutide (Wegovy) indicated No medications subsidised Pharmaceutical Benefits Scheme (PBS) Multiple PBS listing applications (Novo Nordisk 2022 Eli Lilly 2023) rejected based considerations unknown long term effectiveness.5, 6 Most randomised control trials populations use placebo comparator. A 2024 systematic review examining found reductions weight (mean difference, -8.77 kg, p < 0.01), improvements cardiovascular risk factors such lipid profiles blood pressure.7 no head-to-head comparing loss bariatric surgery, limited evidence optimal duration patients. However, benefit–harm modelling study, included data from eight 8847 participants, benefits exceeded harms first two years target 10%.8 expensive may increase inequity access those self-funding or insurance coverage. disproportionately affects low socio-economic status groups differences rates 13% lowest (38%) highest areas (25%).1 Populations lower more likely suffer complications taxpayers through public compared higher status. (defined postcode) less be prescribed (odds ratio [OR], 0.72 2013; OR, 0.95 2019).9 way funds reimburses will need become nuanced include our armamentarium. If access, require smaller pilots targeted defined time periods, pre-transplant, pre-cancer pre-surgery. Australia, 90% surgery occurs private system.10 Private insurers redesigning strategies emerging overseas real-time (Box).11 uniquely exposed risks elective claims, federal government traditionally bears most medicines. advantages payers fund incorporating RAs, including reduction demand many common surgical procedures (eg, orthopaedic), especially obese populations.12 Pre-operative can improve outcomes reduce costs caveats: several United States halted coverage horizons, conversely expanded surgery.13, 14 horizon associated entice younger insurance, could address longstanding structural issues ageing population rising premiums. insurers, provide avenue engage holistic wraparound management services rather than options. It would preferable offer evidence-based hospital substitution option selected high patients, payment alone, under "extras" (general treatment) cover. part preventive programs where divested other subscriptions redistributed larger cohort at weight-related conditions. Or alternative reflecting current system. Expanding being trialled Kingdom's (UK) Health Service (NHS).15 Under UK guidelines, recommended body mass index least 35 one complication.16 £40 million pilot, general practitioners prescribe (Wegovy). key objective pilot determine whether there downstream waiting lists major surgery. Due supply scheme yet initiated.15 wider concerns about NHS it might affect services. criticised ad hoc clinical processes, lack standardised model care, services.15 consistency availability parallel interventions allied supports make evaluating difficult. divert away strategies, insufficient resources infrastructure work intended.15 proven cost-effective providing medicines reducing conditions diabetes, pathologies), much needed PBS-funded Another large area uncertainty insurer subsidisation. relevant PBS. policy international should covered maximum years. serial STEP (semaglutide) SURMOUNT (tirzepatide) studies durations 1.3 1.7 respectively.17, 18 STEP-5 investigated enduring efficacy out practice, non-persistence beyond six months increasingly shortages, preference. US-based retrospective only 19% 1911 adult who filled initial 2015 still receiving year.19 Therapeutic Goods Administration (TGA) recommends if not lost 5% total after maximal dose 12 weeks.20 Although early response loss, effective medication use.20 any rollout patients; however, US, approved paediatric young twelve years.21 populations.22, 23 More ideal length inform robust cost–benefit analysis. three Australia: digital model, shared initiated specialist practitioner follow-up, and, sole prescriber practitioner, nurse practitioner). Regardless mechanism, important. Large equity attracted scrutiny medications. variable deemed receive mail. Such received criticism asynchronous prescribing, perceived governance, breaches advertising code, compounded agents.24 challenges addressed, telehealth valuable services, particularly Additionally, avenues medical cannot met conventional models. safeguards required restore trust telehealth, TGA's ban 1 October 2024.25 Practitioner Regulation Agency created dedicated unit monitor practices services.26 Commission Safety Quality Care undertaking virtual validation national standards delivery.27 accessing via Given burden placed primary referrals specialty themselves, sustainable solution. Medicare, plans their allowing physiotherapy, dietetics exercise physiology.28 Therefore, ideally extension care. safety extrapolated studies. commonly adverse effects gastrointestinal symptoms nausea, vomiting, diarrhoea constipation.29 Other serious rare but acute pancreatitis gall bladder disorders.29 Concerns raised anaesthetic aspiration delayed gastric emptying.29 Patients ongoing monitoring clinician starting RA. structured, pipeline workforce education treatments, RAs. concern, subcutaneous injections. criteria chronic disease plan Medicare-funded, credentialled diabetic educators. Some consumer advocacy Diabetes Australia).30 Specialty role educating fulfil skewed towards complex patients.30 Community pharmacists also integral titration providers organised third parties, pharmaceutical companies.31, 32 removes resource drain administrative providers, drawbacks. Firstly, companies specific product, presentation biased overly optimistic views outcomes.31-33 Secondly, legislation, consumers. protects consumers limits ability evaluate effectiveness training materials improving literacy. stakeholder unknown. Alternative reallocating community support self- supervised administration appropriate scaling introduction almost Consequently, innovative drug class come implementation right time, levels governance ancillary watershed moment unravel manage compounding barriers worthy study. Jennifer Wong honorarium Society delivering educational event. Kyle Williams owns shares Novo (manufacturers Ozempic Wegovy) Mounjaro). remaining authors conflicts interest declare. Not commissioned; externally peer reviewed.
