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Shebani Sethi Dalai, Sarah Adler, Thomas Najarian, Debra Lynn Safer
INTRODUCTION: Bulimia nervosa (BN) and binge eating disorder (BED) are associated with severe psychological and medical consequences. Current therapies are limited, leaving up to 50% of patients symptomatic despite treatment, underscoring the need for additional treatment options. Qsymia, an FDA-approved medication for obesity, combines phentermine and topiramate ER. Topiramate has demonstrated efficacy for both BED and BN, but limited tolerability. Phentermine is FDA-approved for weight loss...
January 2018: Contemporary Clinical Trials
Chinara M Tate, Allan Geliebter
INTRODUCTION: The FDA recently approved three intragastric balloon (IGB) devices, ReShape, ORBERA™, and Obalon for treatment of obesity. Given the high cost, complication risk, and invasiveness of bariatric surgery, IGB treatment may present a safer and lower cost option for weight reduction. IGBs are generally placed in the stomach endoscopically for up to 6 months to reduce gastric capacity, enhance feelings of fullness, and induce weight loss. The mechanism of action likely involves stimulation of gastric mechanoreceptors triggering short-acting vagal signals to brain regions implicated in satiety...
August 2017: Advances in Therapy
Vidya Narayanaswami, Linda P Dwoskin
Obesity is a global epidemic that contributes to a number of health complications including cardiovascular disease, type 2 diabetes, cancer and neuropsychiatric disorders. Pharmacotherapeutic strategies to treat obesity are urgently needed. Research over the past two decades has increased substantially our knowledge of central and peripheral mechanisms underlying homeostatic energy balance. Homeostatic mechanisms involve multiple components including neuronal circuits, some originating in hypothalamus and brain stem, as well as peripherally-derived satiety, hunger and adiposity signals that modulate neural activity and regulate eating behavior...
February 2017: Pharmacology & Therapeutics
Maksim L Maksimov, Andrey A Svistunov, Vadim V Tarasov, Vladimir N Chubarev, Marco Ávila-Rodriguez, George E Barreto, Olga V Dralova, Gjumrakch Aliev
Obesity and metabolic syndrome (MS) are risk factors for diabetes, cancer, some cardiovascular and musculoskeletal diseases. Pharmacotherapy should be used when the body mass index (BMI) exceeds 30 kg/m² or 27 kg/m² with comorbidity. Efficacy and safety of pharmacotherapy depend on the mechanism of action of drugs. In this context, drugs affecting the central and peripheral mediator systems such as cannabinoid receptor antagonists (Rimonabant), neuronal reuptake inhibitor of NE and 5 HT (Sibutramine), neuronal reuptake inhibitor of NE 5-HT DA (Tesofensine), agonist of 5 HT 2C receptors (Lorcaserin) have a high risk of side effects on the central nervous and cardiovascular systems when used for a long period...
2016: Current Pharmaceutical Design
W Scott Butsch
PURPOSE OF REVIEW: Lifestyle modification remains the mainstay of treatment for obesity despite the lack of substantial long-term efficacy. For many who do not respond to lifestyle therapy and are not candidates for weight loss surgery, pharmacotherapy is a viable treatment option. Advances in understanding mechanisms of appetite control, nutrient sensing, and energy expenditure have not only helped shape current drug development but have also changed the way in which antiobesity medications are prescribed...
October 2015: Current Opinion in Endocrinology, Diabetes, and Obesity
G Valsamakis, K Lois, S Kumar, G Mastorakos
The pharmacotherapy of obesity has historically recorded an overall poor safety and efficacy profile largely because of the complex mechanisms involved in the pathophysiology of obesity. It is hoped that a better understanding of the regulation of body weight will lead us to the development of effective and safer drugs. Recent advances in our understanding of the regulation of energy homeostasis has allowed the design of novel anti-obesity drugs targeting specific molecules crucial for the modulation of energy balance, including drugs that induce satiety, modulate nutrient absorption or influence metabolism or lipogenesis...
