Preview

Проблемы Эндокринологии

Расширенный поиск

Персонифицированный подход к терапии ожирения на основе доказательных данных и клинических алгоритмов: семаглутид или тирзепатид

https://doi.org/10.14341/probl13677

Аннотация

26 июня 2025 года в Москве прошло заседание экспертной рабочей группы. В центре обсуждения были вопросы персонализированного применения тирзепатида («Тирзетта®») и семаглутида («Велгия ЭКО®») у пациентов с избыточной массой тела, ожирением и сахарным диабетом 2 типа. По итогам встречи была поставлена задача разработать консенсусный алгоритм назначения этих препаратов для их эффективного использования в российской клинической практике.

Об авторах

Е. А. Трошина
Национальный медицинский исследовательский центр эндокринологии им. акад. И.И. Дедова
Россия

Трошина Екатерина Анатольевна, д.м.н, член-корр. РАН, профессор 

г. Москва, ул. Дмитрия Ульянова д. 11, 117292 



М. Б. Анциферов
Эндокринологический диспансер г. Москвы
Россия

Анциферов Михаил Борисович, д.м.н., профессор 

Москва



А. С. Аметов
Российская медицинская академия непрерывного профессионального образования
Россия

Аметов Александр Сергеевич, д.м.н., профессор 

Москва



Г. Р. Галстян
Национальный медицинский исследовательский центр эндокринологии им. акад. И.И. Дедова
Россия

Галстян Гагик Радикович, д.м.н., проф. 

Москва



Т. Н. Маркова
Российский университет медицины
Россия

Маркова Татьяна Николаевна, д.м.н., проф. 

Москва



Т. И. Романцова
Российская медицинская академия непрерывного профессионального образования
Россия

Романцова Татьяна Ивановна, профессор, д.м.н. 

Москва



Н. В. Мазурина
Национальный медицинский исследовательский центр эндокринологии им. акад. И.И. Дедова
Россия

Мазурина Наталия Валентиновна, д.м.н. 

Москва



О. М. Котешкова
Эндокринологический диспансер г. Москвы
Россия

Котешкова Ольга Михайловна, к.м.н. 

Москва



Список литературы

1. McGowan B, Ciudin A, Baker JL, et al. Framework for the pharmacological treatment of obesity and its complications from the European Association for the Study of Obesity (EASO). Nat Med. 2025. doi: https://doi.org/10.1038/s41591-025-03765-w

2. Nauck MA, Quast DR, Wefers J, Pfeiffer AFH. The evolving story of incretins (GIP and GLP-1) in metabolic and cardiovascular disease: A pathophysiological update. Diabetes Obes Metab. 2021;23 Suppl 3:5-29. doi: https://doi.org/10.1111/dom.14496

3. Christel CM, DeNardo DF, Secor SM. Metabolic and digestive response to food ingestion in a binge-feeding lizard, the Gila monster (Heloderma suspectum). J Exp Biol. 2007;210(Pt 19):3430-9. doi: https://doi.org/10.1242/jeb.004820

4. Park JS, Kim KS, Choi HJ. Glucagon-Like Peptide-1 and Hypothalamic Regulation of Satiation: Cognitive and Neural Insights from Human and Animal Studies. Diabetes Metab J. 2025;49(3):333-347. doi: https://doi.org/10.4093/dmj.2025.0106

5. Eng J, Kleinman WA, Singh L, et al. Isolation and characterization of exendin-4, an exendin-3 analogue, from Heloderma suspectum venom. Further evidence for an exendin receptor on dispersed acini from guinea pig pancreas. J Biol Chem. 1992;267(11):7402-5

6. Krook A, Mulder H. Incretins: turning the venom into the antidote. Diabetologia. 2023;66(10):1762-1764. doi: https://doi.org/10.1007/s00125-023-05987-4

7. De Graaf C, Donnelly D, Wootten D, et al. Glucagon-Like Peptide-1 and Its Class B G Protein-Coupled Receptors: A Long March to Therapeutic Successes. Pharmacol. Rev. 2016;68:954–1013. doi: https://doi.org/10.1124/pr.115.011395

