NEW ORLEANS — Low-dose topiramate did not produce substantially greater weight loss compared with placebo in teens after short-term meal-replacement therapy, according to a presenter here.
However, teens assigned topiramate saw greater reductions in visceral fat and very LDL cholesterol.
“In this trial we introduced the concept of using medication to enhance weight-loss maintenance in adolescents with severe obesity,” Aaron Kelly, PhD, FTOS, associate professor of pediatrics and medicine at the University of Minnesota in Minneapolis, told Endocrine Today. “The human body fights hard to regain lost weight, and we believe pharmacotherapy can help offset some of these biological forces favoring weight gain.”
Kelly and colleagues enrolled 30 adolescents aged 12 to 18 years with severe obesity (mean age, 15.2 years; mean BMI, 40.3 kg/m2; 63% girls) in a pilot study involving 4 weeks of meal replacement therapy (1,400 kcal per day) followed by random assignment to 24 weeks of either topiramate 75 mg daily or placebo. All participants received education in lifestyle modification; 21 completed the study.
After 24 weeks, mean percent change in BMI was similar between the groups. A greater loss of visceral fat was observed in the topiramate group (-165 g; 95% CI = -310 to -20; P = .03) as was a greater reduction in VLDL (-9.4 mg/dL; 95% CI = 17.8 to -1.0; P = .04); reductions in glucose and triglycerides approached significance. Although no concerning changes in motor speed, memory, attention or executive function were observed, 31% of the topiramate group reported paresthesia.
“Low-dose topiramate only modestly reduced BMI in teens with severe obesity. A higher dose may have been more effective, but probably at the expense of more frequent and severe side effects,” Kelly said. “The low-dose used in this trial demonstrated good safety and tolerability, which sets the stage for future studies evaluating topiramate in combination with other weight loss medications in adolescents.”- by Jill Rollet
Kelly A. T-OR-2084. Presented at: ObesityWeek 2016; Oct. 31-Nov. 4, 2016; New Orleans.
Disclosure: Kelly reports serving as an unpaid consultant for Novo Nordisk and receiving drug/placebo from Astra Zeneca for an NIH-funded clinical trial.