Язык: Английский
Процитировано
0
Surgery, Год журнала: 2025, Номер 181, С. 109147 - 109147
Опубликована: Янв. 30, 2025
Laparoscopic adrenalectomy is the preferred surgical approach for adrenal resection. The simultaneous presence of obesity and subsequent liver steatosis may complicate procedure, increasing risk intra- perioperative complications. This study explores effectiveness a preoperative very low-calorie ketogenic diet in improving outcomes patients with undergoing laparoscopic adrenalectomy. A retrospective analysis was conducted on 70 from January 2021 to July 2024 at Bariatric Endocrine-Metabolic Surgery Unit, University Naples "Federico II." Among these, 54 body mass index ≥30 kg/m2 were divided into 2 groups: group A, which underwent 4-week diet, B, did not receive any dietary intervention. Propensity score matching used balance groups confounding factors. Furthermore, subanalysis between performed according right left Group had significantly reduced operative time (94.59 ± 54.11 minutes) compared B (129.22 51.06 minutes, P = .01). Additionally, exhibited fewer complications (P also associated significant reduction 31.74 1.31 29.05 0.99 .001) before surgery. Our suggests can improve scheduled glands supports integration interventions management Future research larger sample sizes randomized controlled trials recommended validate these findings optimize care protocols.
Язык: Английский
Процитировано
0
Obesity Surgery, Год журнала: 2025, Номер unknown
Опубликована: Янв. 29, 2025
Язык: Английский
Процитировано
0
International Journal of Molecular Sciences, Год журнала: 2025, Номер 26(6), С. 2420 - 2420
Опубликована: Март 7, 2025
Obesity remains a major epidemic in developed countries, with limited range of effective pharmacological treatments. The modulation PPARα, CB1, or GLP-1 receptor activity has demonstrated beneficial effects, including anti-obesity actions. In this study, we evaluated novel amide derivative oleic acid and tyrosol (Oleyl hydroxytyrosol ether, OLHHA), PPARα agonist, CB1 antagonist, combination the agonist liraglutide (LIG), as an multitarget therapy to improve both peripheral central alterations animal model diet-induced obesity. rats, exposure high-fat high-fructose diet (HFHFD) induced weight gain increased plasma triglycerides, LDL, hepatic parameters. brain, HFHFD provoked disruptions expression proteins regulating food intake, endocannabinoid system, insulin pathway, inflammation resulted altered tau phosphorylation, thus indicating neurodegenerative changes. Based on our results, administration LIG OLHHA alone was insufficient completely reverse noticed at levels. On other hand, combined treatment compounds (OLHHA+LIG) most promoting body loss ameliorating by HFHFDs rats. This therapeutic approach could represent promising strategy for treating obesity associated comorbidities.
Язык: Английский
Процитировано
0
Biomolecules, Год журнала: 2025, Номер 15(3), С. 408 - 408
Опубликована: Март 13, 2025
Worldwide, nearly 40% of adults are overweight and 13% obese. Health consequences excess weight include cardiovascular diseases, type 2 diabetes, dyslipidemia, increased mortality. Treating obesity is challenging calorie restriction often leads to rebound gain. Treatments such as bariatric surgery create hesitancy among patients due their invasiveness. GLP-1 medications have revolutionized loss can reduce body in obese by between 15% 25% on average after about 1 year. Their mode action mimic the endogenous GLP-1, an intestinal hormone that regulates glucose metabolism satiety. However, drugs carry known risks and, since use for recent, may unforeseen well. They a boxed warning people with personal or family history medullary thyroid carcinoma multiple endocrine neoplasia syndrome 2. Gastrointestinal adverse events (nausea, vomiting, diarrhea) fairly common while pancreatitis obstruction rarer. There be lean mass well premature facial aging. A significant disadvantage using these high rate regain when they discontinued. Achieving success pharmacologic treatment then weaning avoid future negative effects would ideal.
