Phentermine/Topiramate for the Treatment of Adolescent Obesity

Kelly, Aaron S.; Bensignor, Megan O; Hsia, Daniel S.; Shoemaker, Ashley H.; Shih, Winnie; Peterson, Craig A.; Varghese, Santosh T.

doi:10.1056/evidoa2200014

Cited by 90 publications

(86 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The mean BMI reduction was 7.1% for top-dose and 4.8% for mid-dose compared to a gain of 3.3% in the placebo group ( 40 ). About 31% of participants receiving mid-dose and 42.5% receiving top-dose PHN/TPM compared to 0% receiving placebo reduced their BMI by ≥ 10% over one year ( 40 ). Triglycerides significantly decreased by 12% with both mid-dose and top-dose compared to a 8% increase with placebo ( 40 ).…”

Section: Anti-obesity Medication Optionsmentioning

confidence: 96%

“…Currently, there are no published pediatric trials of PHN/TPM in adolescents with T2DM. However, a randomized placebo-controlled trial (RCT) randomized 223 adolescents (mean age of 14.0 years) with a mean BMI of 37.8 kg/m 2 1:1:2 to either placebo, mid-dose PHEN/TPM (7.5 mg/46 mg), and top-dose PHEN/TPM (15 mg/92 mg) ( 40 ). The mean BMI reduction was 7.1% for top-dose and 4.8% for mid-dose compared to a gain of 3.3% in the placebo group ( 40 ).…”

Section: Anti-obesity Medication Optionsmentioning

confidence: 99%

“…However, a randomized placebo-controlled trial (RCT) randomized 223 adolescents (mean age of 14.0 years) with a mean BMI of 37.8 kg/m 2 1:1:2 to either placebo, mid-dose PHEN/TPM (7.5 mg/46 mg), and top-dose PHEN/TPM (15 mg/92 mg) ( 40 ). The mean BMI reduction was 7.1% for top-dose and 4.8% for mid-dose compared to a gain of 3.3% in the placebo group ( 40 ). About 31% of participants receiving mid-dose and 42.5% receiving top-dose PHN/TPM compared to 0% receiving placebo reduced their BMI by ≥ 10% over one year ( 40 ).…”

Section: Anti-obesity Medication Optionsmentioning

confidence: 99%

“…About 31% of participants receiving mid-dose and 42.5% receiving top-dose PHN/TPM compared to 0% receiving placebo reduced their BMI by ≥ 10% over one year ( 40 ). Triglycerides significantly decreased by 12% with both mid-dose and top-dose compared to a 8% increase with placebo ( 40 ). This is of interest as excess circulating lipids accumulate in muscle and liver cells, leading to insulin resistance during T2DM pathogenesis ( 41 , 42 ).…”

Section: Anti-obesity Medication Optionsmentioning

confidence: 99%

“…This is of interest as excess circulating lipids accumulate in muscle and liver cells, leading to insulin resistance during T2DM pathogenesis ( 41 , 42 ). However, it is not known if reduced serum triglycerides lead to improved glycemic control as Whole Body Insulin Sensitivity Index did not significantly increase with either dose compared to placebo and no participants with T2DM were enrolled in this trial ( 40 ).…”

Section: Anti-obesity Medication Optionsmentioning

confidence: 99%

See 4 more Smart Citations

Anti-obesity pharmacotherapy for treatment of pediatric type 2 diabetes: Review of the literature and lessons learned from adults

2022

Self Cite

View full text Add to dashboard Cite

Type 2 diabetes mellitus (T2DM) in adolescents is a more rapidly progressive disease, associated with earlier and higher rates of microvascular complications than in adults. As obesity is a significant risk factor for T2DM development and progression, the American Diabetes Association (ADA) recommends anti-obesity medications (AOMs) as adjuvant therapy for adults with both T2DM and overweight/obesity. In adults, the addition of AOMs to a diabetes regimen can improve glycemic control, reduce weight, and decrease anti-diabetes medication use. The ADA recommends considering bariatric surgery for adolescents with T2DM who have a BMI >35 kg/m2, but did not mention the use of AOMs in their 2022 updated guidelines. Currently, there are three FDA-approved AOMs available for chronic use in adolescents with obesity. Other medications are used in an “off-label” fashion for appetite suppression and BMI reduction. As additional AOMs are being developed and FDA-approved for the pediatric population, new treatment options with novel mechanisms of action will become available for adolescents with T2DM and obesity. In this review, we will discuss the evidence for the use of AOMs in the treatment of T2DM in adolescents, including lessons learned from the adult T2DM literature.

show abstract

Section: Anti-obesity Medication Optionsmentioning

confidence: 96%

Section: Anti-obesity Medication Optionsmentioning

confidence: 99%

Section: Anti-obesity Medication Optionsmentioning

confidence: 99%

Section: Anti-obesity Medication Optionsmentioning

confidence: 99%

Section: Anti-obesity Medication Optionsmentioning

confidence: 99%

See 3 more Smart Citations

Anti-obesity pharmacotherapy for treatment of pediatric type 2 diabetes: Review of the literature and lessons learned from adults