August 2014: Clinical Obesity
Andrea Pucci, Nicholas Finer
The management of obesity remains a major challenge. Dietary therapy often fails, whereas bariatric surgery, although successful, is demanding and applicable to a limited number of patients. Drug therapy has had many setbacks over the past 20 years because of serious adverse effects; however, several new drugs for the treatment of obesity are either licensed in some parts of the world, submitted for registration, or completing phase III trials. These include combinations (at low dose) of existing drugs, e.g...
February 2015: Canadian Journal of Cardiology
John D Gazewood, Kathleen Barry
No abstract text is available yet for this article.
October 15, 2014: American Family Physician
Babak Mahgerefteh, Michael Vigue, Zachary Freestone, Scott Silver, Quang Nguyen
BACKGROUND: Obesity is a serious and costly disease that is growing in epidemic proportions. Obesity-related hospitalizations have nearly tripled from 1996 to 2009. If the current trend in the growth of obesity continues, the total healthcare costs attributable to obesity could reach $861 billion to $957 billion by 2030. The American Medical Association has officially recognized obesity as a disease. Obesity is a public health crisis affecting approximately more than 33% of Americans and costing the healthcare system more than $190 billion annually...
September 2013: American Health & Drug Benefits
Eric A Finkelstein, Eliza Kruger, Sunil Karnawat
BACKGROUND: Phase 3 clinical trial results reveal that Qsymia is a clinically effective long-term treatment for obesity, but whether this treatment is cost-effective compared to a diet and lifestyle intervention has yet to be explored. OBJECTIVE: To quantify the incremental cost-effectiveness of Qsymia (phentermine and topiramate extended-release) for health-related quality of life improvements. STUDY DESIGN AND METHODS: Estimates are based on cost and quality of life outcomes from a 56-week, multicenter, placebo-controlled, phase 3 clinical trial undertaken in 93 health centers in the US...
July 2015: PharmacoEconomics
Eric A Finkelstein, Eliza Kruger
OBJECTIVE: To estimate the incremental cost-effectiveness of clinically proven nonsurgical commercial weight loss strategies for those with BMIs between 25 and 40. METHODS: We performed a systematic literature review to identify randomized controlled trials of commercially available weight loss studies of at least 1 year in duration. Using the results of these trials and publicly available cost data, we quantified the incremental cost per kilogram of weight loss and per quality adjusted life year (QALY) gained...
September 2014: Obesity
Lauren M Azebu
As obesity rates continue to rise in the United States, both physicians and patients have demanded more safe and effective drug treatment options. However, following the fen-phen/Redux and sibutramine failures, the FDA has been hesitant to approve any anti-obesity drugs, despite the magnitude of the epidemic. Some have argued that these public embarrassments have led the FDA to overestimate the risks and underestimate the benefits when deciding whether to approve new anti-obesity drugs. On June 27, 2012, the FDA approved Belviq for chronic weight management, making it the first anti-obesity drug approved by the FDA in thirteen years...
2014: Food and Drug Law Journal
Glen L Xiong, Kishore M Gadde
The treatment of obesity is often met with a myriad of challenges in the primary care setting. Nevertheless, a modest 5% weight loss is considered clinically significant and may be associated with health benefits. Phentermine/topiramate (Qsymia), available in the United States since September 2012, achieves clinically meaningful weight loss along with improvements in weight-related comorbidities. This combination drug therapy could be an additional tool for primary care providers in their quest for effective management of obesity...
March 2014: Postgraduate Medicine
Sergio Melotto
FDA approval of Belviq and Qsymia seems to suggest that novel pharmacological targets to modulate human abnormal eating behaviours are still to be identified. However, a renewed translational approach opens new avenues on eating disorders and female vulnerability, highlighting the role of our reward pathway in obesity and binge eating and leading to potential novel targets. Nevertheless, the 'food addiction' hypothesis is still causing much scientific debate. In this context the interest in the modulation of ghrelin pathway is still very high although, so far, only ghrelin agonism has confirmed its therapeutic potential in cachectic patients...
