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Pharmacological management of obesity in pediatric patients.
Ann Pharmacother. 2015 Feb; 49(2):220-32.AP

Abstract

OBJECTIVE

To review current evidence of pharmacological options for managing pediatric obesity and provide potential areas for future research.

DATA SOURCES

A MEDLINE search (1966 to October 2014) was conducted using the following keywords: exenatide, liraglutide, lorcaserin, metformin, obesity, orlistat, pediatric, phentermine, pramlintide, topiramate, weight loss, and zonisamide.

STUDY SELECTION AND DATA EXTRACTION

Identified articles were evaluated for inclusion, with priority given to randomized controlled trials with orlistat, metformin, glucagon-like peptide-1 agonists, topiramate, and zonisamide in human subjects and articles written in English. References were also reviewed for additional trials.

DATA SYNTHESIS

Whereas lifestyle modification is considered first-line therapy for obese pediatric patients, severe obesity may benefit from pharmacotherapy. Orlistat is the only Food and Drug Administration (FDA)-approved medication for pediatric obesity and reduced body mass index (BMI) by 0.5 to 4 kg/m(2), but gastrointestinal (GI) adverse effects may limit use. Metformin has demonstrated BMI reductions of 0.17 to 1.8 kg/m(2), with mild GI adverse effects usually managed with dose titration. Exenatide reduced BMI by 1.1 to 1.7 kg/m(2) and was well-tolerated with mostly transient or mild GI adverse effects. Topiramate and zonisamide reduced weight when used in the treatment of epilepsy. Future studies should examine efficacy and safety of pharmacological agents in addition to lifestyle modifications for pediatric obesity.

CONCLUSIONS

Lifestyle interventions remain the treatment of choice in pediatric obesity, but concomitant pharmacotherapy may be beneficial in some patients. Orlistat should be considered as second-line therapy for pediatric obesity. Evidence suggests that other diabetes and antiepileptic medications may also provide weight-loss benefits, but safety should be further evaluated.

Authors+Show Affiliations

Wingate University School of Pharmacy, Wingate, NC, USA c.boland@wingate.edu.Wingate University School of Pharmacy, Wingate, NC, USA.Wingate University School of Pharmacy, Wingate, NC, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25366340

Citation

Boland, Cassie L., et al. "Pharmacological Management of Obesity in Pediatric Patients." The Annals of Pharmacotherapy, vol. 49, no. 2, 2015, pp. 220-32.
Boland CL, Harris JB, Harris KB. Pharmacological management of obesity in pediatric patients. Ann Pharmacother. 2015;49(2):220-32.
Boland, C. L., Harris, J. B., & Harris, K. B. (2015). Pharmacological management of obesity in pediatric patients. The Annals of Pharmacotherapy, 49(2), 220-32. https://doi.org/10.1177/1060028014557859
Boland CL, Harris JB, Harris KB. Pharmacological Management of Obesity in Pediatric Patients. Ann Pharmacother. 2015;49(2):220-32. PubMed PMID: 25366340.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pharmacological management of obesity in pediatric patients. AU - Boland,Cassie L, AU - Harris,John Brock, AU - Harris,Kira B, Y1 - 2014/11/03/ PY - 2014/11/5/entrez PY - 2014/11/5/pubmed PY - 2015/7/2/medline KW - exenatide KW - liraglutide KW - lorcaserin KW - metformin KW - obesity KW - orlistat KW - pediatric KW - phentermine KW - pramlintide KW - topiramate KW - weight loss KW - zonisamide SP - 220 EP - 32 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 49 IS - 2 N2 - OBJECTIVE: To review current evidence of pharmacological options for managing pediatric obesity and provide potential areas for future research. DATA SOURCES: A MEDLINE search (1966 to October 2014) was conducted using the following keywords: exenatide, liraglutide, lorcaserin, metformin, obesity, orlistat, pediatric, phentermine, pramlintide, topiramate, weight loss, and zonisamide. STUDY SELECTION AND DATA EXTRACTION: Identified articles were evaluated for inclusion, with priority given to randomized controlled trials with orlistat, metformin, glucagon-like peptide-1 agonists, topiramate, and zonisamide in human subjects and articles written in English. References were also reviewed for additional trials. DATA SYNTHESIS: Whereas lifestyle modification is considered first-line therapy for obese pediatric patients, severe obesity may benefit from pharmacotherapy. Orlistat is the only Food and Drug Administration (FDA)-approved medication for pediatric obesity and reduced body mass index (BMI) by 0.5 to 4 kg/m(2), but gastrointestinal (GI) adverse effects may limit use. Metformin has demonstrated BMI reductions of 0.17 to 1.8 kg/m(2), with mild GI adverse effects usually managed with dose titration. Exenatide reduced BMI by 1.1 to 1.7 kg/m(2) and was well-tolerated with mostly transient or mild GI adverse effects. Topiramate and zonisamide reduced weight when used in the treatment of epilepsy. Future studies should examine efficacy and safety of pharmacological agents in addition to lifestyle modifications for pediatric obesity. CONCLUSIONS: Lifestyle interventions remain the treatment of choice in pediatric obesity, but concomitant pharmacotherapy may be beneficial in some patients. Orlistat should be considered as second-line therapy for pediatric obesity. Evidence suggests that other diabetes and antiepileptic medications may also provide weight-loss benefits, but safety should be further evaluated. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/25366340/Pharmacological_management_of_obesity_in_pediatric_patients_ L2 - http://journals.sagepub.com/doi/full/10.1177/1060028014557859?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -