A Narrative Review: Phentermine and Topiramate for the Treatment of Pediatric Obesity

Abstract

The prevalence of pediatric obesity has increased exponentially over the past four decades. The American Academy of Pediatrics recently released updated clinical practice guidelines highlighting the importance of identifying pediatric obesity as a chronic disease. The guidelines support consideration of concurrent treatment with intensive lifestyle interventions, obesity pharmacotherapy, and bariatric surgery. The dramatic rise in pediatric obesity has spurred interest in utilizing obesity pharmacotherapy to support sustained weight reduction in pediatric cohorts, in the hopes of preventing the emergence of later-appearing, significant co-morbidities. Despite the enormous demand, the obstacles posed by performance of needed clinical trials in the pediatric population markedly limits available pharmacotherapy for the treatment of obesity in pediatrics. Currently, there are five medications approved by the Food and Drug Administration for use in youth with obesity. In 2022, the phentermine/topiramate (PHEN/TPM), once-daily, controlled-release, combination product received FDA approval, for the indication of chronic weight management, in youth with obesity, ages 12 years and older. The objectives of this narrative review are to: (1) Review the mechanism of action of phentermine and topiramate, (2) Summarize the safety and efficacy data of topiramate and phentermine use as both monotherapies and in combination, and (3) Discuss clinical practice guidelines and clinical implications, for the use of these agents in youths with obesity.

Keywords:

• phentermine
• topiramate
• pediatric obesity
• obesity pharmacotherapy

Abbreviations

BMI, Body mass index; zBMI, Body mass index Z-score; %BMI_p95, Percent over the 95th percentile.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Disclosure

Dr Alaina P Vidmar reports non-financial support from Dexcom Inc., personal fees for product from Hippo Education Inc., personal fees for advisory board member in 2022 from Rythym Pharmaceutical, personal fees for educational consultant from Guidepoint, outside the submitted work. The authors report no other conflicts of interest relevant to this article.

Additional information

Funding

This work was supported by grants 1) K23DK134801 NIH NIDDK, 2) Sacchi Foundation Research Scientist, 3) Supported by American Diabetes Association grant #11-22-ICTSN-32, 4) The Southern California Center for Latino Health Pilot Award 2022, 5) UL1TR001855 and UL1TR000130 from the National Center for Advancing Translational Science (NCATS) of the US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.