Using medication and lifestyle counseling to manage weight regain after bariatric surgery

Pharmacotherapy in Conjunction With Lifestyle Counseling for Management of Weight Regain After Bariatric Surgery

This study is testing whether a combination of medication and lifestyle counseling can help people who have regained weight after bariatric surgery lose that weight again.

Quick facts

• Phase: PHASE4
• Study type: Interventional
• Enrollment: 120 (estimated)
• Ages: 18 Years to 70 Years
• Sex: All
• Sponsor: University of California, Irvine (other)
• Locations: 1 site (Orange, California)
• Trial ID: NCT05975580 on ClinicalTrials.gov

What this trial studies

This randomized controlled trial employs a Sequential Multiple Assignment Randomized Trial (SMART) design to evaluate the effectiveness of pharmacotherapy combined with lifestyle counseling in reversing weight regain following bariatric surgery. A total of 120 participants who have experienced weight regain after procedures like sleeve gastrectomy or Roux-en-Y gastric bypass will be randomized to receive either topiramate, phentermine, or a placebo. After four months, those who respond to treatment will continue, while nonresponders will be re-randomized to adjust their medication. Throughout the study, all participants will receive diet and lifestyle counseling to support their weight management efforts.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18-70 who have experienced weight regain of at least 5% after bariatric surgery.

Not a fit: Patients with type 1 diabetes, uncontrolled hypertension, or significant cardiovascular disease may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could significantly help patients regain control over their weight after bariatric surgery.

How similar studies have performed: Other studies have shown promise in using pharmacotherapy for weight management post-bariatric surgery, but this specific approach is novel.

Eligibility criteria

Inclusion Criteria:

1. Male and female subjects aged 18-70 years
2. Had sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) at least 18 months ago
3. Weight regain of ≥5% relative to post-surgery nadir weight
4. Body mass index (BMI) ≥30 kg/m2 or ≥27 kg/m2 with weight-related comorbidities
5. Women of childbearing potential must be using appropriate contraception to avoid pregnancy throughout the study, and must have a negative pregnancy test at study entry
6. Must be able to provide written informed consent

Exclusion Criteria:

1. Type 1 diabetes
2. Insulin-dependent type 2 diabetes
3. Fasting plasma glucose (FPG) ≥240 mg/dL
4. Uncontrolled hypertension defined as systolic blood pressure (SBP) ≥150 mm Hg and/or diastolic blood pressure (DBP) ≥100 mm Hg on the average of three seated measurements after being at rest for at least 5 minutes
5. History of significant (as determined by the investigator) and unstable cardiovascular disease including coronary artery disease, arrhythmias, severe congestive heart failure, or stroke
6. Use of monoamine oxidase inhibitors, current or within 2 weeks
7. Hyperthyroidism or other significant thyroid disease
8. Angle-closure glaucoma
9. Agitated states
10. History of drug abuse within the past year
11. Known hypersensitivity or idiosyncrasy to sympathomimetic amines
12. Severe hepatic disease (non-alcoholic fatty liver disease or non-alcoholic steatohepatitis without portal hypertension or cirrhosis is acceptable)
13. End-stage renal disease
14. History of nephrolithiasis
15. Serum triglycerides ≥500 mg/dL
16. Cancer, not in remission, within the past 2 years except for adequately treated basal cell, squamous cell skin cancer, or in-situ cervical cancer
17. History of psychosis or bipolar disorder
18. Suicidal ideation or unstable/untreated major depressive disorder within the past year
19. Use of antidepressant medication that has not been at stable dose for at least 3 months
20. Hospital Anxiety and Depression Scale (HADS) score of ≥11 for depression or anxiety items
21. Binge Eating Scale (BES) score of ≥27
22. Alcohol use disorder within the past year
23. Epilepsy
24. Currently taking phentermine or topiramate or the combination, or products containing these drugs
25. Currently taking stimulants (e.g., Attention Deficit Hyperactivity Disorder medications)
26. Current use of prescription or over-the-counter weight loss drugs or supplements
27. Taking prescription or over-the-counter drugs or products, which in the opinion of the PI, could be associated with significant effects on body weight
28. Planning additional bariatric surgery procedures in the next 13 months
29. History of revisional bariatric surgery (revisional surgery after adjustable gastric banding is acceptable)
30. Currently participating in another weight loss program or have plans to participate in the next 13 months
31. Smoking cessation within the previous 3 months or plans to quit smoking in the next 13 months
32. Pregnant or breastfeeding or planning pregnancy in the coming 13 months
33. History of, or any existing condition that, in the opinion of the Principal Investigator, would interfere with the study outcomes or place the subject at unacceptable risk by participating in the study

Where this trial is running

Orange, California

• University of California Irvine Medical Center — Orange, California, United States (RECRUITING)

Study contacts

• Principal investigator: Kishore M Gadde, MD — University of California, Irvine
• Study coordinator: Phuong Linh Huynh, MPH

Conditions: Obesity, Bariatric surgery, Weight regain, Antiobesity drugs, Treatment of weight regain