{"id":6210,"date":"2026-08-13T12:19:46","date_gmt":"2026-08-13T12:19:46","guid":{"rendered":"https:\/\/www.ahmetozyigit.com\/?page_id=6210"},"modified":"2026-08-13T12:29:40","modified_gmt":"2026-08-13T12:29:40","slug":"zayiflama-igneleri","status":"publish","type":"page","link":"https:\/\/www.ahmetozyigit.com\/en\/zayiflama-igneleri\/","title":{"rendered":"Zay\u0131flama \u0130\u011fneleri (Ozempic, Mounjaro)"},"content":{"rendered":"
\"\"<\/figure>\n\n\n\n

Zay\u0131flama \u0130\u011fneleri (Ozempic, Mounjaro)<\/strong>\n<\/p>\n\n\n\n

\n Losing weight should not be seen as a goal in itself, but as a tool for a healthier life. It is a known fact that overweight people have higher cardiovascular risks and are more likely to have health problems such as type 2 diabetes and metabolic syndrome. In addition to improving our appearance while losing weight, being healthier in biological and physiological aspects is an important goal for us.\n<\/p>\n\n\n\n

\n If you do not have enough information about weight control and healthy nutrition, it is very important to get help from a nutritionist. In addition, if you think you have an eating disorder and that this eating disorder has a psychological\/psychiatric basis, you should definitely consider getting help from a psychologist or psychiatrist. If you have reservations about this or do not know how to proceed, please ask for help during your consultation with Dr. Ahmet \u00d6zyi\u011fit. \n<\/p>\n\n\n\n

Zay\u0131flama Ama\u00e7l\u0131 Kullan\u0131lan Enjeksiyonlar<\/strong>\n<\/p>\n\n\n\n

1- Liraglutide (Saxenda\u00ae)<\/strong>\n<\/p>\n\n\n\n

\n Liraglutide, obezite tedavisinde kullan\u0131lan ilk jenerasyon GLP-1 resept\u00f6r agonistlerinden biridir. Ba\u015flang\u0131\u00e7ta daha d\u00fc\u015f\u00fck dozlarda tip 2 diyabet tedavisinde kullan\u0131lmaya ba\u015flanm\u0131\u015f, daha sonra 3 mg g\u00fcnl\u00fck dozda Saxenda\u00ae ad\u0131yla obezite tedavisinde kullan\u0131ma girmi\u015ftir.\n<\/p>\n\n\n\n

\n GLP-1 asl\u0131nda v\u00fccudumuzun yemek sonras\u0131nda do\u011fal olarak salg\u0131lad\u0131\u011f\u0131 hormonlardan biridir. Beyindeki i\u015ftah ve tokluk merkezlerini etkiler, mide bo\u015falmas\u0131n\u0131 yava\u015flat\u0131r ve pankreastan glukoza ba\u011f\u0131ml\u0131 ins\u00fclin salg\u0131s\u0131n\u0131 art\u0131r\u0131r. Liraglutide da GLP-1 resept\u00f6rlerini aktive ederek bu do\u011fal sinyalin etkisini daha uzun s\u00fcre devam ettirir. Bunun sonucunda ki\u015fi daha erken doyabilir, \u00f6\u011f\u00fcnler aras\u0131nda daha uzun s\u00fcre tok kalabilir ve toplam enerji al\u0131m\u0131 azal\u0131r.\n<\/p>\n\n\n\n

\n Liraglutide’\u0131n kilo verme konusundaki en \u00f6nemli \u00e7al\u0131\u015fmalar\u0131ndan biri 3.731 obez veya fazla kilolu yeti\u015fkinin dahil edildi\u011fi SCALE \u00e7al\u0131\u015fmas\u0131d\u0131r. \u00c7al\u0131\u015fmada b\u00fct\u00fcn kat\u0131l\u0131mc\u0131lara beslenme ve fiziksel aktivite konusunda da destek verilmi\u015f, buna ek olarak bir gruba g\u00fcnl\u00fck 3 mg liraglutide, di\u011fer gruba ise plasebo uygulanm\u0131\u015ft\u0131r. 56 haftan\u0131n sonunda liraglutide kullananlarda ortalama 8.4 kg, yani ba\u015flang\u0131\u00e7 v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131n\u0131n yakla\u015f\u0131k %8’i kadar kilo kayb\u0131 g\u00f6r\u00fcl\u00fcrken, plasebo grubunda bu oran yakla\u015f\u0131k %2.6 olmu\u015ftur [1].\n<\/p>\n\n\n\n

\n Elbette ortalama rakamlar her hastan\u0131n ayn\u0131 miktarda kilo verece\u011fi anlam\u0131na gelmez. Ayn\u0131 \u00e7al\u0131\u015fmada liraglutide kullanan hastalar\u0131n %63.2’si v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131n\u0131n en az %5’ini, %33.1’i %10’dan fazlas\u0131n\u0131 ve %14.4’\u00fc %15’ten fazlas\u0131n\u0131 kaybetmi\u015ftir [1]. Yani liraglutide’\u0131n ger\u00e7ek ve klinik olarak anlaml\u0131 bir kilo verme etkisi vard\u0131r, ancak hastalar aras\u0131ndaki yan\u0131t olduk\u00e7a de\u011fi\u015fkendir.\n<\/p>\n\n\n\n

\n Liraglutide’\u0131n dezavantajlar\u0131ndan biri her g\u00fcn cilt alt\u0131 enjeksiyon \u015feklinde uygulanmas\u0131d\u0131r. Tedavi genellikle d\u00fc\u015f\u00fck dozda ba\u015flanarak gastrointestinal yan etkileri azaltmak amac\u0131yla kademeli olarak 3 mg g\u00fcnl\u00fck doza \u00e7\u0131kar\u0131l\u0131r.\n<\/p>\n\n\n\n

\n En s\u0131k kar\u015f\u0131la\u015f\u0131lan yan etkiler de gastrointestinal sistemle ilgilidir. \u00d6zellikle bulant\u0131, kusma, ishal, kab\u0131zl\u0131k, haz\u0131ms\u0131zl\u0131k ve kar\u0131n rahats\u0131zl\u0131\u011f\u0131 g\u00f6r\u00fclebilir. Bu \u015fikayetler \u00e7o\u011funlukla tedavinin ba\u015flang\u0131c\u0131nda veya doz art\u0131\u015f\u0131 s\u0131ras\u0131nda ortaya \u00e7\u0131kar ve bir\u00e7ok hastada zaman i\u00e7erisinde azal\u0131r. Fakat daha sonradan \u00e7\u0131kan semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro, Zepbound) adl\u0131 i\u011fneler yan etki bak\u0131m\u0131ndan liraglutide\u2019a oranla \u00e7ok daha d\u00fc\u015f\u00fck bantta yan etkilere sahip olduklar\u0131 i\u00e7in ve kilo verimi a\u00e7\u0131s\u0131ndan da daha ba\u015far\u0131l\u0131 olduklar\u0131 i\u00e7in, saxenda art\u0131k d\u00fcnyada ra\u011fbet g\u00f6ren bir kilo verme aparat\u0131 de\u011fildir. \n<\/p>\n\n\n\n

\n G\u00fcnl\u00fck enjeksiyon gerektirmesi, gastrointestinal yan etkilerinin baz\u0131 hastalarda belirgin olmas\u0131 ve ortalama kilo kayb\u0131n\u0131n yakla\u015f\u0131k %8 aral\u0131\u011f\u0131nda kalmas\u0131 nedeniyle merkezimizde g\u00fcn\u00fcm\u00fczde kilo kontrol\u00fc amac\u0131yla liraglutide tedavisini tercih etmemekteyiz. \n<\/p>\n\n\n\n

2- Semaglutide (Wegovy\u00ae \/ Ozempic\u00ae)<\/strong>\n<\/p>\n\n\n\n

\n Semaglutide, liraglutide sonras\u0131nda GLP-1 tedavilerinde ikinci jenerasyon olarak de\u011ferlendirebilece\u011fimiz ve obezite tedavisinde \u00f6nemli bir d\u00f6n\u00fcm noktas\u0131 olu\u015fturan molek\u00fcld\u00fcr. Liraglutide gibi GLP-1 resept\u00f6r agonisti olarak \u00e7al\u0131\u015f\u0131r, ancak molek\u00fcler yap\u0131s\u0131ndaki de\u011fi\u015fiklikler sayesinde v\u00fccutta \u00e7ok daha uzun s\u00fcre aktif kalabilme \u00f6zelli\u011fine sahiptir. Bunun en pratik sonucu liraglutide gibi her g\u00fcn de\u011fil, haftada yaln\u0131zca bir kez uygulanabilmesidir.\n<\/p>\n\n\n\n

\n Semaglutide ilk olarak tip 2 diyabet tedavisi i\u00e7in Ozempic\u00ae ad\u0131yla kullan\u0131ma girdi. Daha sonra kilo kontrol\u00fc \u00fczerindeki belirgin etkileri g\u00f6r\u00fcl\u00fcnce 2.4 mg haftal\u0131k dozda Wegovy\u00ae obezite tedavisi i\u00e7in geli\u015ftirildi. Burada s\u0131k kar\u0131\u015ft\u0131r\u0131lan bir noktay\u0131 a\u00e7\u0131klamak gerekir: Ozempic ve Wegovy ayn\u0131 etken maddeyi, yani semaglutide’\u0131 i\u00e7erir. Marka farklar\u0131 sadece ruhsatland\u0131rma ve ticari y\u00f6nden farklar i\u00e7erir. \n<\/p>\n\n\n\n

\n Semaglutide’\u0131n kilo verme \u00fczerindeki ba\u015far\u0131s\u0131n\u0131 en net g\u00f6steren \u00e7al\u0131\u015fmalardan biri STEP 1 \u00e7al\u0131\u015fmas\u0131d\u0131r. Diyabeti olmayan, obez veya fazla kilolu 1.961 yeti\u015fkinin dahil edildi\u011fi bu \u00e7al\u0131\u015fmada, beslenme ve fiziksel aktivite d\u00fczenlemesine ek olarak haftada bir 2.4 mg semaglutide kullanan ki\u015filer 68 hafta sonunda ba\u015flang\u0131\u00e7 v\u00fccut a\u011f\u0131rl\u0131klar\u0131n\u0131n ortalama %14.9’unu kaybetmi\u015ftir. Plasebo grubunda ise kilo kayb\u0131 yaln\u0131zca %2.4 olmu\u015ftur [2].\n<\/p>\n\n\n\n

