Role of GLP-1 Receptor Agonists in Pediatric Obesity: Benefits, Risks, and Approaches to Patient Selection
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INVITED COMMENTARY
Role of GLP-1 Receptor Agonists in Pediatric Obesity: Benefits, Risks, and Approaches to Patient Selection Laura C. Page 1
&
Michael Freemark 1,2
Accepted: 5 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Effective treatments for pediatric obesity are limited. Glucagon-like peptide-1 receptor (GLP-1R) agonists have emerged as therapeutic agents for obesity in adults and have shown benefits outside of weight loss. Here we explore the evidence for GLP-1R agonist use in pediatric obesity. Recent Findings Emerging evidence suggests that GLP-1R agonists have a role in pediatric obesity treatment. A recently published, randomized, placebo-controlled trial found a greater reduction in BMI z-score (− 0.22 SDs) in adolescents receiving liraglutide compared with placebo. As in adults, gastrointestinal adverse effects were commonly seen. Summary GLP-1R agonists appear to perform favorably compared with other approved pharmacological agents for pediatric obesity. However, heterogeneity in weight loss response, cost, side effects, and need for injections may limit their use in many pediatric patients. Rather than broadly applying this therapy if it is approved, we suggest careful patient selection and monitoring by clinicians pending further studies. Keywords GLP-1R agonist . Pediatric obesity . Liraglutide . Orlistat . Phentermine . Metformin
Introduction Childhood obesity remains a major global health challenge, with increased rates of co-morbidities including type 2 diabetes, hyperlipidemia, nonalcoholic hepatic steatosis, and hypertension that contribute to morbidity and mortality in adulthood [1]. Thus, effective interventions to combat pediatric obesity stand at the forefront of pediatric research. Given low risk of negative effects, lifestyle interventions are the most frequently studied therapies in children with overweight or obesity. However, even intensive behavioral interventions cause only modest reductions in BMI z-scores and weight is often regained after the interventions end [2–5]. Food and Drug Administration (FDA)-approved pharmacotherapies for pediatric weight loss are limited This article is part of the Topical Collection on Childhood Obesity * Laura C. Page [email protected] 1
Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, 3000 Erwin Road, Suite 200, Durham, NC 27705, USA
2
Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
to two: orlistat, approved in children ages 12 years and older, and phentermine, approved as short-term weight loss therapy in patients older than 16. Like lifestyle interventions, both drugs cause relatively small reductions in BMI, and side effects limit their use and tolerability [6]. Metformin is commonly used to treat pediatric prediabetes and type 2 diabetes and is sometimes used off-label in the pediatric population to limit weight gain or promote weight loss. While generally safe and well-tolerated, its impact on BMI is
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