Department of Pediatrics, Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Child Obes. 2023 Jun;19(4):219-225. doi: 10.1089/chi.2022.0062. Epub 2022 Jun 29.
Topiramate has been shown to result in significant weight loss compared to placebo in adults with obesity. However, there are no consensus guidelines on the acceptability, safety, and efficacy of topiramate for weight loss in children. We present a literature review and case series on topiramate use in young children with severe obesity. We performed a PubMed search from January 2000 to February 2022 utilizing keywords, "topiramate" and "obesity" and "children" and "adolescent." For our case series, children were identified through retrospective chart review from a multidisciplinary weight management program. Eligibility criteria: age ≤12 years, class II or III obesity, completed 16 weeks of topiramate therapy as adjunct to lifestyle modifications. Semistructured interviews were conducted with one parent to review side effects. Literature search yielded nine articles. All studies reported trends toward BMI reduction and weight loss with topiramate monotherapy. Five children met case series eligibility (mean age 10 years 3 months ±1.5 years, 60% female). After 16 weeks of topiramate, all children had a decrease in BMI as a percentage of the 95th percentile (mean -12% [-5% to -18%]). Parents reported improvement in impulsive eating and decreased desire to overeat compared to baseline. Four out of five reported no side effects, one reported drowsiness which resolved by dosing at nighttime. Results suggest that topiramate is well tolerated and may be utilized for weight management in younger children. A randomized controlled trial investigating the impact of topiramate for weight management in this age group is warranted.
托吡酯与安慰剂相比，已被证明可使肥胖成年人显著减轻体重。然而，对于托吡酯用于儿童减肥的可接受性、安全性和疗效，尚无共识指南。我们报告了一项关于托吡酯用于严重肥胖儿童的文献复习和病例系列研究。我们利用关键词“托吡酯”和“肥胖”和“儿童”和“青少年”，在 2000 年 1 月至 2022 年 2 月期间进行了 PubMed 搜索。对于我们的病例系列，儿童是通过多学科体重管理计划的回顾性图表审查确定的。入选标准：年龄≤12 岁，II 类或 III 类肥胖，完成了作为生活方式改变辅助治疗的托吡酯治疗 16 周。对一位家长进行了半结构化访谈，以审查副作用。文献检索得到了 9 篇文章。所有研究均报告了托吡酯单药治疗的 BMI 降低和体重减轻趋势。有 5 名儿童符合病例系列入选标准（平均年龄 10 岁 3 个月±1.5 岁，60%为女性）。在托吡酯治疗 16 周后，所有儿童的 BMI 百分比均下降（平均-12%[-5%至-18%]）。与基线相比，家长报告称冲动性进食和过度进食的欲望有所改善。5 名儿童中有 4 名报告无副作用，1 名报告嗜睡，夜间剂量后缓解。结果表明，托吡酯耐受性良好，可用于治疗年龄较小的儿童的体重管理。需要一项随机对照试验来调查托吡酯对该年龄组体重管理的影响。