\n Belki daha da dikkat \u00e7ekici olan, semaglutide kullanan ki\u015filerin %86.4’\u00fcn\u00fcn v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131n\u0131n en az %5’ini, %69.1’inin en az %10’unu ve %50.5’inin en az %15’ini kaybetmi\u015f olmas\u0131d\u0131r [2]. Bu sonu\u00e7lar semaglutide ile birlikte ila\u00e7la obezite tedavisinde ula\u015f\u0131labilecek kilo kayb\u0131 beklentisini ciddi \u015fekilde de\u011fi\u015ftirmi\u015ftir.\n<\/p>\n\n\n\n

\n Semaglutide’\u0131n \u00f6nemli \u00f6zelliklerinden biri de bu etkinin birka\u00e7 ayl\u0131k k\u0131sa bir d\u00f6nemle s\u0131n\u0131rl\u0131 kalmad\u0131\u011f\u0131n\u0131n g\u00f6sterilmi\u015f olmas\u0131d\u0131r. STEP 5 \u00e7al\u0131\u015fmas\u0131nda tedavi iki y\u0131l boyunca devam ettirilmi\u015f ve 104. haftada ortalama kilo kayb\u0131 %15.2 olarak korunmu\u015ftur [3]. Bu bize tedavi devam etti\u011fi s\u00fcrece semaglutide’\u0131n kilo kontrol\u00fc \u00fczerindeki etkisinin uzun vadede s\u00fcrd\u00fcr\u00fclebilece\u011fini g\u00f6stermektedir.\n<\/p>\n\n\n\n

\n GLP-1 resept\u00f6rleri beyinde i\u015ftah ve enerji al\u0131m\u0131n\u0131n kontrol edildi\u011fi bir\u00e7ok b\u00f6lgede bulunmaktad\u0131r. Semaglutide bu sistemleri etkileyerek a\u00e7l\u0131\u011f\u0131 azalt\u0131r, tokluk hissini art\u0131r\u0131r ve ki\u015finin yemek yeme iste\u011fini azalt\u0131r. Bunun sonucunda ki\u015fi kendisini s\u00fcrekli olarak kalori k\u0131s\u0131tlamaya zorlamak yerine do\u011fal olarak daha az yemek yemeye ba\u015flayabilir.\n<\/p>\n\n\n\n

\n Hastalar\u0131n s\u0131k kulland\u0131\u011f\u0131 bir ifade vard\u0131r: \u201cArt\u0131k s\u00fcrekli yemek d\u00fc\u015f\u00fcnm\u00fcyorum.\u201d Bu asl\u0131nda ilac\u0131n merkezi i\u015ftah kontrol\u00fc \u00fczerindeki etkisini olduk\u00e7a iyi tarif eder. Semaglutide ile kilo kayb\u0131n\u0131n temel mekanizmalar\u0131ndan biri g\u00fcnl\u00fck enerji al\u0131m\u0131ndaki azalmad\u0131r [2]. Ayn\u0131 zamanda glukoza ba\u011f\u0131ml\u0131 ins\u00fclin salg\u0131s\u0131n\u0131 art\u0131r\u0131r, glukagon salg\u0131s\u0131n\u0131 d\u00fczenler ve \u00f6zellikle tedavinin ba\u015flang\u0131c\u0131nda mide bo\u015falmas\u0131n\u0131 yava\u015flatabilir. Bu nedenle kilo kayb\u0131n\u0131n yan\u0131nda glukoz metabolizmas\u0131 \u00fczerinde de \u00f6nemli etkileri vard\u0131r.\n<\/p>\n\n\n\n

\n Semaglutide’\u0131n en s\u0131k g\u00f6r\u00fclen yan etkileri, di\u011fer GLP-1 resept\u00f6r agonistlerinde oldu\u011fu gibi gastrointestinal sistemle ilgilidir. En s\u0131k: bulant\u0131, kusma, ishal, kab\u0131zl\u0131k, \u015fi\u015fkinlik ve kar\u0131n rahats\u0131zl\u0131\u011f\u0131 g\u00f6r\u00fcl\u00fcr. Ancak burada yan etkilerin sadece g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131na de\u011fil, \u015fiddetine ve tedavinin devam ettirilebilirli\u011fine de bakmak gerekir. STEP \u00e7al\u0131\u015fmalar\u0131nda gastrointestinal yan etkiler olduk\u00e7a s\u0131k bildirilmi\u015f olsa da bunlar\u0131n b\u00fcy\u00fck \u00e7o\u011funlu\u011fu hafif veya orta \u015fiddette ve ge\u00e7ici olmu\u015ftur. \u00d6zellikle tedavinin ilk haftalar\u0131nda ve doz art\u0131r\u0131m\u0131 s\u0131ras\u0131nda daha s\u0131k g\u00f6r\u00fcl\u00fcrler ve bir\u00e7ok hastada v\u00fccut ilaca al\u0131\u015ft\u0131k\u00e7a azal\u0131rlar [2,3].\n<\/p>\n\n\n\n

\n Bu nedenle semaglutide tedavisinde dozu yava\u015f ve kontroll\u00fc \u015fekilde art\u0131rmak \u00f6nemlidir. Her hastan\u0131n mutlaka maksimum doza ula\u015fmas\u0131 gerekti\u011fini d\u00fc\u015f\u00fcnm\u00fcyorum. Ayn\u0131 zamanda her hastada illa ki d\u00f6rt haftal\u0131k doz art\u0131\u015f program\u0131n\u0131n standart olarak uygulanmas\u0131 da gerekli de\u011fildir. Ama\u00e7 m\u00fcmk\u00fcn olan en y\u00fcksek dozu kullanmak de\u011fil, etkinlik ile tolerabilite aras\u0131nda hasta i\u00e7in do\u011fru dengeyi bulmakt\u0131r. \n<\/p>\n\n\n\n

\n Dolay\u0131s\u0131yla semaglutide’\u0131n gastrointestinal yan etkileri kesinlikle g\u00f6z ard\u0131 edilmemelidir, ancak do\u011fru doz titrasyonu ve hasta se\u00e7imiyle bir\u00e7ok hastada y\u00f6netilebilir d\u00fczeyde kalmaktad\u0131r. \u00d6zellikle liraglutide (Saxenda)\u2019ya k\u0131yasla yan etki profilinin daha masum oldu\u011funu s\u00f6ylemek m\u00fcmk\u00fcnd\u00fcr.\n<\/p>\n\n\n\n

\n Safra ta\u015f\u0131 ve safra kesesi hastal\u0131klar\u0131 a\u00e7\u0131s\u0131ndan da k\u00fc\u00e7\u00fck fakat ger\u00e7ek bir risk art\u0131\u015f\u0131 bulunmaktad\u0131r. \u00d6zellikle h\u0131zl\u0131 ve fazla kilo kayb\u0131n\u0131n kendisi de safra ta\u015f\u0131 olu\u015fumunu kolayla\u015ft\u0131rd\u0131\u011f\u0131 i\u00e7in bu riskin tamam\u0131n\u0131 ilac\u0131n do\u011frudan etkisine ba\u011flamak m\u00fcmk\u00fcn de\u011fildir.\n<\/p>\n\n\n\n

\n Semaglutide ile ilgili ilk d\u00f6nemlerden beri \u00fczerinde durulan konulardan biri pankreatit riski olmu\u015ftur. Ancak elimizde art\u0131k olduk\u00e7a geni\u015f bir klinik veri bulunmaktad\u0131r ve randomize kontroll\u00fc \u00e7al\u0131\u015fmalar\u0131n sonu\u00e7lar\u0131 semaglutide kullan\u0131m\u0131n\u0131n akut pankreatit riskini anlaml\u0131 \u015fekilde art\u0131rd\u0131\u011f\u0131n\u0131 g\u00f6stermemektedir. 21 randomize \u00e7al\u0131\u015fmada toplam 34.721 hastay\u0131 de\u011ferlendiren geni\u015f bir meta-analizde semaglutide kullanan ki\u015filerde akut pankreatit riski plaseboya g\u00f6re artmam\u0131\u015f, benzer sonu\u00e7 hem d\u00fc\u015f\u00fck hem de y\u00fcksek doz subkutan semaglutide i\u00e7in g\u00f6r\u00fclm\u00fc\u015ft\u00fcr [5]. Benzer \u015fekilde, 17.604 fazla kilolu veya obez hastan\u0131n takip edildi\u011fi b\u00fcy\u00fck SELECT \u00e7al\u0131\u015fmas\u0131n\u0131n g\u00fcvenlik analizinde de semaglutide 2.4 mg ile pankreatit s\u0131kl\u0131\u011f\u0131nda plaseboya k\u0131yasla anlaml\u0131 bir art\u0131\u015f saptanmam\u0131\u015ft\u0131r [6].\n<\/p>\n\n\n\n

\n Dolay\u0131s\u0131yla g\u00fcn\u00fcm\u00fczde mevcut klinik veriler \u0131\u015f\u0131\u011f\u0131nda semaglutide’\u0131n genel pop\u00fclasyona k\u0131yasla pankreatit riskini belirgin \u015fekilde art\u0131ran bir ila\u00e7 oldu\u011funu s\u00f6ylemek do\u011fru de\u011fildir. Pankreatit nadir fakat ciddi bir hastal\u0131k oldu\u011fu i\u00e7in tedavi s\u0131ras\u0131nda \u015fiddetli ve ge\u00e7meyen kar\u0131n a\u011fr\u0131s\u0131 gibi belirtiler elbette de\u011ferlendirilmelidir; ancak bu klinik tedbir, semaglutide’\u0131n pankreatite neden oldu\u011funun g\u00f6sterildi\u011fi anlam\u0131na gelmez.\n<\/p>\n\n\n\n

