Obesity

Letter to the Editor

Combination Pill Effective, But Expensive Megan Dingwall and Justin Moore To the Editor: We read with interest, the trial by Aronne et al. (1) examining the effect of combined phentermine/topiramate ER (Qsymia) on weight reduction versus the effect of the individual agents. Weight loss on the combined drug was greater than each of the individual drug groups, which in turn produced weight loss generally consistent with a past meta-analysis of randomized trials that included phentermine and topiramate (2). These are promising results for patients seeking assistance in weight loss.

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Qsymia is a costly drug, though, whereas its individual components are relatively inexpensive. We regret that the investigators did not examine the effect of phentermine and topiramate given together as separate doses. While combination medications typically are admittedly associated with increased patient compliance in patients with obesity and diabetes (3), simple topiramate is available in doses that would allow approximation of the doses of topiramate ER present in Qsymia. Furthermore, the pharmacokinetics of simple topiramate, with its 19 h half-life (versus the 55 h half-life of topiramate ER), would support its use as a twice daily agent in concert with daily phentermine (4). C 2014 The Obesity Society V

Obesity | VOLUME 22 | NUMBER 8 | AUGUST 2014

References 1. Aronne LJ, Wadden TA, Peterson C, Winslow D, Odeh S, Gadde KM. Evaluation of phentermine and topiramate versus phentermine/topiramate extendedrelease in obese adults. Obesity 2013;21:2163-2171. 2. Zhaoping LM, Maglione M, Tu W, Mojica W, Arterburn D, Shugarman LR, Hilton L, Suttorp M, Solomon V, Shekelle PG, Morton SC. MetaAnalysis: Pharmacologic Treatment of Obesity. Ann Intern Med 2005;142:532-546. 3. Han S, Iglay K, Davies MJ, Zhang Q, Radican L. Glycemic effectiveness and medication adherence with fixed-dose combination or coadministered dual therapy of antihyperglycemic regimens: A metaanalysis. Curr Med Res Opin 2012;28:969-977. 4. Lambrecht LJ, Shekh-Ahmad T, Todd WM, Halvorsen MB, Bialer M. Comparative pharmacokinetic analysis of USL255, a new once-daily extended-release formulation of topiramate. Epilepsia 2011;52:1877-1883.

Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, Kansas Correspondence: M. Dingwall ([email protected]) doi: 10.1002/oby.20794

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Combination pill effective, but expensive.

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