8. Coskun T, Sloop KW, Loghin C, et al. LY3298176, a novel dual GIP and GLP-1 receptor agonist for the treatment of type 2 diabetes mellitus: From discovery to clinical proof of concept. Mol Metab. 2018; 18:3-14. doi: https://doi.org/10.1016/j.molmet.2018.09.009

9. Willard FS, Douros JD, Gabe MB, et al. Tirzepatide is an imbalanced and biased dual GIP and GLP-1 receptor agonist. JCI Insight. 2020;5(17):e140532. doi: https://doi.org/10.1172/jci.insight.140532

10. Романцова Т.И. Тирзепатид — унимолекулярная полифармакология для лечения ожирения. // Эндокринология: новости, мнения, обучение. — 2025. — Т.14. — № 3. — C. 50-64. doi: https://doi.org/10.33029/2304-9529-2025-14-3-50-64

11. Müller TD, Finan B, Bloom SR, et al. Glucagon-like peptide 1 (GLP-1). Mol Metab. 2019;30:72-130. doi: https://doi.org/10.1016/j.molmet.2019.09.010

12. Müller TD, Adriaenssens A, Ahrén B, et al. Glucose-dependent insulinotropic polypeptide (GIP). Mol Metab. 2025;95:102118. doi: 10.1016/j.molmet.2025.102118

13. Campbell JE, Müller TD, Finan B, et al. GIPR/GLP-1R dual agonist therapies for diabetes and weight loss-chemistry, physiology, and clinical applications. Cell Metab. 2023;35(9):1519-1529. doi: https://doi.org/10.1016/j.cmet.2023.07.010

14. Gabery S, Salinas CG, Paulsen SJ, et al. Semaglutide lowers body weight in rodents via distributed neural pathways. JCI Insight. 2020;5(6):e133429. doi: https://doi.org/10.1172/jci.insight.133429

15. Samms RJ, Sloop KW. A Contemporary Rationale for Agonism of the GIP Receptor in the Treatment of Obesity. Diabetes. 2025: dbi240026. doi: https://doi.org/10.2337/dbi24-0026

16. Boer GA, Hay DL, Tups A. Obesity pharmacotherapy: incretin action in the central nervous system. Trends Pharmacol Sci. 2023;44(1):50-63. doi: https://doi.org/10.1016/j.tips.2022.11.001

17. O’Keefe JH, Franco WG, O’Keefe EL. Anti-consumption agents: Tirzepatide and semaglutide for treating obesity-related diseases and addictions, and improving life expectancy. Prog Cardiovasc Dis. 2025;89:102-112. doi: https://doi.org/10.1016/j.pcad.2024.12.010

18. James-Okoro PP, Lewis JE, Gribble FM, Reimann F. The role of GIPR in food intake control. Front Endocrinol (Lausanne). 2025;16:1532076. doi: https://doi.org/10.3389/fendo.2025.1532076

19. Douros JD, Flak JN, Knerr PJ. The agony and the efficacy: central mechanisms of GLP-1 induced adverse events and their mitigation by GIP. Front Endocrinol (Lausanne). 2025;16:1530985. doi: https://doi.org/10.3389/fendo.2025.1530985

20. Samms RJ, Cosgrove R, Snider BM, et al. GIPR Agonism Inhibits PYY-Induced Nausea-Like Behavior. Diabetes. 2022;71(7):1410-1423. doi: https://doi.org/10.2337/db21-0848

21. Urva S, Coskun T, Loghin C, et al. The novel dual glucosedependent insulinotropic polypeptide and glucagon-like peptide-1 (GLP-1) receptor agonist tirzepatide transiently delays gastric emptying similarly to selective long-acting GLP-1 receptor agonists. Diabetes Obes Metab. 2020;22(10):1886-1891. doi: https://doi.org/10.1111/dom.14110

22. Jalleh RJ, Plummer MP, Marathe CS, et al. Clinical Consequences of Delayed Gastric Emptying With GLP-1 Receptor Agonists and Tirzepatide. J Clin Endocrinol Metab. 2024;110(1):1-15. doi: https://doi.org/10.1210/clinem/dgae719. Erratum in: J Clin Endocrinol Metab. 2025;110(10):e3556. doi: https://doi.org/10.1210/clinem/dgaf387