\n Son d\u00f6nemde semaglutide ve tirzepatide ile \u201ck\u00f6rl\u00fck\u201d aras\u0131nda ili\u015fki oldu\u011funa dair olduk\u00e7a sansasyonel haberler \u00e7\u0131kmaya ba\u015flad\u0131. Burada konuyu do\u011fru \u00e7er\u00e7evelemek gerekir. Semaglutide kullanan baz\u0131 hastalarda non-arteritik anterior iskemik optik n\u00f6ropati (NAION) ad\u0131 verilen nadir bir optik sinir hastal\u0131\u011f\u0131 bildirilmi\u015ftir ve baz\u0131 g\u00f6zlemsel \u00e7al\u0131\u015fmalar semaglutide kullanan ki\u015filerde bu riskin bir miktar artabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir. Ancak bu \u00e7al\u0131\u015fmalar ilac\u0131n do\u011frudan NAION\u2019a neden oldu\u011funu kan\u0131tlamaz ve mevcut verilerde mutlak risk olduk\u00e7a d\u00fc\u015f\u00fckt\u00fcr.\n<\/p>\n\n\n\n

\n Bunun yan\u0131nda tamamen farkl\u0131 bir mekanizma olan diyabetik retinopatinin erken k\u00f6t\u00fcle\u015fmesi de uzun zamand\u0131r bilinmektedir. \u00d6zellikle y\u0131llard\u0131r \u00e7ok y\u00fcksek kan \u015fekeri ile ya\u015fayan, zaten diyabetik retinopatisi bulunan ki\u015filerde HbA1c\u2019nin \u00e7ok k\u0131sa s\u00fcrede ve ciddi \u015fekilde d\u00fc\u015f\u00fcr\u00fclmesi retina bulgular\u0131nda ge\u00e7ici k\u00f6t\u00fcle\u015fmeye neden olabilir. Bu durum semaglutide\u2019a \u00f6zg\u00fc de\u011fildir; h\u0131zl\u0131 glisemik d\u00fczelme ile ili\u015fkili bir fenomendir ve insulin dahil g\u00fc\u00e7l\u00fc glukoz d\u00fc\u015f\u00fcr\u00fcc\u00fc tedavilerle daha \u00f6nce de tan\u0131mlanm\u0131\u015ft\u0131r. Semaglutide\u2019\u0131n SUSTAIN-6 \u00e7al\u0131\u015fmas\u0131nda g\u00f6r\u00fclen retinopati sinyalinin de b\u00fcy\u00fck \u00f6l\u00e7\u00fcde ba\u015flang\u0131\u00e7ta retinopatisi bulunan ve HbA1c\u2019si h\u0131zl\u0131 d\u00fc\u015fen hastalarda yo\u011funla\u015ft\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir.\n<\/p>\n\n\n\n

\n Dolay\u0131s\u0131yla sosyal medyada kullan\u0131lan \u201cOzempic k\u00f6r ediyor\u201d gibi ifadeler bilimsel a\u00e7\u0131dan dayana\u011f\u0131 olmayan \u2018clickbait\u2019 tarz\u0131 haberlerden ibarettir. \n<\/p>\n\n\n\n

3- Tirzepatide (Mounjaro\u00ae \/ Zepbound\u00ae)<\/strong><\/p>\n\n\n\n

\n Tirzepatide, obezite tedavisinde bir sonraki jenerasyonu temsil eden ve klasik GLP-1 yakla\u015f\u0131m\u0131n\u0131 bir ad\u0131m ileri ta\u015f\u0131yan molek\u00fcld\u00fcr. Semaglutide yaln\u0131zca GLP-1 resept\u00f6r\u00fcn\u00fc<\/strong> hedeflerken, tirzepatide ayn\u0131 anda hem GLP-1 hem de GIP resept\u00f6rlerini<\/strong> aktive eder. Bu nedenle tirzepatide bir dual GIP\/GLP-1 resept\u00f6r agonisti<\/strong> olarak tan\u0131mlan\u0131r.\n<\/p>\n\n\n\n

\n GIP de GLP-1 gibi yemek sonras\u0131 ba\u011f\u0131rsaklardan salg\u0131lanan do\u011fal bir inkretin hormonudur. \u0130ns\u00fclin salg\u0131s\u0131n\u0131n d\u00fczenlenmesinde, ya\u011f dokusu metabolizmas\u0131nda ve enerji dengesinde rol oynar. Tirzepatide’\u0131n iki farkl\u0131 inkretin sistemini ayn\u0131 anda hedeflemesi, yaln\u0131zca glukoz kontrol\u00fcnde de\u011fil, i\u015ftah ve v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131 \u00fczerinde de olduk\u00e7a g\u00fc\u00e7l\u00fc bir etki olu\u015fturmu\u015ftur.\n<\/p>\n\n\n\n

\n Tirzepatide ba\u015flang\u0131\u00e7ta tip 2 diyabet tedavisi i\u00e7in Mounjaro\u00ae<\/strong> ad\u0131yla kullan\u0131ma girdi. Obezite tedavisindeki etkinli\u011fi g\u00f6sterildikten sonra ise ayn\u0131 etken madde Zepbound\u00ae<\/strong> ad\u0131yla kilo kontrol\u00fc i\u00e7in ruhsatland\u0131r\u0131ld\u0131. Haftada bir kez cilt alt\u0131na uygulan\u0131r ve gastrointestinal yan etkileri azaltmak amac\u0131yla d\u00fc\u015f\u00fck dozdan ba\u015flanarak doz kademeli \u015fekilde art\u0131r\u0131l\u0131r. \n<\/p>\n\n\n\n

\n Tirzepatide’\u0131n kilo verme \u00fczerindeki etkisini g\u00f6steren en \u00f6nemli \u00e7al\u0131\u015fma SURMOUNT-1<\/strong> \u00e7al\u0131\u015fmas\u0131d\u0131r. Diyabeti olmayan, obez veya fazla kilolu 2.539 yeti\u015fkinin kat\u0131ld\u0131\u011f\u0131 bu \u00e7al\u0131\u015fmada tirzepatide 5 mg, 10 mg ve 15 mg dozlar\u0131 plasebo ile kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r. 72 hafta sonunda ortalama kilo kayb\u0131:\n<\/p>\n\n\n\n

5 mg ile yakla\u015f\u0131k %15,<\/strong>\n<\/p>\n\n\n\n

10 mg ile yakla\u015f\u0131k %19.5,<\/strong>\n<\/p>\n\n\n\n

15 mg ile yakla\u015f\u0131k %20.9<\/strong> olarak bulunmu\u015ftur. \n<\/p>\n\n\n\n

\n Plasebo grubundaki ortalama kilo kayb\u0131 ise yaln\u0131zca %3.1 d\u00fczeyinde kalm\u0131\u015ft\u0131r [7]. 15 mg kullanan hastalar\u0131n yakla\u015f\u0131k %57’si ba\u015flang\u0131\u00e7 kilosunun en az %20’sini <\/strong>kaybetmi\u015ftir. Bu, ila\u00e7 tedavisiyle kilo kontrol\u00fcnde daha \u00f6nce \u00e7ok nadir g\u00f6rd\u00fc\u011f\u00fcm\u00fcz bir sonu\u00e7tu [7]. Bu rakamlar\u0131 daha anla\u015f\u0131l\u0131r hale getirirsek, 100 kilogram a\u011f\u0131rl\u0131\u011f\u0131nda bir hastada ortalama %20 kilo kayb\u0131 yakla\u015f\u0131k 20 kilogram<\/strong> anlam\u0131na gelir. Elbette bunlar \u00e7al\u0131\u015fma ortalamalar\u0131d\u0131r; baz\u0131 ki\u015filer \u00e7ok daha fazla, baz\u0131 ki\u015filer ise daha az kilo verir. Ancak tirzepatide ile birlikte farmakolojik obezite tedavisinde %20 ve \u00fczerindeki kilo kayb\u0131 art\u0131k ger\u00e7ek\u00e7i bir hedef haline gelmi\u015ftir.<\/strong>\n<\/p>\n\n\n\n

\n GLP-1 sistemi beyindeki i\u015ftah ve tokluk merkezlerini etkileyerek a\u00e7l\u0131\u011f\u0131 azalt\u0131r ve yemek sonras\u0131nda daha uzun s\u00fcre tok kalmaya yard\u0131mc\u0131 olur. Bunun yan\u0131nda gastrointestinal sistem ve pankreas \u00fczerinden glukoz metabolizmas\u0131n\u0131 d\u00fczenler. GIP resept\u00f6r\u00fcn\u00fcn de sisteme eklenmesi ise metabolik yan\u0131t\u0131 daha kompleks hale getirir. GIP, glukoza ba\u011fl\u0131 ins\u00fclin salg\u0131s\u0131nda \u00f6nemli rol oynar ve ya\u011f dokusu ile merkezi sinir sistemindeki metabolik sinyalleri etkiler.\n<\/p>\n\n\n\n

\n Tirzepatide bu iki sistemi birlikte hedefleyerek:\n<\/p>\n\n\n\n

i\u015ftah\u0131 azalt\u0131r,
tokluk hissini art\u0131r\u0131r,
toplam enerji al\u0131m\u0131n\u0131 azalt\u0131r,
glukoz kontrol\u00fcn\u00fc iyile\u015ftirir ve
ins\u00fclin duyarl\u0131l\u0131\u011f\u0131n\u0131 art\u0131r\u0131r.<\/strong>\n<\/p>\n\n\n\n

\n Bu nedenle tirzepatide kullanan hastalarda yaln\u0131zca kilo kayb\u0131 de\u011fil, bel \u00e7evresi, kan bas\u0131nc\u0131, trigliseridler ve glukoz metabolizmas\u0131 gibi bir\u00e7ok kardiyometabolik parametrede de belirgin iyile\u015fmeler g\u00f6r\u00fclmektedir [7].\n<\/p>\n\n\n\n

\n SURMOUNT-1 \u00e7al\u0131\u015fmas\u0131n\u0131n uzat\u0131lm\u0131\u015f takibinde obezite ve prediyabeti bulunan ki\u015filer yakla\u015f\u0131k \u00fc\u00e7 y\u0131l boyunca<\/strong> takip edilmi\u015ftir. 176 haftal\u0131k tirzepatide tedavisi sonunda kilo kayb\u0131n\u0131n b\u00fcy\u00fck \u00f6l\u00e7\u00fcde devam etti\u011fi g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. En y\u00fcksek dozlarda ortalama kilo kayb\u0131 yakla\u015f\u0131k %23’e yakla\u015fm\u0131\u015ft\u0131r<\/strong> [8].\n<\/p>\n\n\n\n

