Tiivistelmä

Lihavuuden lääkehoitoa harkitaan elintapahoidon tueksi, kun painoindeksi on ≥ 30 kg/m². Jos potilaalla on lihavuuden liitännäissairauksia, voidaan lääkitystä harkita, kun indeksi on yli 27 kg/m². Lääkevaihtoehtoja ovat orlistaatti, liraglutidi sekä naltreksonin ja bupropionin yhdistelmävalmiste. Myös semaglutidin vaikutuksesta on vahvaa näyttöä. Lääkityksen teho on yksilöllistä. Tehoton lääkitys (paino vähenee < 5 %) tulee lopettaa. Merkittävä painonnousu on tyypillinen ongelma lääkehoidon lopettamisen jälkeen. Lääkehoito pitäisi suunnitella riittävän pitkäaikaiseksi.

Summary

Pharmacological therapy for obesity and overweight as an adjunct to lifestyle intervention can be considered when the body mass index is ≥ 30 kg/m², or ≥ 27 kg/m² with obesity-related comorbidities. The history of anti-obesity medications is long and often problematic as several medications have been withdrawn due to cardiovascular hazards and mood disorders. There are currently three options for pharmacotherapy in Finland: orlistat, naltrexone–bupropion, and liraglutide. In addition, the diabetes medication semaglutide is currently under evaluation by the European Medicines Agency as a treatment for obesity. The most efficient drugs for weight loss are the GLP-1 agonists liraglutide and especially semaglutide. Orlistat has the most extensive accumulated long term clinical experience of safety, but its efficacy is only modest. Naltrexone–bupropion has moderate efficacy, but several contraindications and drug-drug interactions complicate its use. Cardiovascular safety is established for liraglutide and semaglutide but only in the treatment of diabetes at lower doses than indicated in obesity therapy. The challenges in pharmacotherapy for obesity include the high treatment discontinuation rates, interindividual differences in response to medications, the tendency to regain weight after the drug treatment, and high costs for the patient due to lack of reimbursement. However, liraglutide was recently granted reimbursement for patients with body mass index ≥ 35 kg/m² and prediabetes, with the additional prerequisite of drug treatment for hypertension or dyslipidaemia. Utilization of the current more efficient anti-obesity medications and better access to therapy should lead to improved long-term outcomes, especially when pharmacotherapy is combined with effective lifestyle interventions.