Differences in weight loss and safety between the glucagon-like peptide-1 receptor agonists: A non-randomized multicenter study from the titration phase.

INTRODUCTION: Obesity increases the risk of type 2 diabetes mellitus and cardiovascular disease (CVD). Weight loss (≥5 %) reduces the risk of CVD. Glucagon-like peptide-1 receptor agonists (GLP1 RA) have shown clinically weight loss. OBJECTIVES: 1) To assess differences in the efficacy of weight loss and HbA1c; 2) to evaluate the safety and adherence during the titration phase. METHODS: It is a multicenter, prospective, and observational study on GLP1 RA naïve patients. The primary end point was the weight loss (≥5 %). Changes in weight, BMI and HbA1c were also calculated as co-primary endpoints. Secondary endpoints were safety, adherence, and tolerance. RESULTS: Among 94 subjects, 42.4 % received dulaglutide, 29,3 % subcutaneous semaglutide, 22,8 % oral semaglutide. 45 % female and the mean age was 62. Baseline characteristics were body weight 99.3 kg, BMI 36.7 kg/m2 and Hba1c 8.2 %. Oral semaglutide achieved the highest reduction: 61.1 % of patients achieving ≥ 5 %, subcutaneous semaglutide 45.8 % and dulaglutide 40.6 %. GLP1 RA significantly reduced body weight (-4.95 kg, p < 0.001) and BMI (-1.86 kg/m2, p < 0.001), without significant differences between groups. Gastrointestinal disorders were the most frequently reported events (74.5 %). 62 % of patients on dulaglutide, 25 % on oral semaglutide and 22 % on subcutaneous semaglutide. CONCLUSIONS: Oral semaglutide achieved the highest proportion of patients that lost ≥ 5 %. GLP1 RA significantly reduced BMI and HbA1c. Most of the reported adverse events were gastrointestinal disorders and they were reported in a major frequency in the dulaglutide group. Oral semaglutide would be a reasonable switch in case of future shortages.

Listado de medicamentos a evitar en atención primaria y su aplicación en pacientes polimedicados / List of medicines to avoid in Primary Care Health and their application in polymedicated patients

Introduction: The high prevalence of inappropriate medication use andits important health consequences for health require specific and agiletools to detect and avoid it.The objective of this work was to elaborate a list of medications toavoid in Primary Care and to apply it on the polymedicated patients ofa Primary Care assistance service.Methods: In the Database of the Spanish General Council of OfficialAssociations of Pharmacists (BOT-Plus) the status and availability ofeach of the 93 MAE of the Prescrire 2019 List was checked. The list ofmedications to be avoided in Primary Care was drawn up with thosethat were marketed in Spain and excluded those that were not financedand those for exclusive hospital use.With the list of medicines to avoid in Primary Care, a retrospectiveanalysis was made of all the prescription reports of polimedicated >10medications for 2017 in a Primary Care services (N=262) in 5 healthcenters. Frequency analysis, central tendency measures and dispersionwere carried out; they were estimated [CI: 95%] and X or Fisher’s exactwas used to determine the association between variables and logisticregression analysis.Results: A prevalence of polymedicated drugs of 1.2% was observed,with a mean age of 71.7 years (DT± 12.4) and a mean prescription of12 drugs (DT±1.7).The list of medications to be avoided in PC included 45 active ingredients. The 50.4% of the polymedicated had at least one drug to avoidand an average age of 68.5 years (DT±11.8). Sex was a risk factor forinappropriate prescription, the fact of being a woman increases withan OR=1.8 (IC95%=1, 3-3.0) the probability of having some medicinesto avoid. The most commonly used drugs to avoid were: duloxetine,sitagliptin and olmesartan. ...

Introduction: La alta prevalencia del uso de medicación inadecuada ysus importantes consecuencias para la salud requieren herramientasespecíficas y ágiles que ayuden a detectarla y evitarla.Objetivo de este trabajo fue elaborar un listado de medicamentos aevitar en AP y aplicarlo en pacientes polimedicados de un servicio asistencial de Atención Primaria (AP).Métodos: En la Base de datos del Consejo General de Colegios Oficialesde Farmacéuticos español (BOT-Plus) se comprobó el estado y disponibilidad de cada uno de los 93 medicamentos del Listado Prescrire2019. Se elaboró el Listado de medicamentos a evitar en AP con aquellos que estaban comercializados en España y se excluyeron los que noestaban financiados y los de uso exclusivo hospitalario.Con el listado de medicamentos a evitar en AP se hizo un análisis retrospectivo de todos (N=262) los informes de prescripción de polimedicados >10 medicamentos del año 2017 en un servicio asistencial deAP (5 centros de salud). Se realizó análisis de frecuencias, medidasde tendencia central y dispersión; se estimaron (IC 95%) y se utilizóX o exacta de Fisher para determinar la asociación entre variables yanálisis de regresión logística.Resultados: Se observó una prevalencia de polimedicados de 1,2%, conuna media de edad de 71,7 ± 12,4 años y una media de prescripcionesde 12 ±1,7 medicamentos.El listado de medicamentos a evitar en AP incluyó 45 principios activos.Los fármacos a evitar más usados han sido: duloxetina, sitagliptina yolmesartán. El 50,4% de los polimedicados tenían al menos un medicamento a evitar y una edad media de 68,5±11,8 años. El sexo fue unfactor de riesgo de prescripción inadecuada, el hecho de ser mujerincrementa con un OR=1,8 (IC 95%=1,3-3,0) la probabilidad de medicamentos a evitar. ...