\n Daha da ilgin\u00e7 olan, ba\u015flang\u0131\u00e7ta prediyabeti bulunan bu ki\u015filerde tip 2 diyabete ilerleme riskinin \u00e7ok ciddi \u015fekilde azalmas\u0131d\u0131r. \u00c7al\u0131\u015fmada tirzepatide alanlarda \u00fc\u00e7 y\u0131ll\u0131k d\u00f6nemde tip 2 diyabet geli\u015fme riski plaseboya g\u00f6re yakla\u015f\u0131k %93 daha d\u00fc\u015f\u00fck <\/strong>bulunmu\u015ftur [8]. \n<\/p>\n\n\n\n

\n Bu sonu\u00e7 tirzepatide’\u0131 sadece bir kilo verme ilac\u0131 olarak g\u00f6rmememizin \u00f6nemli nedenlerinden biridir. Obezitesi ve prediyabeti bulunan bir ki\u015fide ciddi kilo kayb\u0131 sa\u011flamak, ayn\u0131 zamanda diyabete giden metabolik s\u00fcreci de \u00f6nemli \u00f6l\u00e7\u00fcde de\u011fi\u015ftirebilir.\n<\/p>\n\n\n\n

\n Tirzepatide’\u0131n en s\u0131k g\u00f6r\u00fclen yan etkileri yine gastrointestinal sistemle ilgilidir. En s\u0131k bulant\u0131, ishal, kab\u0131zl\u0131k, kusma, erken doyma ve kar\u0131n rahats\u0131zl\u0131\u011f\u0131<\/strong> g\u00f6r\u00fcl\u00fcr. SURMOUNT-1 \u00e7al\u0131\u015fmas\u0131nda gastrointestinal yan etkilerin b\u00fcy\u00fck \u00e7o\u011funlu\u011fu hafif veya orta \u015fiddette<\/strong> olmu\u015f ve \u00f6zellikle doz art\u0131rma d\u00f6nemlerinde g\u00f6r\u00fclm\u00fc\u015ft\u00fcr [7]. Ayn\u0131 zamanda, \u00f6nceki GLP-1 analoglar\u0131na g\u00f6re yan etki g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131n\u0131n ve yan etki \u015fiddetinin \u00e7ok daha az oldu\u011funu s\u00f6ylemek m\u00fcmk\u00fcnd\u00fcr. \n<\/p>\n\n\n\n

\n Tirzepatide’a genellikle 2.5 mg haftal\u0131k<\/strong> dozla ba\u015flanmas\u0131n\u0131n nedeni bu dozun g\u00fc\u00e7l\u00fc bir kilo verme dozu olmas\u0131 de\u011fil, gastrointestinal sistemin ilaca al\u0131\u015fmas\u0131n\u0131 sa\u011flamakt\u0131r. Daha sonra hastan\u0131n tolerans\u0131na ve klinik yan\u0131t\u0131na g\u00f6re doz kademeli \u015fekilde art\u0131r\u0131l\u0131r. Ben burada yine maksimum doza ula\u015fmay\u0131 bir ba\u015far\u0131 kriteri olarak g\u00f6rmem. Bir hasta \u00f6rne\u011fin 5 mg veya 7.5 mg dozda iyi kilo veriyor, i\u015ftah\u0131 kontrol alt\u0131nda ve yan etki ya\u015fam\u0131yorsa, yaln\u0131zca daha y\u00fcksek doza \u00e7\u0131kabiliyoruz diye dozu art\u0131rmak her zaman gerekli de\u011fildir.\n<\/p>\n\n\n\n

\n Semaglutide b\u00f6l\u00fcm\u00fcnde oldu\u011fu gibi tirzepatide i\u00e7in de pankreatit konusu s\u0131k g\u00fcndeme gelmektedir. Ancak mevcut randomize kontroll\u00fc \u00e7al\u0131\u015fmalar ve bunlar\u0131n meta-analizleri tirzepatide’\u0131n akut pankreatit riskini anlaml\u0131 \u015fekilde art\u0131rd\u0131\u011f\u0131n\u0131 g\u00f6stermemektedir.<\/strong> Dokuz randomize \u00e7al\u0131\u015fmada yakla\u015f\u0131k 9.900 hastay\u0131 de\u011ferlendiren bir meta-analizde tirzepatide ile pankreatit riskinde istatistiksel olarak anlaml\u0131 art\u0131\u015f bulunmam\u0131\u015ft\u0131r [11]. Daha yeni analizlerde de benzer \u015fekilde pankreatit olaylar\u0131n\u0131n \u00e7ok nadir oldu\u011fu ve belirgin bir doz-cevap ili\u015fkisi bulunmad\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir. Dolay\u0131s\u0131yla tirzepatide’\u0131 \u201cpankreatit yapan bir ila\u00e7\u201d \u015feklinde tan\u0131mlamak mevcut klinik verilerle uyumlu de\u011fildir. Elbette ge\u00e7mi\u015fte pankreatit ge\u00e7irmi\u015f hastalarda veya \u015fiddetli ve devaml\u0131 kar\u0131n a\u011fr\u0131s\u0131 geli\u015fen ki\u015filerde klinik de\u011ferlendirme gerekir, ancak bu farkl\u0131 bir konudur.\n<\/p>\n\n\n\n

\n Tirzepatide ile ilgili en ilgin\u00e7 geli\u015fmelerden biri de kilo kayb\u0131n\u0131n ba\u015fka obezite ili\u015fkili hastal\u0131klara nas\u0131l yans\u0131d\u0131\u011f\u0131n\u0131 g\u00f6rmeye ba\u015flamam\u0131zd\u0131r. Bunun \u00e7ok g\u00fczel \u00f6rneklerinden biri obstr\u00fcktif uyku apnesidir. <\/strong>SURMOUNT-OSA \u00e7al\u0131\u015fmalar\u0131nda obezitesi ve orta-a\u011f\u0131r derecede obstr\u00fcktif uyku apnesi bulunan ki\u015filerde tirzepatide, yaln\u0131zca v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131n\u0131 azaltmakla kalmam\u0131\u015f; uyku s\u0131ras\u0131nda meydana gelen apne ve hipopne say\u0131s\u0131n\u0131, hipoksik y\u00fck\u00fc ve hs-CRP d\u00fczeylerini de azaltm\u0131\u015ft\u0131r. Ayn\u0131 zamanda sistolik kan bas\u0131nc\u0131nda ve hastalar\u0131n uyku ile ilgili semptomlar\u0131nda da iyile\u015fme g\u00f6r\u00fclm\u00fc\u015ft\u00fcr [12]. \n<\/p>\n\n\n\n

\n Bu \u00e7al\u0131\u015fma obezite tedavisindeki bak\u0131\u015f a\u00e7\u0131s\u0131n\u0131n neden de\u011fi\u015fmesi gerekti\u011fini g\u00fczel g\u00f6steriyor.\n<\/p>\n\n\n\n

\n Ama\u00e7 yaln\u0131zca \u201cKa\u00e7 kilo verdiniz?\u201d <\/strong>de\u011fildir. Ama\u00e7, bu kilo kayb\u0131 ki\u015finin metabolik ve kronik hastal\u0131k riskini ne kadar de\u011fi\u015ftirdi? tarz\u0131 bir d\u00fc\u015f\u00fcncedir.<\/strong>\n<\/p>\n\n\n\n

4- Retatrutide: Bir Sonraki Jenerasyon<\/strong>\n<\/p>\n\n\n\n

\n Retatrutide, kilo verme tedavilerinde \u015fu anda en fazla dikkat \u00e7eken yeni molek\u00fcllerden biridir. Semaglutide yaln\u0131zca GLP-1 resept\u00f6r\u00fcn\u00fc, tirzepatide ise GLP-1 ve GIP resept\u00f6rlerini hedeflerken, retatrutide buna \u00fc\u00e7\u00fcnc\u00fc bir mekanizma daha ekleyerek GLP-1, GIP ve glukagon resept\u00f6rlerini ayn\u0131 anda aktive eder. Bu nedenle retatrutide bir \u201ctriple agonist\u201d, yani \u00fc\u00e7l\u00fc resept\u00f6r agonisti olarak tan\u0131mlanmaktad\u0131r [22].\n<\/p>\n\n\n\n

\n Glukagonun sisteme eklenmesi \u00f6zellikle ilgin\u00e7tir. GLP-1 ve GIP \u00fczerinden i\u015ftah ve glukoz metabolizmas\u0131 kontrol edilirken, glukagon resept\u00f6r\u00fcn\u00fcn aktivasyonu enerji harcamas\u0131 ve ya\u011f metabolizmas\u0131 \u00fczerinde ek etkiler olu\u015fturur. Dolay\u0131s\u0131yla retatrutide yaln\u0131zca ki\u015finin daha az yemesini sa\u011flamay\u0131 de\u011fil, enerji metabolizmas\u0131n\u0131n farkl\u0131 noktalar\u0131n\u0131 ayn\u0131 anda de\u011fi\u015ftirmeyi ama\u00e7layan ve ya\u011f yak\u0131m\u0131n\u0131 daha fazla tetikleyen bir tedavi olarak geli\u015ftirilmi\u015ftir. \n<\/p>\n\n\n\n

\n Retatrutide hen\u00fcz FDA onay\u0131 alm\u0131\u015f bir ila\u00e7 de\u011fildir<\/strong> ve halen ara\u015ft\u0131rma a\u015famas\u0131ndad\u0131r. Ancak Faz 3 program\u0131ndan gelen sonu\u00e7lar olduk\u00e7a g\u00fc\u00e7l\u00fcd\u00fcr ve \u00fcretici firma FDA ba\u015fvurusunu 2027’nin ilk \u00e7eyre\u011finde yapmay\u0131 planlamaktad\u0131r. Dolay\u0131s\u0131yla onay s\u00fcrecinin olumlu sonu\u00e7lanmas\u0131 halinde yak\u0131n gelecekte obezite tedavisindeki se\u00e7enekler aras\u0131na girmesi beklenmektedir.\n<\/p>\n\n\n\n

