台灣成人過重的盛行率，自2013年以來男女合計已超過40%；而國人十大死因中，與肥胖相關的疾病高達八項，肥胖成為國人不得不重視的健康議題。
當肥胖及三高患者至門診求助，應建議個案先改善生活習慣，也就是改變飲食及運動習慣，藉此減少熱量攝取、增加熱量消耗。然而減重後容易復胖，有研究證實這跟荷爾蒙和酵消化酵素的代償有關，使得減重相當不易。
臨床上若是病患BMI≧30kg/m2或是BMI≧27 kg/m2且至少有一種合併症(高血壓、第二型糖尿病或血脂異常)，可使用減重藥物作為低卡飲食及適當運動的輔助治療。
目前三種TFDA認證的減重藥物

• Orlistat (羅氏鮮, Xenical®)
  1999年FDA准許上市，2000年台灣食藥署核可上市。為胰脂酶抑制劑（pancreaticlipase inhibitor），脂肪需要經由胰脂酶分解成脂肪顆粒後才能被人體吸收，抑制胰脂酶能使食物中的脂肪無法分解，進而減少脂肪的吸收並經腸胃道排出體外。常見的副作用有排便次數增加、忍不住的便意、油便、脹氣。由於Orlistat會降低脂肪吸收，連帶影響脂溶性維生素（維生素A、D、E、K、β胡蘿蔔素）的吸收，因此長期使用建議補充維他命。

• Bupropion/Naltrexone(Contrave®) 
  是2014年FDA核准上市的複方製。Bupropion為抗憂鬱劑，可增加多巴胺及正腎上腺素的活性，達到抑制食慾、增加能量消耗的效果；Naltrexone為鴉片拮抗劑，可抑制食慾。副作用較大（心跳、血壓上升），因此不列為首選藥物。使用禁忌為高血壓未控制、癲癇、長期使用鴉片類藥物、14天內曾使用單胺氧化酶抑制劑（MAOI）者。
• Liraglutide(Saxenda®) 
  2014年FDA核准上市的藥物，成分是GLP-1類似物(Glucagon-likepeptide-1 agonist)，能活化胰臟β細胞，刺激胰島素釋放，促使飯後血糖降低，讓血糖能恢復到正常的範圍，GLP-1也能抑制胰臟α細胞分泌昇糖素，降低肝臟糖質新生作用，延遲胃排空速度，降低食慾，故有控制體重的效果。這類藥物作用的程度，會隨著當下的血糖變化，因此較不會引起低血糖的副作用。在2010年Liraglutdie在美國被用於治療二型糖尿病，直至2014年底，FDA才批准作為慢性體重管理藥物。

• 藥物減重的效果比較
  發表於JAMA的統合分析文章，比較三種藥物減重效果和副作用。可發現這三種藥物在使用52周時都有至少5%以上的減重效果。

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​若有任何問題或需要領取相關藥物之疑問者，都歡迎加官方LINE帳號(點此即可加入)詢問。

參考資料：
​Obesity Management: Clinical Review and Update of the Pharmacologic Treatment Options

Current treatments for obesity

​雄性禿與圓禿有甚麼差別呢？

能治療圓禿，那能治療雄性禿嗎？

Two Phase 3 Trials of Baricitinib for Alopecia Areata
List of authors.
Brett King, M.D., Ph.D., Manabu Ohyama, M.D., Ph.D., Ohsang Kwon, M.D., Ph.D., Abraham Zlotogorski, M.D., Justin Ko, M.D., Natasha A. Mesinkovska, M.D., Ph.D., Maria Hordinsky, M.D., Yves Dutronc, M.D., Wen-Shuo Wu, M.D., Jill McCollam, Pharm.D., Chiara Chiasserini, Sc.D., Guanglei Yu, Ph.D., et al., for the BRAVE-AA Investigators*

Abstract
BACKGROUND
Alopecia areata is an autoimmune condition characterized by rapid hair loss in the scalp, eyebrows, and eyelashes, for which treatments are limited. Baricitinib, an oral, selective, reversible inhibitor of Janus kinases 1 and 2, may interrupt cytokine signaling implicated in the pathogenesis of alopecia areata.

METHODS

We conducted two randomized, placebo-controlled, phase 3 trials (BRAVE-AA1 and BRAVE-AA2) involving adults with severe alopecia areata with a Severity of Alopecia Tool (SALT) score of 50 or higher (range, 0 [no scalp hair loss] to 100 [complete scalp hair loss]). Patients were randomly assigned in a 3:2:2 ratio to receive once-daily baricitinib at a dose of 4 mg, baricitinib at a dose of 2 mg, or placebo. The primary outcome was a SALT score of 20 or less at week 36.

RESULTS
We enrolled 654 patients in the BRAVE-AA1 trial and 546 in the BRAVE-AA2 trial. The estimated percentage of patients with a SALT score of 20 or less at week 36 was 38.8% with 4-mg baricitinib, 22.8% with 2-mg baricitinib, and 6.2% with placebo in BRAVE-AA1 and 35.9%, 19.4%, and 3.3%, respectively, in BRAVE-AA2. In BRAVE-AA1, the difference between 4-mg baricitinib and placebo was 32.6 percentage points (95% confidence interval [CI], 25.6 to 39.5), and the difference between 2-mg baricitinib and placebo was 16.6 percentage points (95% CI, 9.5 to 23.8) (P<0.001 for each dose vs. placebo). In BRAVE-AA2, the corresponding values were 32.6 percentage points (95% CI, 25.6 to 39.6) and 16.1 percentage points (95% CI, 9.1 to 23.2) (P<0.001 for each dose vs. placebo). Secondary outcomes for baricitinib at a dose of 4 mg but not at a dose of 2 mg generally favored baricitinib over placebo. Acne, elevated levels of creatine kinase, and increased levels of low- and high-density lipoprotein cholesterol were more common with baricitinib than with placebo.

CONCLUSIONS
In two phase 3 trials involving patients with severe alopecia areata, oral baricitinib was superior to placebo with respect to hair regrowth at 36 weeks. Longer trials are required to assess the efficacy and safety of baricitinib for alopecia areata. (Funded by Eli Lilly under license from Incyte; BRAVE-AA1 and BRAVE-AA2 ClinicalTrials.gov numbers, NCT03570749. opens in new tab and NCT03899259. opens in new tab.)

參考資料：
Two Phase 3 Trials of Baricitinib for Alopecia Areata
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