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BACKGROUND: Long-term treatment of obesity with lifestyle changes alone is unsustainable for most individuals. Antiobesity medications are recommended for individuals with a body mass index (BMI) ≥ 30 kg/m² or ≥ 27 kg/m² with one or more comorbidities. In Brazil, the prescription of combined sibutramine plus topiramate for obesity management is common in daily clinical practice. However, data on its effectiveness and safety are lacking. Thus, the objective of this study was to evaluate this combination for treating obesity in a real-world scenario. METHODS: This retrospective cohort study included individuals with obesity ≥ 18 years prescribed sibutramine and topiramate for at least 3 months between 2012 and 2022 at a large tertiary healthcare center. Baseline and follow-up data were collected from medical records. RESULTS: Among 861 medical records screened, 246 (28.6%) were included. Most participants were female (86.2%) with a mean age of 42.8 ± 12.7 years, 52% had hypertension, 31.3% type 2 diabetes and 30% dyslipidemia. The average baseline BMI and weight were 39.7 kg/m² and 104.2 kg, respectively. The mean daily doses of sibutramine and topiramate were 11 ± 2.1 mg and 119.7 ± 54.7 mg, respectively. There was a significant change in body weight precociously at 3 months on the combination (96.8 ± 20.7 kg, p < 0.001), with 61.8% of patients achieving at least ≥ 5% of weight loss, 29.4% ≥10% and 10.9% ≥15%. At 36 months, 64% maintained at least ≥ 5% of weight loss, 40.6% ≥10% and 26.5% ≥15%. Common adverse effects included paresthesia, memory impairment, bradyphrenia and elevated blood pressure. The discontinuation rate was 24.4%. No major safety concern was observed in a mean follow-up of 25.3 months. CONCLUSION: In a real-world setting, sibutramine and topiramate combination therapy was associated with clinically meaningful weight loss alongside a good tolerability profile.
Cercato et al. (Mon,) studied this question.