\n Retatrutide’\u0131n ilk b\u00fcy\u00fck ses getiren sonu\u00e7lar\u0131 2023 y\u0131l\u0131nda New England Journal of Medicine’da yay\u0131mlanan Faz 2 \u00e7al\u0131\u015fmas\u0131ndan geldi. Obezitesi veya fazla kilosu bulunan 338 yeti\u015fkinin dahil edildi\u011fi \u00e7al\u0131\u015fmada retatrutide haftada bir kez farkl\u0131 dozlarda uygulanm\u0131\u015ft\u0131r [22].\n<\/p>\n\n\n\n

\n 48 hafta sonunda ortalama kilo kayb\u0131 8 mg dozunda %22.8, 12 mg dozunda ise %24.2 olarak bulunmu\u015ftur. 12 mg kullanan ki\u015filerin tamam\u0131 ba\u015flang\u0131\u00e7 kilosunun en az %5’ini, %93’\u00fc en az %10’unu ve %83’\u00fc en az %15’ini kaybetmi\u015ftir [22].\n<\/p>\n\n\n\n

\n Belki daha da ilgin\u00e7 olan, 48. haftada kilo kayb\u0131n\u0131n hen\u00fcz plato yapmam\u0131\u015f olmas\u0131d\u0131r. Yani \u00e7al\u0131\u015fma sona erdi\u011finde y\u00fcksek doz kullanan hastalar\u0131n kilo verme e\u011frisi halen a\u015fa\u011f\u0131 do\u011fru devam ediyordu [22]. Bu da daha uzun s\u00fcreli tedavide ne kadar kilo kayb\u0131 elde edilebilece\u011fi sorusunu g\u00fcndeme getirmi\u015ftir.\n<\/p>\n\n\n\n

\n Yan etkiler ise b\u00fcy\u00fck \u00f6l\u00e7\u00fcde bu ila\u00e7 grubundan bekledi\u011fimiz gastrointestinal yan etkiler olmu\u015ftur. Bulant\u0131, ishal, kusma ve kab\u0131zl\u0131k en s\u0131k g\u00f6r\u00fclen \u015fikayetler aras\u0131ndad\u0131r. Bunlar\u0131n \u00e7o\u011fu hafif veya orta \u015fiddette olmu\u015f, daha d\u00fc\u015f\u00fck ba\u015flang\u0131\u00e7 dozu kullan\u0131lmas\u0131 gastrointestinal yan etkilerin azalt\u0131lmas\u0131na yard\u0131mc\u0131 olmu\u015ftur [22].\n<\/p>\n\n\n\n

\n Retatrutide’\u0131n benim i\u00e7in en dikkat \u00e7ekici taraflar\u0131ndan biri ise karaci\u011fer ya\u011flanmas\u0131 \u00fczerindeki etkisidir. Metabolik disfonksiyonla ili\u015fkili ya\u011fl\u0131 karaci\u011fer hastal\u0131\u011f\u0131, yani g\u00fcncel ad\u0131yla MASLD, obezite ve ins\u00fclin direnci ile \u00e7ok yak\u0131ndan ili\u015fkilidir. Karaci\u011ferde biriken ya\u011f zaman i\u00e7erisinde inflamasyona, MASH’a ve baz\u0131 hastalarda fibrozis ve siroza kadar ilerleyebilir.\n<\/p>\n\n\n\n

\n Retatrutide’\u0131n Faz 2 \u00e7al\u0131\u015fmas\u0131n\u0131n \u00f6zel bir alt analizinde, ba\u015flang\u0131\u00e7ta karaci\u011fer ya\u011f oran\u0131 %10 veya \u00fczerinde olan 98 hasta ayr\u0131ca incelenmi\u015ftir. Karaci\u011fer ya\u011f miktar\u0131 MRI tabanl\u0131 y\u00f6ntemlerle \u00f6l\u00e7\u00fclm\u00fc\u015ft\u00fcr [23]. Sadece 24 haftal\u0131k tedaviden sonra karaci\u011fer ya\u011f miktar\u0131 8 mg retatrutide ile ortalama %81.4, 12 mg ile %82.4 oran\u0131nda azalm\u0131\u015ft\u0131r. Plasebo grubunda ise anlaml\u0131 bir de\u011fi\u015fiklik g\u00f6r\u00fclmemi\u015ftir [23].\n<\/p>\n\n\n\n

\n Daha da ilgin\u00e7 olan, 48. haftada 8 mg ve 12 mg kullanan hastalar\u0131n yakla\u015f\u0131k %90’\u0131nda karaci\u011fer ya\u011f oran\u0131n\u0131n %5’in alt\u0131na, yani \u00e7al\u0131\u015fmada normal kabul edilen seviyeye inmi\u015f olmas\u0131d\u0131r [23]. Bu sonu\u00e7 bize retatrutide’\u0131n etkisinin yaln\u0131zca tart\u0131daki kilo kayb\u0131ndan ibaret olmad\u0131\u011f\u0131n\u0131 g\u00f6steriyor. Visseral ya\u011f, ins\u00fclin direnci ve karaci\u011ferdeki ya\u011f depolanmas\u0131 gibi metabolik bozukluklar\u0131n ayn\u0131 anda hedeflenebilmesi, gelecekte bu molek\u00fcl\u00fcn sadece obezite de\u011fil MASLD ve di\u011fer metabolik hastal\u0131klar a\u00e7\u0131s\u0131ndan da \u00f6nemli bir tedavi haline gelme ihtimalini g\u00fcndeme getiriyor.\n<\/p>\n\n\n\n

\n Bu nedenle retatrutide’\u0131n \u00f6nemi sadece \u201cbiraz daha fazla kilo verdirmesi\u201d olmayabilir. E\u011fer devam eden \u00e7al\u0131\u015fmalar ilk sonu\u00e7lar\u0131 do\u011frularsa, obezite, visseral ya\u011flanma, ins\u00fclin direnci ve ya\u011fl\u0131 karaci\u011fer hastal\u0131\u011f\u0131n\u0131 ayn\u0131 metabolik \u00e7er\u00e7eve i\u00e7erisinde hedefleyen yeni jenerasyon tedavilerden biri haline gelebilir.\n<\/p>\n\n\n\n

K\u0131yaslamal\u0131 Kilo Kayb\u0131 Potansiyelleri<\/strong>\n<\/p>\n\n\n\n

A\u015fa\u011f\u0131daki grafik, yap\u0131lan bilimsel \u00e7al\u0131\u015fmalar ile farkl\u0131 zay\u0131flama i\u011fneleri ile elde edilebilen ortalama kilo kayb\u0131n\u0131 g\u00f6stermektedir:<\/strong>\n<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Kilo Kayb\u0131ndan \u00d6te Sa\u011fl\u0131k Kazan\u0131mlar\u0131<\/strong>\n<\/p>\n\n\n\n

\n Semaglutide (Ozempic\u00ae ve Wegovy\u00ae) ile Tirzepatide (Mounjaro\u00ae ve Zepbound\u00ae) <\/strong>adl\u0131 tedavilerin sadece kilo verme i\u00e7in kullan\u0131lmaya ba\u015flanm\u0131\u015f olsalar da, son zamanlarda bu ila\u00e7lar\u0131n kullan\u0131m\u0131 ile birlikte kalp ve damar hastal\u0131klar\u0131 riskinin azald\u0131\u011f\u0131n\u0131, v\u00fccuttaki inflamasyonun azald\u0131\u011f\u0131n\u0131, demans grubu Alzheimer gibi hastal\u0131klarda koruyucu bir rol oynayabilece\u011fini, hatta baz\u0131 kanser vakalar\u0131nda kanserin ilerlemesinde yava\u015flatma g\u00f6revi g\u00f6rebilece\u011fine dair ciddi bilimsel \u00e7al\u0131\u015fmalar gelmeye ba\u015flad\u0131.\n<\/p>\n\n\n\n

\n Ben kend hastalar\u0131mda da bu de\u011fi\u015fimi birebir g\u00f6zlemlemekteyim. Tedavi \u00f6ncesi yap\u0131lan test sonu\u00e7lar\u0131 ve tedavi sonras\u0131 yap\u0131lan test sonu\u00e7lar\u0131 gerek \u015feker metabolizmas\u0131, gerek kolesterol d\u00fczeyleri, gerek inflamasyon marker\u2019lar\u0131 a\u00e7\u0131s\u0131ndan olduk\u00e7a olumlu g\u00f6zlemlenmektedir.\n<\/p>\n\n\n\n

\n Kalp ve damar hastal\u0131klar\u0131 a\u00e7\u0131s\u0131ndan elimizdeki en g\u00fc\u00e7l\u00fc verilerden biri semaglutide ile yap\u0131lan SELECT \u00e7al\u0131\u015fmas\u0131d\u0131r. Bu \u00e7al\u0131\u015fmada diyabeti olmayan ancak fazla kilolu veya obez ve daha \u00f6nce kalp-damar hastal\u0131\u011f\u0131 ge\u00e7irmi\u015f 17.604 ki\u015fi takip edilmi\u015ftir. Semaglutide kullanan grupta kardiyovask\u00fcler \u00f6l\u00fcm, kalp krizi veya inmeden olu\u015fan birle\u015fik kardiyovask\u00fcler sonlan\u0131m riski plaseboya g\u00f6re yakla\u015f\u0131k %20 daha d\u00fc\u015f\u00fck bulunmu\u015ftur [13]. Bu sonu\u00e7 \u00f6zellikle \u00f6nemlidir \u00e7\u00fcnk\u00fc fayda yaln\u0131zca kan \u015fekeri y\u00fcksek diyabet hastalar\u0131nda de\u011fil, diyabeti olmayan obez bireylerde de g\u00f6sterilmi\u015ftir.\n<\/p>\n\n\n\n

