SAT-LB022 Effects of Intermittent Versus Continuous Phentermine Therapy on Weight Reduction and Inflammatory Markers in Obese Non-diabetic Patients
Introduction: Intermittent phentermine therapy has been proposed as an alternative to overcome tolerance associated with continuous daily use of phentermine to promote greater weight loss.
Aim: To compare the effects of intermittent versus continuous phentermine therapy on weight reduction, cardiometabolic profile, inflammatory and anti-inflammatory markers in obese non-diabetic patients.
Methods: Non-diabetic obese adults [body mass index (BMI) 27.5 to 35kg/m 2 ] were recruited from obesity clinic. Eligible subjects were randomized to receive either continuous phentermine (30mg daily) or intermittent phentermine therapy (30mg daily for 4 weeks alternate with 2 weeks of treatment-free periods) for a total of 24 weeks, in addition to lifestyle modification (comprising of calorie restriction of 1200 kcal per day and at least 150 minutes per week of moderate intensity exercise). Primary endpoints were change in body weight from baseline as well as proportion of subjects losing at least 5% and 10% of baseline body weight at week 24 respectively.
Results: Thirty-eight subjects [86.8% females, median age 36.5 years (interquartile range, IQR 32, 41.3), BMI 31.8kg/m 2 (IQR 30.4, 33.4) and waist circumference 94.9cm (IQR 90.2, 99.1)] were randomised to either continuous (n=19) or intermittent phentermine arm (n=19). Fourteen subjects in the former and all in the latter completed the study. There were no significant differences in the degree of weight reduction [ – 7.3 kg (IQR – 10.1, – 3.4) vs – 9.7 kg (IQR -11.2, -7.2), p=0.10] as well as the proportion of subjects who achieved at least 5% and 10% of weight loss (78.9% vs 94.7%, p=0.34; 47.4% vs 73.7%, p=0.18 respectively) at week 24 in both arms. Nonetheless, intermittent phentermine therapy resulted in greater decrease in waist circumference while continuous phentermine therapy produced greater reduction in fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and high-sensitivity C-reactive protein (hsCRP). Both regimes reduced the prevalence of insulin resistance and showed no difference in reduction of the proportion of subjects with high cardiovascular risk (as defined by hsCRP > 3mg/L). No significant between-group differences were seen in changes of blood pressure, pulse rate, glycaemic indices, lipids, adiponectin, binge eating scale scores and 36-item Short Form Survey version 2 (SF-36v2) scores. The most common side effects were dry mouth and insomnia. There was no difference in the occurrence of adverse events between the 2 treatment arms.
Conclusion: Intermittent phentermine therapy is as effective as conventional daily phentermine treatment in promoting weight reduction while having similar side effect profile. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.
Phentermine and Topiramate
Phentermine and topiramate is used to help adults and children aged 12 years or older who are obese, or certain adults who are overweight and have weight-related medical problems to lose weight and to keep from gaining back that weight. Phentermine and topiramate must be used along with a reduced calorie diet and exercise plan. Phentermine is in a class of medications called anorectics. It works by decreasing appetite. Topiramate is in a class of medications called anticonvulsants. It works by decreasing appetite and by causing feelings of fullness to last longer after eating.
How should this medicine be used?
Phentermine and topiramate come as extended-release capsules to take by mouth. The medication is usually taken with or without food once a day in the morning. This medication may cause difficulty falling asleep or staying asleep if it is taken in the evening. Take phentermine and topiramate at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take phentermine and topiramate exactly as directed.
Your doctor will probably start you on a low dose of phentermine and topiramate and increase your dose after 14 days. After you take this dose for 12 weeks, your doctor will check to see how much weight you have lost. If you have not lost a certain amount of weight, your doctor may tell you to stop taking phentermine and topiramate or may increase your dose and then increase it again after 14 days. After you take the new dose for 12 weeks, your doctor will check to see how much weight you have lost. If you have not lost a certain amount of weight, it is not likely that you will benefit from taking phentermine and topiramate, so your doctor will probably tell you to stop taking the medication.
Phentermine and topiramate may be habit forming. Do not take a larger dose, take it more often, or take it for a longer period of time than prescribed by your doctor.
Phentermine and topiramate will help control your weight only as long as you continue to take the medication. Do not stop taking phentermine and topiramate without talking to your doctor. If you suddenly stop taking phentermine and topiramate, you may experience seizures. Your doctor will tell you how to decrease your dose gradually.
Because of the risk of birth defects, phentermine and topiramate is available only through a special restricted distribution program. A program called the Qsymia REMS (Risk Evaluation and Mitigation Strategy) Program has been set up to decrease the risks of taking phentermine and topiramate. You can only receive the medication from a pharmacy that participates in the program. Ask your doctor if you have any questions about participating in the program or how to get your medication.
Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with phentermine and topiramate and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (https://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer’s website to obtain the Medication Guide.
Abstract
Introduction: Intermittent phentermine therapy has been proposed as an alternative to overcome tolerance associated with continuous daily use of phentermine to promote greater weight loss.
Aim: To compare the effects of intermittent versus continuous phentermine therapy on weight reduction, cardiometabolic profile, inflammatory and anti-inflammatory markers in obese non-diabetic patients.
Methods: Non-diabetic obese adults [body mass index (BMI) 27.5 to 35kg/m 2 ] were recruited from obesity clinic. Eligible subjects were randomized to receive either continuous phentermine (30mg daily) or intermittent phentermine therapy (30mg daily for 4 weeks alternate with 2 weeks of treatment-free periods) for a total of 24 weeks, in addition to lifestyle modification (comprising of calorie restriction of 1200 kcal per day and at least 150 minutes per week of moderate intensity exercise). Primary endpoints were change in body weight from baseline as well as proportion of subjects losing at least 5% and 10% of baseline body weight at week 24 respectively.
Results: Thirty-eight subjects [86.8% females, median age 36.5 years (interquartile range, IQR 32, 41.3), BMI 31.8kg/m 2 (IQR 30.4, 33.4) and waist circumference 94.9cm (IQR 90.2, 99.1)] were randomised to either continuous (n=19) or intermittent phentermine arm (n=19). Fourteen subjects in the former and all in the latter completed the study. There were no significant differences in the degree of weight reduction [ – 7.3 kg (IQR – 10.1, – 3.4) vs – 9.7 kg (IQR -11.2, -7.2), p=0.10] as well as the proportion of subjects who achieved at least 5% and 10% of weight loss (78.9% vs 94.7%, p=0.34; 47.4% vs 73.7%, p=0.18 respectively) at week 24 in both arms. Nonetheless, intermittent phentermine therapy resulted in greater decrease in waist circumference while continuous phentermine therapy produced greater reduction in fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and high-sensitivity C-reactive protein (hsCRP). Both regimes reduced the prevalence of insulin resistance and showed no difference in reduction of the proportion of subjects with high cardiovascular risk (as defined by hsCRP > 3mg/L). No significant between-group differences were seen in changes of blood pressure, pulse rate, glycaemic indices, lipids, adiponectin, binge eating scale scores and 36-item Short Form Survey version 2 (SF-36v2) scores. The most common side effects were dry mouth and insomnia. There was no difference in the occurrence of adverse events between the 2 treatment arms.
Conclusion: Intermittent phentermine therapy is as effective as conventional daily phentermine treatment in promoting weight reduction while having similar side effect profile. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.
