PREDICTORS OF WEIGHT-LOSS DURING TREATMENT WITH D-FENFLURAMINE

Objectives. To identify parameters predictive of weight loss during tr eatment with d-fenfluramine. This may provide a tool to recognize pati ents who are sensitive to the weight-reducing effect of d-fenfluramine and thus prevent unnecessary prescription. Design. An open interventi on study during which biweekly control visits were scheduled. The stud y lasted 12 weeks. Setting. The General Internal Medicine outpatient c linic of the Leiden University Hospital. Patients were recruited throu gh a newspaper advertisement. Subjects. Forty-eight healthy, obese pat ients (36 women and 12 men), aged 39 +/- 10 years (mean +/- SD) with a body mass index of 34.3 +/- 4.1 kg/m(2) enrolled. Interventions. d-Fe nfluramine 15 mg twice daily for 12 weeks. Main outcome measures, Body weight, height, waist and hip circumference, food intake, smoking hab its, obesity history, treatment history, family history of obesity and compliance with the medication scheme were recorded as potential pred ictors of weight loss. Results. One patient was withdrawn because of d epressive symptoms. Thirteen patients did not lose weight. On average, the other 34 patients lost 5.7 +/- 2.9 kg or 18.1 +/- 9.4% of excess body weight. High compliance with the drug regimen was associated with a twofold greater weight loss (17.7 +/- 12.3 vs. 9.0 +/- 9.4% of exce ss weight, ANOVA, P = 0.0088). Patients with a positive family history of obesity lost twice as much weight as patients without obese relati ves (15.8 +/- 11.8 vs. 6.0 +/- 7.3% of excess weight; ANOVA, P = 0.007 8). No other potential determinants were predictive for weight loss. C onclusions. Informing patients that compliance with the medication sch eme improves treatment outcome will be useful. Previous failures to lo se weight should not exclude patients from treatment. A positive famil y history of obesity needs further evaluation as a possible determinan t of weight loss in forthcoming studies.