\n Bu ila\u00e7lar\u0131n inflamasyon \u00fczerindeki etkileri de giderek daha fazla dikkat \u00e7ekmektedir. Semaglutide ile yap\u0131lan STEP \u00e7al\u0131\u015fmalar\u0131nda ve daha sonraki analizlerde sistemik inflamasyonun en s\u0131k kullan\u0131lan g\u00f6stergelerinden biri olan hs-CRP d\u00fczeylerinde belirgin azalma g\u00f6sterilmi\u015ftir [14,15]. \u00d6rne\u011fin SELECT verilerinde semaglutide ile hs-CRP yakla\u015f\u0131k %38 oran\u0131nda azalm\u0131\u015ft\u0131r. Daha da ilgin\u00e7 olan, bu d\u00fc\u015f\u00fc\u015f\u00fcn yaln\u0131zca kilo kayb\u0131yla a\u00e7\u0131klanamamas\u0131d\u0131r. Semaglutide tedavisiyle baz\u0131 inflamatuvar proteinlerde kilo ve HbA1c de\u011fi\u015fiminden ba\u011f\u0131ms\u0131z de\u011fi\u015fiklikler de g\u00f6sterilmi\u015ftir [16]. Bu nedenle GLP-1 temelli tedavilerin etkisinin yaln\u0131zca \u201ckilo verdikleri i\u00e7in inflamasyon azal\u0131yor\u201d \u015feklinde a\u00e7\u0131klanmas\u0131 giderek yetersiz kalmaktad\u0131r.\n<\/p>\n\n\n\n

\n N\u00f6rodejeneratif hastal\u0131klar konusunda da olduk\u00e7a ilgin\u00e7 sonu\u00e7lar gelmektedir. Tip 2 diyabetli geni\u015f hasta pop\u00fclasyonlar\u0131n\u0131 inceleyen ger\u00e7ek ya\u015fam \u00e7al\u0131\u015fmalar\u0131nda semaglutide kullanan ki\u015filerde ilk kez Alzheimer hastal\u0131\u011f\u0131 tan\u0131s\u0131 alma riskinin, di\u011fer baz\u0131 diyabet ila\u00e7lar\u0131n\u0131 kullananlara k\u0131yasla daha d\u00fc\u015f\u00fck oldu\u011fu bildirilmi\u015ftir [17]. Bir \u00e7al\u0131\u015fmada semaglutide kullanan hastalarda \u00fc\u00e7 y\u0131ll\u0131k takipte Alzheimer tan\u0131s\u0131 alma riski insulin kullananlarla kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda belirgin \u015fekilde daha d\u00fc\u015f\u00fck bulunmu\u015ftur. Daha geni\u015f GLP-1 resept\u00f6r agonisti analizlerinde de demans ve di\u011fer n\u00f6rokognitif hastal\u0131klar\u0131n g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131nda azalma y\u00f6n\u00fcnde sonu\u00e7lar elde edilmi\u015ftir [18,19]. \n<\/p>\n\n\n\n

\n Bunun biyolojik a\u00e7\u0131dan da mant\u0131kl\u0131 olabilecek birka\u00e7 a\u00e7\u0131klamas\u0131 vard\u0131r. GLP-1 resept\u00f6rleri yaln\u0131zca pankreas ve gastrointestinal sistemde bulunmaz; merkezi sinir sisteminde de bulunurlar. GLP-1 sinyalinin n\u00f6roinflamasyon, insulin sinyali, mitokondri fonksiyonu ve sinaptik plastisite gibi Alzheimer hastal\u0131\u011f\u0131nda \u00f6nemli oldu\u011fu d\u00fc\u015f\u00fcn\u00fclen bir\u00e7ok mekanizmay\u0131 etkileyebildi\u011fi g\u00f6sterilmi\u015ftir. Obezite, tip 2 diyabet, vask\u00fcler hastal\u0131k ve kronik inflamasyonun kendileri de demans i\u00e7in \u00f6nemli risk fakt\u00f6rleridir. Dolay\u0131s\u0131yla bu ila\u00e7lar\u0131n ayn\u0131 anda bu risk fakt\u00f6rlerinin birka\u00e7\u0131n\u0131 azalt\u0131yor olmas\u0131, ileride n\u00f6rodejeneratif hastal\u0131klar\u0131n \u00f6nlenmesinde farkl\u0131 bir kullan\u0131m alan\u0131 yaratabilir. \n<\/p>\n\n\n\n

\n Kanser konusunda gelen veriler de dikkat \u00e7ekicidir. Obezite ve hiperins\u00fclinemi; meme, kolorektal, karaci\u011fer ve endometrium kanseri dahil bir\u00e7ok kanser tipiyle ili\u015fkilidir. Dolay\u0131s\u0131yla kilo kayb\u0131, ins\u00fclin direncindeki azalma ve sistemik inflamasyonun d\u00fc\u015fmesi teorik olarak kanser riskini ve t\u00fcm\u00f6r biyolojisini etkileyebilir. Son d\u00f6nemde bu konuda art\u0131k yaln\u0131zca teorik \u00e7al\u0131\u015fmalar de\u011fil, geni\u015f ger\u00e7ek ya\u015fam verileri de gelmeye ba\u015flam\u0131\u015ft\u0131r. 2026 y\u0131l\u0131nda Amerikan Klinik Onkoloji Derne\u011fi’nde sunulan geni\u015f veri analizlerinde GLP-1 resept\u00f6r agonisti kullanan kanser hastalar\u0131nda akci\u011fer, meme, kolorektal ve hepatosel\u00fcler kanserlerde metastatik progresyon riskinin daha d\u00fc\u015f\u00fck oldu\u011fu bildirilmi\u015ftir [20]. \u0130ncelenen yedi kanser tipinin alt\u0131s\u0131nda metastatik ilerlemenin daha d\u00fc\u015f\u00fck oldu\u011fu, d\u00f6rt kanser grubunda ise bu fark\u0131n istatistiksel olarak anlaml\u0131 oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr.\n<\/p>\n\n\n\n

\n Bu bulgular\u0131n olas\u0131 a\u00e7\u0131klamas\u0131 sadece kilo kayb\u0131 de\u011fildir. GLP-1 sinyalinin inflamasyon, ins\u00fclin\/IGF ili\u015fkili b\u00fcy\u00fcme yollar\u0131, imm\u00fcn sistem ve baz\u0131 t\u00fcm\u00f6r h\u00fccrelerinin metabolizmas\u0131 \u00fczerinde do\u011frudan veya dolayl\u0131 etkileri olabilece\u011fi ara\u015ft\u0131r\u0131lmaktad\u0131r. Laboratuvar ve hayvan \u00e7al\u0131\u015fmalar\u0131nda baz\u0131 kanser modellerinde GLP-1 resept\u00f6r aktivasyonunun t\u00fcm\u00f6r b\u00fcy\u00fcmesi ve metastazla ili\u015fkili mekanizmalar\u0131 bask\u0131layabilece\u011fine dair veriler bulunmaktad\u0131r [21]. \n<\/p>\n\n\n\n

\n Tabii ki daha geni\u015f kapsaml\u0131 ve daha uzun soluklu \u00e7al\u0131\u015fmalar\u0131 beklemek uygun olacakt\u0131r fakat ilk ba\u015flarda insanlar\u0131n kafas\u0131nda olan \u201cuzun vadede bu i\u011fneler bana zarar verir mi?\u201d g\u00f6r\u00fc\u015f\u00fc, yava\u015f yava\u015f \u201cbu i\u011fnelerin kullan\u0131m\u0131n\u0131 ba\u015fka rahats\u0131zl\u0131klarda da d\u00fc\u015f\u00fcnmeli miyiz?\u201d sorusuna b\u0131rak\u0131yor.\n<\/p>\n\n\n\n

\n Asl\u0131nda bu de\u011fi\u015fim \u00e7ok \u00f6nemli. Semaglutide ve tirzepatide art\u0131k yaln\u0131zca tart\u0131daki rakam\u0131 azaltan ila\u00e7lar olarak ara\u015ft\u0131r\u0131lm\u0131yor. Kardiyovask\u00fcler hastal\u0131k, kronik inflamasyon, karaci\u011fer hastal\u0131\u011f\u0131, uyku apnesi, diyabetin \u00f6nlenmesi, n\u00f6rodejeneratif hastal\u0131klar ve hatta kanser biyolojisi gibi \u00e7ok farkl\u0131 alanlarda bu ila\u00e7lar\u0131n potansiyel etkileri ara\u015ft\u0131r\u0131l\u0131yor. Belki de \u00f6n\u00fcm\u00fczdeki y\u0131llarda bu ila\u00e7lara yaln\u0131zca \u201czay\u0131flama i\u011fneleri\u201d<\/strong> demek olduk\u00e7a yetersiz kalacakt\u0131r.\n<\/p>\n\n\n\n

Why Should I Get Tested Before I Start?<\/strong>\n<\/p>\n\n\n\n

\n Tedaviye ba\u015flamadan \u00f6nce baz\u0131 testlerin yap\u0131lmas\u0131 gerekir. Bunun amac\u0131 yaln\u0131zca ki\u015finin ilac\u0131 kullanmaya uygun olup olmad\u0131\u011f\u0131n\u0131 de\u011ferlendirmek de\u011fil, ayn\u0131 zamanda kilo probleminin alt\u0131nda yatan metabolik veya hormonal nedenleri ara\u015ft\u0131rmak, olas\u0131 risk fakt\u00f6rlerini belirlemek ve tedavi \u00f6ncesinde kar\u015f\u0131la\u015ft\u0131rabilece\u011fimiz bir ba\u015flang\u0131\u00e7 noktas\u0131 olu\u015fturmakt\u0131r.\n<\/p>\n\n\n\n

\n \u00d6rne\u011fin a\u00e7l\u0131k glukozu, HbA1c ve a\u00e7l\u0131k ins\u00fclini bize glukoz metabolizmas\u0131 ve ins\u00fclin direnci hakk\u0131nda bilgi verirken; karaci\u011fer ve b\u00f6brek fonksiyon testleri tedavi \u00f6ncesinde genel metabolik durumu de\u011ferlendirmemize yard\u0131mc\u0131 olur. Lipid profili, tiroid fonksiyonlar\u0131 ve gerekli durumlarda di\u011fer hormonal testler de de\u011ferlendirmeye eklenebilir. \u00d6zellikle karaci\u011fer ya\u011flanmas\u0131, prediyabet, ins\u00fclin direnci veya lipid bozuklu\u011fu bulunan ki\u015filerde bu de\u011ferleri tedavi \u00f6ncesinde bilmek \u00f6nemlidir. \u00c7\u00fcnk\u00fc ba\u015far\u0131l\u0131 bir tedaviyi sadece \u201cka\u00e7 kilo verildi?\u201d sorusuyla de\u011fil, ki\u015finin metabolik sa\u011fl\u0131\u011f\u0131nda ne kadar iyile\u015fme sa\u011fland\u0131\u011f\u0131yla da de\u011ferlendirmek gerekir.\n<\/p>\n\n\n\n