Язык: Английский
Процитировано
0
Diabetes Obesity and Metabolism, Год журнала: 2025, Номер unknown
Опубликована: Март 14, 2025
Abstract Aims To understand real‐world tirzepatide use among individuals without type 2 diabetes ( T2D ) diagnoses in a US electronic health record EHR database. Materials and Methods This retrospective, descriptive, cohort study used Veradigm's® Network database linked with administrative claims. Adults (≥18 years) included had ≥1 prescription (index period: 13 May 2022–31 August 2023); continuous medical pharmacy enrolment for ≥12 months pre‐index; no diagnosis or baseline medications except metformin (overall cohort). ‘Anti‐obesity medication (AOM)‐eligible cohort’ body mass index (BMI) ≥30 ≥27 kg/m obesity‐related complication (ORC) ≥6 of post‐index enrollment. Results The overall 10,193 (mean age: 45.0 years; female: 77.1%). Among 6623 BMI data, 5931 were AOM‐eligible. Of these, 3470 6‐month follow‐up data (AOM‐eligible cohort; ORC: 76.5%; ≥2 ORCs: 51.8%). Treatment patterns at 6 assessed 755 complete claims the AOM‐eligible cohort. Most (95.6%) initiated on dose ≤5 mg. At fifth refill n = 448), 91.1% receiving doses ≤10 months, adherence was 55.5% persistence 54.2%. discontinued 346), 10.1% switched to an alternate AOM. Conclusions Majority ORC, half ORCs, indicating that this being people multimorbidity. Tirzepatide escalation slower than clinical trials, which may have implications its effectiveness.
Язык: Английский
Процитировано
0
Journal of Anesthesia Analgesia and Critical Care, Год журнала: 2025, Номер 5(1)
Опубликована: Март 28, 2025
Glucagon-like peptide-1 receptor agonists are a class of drugs that mimic natural incretin hormone released by the intestine after meals, and they well-suited for treating type 2 diabetes. also lead to satiety appetite reduction through action on brain's regulation centers, leading weight loss in obese patients. However, because glucagon-like work slow gastric emptying, safety concern has been raised patients undergoing deep sedation or general anesthesia regarding aspiration, considering their long half-life blood, difficult manage perioperative period. The purpose this review is (i) explore present knowledge about risk aspiration before anesthesia; (ii) describe method evaluating presence liquid food stomach surgery; (iii) balance actual warning with opportunity future discovery benefits.
Язык: Английский
Процитировано
0
Diabetology & Metabolic Syndrome, Год журнала: 2025, Номер 17(1)
Опубликована: Апрель 1, 2025
Considering the important role of cardiometabolic risk factors in different societies on increasing burden non-communicable diseases, this study we will investigate possible effects Beinaglutide as an glucagon-like peptide-1 receptor agonists (GLP-1RAs) these factors. In order to identify all randomized controlled trials that investigated factors, a systematic search was conducted original databases using predefined keywords until July 2024. The pooled weighted mean difference and 95% confidence intervals were computed random-effects model. A quantitative meta-analysis results from 7 studies with 872 participants showed has significant lowering effect weight (WMD: -3.74 kg; CI: -5.03, -2.45), body mass index (BMI) (WMD:-1.64 kg/m2; -2.10, -1.17), waist circumference (WC) -3.19 cm; -4.65 -1.73), triglycerid (TG) levels -0.14 mmol/l with; -0.25, -0.04), systolic blood pressure (SBP) -1.76 mm/Hg; -2.61, -0.91). Furthermore, obtain subgroup analysis greater reduction TG during intervention more than 12 weeks. addition, loss doses less 0.4 mg compared or equal mg. show is effective reducing related obesity, wll SBP, especially longer interventions lower doses.
Язык: Английский
Процитировано
0
Journal of Craniofacial Surgery, Год журнала: 2025, Номер unknown
Опубликована: Апрель 1, 2025
Botulinum toxin, as a common facial wrinkle removal product, can be used for rejuvenation or improvement of skin texture, which is commonly cosmetic injectable product. However, botulinum toxin may lead to decreased immune function, causing series subsequent complications. This case report describes 32-year-old female patient who developed herpes zoster after receiving injections semaglutide, and hyaluronic acid. Viral infection function are triggers zoster. After injection the local response affected, activate latent varicella-zoster virus that causes
Язык: Английский
Процитировано
0