Hormonal
For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.
If you have severe, early-onset obesity with hyperphagia, ask your doctor about genetic testing for monogenic causes. If you have a mutation in the leptin-melanocortin pathway (leptin, POMC, PCSK1, or LEPR genes), targeted treatments like setmelanotide or metreleptin can be highly effective, resulting in significant weight loss for many patients.
Recombinant human leptin is transformative for individuals with leptin deficiency... Setmelanotide... results in substantial reduction in hunger and weight loss of ≥10% after 1 year of treatment in 80% of individuals with POMC deficiency and 45% of those with LEPR deficiency.
Why this rating
Based on clinical trials showing substantial and consistent weight loss in specific genetic subgroups.
Source
Individualised prescription of medications for treatment of obesity in adults
Samantha Hocking et al. · Reviews in Endocrine and Metabolic Disorders · 2023
DOI 10.1007/s11154-023-09808-2
More from this paper
- Early weight loss (≥5%) within 12-16 weeks is the only consistent predictor of long-term efficacy for obesity pharmacotherapy in polygenic obesity, justifying the discontinuation of ineffective medications.Strong
- For polygenic obesity, precision medicine approaches targeting specific genetic variants or phenotypes have not yet translated into reliable clinical guidance for selecting obesity medications, making early weight loss response the only consistent predictor of long-term efficacy.Good
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