Uso de injeções lipolíticas com desoxicolato de sódio em depósitos de gordura: contexto histórico e atual
DOI:
https://doi.org/10.33233/fb.v18i3.1062Abstract
Desde a primeira publicação a respeito, em 2001, injeções lipolíticas para gordura localizada tornou-se um procedimento amplamente utilizado na clínica. Consiste de múltiplas injeções subcutâneas de compostos lipolíticos, que podem ter diversos mecanismos de ação. O fármaco mais utilizado atualmente, o desoxicolato de sódio, foi descoberto por acaso, em uma associação com fosfatidilcolina em que sua única função era de veículo da fórmula. Conforme estudos foram sendo realizados, concluiu-se que a ação no tecido era devido ao desoxicolato, um sal biliar que emulsiona os lipídios da membrana celular, resultando em lise do adipócito e consequente necrose do tecido adiposo. Seus principais efeitos adversos, muito frequentemente relatados, incluem dor intensa, edema e formação de nódulos fibrosos nos pontos aplicados. Em decorrência de falhas na aplicação, alguns efeitos adversos mais graves podem ocorrer, como injúria do nervo facial e infecções persistentes. Apesar destes, a utilização de desoxicolato de sódio na camada subcutânea apresenta resultados muito positivos, como publicado em diversos ensaios clínicos, inclusive com relação í satisfação do paciente perante o desfecho final, sendo, portanto, uma boa escolha de técnica para contorno corporal e diminuição de depósitos de gordura localizados.
Palavras-chave: injeções lipolíticas, gordura localizada, desoxicolato de sódio, fosfatidilcolina.
References
Rittes PG. The use of phosphatidylcholine for correction of lower lid bulging due to prominent fat pads. Dermatol Surg 2001;27(4):391-2.
Rittes PG. The use of phosphatidylcholine for correction of localized fat deposits. Aesthetic Plast Surg 2003;27(4):315-8.
Hexsel D, Serra M, Mazzuco R, Dal'Forno T, Zechmeister D. Phosphatidylcholine in the treatment of localized fat. J Drugs Dermatol 2003;2(5):511-8.
Ablon G, Rotunda AM. Treatment of lower eyelid fat pads using phosphatidylcholine: clinical trial and review. Dermatol Surg 2004;30(3):422-7.
Duncan DI, Hasengschwandtner F. Lipodissolve for subcutaneous fat reduction and skin retraction. Aesthet Surg J 2005;25(5):530-43.
Rotunda AM, Suzuki H, Moy RL, Kolodney MS. Detergent effects of sodium deoxycholate are a major feature of an injectable phosphatidylcholine formulation used for localized fat dissolution. Dermatol Surg 2004;30(7):1001-8.
Duncan D, Rubin JP, Golitz L, Badylak S, Kesel L, Freund J et al. Refinement of technique in injection lipolysis based on scientific studies and clinical evaluation. Clin Plast Surg 2009;36(2):195-209.
Hasengschwandtner F. Phosphatidylcholine treatment to induce lipolysis. J Cosmet Dermatol 2005;4(4):308-13.
Brown SA. The science of mesotherapy: chemical anarchy. Aesthet Surg J 2006;26(1):95-8.
Rose PT, Morgan M. Histological changes associated with mesotherapy for fat dissolution. J Cosmet Laser Ther 2005;7(1):17-9.
Salti G, Ghersetich I, Tantussi F, Bovani B, Lotti T. Phosphatidylcholine and sodium deoxycholate in the treatment of localized fat: a double-blind, randomized study. Dermatol Surg 2008;34(1):60-6.
Hubner NF, Horch RE, Polykandriotis E, Rau TT, Dragu A. A histopathologic and immunohistochemical study on liquification of human adipose tissue ex vivo. . Aesthetic Plast Surg 2014;38(5):976-84.
Noh Y, Heo CY. The effect of phosphatidylcholine and deoxycholate compound injections to the localized adipose tissue: an experimental study with a murine model. Arch Plast Surg 2012;39(5):452-6.
Bechara FG, Sand M, Hoffmann K, Sand D, Altmeyer P, Stucker M. Fat tissue after lipolysis of lipomas: a histopathological and immunohistochemical study. J Cutan Pathol 2007;34(7):552-7.
Rittes PG, Rittes JC, Carriel Amary MF. Injection of phosphatidylcholine in fat tissue: experimental study of local action in rabbits. Aesthetic Plast Surg 2006;30(4):474-8.
Bechara FG, Skrygan M, Kreuter A, Altmeyer P, Gambichler T. Cytokine mRNA levels in human fat tissue after injection lipolysis with phosphatidylcholine and deoxycholate. Arch Dermatol Res 2008;300(8):455-9.
