Topiramate for Weight Management in Children With Severe Obesity

Berman, Casey; Naguib, Monica; Hegedus, Elizabeth; Vidmar, Alaina P.

doi:10.1089/chi.2022.0062

Cited by 7 publications

(7 citation statements)

References 25 publications

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“…As a 5 percentage-point reduction in %BMIp95 has been associated with improvements in cardiometabolic risk factors, and given the natural progression for pediatric obesity to worsen over time, we consider this to be clinically relevant (56, 57). Further, our results generally align with those reported in other observational studies of youth with obesity prescribed topiramate in other (not necessarily weight management) clinical settings (19,22,23). For example, in a literature review (n = 9 studies) and case series of youth with severe obesity (n = 5; ages 10-11 years old; baseline %BMIp95 1.28-2.50 times the 95th percentile) prescribed topiramate, Berman et al found that all studies reported trends toward BMI reduction, and a mean 16-week 12% reduction in % BMIp95 among those in the case series (23).…”

Section: Discussionsupporting

confidence: 90%

“…While substantial individual-level variability in response was observed, given the small sample size baseline characteristics associated with response could not be evaluated (19). Other studies have also shown overall BMI reduction or stabilization, and that baseline characteristics including higher BMI and younger age may predict response (20)(21)(22)(23)(24). However, these studies included both youth and adults with or without obesity, those not necessarily followed in weight management clinics, those not prescribed topiramate for obesity treatment (i.e., prescribed for epilepsy, psychiatric disorders, etc.…”

Section: Introductionmentioning

confidence: 99%

“…However, these studies included both youth and adults with or without obesity, those not necessarily followed in weight management clinics, those not prescribed topiramate for obesity treatment (i.e., prescribed for epilepsy, psychiatric disorders, etc. ), and/or those with known genetic syndromes (i.e., Prader-Willi) (20)(21)(22)(23)(24).…”

Section: Introductionmentioning

confidence: 99%

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Clinical effectiveness and predictors of response to topiramate plus lifestyle modification in youth with obesity seen in a weight management clinical setting

Bomberg,

Clark,

Rudser

et al. 2024

Front. Endocrinol.

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IntroductionObesity affects approximately 20% of U.S. youth. Anti-obesity medications (AOMs) are promising lifestyle modification adjuncts for obesity treatment, and topiramate is commonly prescribed in pediatric weight management clinics. It is important to determine “real-world” effectiveness of AOMs and, given shifts towards personalized approaches, characteristics potentially predicting better or worse response. We therefore sought to describe clinical effectiveness from topiramate plus lifestyle modification, and to determine if baseline phenotypic characteristics are associated with better or worse response.MethodsWe performed a retrospective cohort study (2012-2020) among youth (<18 years old) followed in a U.S. academic-based weight management clinic. Baseline characteristics (i.e., body mass index (BMI), liver function tests, eating-related behaviors) and outcomes (%BMI of 95th percentile (%BMIp95), BMI, percent %BMI change, weight) were determined through review of electronic health records and clinic intake survey data.ResultsAmong 282 youth prescribed topiramate plus lifestyle modifications (mean baseline age 12.7 years, %BMIp95 144%), %BMIp95 and percent BMI change were statistically significantly reduced at each time point (1.5-, 3-, 6-, and 12-month %BMIp95 reductions: -2.2, -3.9, -6.6, and -9.3 percentage points, respectively; percent BMI reduction: -1.2%, -1.9%, -3.2%, and -3.4%, respectively; all p<0.01). Considering multiple comparisons, no baseline characteristics statistically significantly predicted response at any time point.ConclusionsWe found that topiramate plus lifestyle modification reduced %BMIp95 and BMI among youth in a weight management clinical setting, and that no baseline characteristics evaluated were associated with response. These results should be considered preliminary given the observational nature of this study, and prospective studies are needed to further characterize clinical effectiveness and identify and confirm potential predictors of response.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Clinical effectiveness and predictors of response to topiramate plus lifestyle modification in youth with obesity seen in a weight management clinical setting

Bomberg,

Clark,

Rudser

et al. 2024

Front. Endocrinol.

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“…35 Additionally, a review suggested that topiramate is well tolerated and effective for weight management in obese children. 36 Given the challenges surrounding SGA-induced weight gain in children, the limited scope of existing interventions, and the emerging evidence for topiramate as a potential pharmacological option, we present the first systematic review and meta-analysis aimed at determining the efficacy and tolerability of topiramate for the treatment of SGA-associated weight gain in children.…”

Section: Introductionmentioning

confidence: 99%

“…Notably, a previous meta‐analysis found that topiramate was more effective than placebo in reducing antipsychotic‐induced weight gain in adults 35 . Additionally, a review suggested that topiramate is well tolerated and effective for weight management in obese children 36 …”

Section: Introductionmentioning

confidence: 99%

Efficacy of topiramate in reducing second‐generation antipsychotic‐associated weight gain among children: A systematic review and meta‐analysis

Costa,

Moraes,

Assunção

et al. 2024

Diabetes Obesity Metabolism

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AimsTo conduct a systematic review and meta‐analysis with the aim of synthesizing existing data on the efficacy and safety of topiramate as an adjunctive treatment for reducing second‐generation antipsychotic (SGA)‐associated weight gain in children aged 4–18 years.MethodsWe conducted a comprehensive search of PubMed, Embase, PsychNet and Web of Science from time of their inception up to 12 February 2024, including randomized controlled trials that compared SGA treatment with and without topiramate co‐administration in children. The primary outcomes were changes in body weight and body mass index (BMI). Heterogeneity was assessed using I2 statistics.ResultsThis systematic review included five randomized trials, totalling 139 participants (43.9% female; mean [SD] age 11.9 [3.5] years). Four of these trials were included in the meta‐analysis, comprising 116 subjects. We found that topiramate was significantly effective both in reducing SGA‐associated weight gain, with a mean difference of −2.80 kg (95% confidence interval [CI] −5.28 to −0.31; p = 0.037, I2 = 86.7%) and a standardized mean difference (SMD) of −1.33 (95% CI −2.14 to −0.51; p = 0.014, I2 = 31.7%), and in reducing BMI change compared to placebo (SMD −1.90, 95% CI −3.09 to −0.70; p = 0.02, I2 = 0%). Sedation risk was lower with topiramate than with placebo (odds ratio 0.19, 95% CI 0.11–0.32; p < 0.01, I2 = 0%). No significant differences were found in dropouts, any other side effects, and metabolic parameters, such as triglycerides, total cholesterol, low‐density lipoprotein, high‐density lipoprotein, and glucose. None of the included studies reported assessments on cognitive side effects.ConclusionThis meta‐analysis suggests that topiramate is an effective and safe option for mitigating SGA‐associated weight gain in children.

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