The Korean Ministry of Food and Drug Safety has approved three anti-obesity drugs for long-term management in the past decade. In addition, since 2019, bariatric surgery has been financially supported by National Health Insurance Service in Korea. In this review, the mechanisms of action and the clinical implications of the recently approved anti-obesity drugs, lorcaserin, naltrexone/bupropion, and liraglutide are explained. Lorcaserin stimulates proopiomelanocortin (POMC)/cocaine- and amphetamine-regulated transcript (CART) neurons and inhibits neuropeptide Y (NPY)/agouti-related peptide (AgRP) neurons, which results in the activation of melanocortin 3/4 receptors. Naltrexone/bupropion stimulates POMC neurons through bupropion; this stimulation is augmented by blocking the autoinhibitory mechanism of POMC with naltrexone. The hypophagic effect of liraglutide is mediated through the direct activation of POMC/CART neurons and the indirect suppression of NPY/AgRP neurons through γ-aminobutyric acid-dependent signaling, with adjunctive suppression of the mesolimbic dopamine reward system. In addition to liraglutide, another glucagon-like peptide-1 receptor agonist, semaglutide, is expected to be added to the list of anti-obesity drugs in the near future. In patients with obesity and high cardiovascular risk, lorcaserin was considered neutral and liraglutide was considered favorable, whereas inconclusive results were obtained for naltrexone/bupropion.
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Background : Bupropion SR (sustained-release) is the first non-nicotine-based therapy that is effective for achieving abstinence from smoking. We conducted this clinical trial of bupropion SR for smoking cessation with a seven week follow-up.
Methods : The study subjects involved fifty smokers who had visited the Family Medicine Department at Asan Medical Center from May 2003 to January 2004. Treatment consisted of seven weeks of bupropion 150 mg twice daily. The target day for quitting smoking was day 7.
Results : Among 50 subjects who had received bupropion SR, 28 subjects completed the clinical trial and were analyzed. Nineteen subjects were lost to follow up after their first visit. Three subjects discontinued the medication on their own and were lost to follow up after their second visit. According to a telephone interview, 17 subjects out of 22 subjects who were lost failed to feel the need of a revisit for smoking cessation. The rate of abstinence was 26.77% at week 7. The major causes of relapse in smoking were stressful events and anxiety. Only one subject discontinued the treatment attributed to adverse event (nausea). The most common adverse events were insomnia, anxiety, arthralgia, and nausea. We studied to see if the amount of smoking, other smokers in the household, previous attempts to quit, Beck Depression Inventory, and Fagerstrom Tolerance Questionnaire were associated with smoking cessation. However, they failed to show any significant correlation.
Conclusion : This trial showed that the abstinence rate at the end of 7th week was 25.7% without any serious adverse events.
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