February 2014: Current Opinion in Pharmacology
Dimitrios N Kiortsis
BACKGROUND AND OBJECTIVE: Very few drugs are approved for obesity treatment by regulatory agencies. Very recently phentermine/topiramate controlled-release [PHEN/TPM CR; (Qsymia®)] obtained Food and Drug Administration (FDA) approval as an addition to a reduced-calorie diet and exercise for chronic weight management. Our aim was to review the available clinical evidence on weight loss, metabolic effects and adverse events associated with use of this product. METHODS: Randomized controlled trials with phentermine/topiramate controlled-release were selected through a Medline search using the terms: phentermine and topiramate, phentermine and controlled release topiramate, new anti-obesity drugs and phentermine/topiramate, recent combinations of anti-obesity drugs and Qnexa®...
October 2013: Hormones: International Journal of Endocrinology and Metabolism
Grace Shyh, Angela Cheng-Lai
Obesity is a risk factor for a wide range of conditions, including cardiovascular disease. Although lifestyle modifications remain the cornerstone for the management of obesity, pharmacologic agents may be a helpful addition to patients who have comorbidities and do not respond adequately to diet and exercise. Lorcaserin and phentermine/topiramate ER are 2 long-awaited agents, approved in 2012 for obesity management, 13 years since orlistat received US Food and Drug Administration approval in 1999. Lorcaserin is a serotonin agonist, whereas phentermine/topiramate is a combination of a sympathomimetic agent and an antiepileptic drug; both these agents have been shown to reduce weight significantly and improve cardiovascular and metabolic parameters, such as blood pressure, lipids, and HbA1C...
January 2014: Cardiology in Review
David J Lonneman, Jose A Rey, Brian D McKee
Phentermine/topiramate extended-release capsules (Qsymia) for weight loss.
August 2013: P & T: a Peer-reviewed Journal for Formulary Management
G W Kim, J E Lin, E S Blomain, S A Waldman
Obesity is a growing pandemic, and related health and economic costs are staggering. Pharmacotherapy, partnered with lifestyle modifications, forms the core of current strategies to reduce the burden of this disease and its sequelae. However, therapies targeting weight loss have a significant history of safety risks, including cardiovascular and psychiatric events. Here, evolving strategies for developing antiobesity therapies, including targets, mechanisms, and developmental status, are highlighted. Progress in this field is underscored by Belviq (lorcaserin) and Qsymia (phentermine/topiramate), the first agents in more than 10 years to achieve regulatory approval for chronic weight management in obese patients...
January 2014: Clinical Pharmacology and Therapeutics
Masamitsu Nakazato
Obesity-related diseases including diabetes, dyslipidemia, and hypertension worsen quality of life of patients and waste medical expenses. To reduce the excess body weight, anti-obesity drugs that reduce appetite or lipid absorption from the intestine have been developed. Only Mazindol can be used in Japan at present, whereas Orlistat was launched and very recently Lorcaserin and Qsymia have been accepted in the US and/or European countries. In addition, a variety of drugs having various mechanisms have been investigated in clinical and basic stages...
February 2013: Nihon Rinsho. Japanese Journal of Clinical Medicine
Jin Hee Shin, Kishore M Gadde
Qsymia™ (Vivus Inc, Mountain View, CA, USA), a combination of phentermine and delayed-release topiramate, has been available in the US since September 2012 for the treatment of obesity. Phentermine is an anorexigenic agent, which is approved for the short-term treatment of obesity, while topiramate is approved for nonweight loss indications - seizure disorders and migraine prophylaxis. The amount of weight loss achieved with combination therapy is of a greater magnitude than what could be achieved with either agent alone...
2013: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
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