Clinical impact of Glucagon like peptide-1 receptor analogs on the complications of obesity

Background: Obesity is a chronic disease associated with increased morbidity and mortality due to its complications. The aims of obesity treatment are primarily to accomplish weight loss, and prevention or treatment of its complications. Lifestyle changes along with behavioral therapy constitute the first line treatment of obesity followed by pharmacotherapy. Glucagon-like peptide receptor analogs (GLP-1 RA’s) are among the approved pharmacotherapy options. Their central effect on suppressing appetite results in considerable weight loss. However their effect on the complications of obesity have not been very well recognized. This review aims to analyze the effects of GLP-RA’s on the complications of obesity, as diabetes mellitus, hypertension, nonalcoholic steatohepatitis (NASH), cardiovascular diseases, polycystic ovary syndrome, infertility, obstructive sleep apnea (OSA) and central nervous system problems. Summary: Data from preclinical studies and clinical trials have been thoroughly evaluated. Effects regarding the complications as far as the scope of this review has covered can be summarized as blood glucose lowering, blood pressure lowering, resolution of NASH, improving major cardiovascular events, improving fertility and sex hormone levels, improvement in OSA symptoms and in cognitive scores. Although the mechanisms are not fully elucidated, it is clear that the effects are not solely due to weight loss, but some pleiotropic effects like decreased inflammation, oxidative stress and fibrosis also play role in some of the complications. Key messages: Treating obesity is not only enabling weight loss but ameliorating complications related with obesity. Thus any anti-obesity medication has to have some favorable effects on the complications. As far as the GLP-RA’s analogs are concerned, there seem to be improvement in many of the complications regardless of the weight loss effect of these medications.