Verrotti Alberto, Parisi Pasquale, Agostinelli Sergio, Loiacono Giulia, Marra Francesca, Coppola Giangennaro, Pisani Laura Rosa, Gorgone Gaetano, Striano Pasquale, Pisani Francesco, Belcastro Vincenzo
Department of Pediatrics, University of Perugia, Perugia, Italy.
CNS Drugs. 2015 Feb;29(2):163-9. doi: 10.1007/s40263-015-0229-z.
To monitor weight regain after therapy discontinuation in patients with migraine experiencing weight loss during topiramate (TPM) treatment.
Patients with migraine without aura were enrolled in this observational prospective study. Weight, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, plasma levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, leptin, and ghrelin, and homeostatic model assessment of insulin resistance (HOMA-IR) were evaluated before starting TPM (T1), at 3 (T2) and 6 (T3) months of treatment and 6 months after withdrawal of TPM (T4). Weight loss/regain was considered as a change of </>5% of pre-TPM body weight.
A total of 241 patients were analyzed. Of these, 87 (36%) patients experienced weight loss on TPM medication. During TPM therapy significant reductions in mean values of weight (p<0.001), BMI (p<0.001), waist circumference (p<0.01), HOMA-IR (p<0.01), and leptin (p<0.01) were observed. After TPM discontinuation, all of these parameters showed a clear trend to increase at T4, achieving pre-TPM values in 27 patients. Among potential predictors, only HOMA-IR before starting TPM (parameter estimate=1.36, effect size=0.75; p=0.006) was significantly associated with weight regain after therapy discontinuation.
Loss of body weight is a reversible effect, which at 6 months after TPM discontinuation shows a clear trend to return to baseline values. HOMA-IR is the only predictive factor of weight regain.
监测在托吡酯（TPM）治疗期间体重减轻的偏头痛患者停药后的体重恢复情况。
无先兆偏头痛患者纳入本前瞻性观察研究。在开始TPM治疗前（T1）、治疗3个月（T2）和6个月（T3）以及TPM停药后6个月（T4），评估体重、体重指数（BMI）、腰围、收缩压和舒张压、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、瘦素和胃饥饿素的血浆水平，以及胰岛素抵抗稳态模型评估（HOMA-IR）。体重减轻/恢复被视为TPM治疗前体重变化超过5%。
共分析241例患者。其中，87例（36%）患者在TPM治疗期间体重减轻。在TPM治疗期间，观察到体重（p<0.001）、BMI（p<0.001）、腰围（p<0.01）、HOMA-IR（p<0.01）和瘦素（p<0.01）的平均值显著降低。TPM停药后，所有这些参数在T4时均呈现明显的上升趋势，27例患者达到TPM治疗前的值。在潜在预测因素中，仅开始TPM治疗前的HOMA-IR（参数估计=1.36，效应量=0.75；p=0.006）与停药后体重恢复显著相关。
体重减轻是一种可逆效应，在TPM停药6个月后呈现明显的恢复到基线值的趋势。HOMA-IR是体重恢复的唯一预测因素。
