Topiramate in Adolescents With Severe Obesity

This study is currently recruiting participants.
Verified July 2013 by University of Minnesota - Clinical and Translational Science Institute
Sponsor:
Information provided by (Responsible Party):
University of Minnesota - Clinical and Translational Science Institute
ClinicalTrials.gov Identifier:
NCT01859013
First received: May 9, 2013
Last updated: July 3, 2013
Last verified: July 2013

May 9, 2013
July 3, 2013
June 2013
May 2014   (final data collection date for primary outcome measure)
Percent Change from Baseline in Body Mass Index at 28-Weeks [ Time Frame: Baseline and 28-Weeks ] [ Designated as safety issue: No ]
The Percent Change from Baseline in Body Mass Index at 28-Weeks
Same as current
Complete list of historical versions of study NCT01859013 on ClinicalTrials.gov Archive Site
Not Provided
Not Provided
Not Provided
Not Provided
 
Topiramate in Adolescents With Severe Obesity
BMI Reduction With Meal Replacements + Topiramate in Adolescents With Severe Obesity

The prevalence of severe pediatric obesity is on the rise and youth with this condition are at elevated risk for developing chronic diseases such as cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Topiramate, a medication approved by the Food and Drug Administration (FDA) for the treatment of seizures in adults and children, is associated with weight loss. Although not FDA approved for the treatment of obesity, studies in obese adults have demonstrated weight reduction of approximately 5% with 6-12 months of therapy. However, the weight loss effect of topiramate has never been evaluated among children and adolescents. Therefore, the goal of this pilot study is to evaluate the safety and efficacy of 24 weeks of topiramate therapy with a 4-week run-in of meal replacement therapy in adolescents with severe obesity. The primary hypothesis is that 4 weeks of meal replacement therapy followed by 24 weeks of topiramate will have a larger average percent decline in BMI between baseline and 28 weeks compared to meal replacement therapy followed by placebo.

The prevalence of severe pediatric obesity is on the rise and youth with this condition are at elevated risk for developing chronic diseases such as cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Lifestyle modification therapy alone is ineffective for most adolescents with severe obesity and few patients qualify for bariatric surgery. Many patients would likely benefit from pharmacotherapy but only one medication (orlistat) is approved for use in adolescents but notable side effects and limited efficacy impede its clinical use. Topiramate, a medication approved by the Food and Drug Administration (FDA) for the treatment of seizures in adults and children, is associated with weight loss. Although not FDA approved for the treatment of obesity, studies in obese adults have demonstrated weight reduction of approximately 5% with 6-12 months of therapy. However, the weight loss effect of topiramate has never been evaluated among children and adolescents. Therefore, the goal of this pilot study is to evaluate the safety and efficacy of 24 weeks of topiramate therapy with a 4-week run-in of meal replacement therapy in adolescents with severe obesity.

This will be a 28-week, randomized, double-blind, placebo-controlled, pilot clinical trial of meal replacement therapy (4 weeks) followed by topiramate (24 weeks) vs. meal replacement therapy (4 weeks) followed by placebo (24 weeks) for BMI reduction and cardiometabolic risk factor improvement in 36 adolescents (ages 12-17 years old) with severe obesity. Monthly lifestyle modification/behavioral counseling will be delivered by trained study coordinators to patients in both groups. The lifestyle modification education materials will be given to patients and selected sections will be discussed at each monthly contact (five face-to-face sessions and three phone sessions).

The primary object is to evaluate the effect of meal replacement therapy followed by topiramate vs. meal replacement therapy followed by placebo on percent change in BMI among adolescents with severe obesity. The primary hypothesis is that 4 weeks of meal replacement therapy followed by 24 weeks of topiramate will have a larger average percent decline in BMI between baseline and 28 weeks compared to meal replacement therapy followed by placebo.