\n Ayn\u0131 zamanda, sadece ilaca ba\u015flay\u0131p ba\u015flamamak de\u011fil, hatta \u00f6ncesi ve sonras\u0131n\u0131 k\u0131yaslamak de\u011fil, ayn\u0131 zamanda hastan\u0131n ba\u015fka bir risk fakt\u00f6r\u00fc mevcut ise, onun da giderilmesini sa\u011flamakt\u0131r. Hasta sadece kilo verme amac\u0131 ile gelmi\u015f olabilir. Ama benim amac\u0131m hastay\u0131 ba\u015flang\u0131\u00e7 noktas\u0131ndan daha sa\u011fl\u0131kl\u0131 bir noktaya ta\u015f\u0131makt\u0131r. Bu sebeple tedaviye ba\u015flamadan \u00f6nce mutlaka kapsaml\u0131 bir test paneli isterim. Bu panelin i\u00e7erisinde:\n<\/p>\n\n\n\n

\n 1. Kan \u015eekeri Testleri (AK\u015e, ins\u00fclin, Homa-IR ve HbA1c)<\/strong>: It is done to evaluate current blood sugar levels and long-term blood sugar control. In addition, the person's insulin resistance is evaluated.\n<\/p>\n\n\n\n

\n 2. B\u00f6brek Fonksiyon Testleri (Kreatinin, BUN ve Elektrolitler)<\/strong>: B\u00f6brek fonksiyonlar\u0131n\u0131 anlamam\u0131za ve hastan\u0131n elektrolit dengesine bakmam\u0131za ve belli ba\u015fl\u0131 risklerin \u00fczerine gidebilmemize yard\u0131mc\u0131 olur.\n<\/p>\n\n\n\n

3. Karaci\u011fer Fonksiyon Testleri (ALT, AST, GGT, ALP ve Total Bilirubin):<\/strong> Tedavi \u00f6ncesinde karaci\u011fer ve safra yollar\u0131n\u0131n genel durumunu de\u011ferlendirmek, \u00f6zellikle obezite ve ins\u00fclin direnciyle s\u0131k birlikte g\u00f6r\u00fclen karaci\u011fer ya\u011flanmas\u0131 (MASLD) a\u00e7\u0131s\u0131ndan ba\u015flang\u0131\u00e7 de\u011ferlerini belirlemek i\u00e7in \u00f6nemlidir. ALT ve AST daha \u00e7ok karaci\u011fer h\u00fccrelerindeki hasar hakk\u0131nda bilgi verirken, GGT, ALP ve bilirubin safra yollar\u0131 ve karaci\u011ferin safra at\u0131l\u0131m\u0131 hakk\u0131nda tamamlay\u0131c\u0131 bilgiler sa\u011flar. Bu testlerdeki anormallikler gerekti\u011finde karaci\u011fer ultrasonu veya daha ileri incelemelerin yap\u0131lmas\u0131na da yard\u0131mc\u0131 olabilir.\n<\/p>\n\n\n\n

4. Tiroid Fonksiyon Testleri (TSH, fT4, Anti-Tg ve Anti-TPO):<\/strong> Tedavi \u00f6ncesinde tiroid fonksiyonlar\u0131n\u0131 de\u011ferlendirmek ve ki\u015finin Hashimoto tiroiditi, hipotiroidi veya ba\u015fka bir tiroid hastal\u0131\u011f\u0131 olup olmad\u0131\u011f\u0131n\u0131 anlamak \u00f6nemlidir. \u00c7\u00fcnk\u00fc tiroid fonksiyon bozukluklar\u0131 metabolizma, enerji d\u00fczeyi ve kilo kontrol\u00fcn\u00fc do\u011frudan etkileyebilir. Hashimoto veya di\u011fer yayg\u0131n tiroid hastal\u0131klar\u0131n\u0131n bulunmas\u0131 semaglutide veya tirzepatide kullan\u0131m\u0131na tek ba\u015f\u0131na engel de\u011fildir ve tiroid fonksiyonlar\u0131 uygun \u015fekilde takip edilerek bu tedaviler kullan\u0131labilir. Buradaki ama\u00e7 GLP-1 tedavisinden ka\u00e7\u0131nmak de\u011fil, kilo problemini etkileyebilecek e\u015flik eden bir tiroid hastal\u0131\u011f\u0131n\u0131 tespit etmek ve tedaviyi ki\u015finin genel metabolik durumuna g\u00f6re planlamakt\u0131r.\n<\/p>\n\n\n\n

5. Pankreas Enzimleri (Amilaz ve Lipaz):<\/strong> Amilaz ve \u00f6zellikle lipaz d\u00fczeyleri pankreas hakk\u0131nda ek bilgi sa\u011flayabilir ve ki\u015finin bilinen veya \u015f\u00fcphelenilen bir pankreas hastal\u0131\u011f\u0131 varsa tedavi \u00f6ncesinde de\u011ferlendirmeye dahil edilebilir. Ancak semaglutide veya tirzepatide ba\u015flanacak her hastada pankreatit riskini \u00f6ng\u00f6rmek amac\u0131yla rutin olarak bu enzimlerin \u00f6l\u00e7\u00fclmesi gerekli de\u011fildir. Klinik \u00f6yk\u00fc, daha \u00f6nce ge\u00e7irilmi\u015f pankreatit, safra ta\u015f\u0131 \u00f6yk\u00fcs\u00fc, a\u015f\u0131r\u0131 trigliserid y\u00fcksekli\u011fi ve mevcut kar\u0131n a\u011fr\u0131s\u0131 gibi risk fakt\u00f6rlerinin de\u011ferlendirilmesi daha anlaml\u0131d\u0131r.\n<\/p>\n\n\n\n

6. Lipid Profili (Total Kolesterol, LDL, HDL, Trigliserid, ApoB ve Lp(a)):<\/strong> Kilo problemi olan ki\u015filerde ins\u00fclin direnci, y\u00fcksek trigliserid, d\u00fc\u015f\u00fck HDL ve di\u011fer lipid bozukluklar\u0131 s\u0131k g\u00f6r\u00fclebildi\u011fi i\u00e7in tedavi \u00f6ncesinde lipid profilinin ayr\u0131nt\u0131l\u0131 olarak de\u011ferlendirilmesi \u00f6nemlidir. Ben standart lipid paneline ek olarak ApoB ve Lp(a) d\u00fczeylerini de rutin olarak de\u011ferlendirmeyi tercih ederim. ApoB, dola\u015f\u0131mdaki aterojenik lipoprotein par\u00e7ac\u0131klar\u0131n\u0131n toplam say\u0131s\u0131 hakk\u0131nda LDL kolesterolden farkl\u0131 ve tamamlay\u0131c\u0131 bilgi verir ve kardiyovask\u00fcler riskin daha do\u011fru de\u011ferlendirilmesine yard\u0131mc\u0131 olur. Lp(a) ise b\u00fcy\u00fck \u00f6l\u00e7\u00fcde genetik olarak belirlenen, klasik lipid panelinde g\u00f6r\u00fclmeyen ve y\u00fcksek oldu\u011funda kalp-damar hastal\u0131\u011f\u0131 riskini ba\u011f\u0131ms\u0131z olarak art\u0131rabilen \u00f6nemli bir risk fakt\u00f6r\u00fcd\u00fcr. Bu nedenle yaln\u0131zca LDL de\u011ferine bakmak yerine ki\u015finin ba\u015flang\u0131\u00e7taki lipid ve kardiyovask\u00fcler risk profilini daha geni\u015f bir \u00e7er\u00e7evede de\u011ferlendirmeyi tercih ederim. Kilo kayb\u0131 ve metabolik sa\u011fl\u0131ktaki iyile\u015fmeyle birlikte lipid profilindeki de\u011fi\u015fiklikleri takip etmek de tedavinin tart\u0131 d\u0131\u015f\u0131ndaki faydalar\u0131n\u0131 g\u00f6rmemize yard\u0131mc\u0131 olur.\n<\/p>\n\n\n\n

7. Vitamin D\u00fczeyleri (D vitamini, B12 ve folat)<\/strong>\n<\/p>\n\n\n\n

\n Tedavi \u00f6ncesinde s\u0131k g\u00f6r\u00fclen vitamin eksikliklerini tespit etmek ve gerekiyorsa tedaviye ba\u015flamadan veya tedavi s\u0131ras\u0131nda bunlar\u0131 d\u00fczeltmek amac\u0131yla de\u011ferlendirilir. Semaglutide ve tirzepatide i\u015ftah\u0131 ve toplam besin al\u0131m\u0131n\u0131 belirgin \u015fekilde azaltabildi\u011fi i\u00e7in, \u00f6zellikle uzun s\u00fcreli tedavilerde yeterli mikrobesin al\u0131m\u0131na dikkat etmek \u00f6nemlidir. D vitamini d\u00fczeyi kemik, kas ve genel metabolik sa\u011fl\u0131k a\u00e7\u0131s\u0131ndan; B12 ve folat ise kan yap\u0131m\u0131, sinir sistemi ve h\u00fccresel fonksiyonlar a\u00e7\u0131s\u0131ndan \u00f6nem ta\u015f\u0131r. Ba\u015flang\u0131\u00e7ta mevcut olan eksikliklerin bilinmesi, kilo verme s\u00fcrecinde geli\u015febilecek beslenme yetersizliklerinin \u00f6n\u00fcne ge\u00e7ilmesine ve gerekti\u011finde ki\u015fiye uygun destek planlanmas\u0131na yard\u0131mc\u0131 olur.\n<\/p>\n\n\n\n

\n E\u011fer bu testlerde biz bozukluk g\u00f6zlemlenirse, daha ileri tetkikler de istenebilir.\n<\/p>\n\n\n\n

