Comparison of combinations of drugs for treatment of obesity: body weight and echocardiographic status

Whigham, L. D.; Dhurandhar, N. V.; Rahko, P. S.; Atkinson, R. L.
May 2007
International Journal of Obesity;May2007, Vol. 31 Issue 5, p850
Academic Journal
journal article
Background:Obesity treatment with single drugs produces weight losses of about 8–10% of initial body weight. Few studies of combinations of drugs for treating obesity have been published. The combination of phentermine, an adrenergic agent, and fenfluramine, a serotonergic agent, (phen–fen) produced weight losses of about 15% of initial body weight. Fenfluramine is no longer available because it was associated with cardiac valve lesions. Phentermine–fluoxetine (phen–flu) has been proposed as an alternative for phen–fen.Objective:To compare the efficacy of treatment and prevalence of cardiac valve abnormalities on phen–flu vs phen–fen.Design:Retrospective chart review of all patients treated for at least 3 months with phen–flu (N=97) to a random sample of patients treated with phen–fen (N=98) in the Clinical Nutrition Clinic at the University of Wisconsin. Comparison of echocardiograms in all patients treated solely with phen–flu (N=21) to a random sample of patients treated with phen–fen (N=47), and to a group of subjects never treated with obesity drugs (N=26).Results:With last observation carried forward analysis (LOCF), at 6 months of treatment the phen–fen patients lost 12.6±0.6% of baseline weight and phen–flu patients lost 9.0±0.6% (P<0.001). With completers analysis, there were no significant differences in weight loss as a percent of baseline weight at 6 months (14.4±0.6 vs 13.3±0.9%). LOCF decreases in body mass index (BMI) at 6 months were −5.3 and −3.6 kg/m2 for phen–fen and phen–flu, respectively (P<0.001), and 6.2±0.3 vs 5.4±0.4 kg/m2, respectively, for the completers analysis (P – NS). Dropout rate at 6 months was higher in phen–flu subjects (44 vs 28%). In subjects without atherosclerosis of valves (presumably pre-existing), cardiac valve lesions occurred in eight of 38 phen–fen subjects and in none of 15 phen–flu subjects or 25 control subjects who had not been treated with drugs.Conclusions:The combination of phentermine and fluoxetine was not as effective as phen–fen, but was not associated with cardiac valve lesions. Longer term, larger scale studies of phen–flu are warranted.International Journal of Obesity (2007) 31, 850–857. doi:10.1038/sj.ijo.0803498; published online 5 December 2006


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