23. Min JS, Jo SJ, Lee S, Kim DY, Kim DH, Lee CB, Bae SK. A Comprehensive Review on the Pharmacokinetics and Drug-Drug Interactions of Approved GLP-1 Receptor Agonists and a Dual GLP-1/GIP Receptor Agonist. Drug Des Devel Ther. 2025;19:3509-3537. doi: https://doi.org/10.2147/DDDT.S506957

24. Wong CK, McLean BA, Baggio LL, et al. Central glucagon-like peptide 1 receptor activation inhibits Toll-like receptor agonistinduced inflammation. Cell Metab. 2024;36(1):130-143.e5. doi: https://doi.org/10.1016/j.cmet.2023.11.009

25. Papakonstantinou I, Tsioufis K, Katsi V. Spotlight on the Mechanism of Action of Semaglutide. Curr Issues Mol Biol. 2024;46(12):14514-14541. doi: https://doi.org/10.3390/cimb46120872

26. Regmi A, Aihara E, Christe ME, et al. Tirzepatide modulates the regulation of adipocyte nutrient metabolism through long-acting activation of the GIP receptor. Cell Metab. 2024;36(7):1534-1549.e7. doi: https://doi.org/10.1016/j.cmet.2024.05.010

27. Yu X, Chen S, Funcke JB, et al. The GIP receptor activates futile calcium cycling in white adipose tissue to increase energy expenditure and drive weight loss in mice. Cell Metab. 2025;37(1):187-204.e7. doi: https://doi.org/10.1016/j.cmet.2024.11.003

28. Yaribeygi H, Maleki M, Jamialahmadi T, Sahebkar A. Anti-inflammatory benefits of semaglutide: State of the art. J Clin Transl Endocrinol. 2024;36:100340. doi: https://doi.org/10.1016/j.jcte.2024.100340

29. Badve SV, Bilal A, Lee MMY, Sattar N, Gerstein HC, et al. Effects of GLP-1 receptor agonists on kidney and cardiovascular disease outcomes: a meta-analysis of randomised controlled trials. Lancet Diabetes Endocrinol. 2025;13(1):15-28. doi: https://doi.org/10.1016/S2213-8587(24)00271-7

30. Vear A, Heneka MT, Clemmensen C. Incretin-based therapeutics for the treatment of neurodegenerative diseases. Nat Metab. 2025;7(4):679-696. doi: https://doi.org/10.1038/s42255-025-01263-4

31. Malhotra A, Grunstein RR, Fietze I, Weaver TE, Redline S, et al; SURMOUNT-OSA Investigators. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. N Engl J Med. 2024;391(13):1193-1205. doi: https://doi.org/10.1056/NEJMoa2404881. Erratum in: N Engl J Med. 2024;391(15):1464. doi: https://doi.org/10.1056/NEJMx240005

32. Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, et al; Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines For Medical Care of Patients With Obesity. Endocr Pract. 2016;22Suppl 3:1-203. doi: https://doi.org/10.4158/EP161365

33. Aronne LJ, Horn DB, le Roux CW, Ho W, Falcon BL, et al; SURMOUNT-5 Trial Investigators. Tirzepatide as Compared with Semaglutide for the Treatment of Obesity. N Engl J Med. 2025. doi: https://doi.org/10.1056/NEJMoa2416394

34. Lincoff AM, Brown-Frandsen K, Colhoun HM, Deanfield J, Emerson SS, et al; SELECT Trial Investigators. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023;389(24):2221-2232. doi: https://doi.org/10.1056/NEJMoa2307563

35. Zhao Z, Song J, Faurby M, et al. Lower Risk of MACE and All-Cause Death in Patients Initiated on Semaglutide 2.4 mg in Routine Clinical Care: Results from the SCORE Study (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity in the Real World). Moderated poster presentation presented at the American College of Cardiology Scientific Session & Expo 2025; 29-31 March 2025; McCormick Place Convention Center, Chicago, US. Presentation 947-13