Wollina U, Goldman A. ATX-101 for reduction of submental fat. Expert Opin Pharmacother 2015;16(5):755-62.
Reeds DN, Mohammed BS, Klein S, Boswell CB, Young VL. Metabolic and structural effects of phosphatidylcholine and deoxycholate injections on subcutaneous fat: a randomized, controlled trial. Aesthet Surg J 2013;33(3):400-8.
Gupta A, Lobocki C, Singh S, Robertson M, Akadiri OA, Malhotra G et al. Actions and comparative efficacy of phosphatidylcholine formulation and isolated sodium deoxycholate for different cell types. Aesthetic Plast Surg 2009;33(3):346-52.
Thuangtong R, Bentow JJ, Knopp K, Mahmood NA, David NE, Kolodney MS. Tissue-selective effects of injected deoxycholate. Dermatol Surg 2010;36(6):899-90.
Klein SM, Schreml S, Nerlich M, Prantl L. In vitro studies investigating the effect of subcutaneous phosphatidylcholine injections in the 3T3-L1 adipocyte model: lipolysis or lipid dissolution? Plast Reconstr Surg 2009;124(2):419-27.
Walker P, Lee D. A phase 1 pharmacokinetic study of ATX-101: serum lipids and adipokines following synthetic deoxycholic acid injections. J Cosmet Dermatol 2015;14(1):33-9.
Tawfik HA, Zuel-Fakkar N, Elmarasy R, Talib N, Elsamkary M, Abdallah MA. Phosphatidylcholine for the treatment of prominent lower eyelid fat pads: a pilot study. Ophthal Plast Reconstr Surg 2011;27(3):147-51.
Kopera D, Horejsi R, Werner S, Moeller R. Injection lipolysis for reduction of saddlebag trochanteric bulges--half-side controlled pilot study. J Dtsch Dermatol Ges 2008;6(4):287-90.
Co AC, Abad-Casintahan MF, Espinoza-Thaebtharm A. Submental fat reduction by mesotherapy using phosphatidylcholine alone vs. phosphatidylcholine and organic silicium: a pilot study. J Cosmet Dermatol 2007;6(4):250-7.
Rzany B, Griffiths T, Walker P, Lippert S, McDiarmid J, Havlickova B. Reduction of unwanted submental fat with ATX-101 (deoxycholic acid), an adipocytolytic injectable treatment: results from a phase III, randomized, placebo-controlled study. Br J Dermatol 2014;170(2):445-53.
Ascher B, Hoffmann K, Walker P, Lippert S, Wollina U, Havlickova B. Efficacy, patient-reported outcomes and safety profile of ATX-101 (deoxycholic acid), an injectable drug for the reduction of unwanted submental fat: results from a phase III, randomized, placebo-controlled study. J Eur Acad Dermatol Venereol 2014;28(12):1707-15.
McDiarmid J, Ruiz JB, Lee D, Lippert S, Hartisch C, Havlickova B. Results from a pooled analysis of two European, randomized, placebo-controlled, phase 3 studies of ATX-101 for the pharmacologic reduction of excess submental fat. Aesthetic Plast Surg 2014;38(5):849-6.
Jones DH, Carruthers J, Joseph JH, Callender VD, Walker P, Lee DR et al. REFINE-1, a multicenter, randomized, double-blind, placebo-controlled, Phase 3 Trial With ATX-101, an injectable drug for submental fat reduction. Dermatol Surg 2016;42(1):38-49.
Duncan DI, Chubaty R. Clinical safety data and standards of practice for injection lipolysis: a retrospective study. Aesthet Surg 2006;26(5):575-85.
Rittes PG. The lipodissolve technique: clinical experience. Clin Plast Surg 2009;36(2):215-21.
Kythera Biopharmaceuticals I. ATX-101 (Deoxycholic Acid) Injection: Food and Drug Administration; 2015 [22/04/16]. Available from: http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/DermatologicandOphthalmicDrugsAdvisoryCommittee/UCM436604.pdf.
Park EJ, Kim HS, Kim M, Oh HJ. Histological changes after treatment for localized fat deposits with phosphatidylcholine and sodium deoxycholate. J Cosmet Dermatol 2013;12(3):240-3.
Di Toro G, Rauso R. Skin Necrosis Following Adipocitolitic Solution Injections. Aesthet Surg J 2016;36(2):NP74-6.
ANVISA. Medicamento Lipostabil não possui registro no Brasil 2002. [citado 2016 abr 3]. DisponÃvel em URL: http://www.anvisa.gov.br/divulga/noticias/2002/301202.htm.
ANVISA. Anvisa esclarece situação do “Lipostabil brasileiro†2005. [citado 2016 abr 3]. DisponÃvel em URL: http://www.anvisa.gov.br/divulga/noticias/2005/191005.htm.
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