\n ***\n<\/p>\n\n\n\n

\n Burada yer alan t\u00fcm bilgiler yaln\u0131zca genel bilgilendirme ve e\u011fitim amac\u0131yla sunulmaktad\u0131r. Bu i\u00e7erikler herhangi bir hastal\u0131\u011f\u0131n tan\u0131s\u0131n\u0131 koymak, ki\u015fiye \u00f6zel t\u0131bbi de\u011ferlendirme yapmak veya herhangi bir tedaviyi ba\u015flatmak, de\u011fi\u015ftirmek ya da sonland\u0131rmak amac\u0131 ta\u015f\u0131mamaktad\u0131r.\n<\/p>\n\n\n\n

\n Sunulan bilgiler, hekim muayenesinin, ki\u015fisel t\u0131bbi de\u011ferlendirmenin veya profesyonel sa\u011fl\u0131k hizmetinin yerine ge\u00e7mez. Sa\u011fl\u0131k durumlar\u0131 ve tedavi gereksinimleri ki\u015fiden ki\u015fiye farkl\u0131l\u0131k g\u00f6sterebilece\u011finden, herhangi bir ila\u00e7, takviye, tedavi veya t\u0131bbi uygulamaya ba\u015flamadan ya da mevcut tedavinizde de\u011fi\u015fiklik yapmadan \u00f6nce kendi hekiminize veya ilgili sa\u011fl\u0131k profesyoneline dan\u0131\u015fman\u0131z \u00f6nerilir.\n<\/p>\n\n\n\n

\n T\u0131bbi bilgiler ve bilimsel veriler zaman i\u00e7erisinde de\u011fi\u015febilece\u011finden, burada sunulan bilgilerin her birey veya her klinik durum i\u00e7in ge\u00e7erli oldu\u011fu kabul edilmemelidir.\n<\/p>\n\n\n\n

\n I wish you healthy days,\n<\/p>\n\n\n\n


Dr. Ahmet \u00d6zyi\u011fit<\/strong>, MD, MSc, PgDip, FAAMM, ABAARM
Longevity Physician<\/p>\n\n\n\n

\n Elite Research and Surgical Hospital\n<\/p>\n\n\n\n

<\/div>\n\n\n\n

Kaynaklar<\/strong>\n<\/p>\n\n\n\n

\n 1. Pi-Sunyer X, Astrup A, Fujioka K, et al. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management.<\/em> New England Journal of Medicine. 2015;373:11-22. DOI: 10.1056\/NEJMoa1411892 \n<\/p>\n\n\n\n

\n 2. Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity.<\/em> New England Journal of Medicine. 2021;384:989-1002. DOI: 10.1056\/NEJMoa2032183. \n<\/p>\n\n\n\n

\n 3. Garvey WT, Batterham RL, Bhatta M, et al. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial.<\/em> Nature Medicine. 2022;28:2083-2091. DOI: 10.1038\/s41591-022-02026-4. \n<\/p>\n\n\n\n

\n 4. Rubino DM, Greenway FL, Khalid U, et al. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8 Randomized Clinical Trial.<\/em> JAMA. 2022;327:138-150.\n<\/p>\n\n\n\n

5.<\/strong> Masson W, Lobo M, Barbagelata L, et al. Acute pancreatitis due to different semaglutide regimens: An updated meta-analysis. Endocrinolog\u00eda, Diabetes y Nutrici\u00f3n. 2024. DOI: 10.1016\/j.endien.2024.03.012<\/strong>. \n<\/p>\n\n\n\n

6.<\/strong> Kushner RF, Ryan DH, Deanfield J, et al. Safety profile of semaglutide versus placebo in the SELECT study: a randomized controlled trial. Obesity. 2025;33:452\u2013462. DOI: 10.1002\/oby.24222<\/strong>.\n<\/p>\n\n\n\n

7.<\/strong> Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity. New England Journal of Medicine. 2022;387:205-216. DOI: 10.1056\/NEJMoa2206038<\/strong>. \n<\/p>\n\n\n\n

8.<\/strong> Jastreboff AM, le Roux CW, Stefanski A, et al. Tirzepatide for Obesity Treatment and Diabetes Prevention. New England Journal of Medicine. 2025;392:958-971. DOI: 10.1056\/NEJMoa2410819<\/strong>. \n<\/p>\n\n\n\n

9.<\/strong> Aronne LJ, Sattar N, Horn DB, et al. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA. 2024;331:38-48. DOI: 10.1001\/jama.2023.24945<\/strong>.\n<\/p>\n\n\n\n

10.<\/strong> Tong K, et al. Gastrointestinal adverse events of tirzepatide in the treatment of type 2 diabetes mellitus: a meta-analysis and trial sequential analysis. Medicine. 2023.\n<\/p>\n\n\n\n

11.<\/strong> Zeng Q, Xu J, Mu X, et al. Safety issues of tirzepatide (pancreatitis and gallbladder or biliary disease) in type 2 diabetes and obesity: a systematic review and meta-analysis. Frontiers in Endocrinology. 2023;14:1214334. DOI: 10.3389\/fendo.2023.1214334<\/strong>.\n<\/p>\n\n\n\n

12.<\/strong> Malhotra A, Grunstein RR, Fietze I, et al. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. New England Journal of Medicine. 2024;391:1193-1205. DOI: 10.1056\/NEJMoa2404881<\/strong>.\n<\/p>\n\n\n\n

\n 13. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes.<\/em> New England Journal of Medicine. 2023;389:2221-2232. DOI: 10.1056\/NEJMoa2307563.\n<\/p>\n\n\n\n

\n 14. Verma S, et al. Effects of once-weekly semaglutide 2.4 mg on C-reactive protein in adults with overweight or obesity: Exploratory analyses of STEP 1, STEP 2, and STEP 3.<\/em> eClinicalMedicine. 2023.\n<\/p>\n\n\n\n

\n 15. Mosenzon O, et al. Impact of semaglutide on high-sensitivity C-reactive protein: exploratory patient-level analyses of SUSTAIN and PIONEER randomized clinical trials.<\/em> Cardiovascular Diabetology. 2022.\n<\/p>\n\n\n\n

\n 16. Maretty L, et al. Proteomic changes upon treatment with semaglutide in people with obesity.<\/em> Nature Medicine. 2025. DOI: 10.1038\/s41591-024-03355-2. \n<\/p>\n\n\n\n

\n 17. Wang W, et al. Associations of semaglutide with first-time diagnosis of Alzheimer’s disease in patients with type 2 diabetes: Target trial emulation using nationwide real-world data in the US.<\/em> Alzheimer’s & Dementia. 2024. DOI: 10.1002\/alz.14313. \n<\/p>\n\n\n\n

\n 18. Cheng HW, et al. Impact of Glucagon-Like Peptide-1 Receptor Agonists on Dementia Risk in Patients With Type 2 Diabetes Mellitus.<\/em> 2025. \n<\/p>\n\n\n\n

\n 19. Xie Y, et al. Mapping the effectiveness and risks of GLP-1 receptor agonists.<\/em> Nature Medicine. 2025. \n<\/p>\n\n\n\n

\n 20. Orland MD, et al. Can GLP-1 receptor agonists mitigate cancer progression? A real-world analysis across obesity-associated malignancies.<\/em> Journal of Clinical Oncology. 2026;44(Suppl):3143. DOI: 10.1200\/JCO.2026.44.16_suppl.3143.\n<\/p>\n\n\n\n

\n 21. Temperley HC, et al. Metabolic Modulation in Cancer Care: The Potential Role of GLP-1 Receptor Agonists.<\/em> Journal of Clinical Oncology. 2026. DOI: 10.1200\/JCO-26-00062. \n<\/p>\n\n\n\n

\n 22. Jastreboff AM, Kaplan LM, Fr\u00edas JP, et al. Triple-Hormone-Receptor Agonist Retatrutide for Obesity \u2014 A Phase 2 Trial.<\/em> New England Journal of Medicine. 2023;389:514-526. DOI: 10.1056\/NEJMoa2301972. \n<\/p>\n\n\n\n

\n 23. Sanyal AJ, et al. Triple hormone receptor agonist retatrutide for metabolic dysfunction-associated steatotic liver disease: a randomized phase 2a trial.<\/em> Nature Medicine. 2024;30:2037-2048. \n<\/p>","protected":false},"excerpt":{"rendered":"

Zay\u0131flama \u0130\u011fneleri (Ozempic, Mounjaro) Kilo vermek kendi i\u00e7erisinde bir hedef de\u011fil, daha sa\u011fl\u0131kl\u0131 bir ya\u015fam i\u00e7in bir ara\u00e7 olarak g\u00f6r\u00fclmelidir. Kilo fazlas\u0131 olan ki\u015filerin kardiyovask\u00fcler risklerinin daha y\u00fcksek oldu\u011fu, tip 2 diyabet ve metabolik sendrom gibi sa\u011fl\u0131k sorunlar\u0131n\u0131n daha s\u0131k g\u00f6r\u00fcld\u00fc\u011f\u00fc bilinen bir ger\u00e7ektir. Kilo verirken g\u00f6r\u00fcnt\u00fcm\u00fcz\u00fcn g\u00fczelle\u015fmesinin yan\u0131 s\u0131ra, biyolojik ve fizyolojik y\u00f6nden de […]<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-6210","page","type-page","status-publish","hentry"],"blocksy_meta":[],"_links":{"self":[{"href":"https:\/\/www.ahmetozyigit.com\/en\/wp-json\/wp\/v2\/pages\/6210","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ahmetozyigit.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ahmetozyigit.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ahmetozyigit.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ahmetozyigit.com\/en\/wp-json\/wp\/v2\/comments?post=6210"}],"version-history":[{"count":6,"href":"https:\/\/www.ahmetozyigit.com\/en\/wp-json\/wp\/v2\/pages\/6210\/revisions"}],"predecessor-version":[{"id":6220,"href":"https:\/\/www.ahmetozyigit.com\/en\/wp-json\/wp\/v2\/pages\/6210\/revisions\/6220"}],"wp:attachment":[{"href":"https:\/\/www.ahmetozyigit.com\/en\/wp-json\/wp\/v2\/media?parent=6210"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}