36. Packer M, Zile MR, Kramer CM, Baum SJ, Litwin SE, et al; SUMMIT Trial Study Group. Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med. 2025;392(5):427-437. doi: https://doi.org/10.1056/NEJMoa2410027

37. Kosiborod MN, Abildstrøm SZ, Borlaug BA, Butler J, Rasmussen S, et al; STEP-HFpEF Trial Committees and Investigators. Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med. 2023;389(12):1069-1084. doi: https://doi.org/10.1056/NEJMoa2306963

38. Malhotra A, Grunstein RR, Fietze I, Weaver TE, Redline S, et al; SURMOUNT-OSA Investigators. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. N Engl J Med. 2024;391(13):1193-1205. doi: https://doi.org/10.1056/NEJMoa2404881. Erratum in: N Engl J Med. 2024;391(15):1464. doi: https://doi.org/10.1056/NEJMx240005

39. Bliddal H, Bays H, Czernichow S, Uddén Hemmingsson J, Hjelmesæth J, et al; STEP 9 Study Group. OnceWeekly Semaglutide in Persons with Obesity and Knee Osteoarthritis. N Engl J Med. 2024;391(17):1573-1583. doi: https://doi.org/10.1056/NEJMoa2403664

40. Loomba R, Hartman ML, Lawitz EJ, Vuppalanchi R, Boursier J, et al; SYNERGY-NASH Investigators. Tirzepatide for Metabolic Dysfunction-Associated Steatohepatitis with Liver Fibrosis. N Engl J Med. 2024;391(4):299-310. doi: https://doi.org/10.1056/NEJMoa2401943

41. Phase 3 ESSENCE Trial: Semaglutide in Metabolic DysfunctionAssociated Steatohepatitis. Gastroenterol Hepatol (N Y). 2024;20(12 Suppl 11):6-7

42. McGowan BM, Bruun JM, Capehorn M, Pedersen SD, Pietiläinen KH, et al; STEP 10 Study Group. Efficacy and safety of once-weekly semaglutide 2·4 mg versus placebo in people with obesity and prediabetes (STEP 10): a randomised, double-blind, placebo-controlled, multicentre phase 3 trial. Lancet Diabetes Endocrinol. 2024;12(9):631-642. doi: https://doi.org/10.1016/S2213-8587(24)00182-7

43. Jastreboff AM, le Roux CW, Stefanski A, Aronne LJ, Halpern B, et al; SURMOUNT-1 Investigators. Tirzepatide for Obesity Treatment and Diabetes Prevention. N Engl J Med. 2025;392(10):958-971. doi: https://doi.org/10.1056/NEJMoa2410819

44. Garvey WT, Frias JP, Jastreboff AM, le Roux CW, Sattar N, et al; SURMOUNT-2 investigators. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2023;402(10402):613-626. doi: https://doi.org/10.1016/S0140-6736(23)01200-X

45. Davies M, Færch L, Jeppesen OK, Pakseresht A, Pedersen SD, et al; STEP 2 Study Group. Semaglutide 2·4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebocontrolled, phase 3 trial. Lancet. 2021;397(10278):971-984. doi: https://doi.org/10.1016/S0140-6736(21)00213-0


Рецензия

Для цитирования:


Трошина Е.А., Анциферов М.Б., Аметов А.С., Галстян Г.Р., Маркова Т.Н., Романцова Т.И., Мазурина Н.В., Котешкова О.М. Персонифицированный подход к терапии ожирения на основе доказательных данных и клинических алгоритмов: семаглутид или тирзепатид. Проблемы Эндокринологии. 2025;71(5):19-30. https://doi.org/10.14341/probl13677

For citation:


Troshina E.A., Antsiferov M.B., Ametov A.S., Galstyan G.R., Markova T.N., Romantsova T.I., Mazurina N.V., Koteshkova O.M. A personalized, evidence-based approach to obesity therapy using clinical algorithms: semaglutide or tirzepatide. Problems of Endocrinology. 2025;71(5):19-30. (In Russ.) https://doi.org/10.14341/probl13677

Просмотров: 47


ISSN 0375-9660 (Print)
ISSN 2308-1430 (Online)