Use of phentermine-topiramate extended release in combination with sleeve gastrectomy in patients with BMI 50 kg/m 2 or more

• Published in: Surgery for obesity and related diseases Vol. 15; no. 7; p. 1039
• Main Authors: Ard, Jamy D, Beavers, Daniel P, Hale, Erica, Miller, Gary, McNatt, Stephen, Fernandez, Adolfo
• Format: Journal Article
• Language: English
• Published: United States 01.07.2019
• Subjects: Antiobesity medication; Phentermine/topiramate extended release; Super obesity; Sleeve gastrectomy
• ISSN: 1878-7533

Super obesity (body mass index [BMI] ≥50 kg/m ) 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/m compared with 57.0 ± 5.6 kg/m 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/m for phen/top versus 42 kg/m 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.