Highlights
- 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.
Abstract
Background
Super obesity (body mass index [BMI] ≥50 kg/m2) treatment can be complicated and high risk.
Objectives
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.
Setting
Academic medical center in Winston Salem, North Carolina.
Methods
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).
Results
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).
Conclusions
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.
Key words
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Article info
Publication history
Published online: April 19, 2019
Accepted:
April 16,
2019
Received:
January 21,
2019
Footnotes
Vivus, Inc. provided medication for this trial.
Identification
Copyright
© 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
