Is immediate-release topiramate an effective treatment for adult obesity?

Abstract

Q: Is immediate-release topiramate an effective treatment for adult obesity? Evidence-Based Answer: Yes. Topiramate (at daily doses of 64-400 mg) produces an average 5.34 kg of additional weight loss compared with placebo (95% confidence interval [CI], -6.12 to -4.56) in overweight to obese adults for periods of 16 to 60 weeks (strength of recommendation [SOR]: A, meta-analyses of randomized controlled trials [RCTs]). Topiramate increases the chances of losing 5% or more of aseline body weight (BBW) with a number needed to treat (NNT) of 3 (95% CI, 2-3) and 10% or more of BBW with an NNT of 4 (95% CI, 3-4). However, approximately 17% of patients discontinue the drug because of adverse effects, including paresthesia, hypoesthesia, taste perversion, and psychomotor impairment (SOR: A, meta-analyses of RCTs).