Combined therapy for overweight and obese adults potentially beneficial

January 01, 0001

Combined therapy for overweight and obese adults potentially beneficial

Obesity is associated with a reduction in life expectancy and an increase in mortality from cardiovascular diseases, cancer, and other causes. The researchers from the US therefore assessed the efficacy and safety of two doses of phentermine plus topiramate controlled-release combination as an adjunct to diet and lifestyle modification for weight loss and metabolic risk reduction in individuals who were overweight and obese, with two or more risk factors. In this 56-week phase 3 trial, they randomly assigned overweight or obese adults (aged 18-70 years), with a body-mass index of 27-45 kg/sqm and two or more comorbidities (hypertension, dyslipidaemia, diabetes or prediabetes, or abdominal obesity) to placebo, once-daily phentermine 7.5 mg plus topiramate 46.0 mg, or once-daily phentermine 15.0 mg plus topiramate 92.0 mg in a 2:1:2 ratio in 93 centres in the US.

At 56 weeks, change in bodyweight was -1.4 kg, -8.1 kg, - 8.5 to -7·1; p<0·0001), and -10.2 kg in the patients assigned to placebo, phentermine 7.5 mg plus topiramate 46.0 mg, and phentermine 15.0 mg plus topiramate 92.0 mg, respectively. 21% patients achieved patients achieved at least 5% weight loss with placebo, 62% with phentermine 7.5 mg plus topiramate 46.0 mg, and 70% with phentermine 15.0 mg plus topiramate 92.0 mg; for greater than or equal to 10% weight loss, the corresponding numbers were 7%, 37% and 48%. The most common adverse events were dry mouth 2%, 13% and 21% in the groups assigned to placebo, phentermine 7.5 mg plus topiramate 46.0 mg, and phentermine 15.0 mg plus topiramate 92·0 mg, respectively, paraesthesia 2%, 14%, 21% respectively), constipation 6%, 15% and 17% respectively), insomnia 5%, 6%

The researchers concluded: "The combination of phentermine and topiramate, with office-based lifestyle interventions, might be a valuable treatment for obesity that can be provided by family doctors."

Possibly helpful if lifestyle interventions do not work.

For the full abstract, click here.

The Lancet 377 (9774):1341-1352, 16 April 2011 © Elsevier Ltd
Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Kishore M Gadde, David B Allison, Donna H Ryan et al. Correspondence to Kishore Gadde: [email protected]

Category: T. Endocrine/Metabolic/Nutritional. Keywords: phentermine, topiramate, combination, weight, comorbidities, overweight, obese, adults, randomized placebo controlled trial, phase 3 trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 6 May 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.