Topiramate monotherapy for weight reduction in patients with type 2 diabetes mellitus: A systematic review and meta-analysis.
OBJECTIVE
To conduct a systematic review with meta-analysis to determine the efficacy and safety of topiramate as monotherapy for weight reduction in patients with type 2 diabetes mellitus.


METHODS
We searched MEDLINE, Embase, and International Pharmaceutical Abstracts from inception to June 2015. We included randomized controlled trials that evaluated topiramate monotherapy versus control agents or placebo for weight loss in obese type 2 diabetes patients.


RESULTS
Of the 284 studies identified, 5 studies fulfilled the inclusion criteria. Topiramate decreased weight by a mean difference of 3.4kg (95% CI, -3.79 to -3.04) compared to placebo. Mean HbA1c reduction of -0.4% (95% CI, -0.58 to -0.32) and mean BMI reduction of -1.43kg/m(2) (95% CI, -1.83 to -1.03) were both significantly observed with topiramate (p<0.00001). Serious and total adverse events occurred more commonly among topiramate users, with a risk ratio for serious adverse events of 1.69 (95% CI, 1.00-2.87). All but one study had high risk of bias.


CONCLUSIONS
Topiramate monotherapy reduced weight in obese type 2 diabetes patients, but increased adverse events including serious adverse events. Given these safety concerns and the absence of data on clinically meaningful efficacy endpoints, clinicians should generally avoid use of topiramate alone for this indication.
College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar. Electronic address: bridgetj@qu.edu.qa.
Bridget
B
Paravattil
College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar.
Kyle J
KJ
Wilby
University of British Columbia Hospital, 2211 Westbrook Mall, Vancouver, Canada.
Ricky
R
Turgeon
D001835:Body Weight / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D000077236:Topiramate; D015431:Weight Loss / Q000187:drug effects*
D018696:Neuroprotective Agents; D000077236:Topiramate; D005632:Fructose
Obesity; Topiramate; Type 2 diabetes mellitus; Weight loss