Systematic Review on Efficacy and Safety of Glucagon-Like Peptide-1 Receptor Agonists in the Treatment of Obesity in Children and Adolescents
OBJECTIVE:To systematically review the efficacy and safety of glucagon-like peptide-1(GLP-1)receptor agonists in the treatment of obesity in children and adolescents.METHODS:PubMed,Embase,Web of Science,the Cochrane Library,CNKI,Wanfang Data,and VIP databases were retrieved for randomized controlled trials(RCT)of GLP-1 receptor agonists and placebo in the treatment of obesity in children and adolescents(from database establishment to Dec.31st,2023).Literature screening and data extraction were performed based on inclusion and exclusion criteria,and Meta-analysis was performed using RevMan 5.3 software.RESULTS:A total of 11 RCT were enrolled,including 981 children and adolescents with obesity.There were 542 cases in the study group(227 cases of liraglutide,78 cases of exenatide,134 cases of semaglutide,103 cases of duraglutide)and 439 cases in the control group.The risk of literature bias was moderate.Meta-analysis results showed that compared with the placebo,GLP-1 receptor agonists can reduce body mass(MD=-3.83,95%CI=-5.94--1.71,P=0.000 4),body mass index(BMI)(MD=-1.94,95%CI=-3.17--0.70,P=0.002),BMI-Z score(MD=-0.18,95%CI=-0.33--0.03,P=0.02),glycated hemoglobin(HbA1c)(MD=-0.22,95%CI=-0.38--0.07,P=0.005),and fasting blood glucose(MD=-4.43,95%CI=-8.18--0.68,P=0.02)in children and adolescents with obesity,with statistically significant differences.Subgroup analysis showed that weekly preparations may not have statistical significance in reducing body mass,yet weekly preparations could better reduce BMI and BMI-Z scores compared with daily preparations.Meanwhile,GLP-1 receptor agonists significantly lower fasting blood glucose and HbA1c levels in obese children and adolescents with type 2 diabetes compared with those without type 2 diabetes.Compared with the control group,GLP-1 receptor agonists increased the incidence of nausea(OR=3.13,95%CI=2.23-4.39,P<0.000 01),vomiting(OR=5.97,95%CI=3.79-9.41,P<0.000 01),diarrhea(OR=1.45,95%CI=1.02-2.06,P=0.04),and dizziness(OR=2.68,95%CI=1.36-5.26,P=0.004),with statistically significant differences.CONCLUSIONS:GLP-1 receptor agonists can reduce body mass,BMI,HbA1c,and fasting blood glucose in children and adolescents with obesity,but the incidence of gastrointestinal adverse drug reactions is high,and attention should be paid to the clinical use.
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