Outcomes of using a second generation AED in Recalcitrant Obesity: A Case Series

Lonny E. Horowitz, MD

Atlanta Bariatric Medicine Diet & Wellness Centers

Presented at the 53rd Annual Obesity Symposium

American Society of Bariatric Physicians

October 10, 2003 Chicago, Illinois

Objective: To evaluate the clinical efficacy of topiramate as an adjunctive therapy in medically stable patients with recalcitrant obesity who have reached a plateau.

Background: Diet, pharmacologic intervention, and behavioral modification are successful strategies resulting in weight loss for many patients. Despite early success, some patients who are compliant with medical treatment will reach a plateau. A review of the literature revealed that many of the pharmacologic agents currently used to treatment obesity do not spare lean muscle mass. Weight loss with topiramate, an antiepileptic drug, has been reported as an adverse event in epilepsy with sparing of lean muscle mass. Our study was undertaken as a pilot inquiry to determine: 1) if topiramate would be an efficacious adjunctive agent in the obese patient who had reached a plateau 2) and the effect on body composition in these patients.

Design/Methods: A total of six patients were identified as appropriate candidates for a trial of adjunctive topiramate in addition to their standard bariatric medical treatment (e.g. medication, diet, exercise). Patients had been under the care of a board certified bariatrician for 1-10 years and were medically stable. All patients were assessed at initiation of treatment and monitored weekly and biweekly for a five-month period from April 2003 to September 2003. Weight, BMI and vital signs were recorded for each visit. Body composition was assessed before topiramate was added at incrementally increasing dosages for for eight weeks. Body composition was again performed at study end.

Results: Total weight gain or loss, weight loss or gain with the addition of topiramate, and effects on BMI are listed in Tables 1-3.

Table 1. Total Weight Loss or Gain (in lbs.)

Patient ID	Initial Weight	Weight Loss or Gain: Pre-TPM	Weight at TPM Initiation	Total Weight Loss or Gain with TPM	Total Weight Loss
01 –SW	185.6	-7.1	179.5	- 3.5	15.0
02- CA	412.0	-74.5	337.5	-28.5	103.0
03- JD	197.5	16.5	179.0	- 4.5	4.0
04- JH	272.0	-52.0	220.0	+1.5	55.5
05- VM	364.0	-6.5	351.5	-35.5	32.0
06- DF	204.5	-20.5	181.0	-17.0	40.5

Table 2a. Weight Gain or Loss by Visit (in lbs.)

Patient ID	Visit 1	Visit 2	Visit 3	Visit 4	Visit 5
01 –SW	-1.0	+0.5	+2.0	-0.5	-2.0
02- CA	-4.0	-1.0	-5.5	-2.0	-2.0
03- JD	+0.5	0.0	0.0	0.0	-0.5
04- JH	0.0	-1.0	0.0	0.0	-0.5
05- VM	-2.0	0.0	-5.5	-7.0	0.0
06- DF	0.5	-5.5	-2.0	-0.5	-2.0

Table 2b. Weight Gain or Loss by Visit (in lbs.) continued

Patient ID	Visit 6	Visit 7	Visit 8	Visit 9/ Study Completion	Cumulative Weight Loss or Gain with TPM
01 -SW	-1.0	-0.5	0.0	-2.0	- 3.5
02- CA	-2.0	-2.0	0.0	+0.5	-28.5
03- JD	-0.5	-2.5	-1.0	-0.5	- 4.5
04- JH	-2.0	+3.5	+1.5	-3.0	+1.5
05- VM	-5.0	-3.0	-2.0	-3.0	-35.5
06- DF	-1.5	+0.5	-1.0	-4.5	-17.0

Graph 1- Weight Gain or Loss by Visit (in lbs.)

Table 3. Body Mass Index

Patient ID	Initial BMI	BMI Pre-TPM	BMI Last Visit	BMI D S/P TPM
01 –SW	32.83	32.64	32.18	-0.46
02- CA	70.71	57.92	53.03	-4.89
03- JD	33.89	30.63	30.55	-0.08
04- JH	37.93	30.68	30.89	+0.21
05- VM	58.74	56.72	50.99	-5.73
06- DF	36.22	36.22	29.05	-7.17

Conclusions: Preliminary evidence suggests that topiramate may be a useful adjunct treatment for severely obese patients who have stopped responding to standard medical treatment that included medication, diet, and exercise. All three patients in this sample who lost less than five pounds had beneficial effects on body composition similar to those shown in Table 4 for Patient #04-JH who gained 1.5 lb. over the study period. Furthermore, it is apparent that lean body mass is spared and is apparently augmented in some individuals. These results suggest that further analysis is warranted on patients whom we would normally consider treatment failures with non-surgical intervention for obesity.

Table 4. Patient 04 – JH: Body Composition

	Baseline: Pre- TPM		Last Visit: Post-TPM
Lean Body Mass	56 %	123 lb.	59 %	160 lb.
Fat Body Mass	44 %	97 lb.	41 %	112 lb.
Body Water	44 %	44 liters	44 %	54 liters
Resistance	595	---	459	---

For more information, contact Dr. Horowitz at dietmd@bariatrics.com 

 

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