Combination of Phentermine/Topiramate Er and Liraglutide 3 Mg for Intensive Therapy of Severe Obesity & T2Dm: A Case Series and Brief Review

ABSTRACT Objective: Patients with obesity and type 2 diabetes have severe obesity warranting intensive treatment. The medical treatment of obesity can use multiple medications that target different pathways. At present, these medications are used independently for the treatment of obesity, and there are scant data for using phentermine/topiramate (phen/top) and liraglutide combination. Methods: Here, we present interventional data and outcome of 3 obese, diabetic patients treated with these medications. Results: Patient A achieved net weight loss of 25.6% over a 30-month period on phen/top and liraglutide. This weight loss correlated with improvement in triglyceride levels (154 to 91 mg/dL), high-density lipoprotein (HDL) levels (40 to 44 mg/dL), and hemoglobin A1c (7.6 to 6.1% [60 to 43 mmol/mol]). On phen/top and liraglutide, patient B had weight loss of 11% over 24 months. Interestingly, this weight loss was correlated with an increase in triglyceride levels (116 to 231 mg/dL) and improvement in HDL (27 to 39 mg/dL). Prior to weight loss, patient was on 50 units of glargine twice daily, which was titrated off with improvement in hemoglobin A1c (15.1 to 6.2% [142 to 44 mmol/mol]). On phen/top and liraglutide, patient C had net weight loss of 27% at 18 months. This weight loss was correlated with triglyceride improvement (129 to 83 mg/dL) and HDL improvement (32 to 38 mg/dL). Prior to weight loss, patient was on 45 units of glargine, which was tapered off with an improved A1c (6.3 to 5.9% [45 to 41 mmol/mol]). Conclusion: The above cases highlight the potential for using multiple medications to target different areas for the treatment of obesity. Abbreviations: BMI = body mass index; FDA = Food and Drug Administration; HbA1c = hemoglobin A1c; HDL = high-density lipoprotein; LDL = low-density lipoprotein; phen/top = phentermine/topiramate; T2DM = type 2 diabetes mellitus