Will Phentermine Plus Topiramate Emerge as a Novel Treatment for Obesity?

Obesity is a serious health issue affecting an increasing number of people today. It increases the chances of a person suffering from other conditions like hypertension and diabetes. Weight reduction results in a decrease in these associated health issues.

Obesity is treated with lifestyle modifications, medications as well as surgery. In the recent years, a number of drugs previously used for obesity like sibutramine and rimonabant have been banned due to side effects. Hence the search for an effective anti-obesity drug or drug combination continues.

Researchers have recently explored the use of a combination of two drugs, phentermine and topiramate, for the treatment of obesity. Phentermine is an anti-obesity drug. Topiramate is a drug normally used to treat epilepsy and to prevent migraines. The use of this combination for obesity was earlier turned down by the FDA due to concerns of adverse effects like cognitive disorders, metabolic acidosis, increased heart rate, and birth defects.

The CONQUER study was carried out to assess the efficacy and safety of a combination of these two drugs in the treatment of obesity. Two doses of the combination were studied in overweight or obese individuals in the United States over a time period of 56 weeks. The individuals participating in the study also suffered from at least two other weight- related health issues like high blood pressure, high cholesterol, prediabetes, diabetes and abdominal obesity.

The researchers found that the combination of phentermine and topiramate in both lower as well as higher doses produced significant weight loss. Weight reduction also resulted in an improvement of the associated illnesses like diabetes, high cholesterol and hypertension. The combination produced side effects like dry mouth, constipation, paresthesias, altered taste, and some psychiatric and cognitive effects. These side effects are known side effects of the drugs when used separately, and no untoward side effects were noted with the combination. People with depression were not used in the study. Birth defects were not mentioned in the study.

Thus, according to the CONQUER study, the combination of phentermine and topiramate is an effective treatment in obesity with manageable and tolerable side effects. It also helps in reduction of other associated illnesses with obesity. The combination is yet to be approved by the FDA for the treatment of obesity.

Source: 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. The Lancet 2011; 377 (9774): 1341 – 1352.

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Source-Medindia