Combination treatment to CONQUER obesity?

Division of Geriatrics and Aging, University of Rochester School of Medicine and Dentistry, Highland Hospital, Rochester, NY, USA.
The Lancet (Impact Factor: 39.21). 04/2011; 377(9774):1295-7. DOI: 10.1016/S0140-6736(11)60518-7
Source: PubMed
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    ABSTRACT: Obesity is now a major public health concern worldwide with increasing prevalence and a growing list of comorbidities and complications. The morbidity, mortality and reduced productivity associated with obesity and its complications result in a major burden to health care costs. Obesity is a complex chronic medical syndrome often with multiple different etiologic factors in individual patients. The long term successful management of obesity remains particularly challenging and invariably requires a multifaceted approach including lifestyle and behavioral modification, increased physical activity, and adjunctive pharmacotherapy. Bariatric surgery remains a last resort though at present it has the best results for achieving sustained robust weight loss. Obesity pharmacotherapy has been very limited in its role for long term obesity management because of the past history of several failed agents as well as the fact that presently available agents are few, and generally utilized as monotherapy. The recent FDA approval of the fixed drug combination of phentermine and extended release topiramate (topiramate-ER) (trade name Qsymia™) marks the first FDA approved combination pharmacotherapeutic agent for obesity since the Phen-Fen combination of the 1990s. This review details the history and clinical trial basis for the use of both phentermine and topiramate in obesity therapeutics as well as the results of clinical trials of their combination for obesity treatment in humans. The initial clinical approval trials offer evidence that this fixed drug combination offers synergistic potential for effective, robust and sustained weight loss with mean weight loss of at least 10% of baseline achieved and sustained for up to 2 years in over 50% of subjects treated. It is anticipated that this agent will be the first in a new trend of multi-agent combination therapy for the chronic adjunctive management of obesity.
    Drug Design, Development and Therapy 01/2013; 7:267-78. DOI:10.2147/DDDT.S31443 · 3.03 Impact Factor
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    ABSTRACT: Non-alcoholic fatty liver disease (NAFLD) is closely linked to obesity and constitutes part of the metabolic syndrome, which have been associated with low serum vitamin D (VD). Due to known crosstalk between VD and transforming growth factor (TGF)-β signalling, VD has been proposed as an antifibrotic treatment.
    Gut 08/2014; 64(5). DOI:10.1136/gutjnl-2014-307024 · 13.32 Impact Factor
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    ABSTRACT: Abstract Background: Obesity is one of the major problems of health policy in different countries. Pharmacological attempts have been made to help affected people without a definitive solution. Some agents -either with peripheral or central effect- are available in the market. On July 2012, the FDA approved two novel preparations for obese patients: 1) topiramate-phentermine -the first one an anticonvulsant and the second one a sympathomimetic amine- and, 2) lorcaserin a 5-HT2CR agonist. Both preparations emerged as new options for weight management. Scope: Based on the complex biology of eating behavior, in this review we discuss the features, mechanisms of action, pharmacokinetics, advantages and possible disadvantages of these new agents. Findings. Conclusion. With differences in efficacy (higher for the topiramate-phentermine combination), both preparations are active in reducing appetite and body weight, as well as in improving comorbidities. Additional information will be collected from phase IV surveillance. Focus on cardiovascular, neuropsychiatric (for both introductions) and embrio-fetal safety (especially for topiramate) is expected.
    Current Medical Research and Opinion 01/2014; DOI:10.1185/03007995.2014.884494 · 2.37 Impact Factor