2022

Self Cite

View full text Add to dashboard Cite

show abstract

Medications for Obesity

Gudzune,

Kushner

2024

JAMA

View full text Add to dashboard Cite

ImportanceObesity affects approximately 19% of women and 14% of men worldwide and is associated with increased morbidity. Antiobesity medications (AOMs) modify biological processes that affect appetite and significantly improve outcomes, such as type 2 diabetes, hypertension, and dyslipidemia.ObservationsAOMs should be administered in combination with lifestyle interventions and can be classified according to their mechanisms of action. Orlistat modifies digestive tract absorption and causes gastrointestinal adverse effects, such as oily fecal spotting and urgency, in more than 25% of patients. Centrally acting drugs, such as phentermine-topiramate and naltrexone-bupropion, regulate appetite in the brain and are associated with constipation in approximately 20% of patients, although the incidence of other adverse effects (eg, paresthesia, nausea) varies by medication. Nutrient-stimulated hormone-based medications, such as liraglutide, semaglutide, and tirzepatide, mimic the actions of enteropancreatic hormones that modify central appetite regulation and provide multiple cardiometabolic weight-loss benefits. Adverse effects of these drugs include nausea (28%-44%), diarrhea (21%-30%), and constipation (11%-24%). The relative potency of adult obesity medications has been studied in meta-analyses. Compared with placebo, orlistat was associated with 3.1% greater weight loss (52 randomized clinical trials [RCTs]; 16 964 participants), phentermine-topiramate was associated with 8.0% greater weight loss (5 RCTs; 3407 participants), naltrexone-bupropion was associated with 4.1% greater weight loss (6 RCTs; 9949 participants), liraglutide was associated with 4.7% greater weight loss (18 RCTs; 6321 participants), semaglutide was associated with 11.4% greater weight loss (5 RCTs; 4421 participants), and tirzepatide 15 mg was associated with 12.4% greater weight loss (6 RCTs; 1972 participants).Conclusion and RelevanceObesity is associated with increased morbidity. Antiobesity medications are effective adjunctive therapy to lifestyle changes for improved weight loss and health outcomes.

show abstract

Obesity in Adolescents

Kelly,

Armstrong,

Michalsky

et al. 2024

JAMA

Self Cite

View full text Add to dashboard Cite

ImportanceObesity affects approximately 21% of US adolescents and is associated with insulin resistance, hypertension, dyslipidemia, sleep disorders, depression, and musculoskeletal problems. Obesity during adolescence has also been associated with an increased risk of mortality from cardiovascular disease and type 2 diabetes in adulthood.ObservationsObesity in adolescents aged 12 to younger than 18 years is commonly defined as a body mass index (BMI) at the 95th or greater age- and sex-adjusted percentile. Comprehensive treatment in adolescents includes lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. Lifestyle modification therapy, which includes dietary, physical activity, and behavioral counseling, is first-line treatment; as monotherapy, lifestyle modification requires more than 26 contact hours over 1 year to elicit approximately 3% mean BMI reduction. Newer antiobesity medications, such as liraglutide, semaglutide, and phentermine/topiramate, in combination with lifestyle modification therapy, can reduce mean BMI by approximately 5% to 17% at 1 year of treatment. Adverse effects vary, but severe adverse events from these newer antiobesity medications are rare. Surgery (Roux-en-Y gastric bypass and vertical sleeve gastrectomy) for severe adolescent obesity (BMI ≥120% of the 95th percentile) reduces mean BMI by approximately 30% at 1 year. Minor and major perioperative complications, such as reoperation and hospital readmission for dehydration, are experienced by approximately 15% and 8% of patients, respectively. Determining the long-term durability of all obesity treatments warrants future research.Conclusions and RelevanceThe prevalence of adolescent obesity is approximately 21% in the US. Treatment options for adolescents with obesity include lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. Intensive lifestyle modification therapy reduces BMI by approximately 3% while pharmacotherapy added to lifestyle modification therapy can attain BMI reductions ranging from 5% to 17%. Surgery is the most effective intervention for adolescents with severe obesity and has been shown to achieve BMI reduction of approximately 30%.

show abstract

Phentermine/Topiramate for the Treatment of Adolescent Obesity

Cited by 90 publications

References 19 publications

Anti-obesity pharmacotherapy for treatment of pediatric type 2 diabetes: Review of the literature and lessons learned from adults

Anti-obesity pharmacotherapy for treatment of pediatric type 2 diabetes: Review of the literature and lessons learned from adults

Medications for Obesity

Obesity in Adolescents

Contact Info

Product

Resources

About