Use of phentermine-topiramate extended release in combination with sleeve gastrectomy in patients with BMI 50 kg/m2 or more


      • 1-
        This is a report of a pilot trial designed to test the feasibility and impact of using phentermine/topiramate extended release (phen/top) pre and postoperatively in patients with super obesity undergoing sleeve gastrectomy (LSG).
      • 2-
        The phen/top treatment group lost over 2 times as much weight (28.1±12.8 kg vs 12.3±12.5 kg) during preoperative treatment as compared to controls.
      • 3-
        At 2 years, there was an excess weight loss percent difference of -18.2% (95% CI, -32.1, -4.4) that favored the phen/top treatment group.
      • 4-
        In patients with super obesity, a higher proportion treated with phen/top plus LSG treatment compared to LSG alone achieved a BMI <40 kg/m2 at 2 years of treatment.



      Super obesity (body mass index [BMI] ≥50 kg/m2) treatment can be complicated and high risk.


      We studied whether the pre and postoperative use of phentermine and topiramate (phen/top) combined with laparoscopic sleeve gastrectomy (LSG) in super obesity increases the odds of achieving a BMI <40 at 2 years postoperatively.


      Academic medical center in Winston Salem, North Carolina.


      We recruited patients between 2014 and 2016 who had a BMI ≥50 and planned to undergo LSG (n = 25) to participate in an open-label trial. Participants took phen/top (7.5/46–15/92 mg/d) for at least 3 months preoperatively and 2 years postoperatively. We compared weight loss, BMI changes, and odds for achieving BMI <40 for phen/top + LSG to historical controls. Controls had an initial BMI ≥50 and underwent LSG, without phen/top, at our center during the same timeframe (n = 40).


      Of the 25 participants recruited, 13 completed LSG. Phen/top participants had a baseline BMI of 61.2 ± 7.1 kg/m2 compared with 57.0 ± 5.6 kg/m2 for control participants. Percent initial weight loss was –39.3% (phen/top + LSG) versus –31.4% (control) at 12 months, P = .018; by 24 months, phen/top + LSG had an 11.2% greater initial weight loss, P = .007. At 24 months, the mean BMI was 33.8 kg/m2 for phen/top versus 42 kg/m2 for controls. The odds ratio for achieving a BMI <40 at 2 years with phen/top + LSG versus LSG alone was 4.1 (95% confidence interval, 0.8–21).


      Compared with LSG alone, phen/top combined with LSG may help patients with a BMI >50 achieve greater weight loss and reach a BMI <40. Long-term, controlled trials are needed to follow up these results.

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