The secondary objective is to characterize the safety profile of topiramate for the treatment of adolescent obesity, evaluate the effects of meal replacement therapy followed by topiramate vs. meal replacement therapy followed by placebo on risk factors for CVD and T2DM, and evaluate response to topiramate treatment based on baseline eating behavior phenotype in adolescents with severe obesity. The secondary hypothesis is that 4 weeks of meal replacement therapy followed by 24 weeks of topiramate will significantly reduce average absolute BMI, absolute and percent body weight, percent total body and visceral fat, systolic blood pressure, fasting triglycerides and insulin, compared to meal replacement therapy followed by placebo, and that the presence of binge eating disorder characteristics at baseline will be associated with greater reduction in BMI with topiramate treatment.

Interventional
Phase 2
Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
  • Obesity, Morbid
  • Obesity
  • Weight Loss
  • Drug: Topiramate
    Topiramate will be initiated at a dose of 25 mg (taken orally once daily in the evening), escalated to 50 mg (taken orally once daily in the evening) after 1 week, and escalated to 75 mg (taken orally 25 mg in the morning and 50 mg in the evening) after 2 weeks. Patients who do not tolerate dose escalation will be reduced to the highest tolerated dose for the remainder of the trial.
    Other Name: Topamax
  • Other: Placebo
    Placebo will be taken orally once daily in the evening for the first two weeks, and orally twice daily (AM and PM) for the remainder of the study.
    Other Name: Sugar Pill
  • Experimental: Topiramate
    Four (4) weeks of meal replacement therapy, followed by 28-weeks of topiramate therapy. Topiramate will be initiated at a dose of 25 mg (taken orally once daily in the evening), escalated to 50 mg (taken orally once daily in the evening) after 1 week, and escalated to 75 mg (taken orally 25 mg in the morning and 50 mg in the evening) after 2 weeks.
    Intervention: Drug: Topiramate
  • Placebo Comparator: Sugar Pill
    Four (4) weeks of meal replacement therapy, followed by 28-weeks of placebo (sugar pill) therapy.
    Intervention: Other: Placebo
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
36
December 2014
May 2014   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • BMI ≥1.2 times the 95th percentile (based on gender and age) or BMI ≥35 kg/m2
  • 12-17 years old
  • Tanner stage IV or V by physical exam

Exclusion Criteria:

  • Tanner stage I, II, or III
  • BMI ≥50 kg/m2
  • Type 1 or 2 diabetes mellitus
  • Previous (within 6-months) or current use of weight loss medication (patients may undergo washout)
  • Previous (within 6-months) or current use of drugs associated with weight gain (e.g. steroids/anti-psychotics)
  • Previous bariatric surgery
  • Recent initiation (within 3-months) of anti-hypertensive or lipid medication
  • Previous (within 6-months) or current use of medication to treat insulin resistance or hyperglycemia (patients may undergo washout)
  • Major psychiatric disorder
  • Females: Pregnant, planning to become pregnant, or unwilling to use 2 or more acceptable methods of contraception when engaging in sexual activity throughout the study
  • Tobacco use
  • Liver/renal dysfunction

    • ALT or AST >2.5 times the upper limit of normal
    • Bicarbonate <18 mmol/L
    • Creatinine >1.2 mg/dL
  • Glaucoma
  • Obesity associated with genetic disorder (monogenetic obesity)
  • Hyperthyroidism or uncontrolled hypothyroidism
  • History of suicidal thought/attempts
  • History of kidney stones
  • History of cholelithiasis
  • Current use of other carbonic anhydrase inhibitor
Both
12 Years to 17 Years
No
Contact: Aaron S Kelly, Ph.D. 612-626-3492 kelly105@umn.edu
Contact: Anne L Norris, MPH 612-626-3813 kelli023@umn.edu
United States
 
NCT01859013
1304M31241
Yes
University of Minnesota - Clinical and Translational Science Institute
University of Minnesota - Clinical and Translational Science Institute
Not Provided
Principal Investigator: Aaron S Kelly, Ph.D. University of Minnesota - Clinical and Translational Science Institute
University of Minnesota - Clinical and Translational Science Institute
July 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP