By Dr. Ed Hendricks on December 22, 2009
Arena Pharmaceuticals announced today that the company has submitted their application to the US Food and Drug Administration (FDA) for marketing approval for Lorcaserin, Arena’s internally discovered and developed drug candidate for weight management, including weight loss and maintenance of weight loss. The press release indicated the submission is based on an extensive data package from lorcaserin’s clinical development program that includes 18 clinical trials totaling 8,576 patients.
Now the waiting begins to see if the FDA will approve this novel drug.
By Dr. Ed Hendricks on December 20, 2009
History
Human Chorionic Gonadotropin (HCG) is a hormone normally secreted by the trophoblastic cells of the placenta during pregnancy. It was first described as a treatment for obesity in conjunction with a very low calorie diet by Dr. A. Simeons in 1954 [1]. The Simeons method consisted of a rigid diet of about 500 calories per day combined with 125 units of HCG injected six days per week for 8 weeks. For each of the two meals permitted daily, patients were instructed to select one item from each of four food groups, protein, vegetable, bread, and fruit. For protein servings patients were told to select from the following list: 3.5 ounces of meat, 3.75 ounces of fish, 4 ounces of Hoop cheese, or 6 egg whites. The latter two choices were to be selected occasionally [2]. The protein intake on the Simeons diet therefore ranged from about 45 to 50 grams per day. The Simeons method was very popular in the 1970s and advocates claimed that the method had numerous advantages including rapid weight loss with minimal hunger, no weakness, and dramatic loss of fat in the stomach, hips, thighs, and upper arms.
The method was wildly popular in the early 1970s; there were HCG weight loss clinics in every city in the U.S. After a series of clinical trials disputing the effectiveness of the Simeons method it fell from favor, but popular demand for HCG in the treatment of obesity has recently resurfaced in the United States. At the time the Simeons method was popular only HCG for injection was available. Sublingual HCG tablets were developed relatively recently. Perhaps this is one reason the method has resurfaced.
Discussion
Although there were a few early studies in agreement with Simeons recommendations [2-3], a number of subsequent studies produced evidence that the HCG in the Simeons method was ineffectual and that the weight loss was entirely due to the diet [4-7]. A meta-analysis review in 1995 of prior studies concluded that there is no scientific evidence that HCG is effective in the treatment of obesity [8]. The meta-analysis found insufficient evidence supporting the claims that HCG is effective in altering fat-distribution, hunger reduction or in inducing a feeling of well-being. The authors stated “…the use of HCG should be regarded as an inappropriate therapy for weight reduction…” In the authors’opinion, “Pharmacists and physicians should be alert on the use of HCG for Simeons therapy. The results of this meta-analysis supports a firm standpoint against this improper indication. Restraints on physicians practicing this therapy can be based on our findings.” PubMed and Google Scholar searches (on December 2, 2009) revealed no favorable reports on the Simeons method since the 1966 report by Lebon [3].
The diet employed in the Simeons method provides a daily protein intake below that recommended by the RDA for most patients. Although the caloric intake of the Simeons diet is similar to that of an early (prior to about 1985) VLCD, but the protein intake is much lower than that prescribed for VLCDs in current use. Indeed, in the last few years several well-known researchers have produced very convincing evidence that most adults benefit from protein intakes well above the minimum RDA and intakes more than double the minimum RDA improve weight loss during caloric restriction diets [9-10]. A further criticism of the Simeons diet is that the amounts of protein per serving recommended do not reach 30 grams, the threshold dose required for initiation of muscle protein synthesis [11-14]. In view of these recent advances in nutrition science, the Simeons diet is severely deficient in protein.
Recent studies indicate that HCG injections in men, especially men with testosterone deficiency, can produce a slight gain in muscle mass, thought to be due to rises in testosterone levels [15]. The doses in the latter study were 250 units twice weekly. However, no studies have been reported of muscle mass changes in patients before and after weight loss with the Simeons method. Therefore one cannot assume that weight loss with the Simeons method will result in a net gain in muscle mass. Rather, loss of muscle mass can be expected. There are no reports in the medical literature regarding the effectiveness of sublingual HCG.
Summary:
Numerous clinical trials have shown HCG to be ineffectual in producing weight loss. HCG injections can induce a slight increase in muscle mass in androgen-deficient males. The daily protein intake in the Simeons diet is set at about 40% of what we advise with our diets. The last favorable report of the Simeons method was in 1966, 43 years ago, at a time when scientific knowledge of protein requirements was rudimentary. All of the medical reports since 1966 reject both the use of HCG and the protein-deficient Simenons diet. Patients who are treated with the Simeons method lose weight because the diet is a protein-deficient starvation diet in which the patient loses muscle mass. Neither HCG infections nor sublingual HCG accelerates weight loss. The Simeons method is harmful since it promotes loss of muscle mass.
Recommendations:
References:
1. Simeons A. The action of chorionic gonadotropin in the obese. Lancet 1954; 2: 946-947.
2. Asher WL, Harper HW. Effect of human chorionic gonadotrophin on weight loss, hunger, and feeling of well-being. Am J Clin Nutr 1973; 26: 211-218.
3. Lebon P. Treatment of overweight patients with gonadotropin: follow-up study. J Am Geriat Soc 1966; 14: 116-125.
4. Greenway FL, Bray GA. Human chorionic gonadotropin (HCG) in the treatment of obesity: a critical assessment of the Simeons method. West J Med 1977; 127: 461-463. PMCID: 1237915.
5. Stein M, Julis R, Peck C, Hinshaw W, Sawicki J, Deller J, Jr. Ineffectiveness of human chorionic gonadotropin in weight reduction: a double-blind study. Am J Clin Nutr 1976; 29: 940-948.
6. Young RL, Fuchs RJ, Woltjen MJ. Chorionic Gonadotropin in Weight Control: A Double-Blind Crossover Study. JAMA 1976; 236: 2495-2497.
7. Bosch B, Venter I, Stewart RI, Bertram SR. Human chorionic gonadotrophin and weight loss. A double-blind, placebo-controlled trial. S Afr Med J 1990; 77: 185-189.
8. Lijesen GK, Theeuwen I, Assendelft WJ, Van Der Wal G. The effect of human chorionic gonadotropin (HCG) in the treatment of obesity by means of the Simeons therapy: a criteria-based meta-analysis. British journal of clinical pharmacology 1995; 40: 237-243. PMCID: 1365103.
9. Layman D. Dietary guidelines should reflect new understandings about adult protein needs. Nutrition & metabolism 2009; 6: 12.
10. Layman DK. Protein quantity and quality at levels above the RDA improves adult weight loss. J Am Coll Nutr 2004; 23: 631S-636S.
11. Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care 2009; 12: 86-90.
12. Paddon-Jones D, Short KR, Campbell WW, Volpi E, Wolfe RR. Role of dietary protein in the sarcopenia of aging. Am J Clin Nutr 2008; 87: 1562S-1566.
13. Paddon-Jones D, Westman E, Mattes RD, Wolfe RR, Astrup A, Westerterp-Plantenga M. Protein, weight management, and satiety. Am J Clin Nutr 2008; 87: 1558S-1561.
14. Symons TB, Sheffield-Moore M, Wolfe RR, Paddon-Jones D. A moderate serving of high-quality protein maximally stimulates skeletal muscle protein synthesis in young and elderly subjects. J Am Diet Assoc 2009; 109: 1582-1586.
15. Liu PY, Wishart SM, Handelsman DJ. A Double-Blind, Placebo-Controlled, Randomized Clinical Trial of Recombinant Human Chorionic Gonadotropin on Muscle Strength and Physical Function and Activity in Older Men with Partial Age-Related Androgen Deficiency. J Clin Endocrinol Metab 2002; 87: 3125-3135.
By Dr. Ed Hendricks on September 8, 2009
The following is excerpted from a memo to the staff at the Center for Weight Management dated September 8, 2009
Swine Flu or H1N1 Influenza:
Publication of research reports on vitamin D continues to accelerate with 545 papers published in the last 90 days. The CDC has announced that so far, Swine flu, H1N1, has killed thirty-six children in U.S. and analysis of CDC data indicates Vitamin D deficient children at higher risk of death. 75% of teenagers in the US are vitamin D deficient with levels below 26 ng/ml. Vitamin D deficiency in adults is also prevalent.
Vitamin D Dose Revised Recommendations:
John Cannell, M.D., of the Vitamin D Council, has revised his recommendations regarding Vitamin D dosages so I have revised our as well:
In the absence of flu symptoms or exposure:
1. Every adult and adolescent should take one 5,000 I.U. vitamin D capsule daily.
2. Children should take one 1,000 I.U. vitamin D capsule daily for each 25 pounds of weight. Thus a child weighing 75 pounds should take 3 capsules, etc.
If exposed to the flu increase the vitamin D dose as follows:
Adults, adolescents, and children should take 1,000 I.U. per pound of body weight daily for at least 3 days. If re-exposed during the 3 days add 3 more days.
If influenza symptoms develop (at any time):
Adults, adolescents, and children should take 1,000 I.U. per pound body weight for at least 10 days. If symptoms are present at day 10, continue for another 10 days.
These doses with 50,000 I.U. dose capsules of vitamin D are a prescription and must be prescribed and dispensed by a practitioner. Practitioners must explain such prescriptions to the patient (or to a parent if it is for a child or adolescent.) Since these high doses of vitamin D can lead to toxicity if continued for too long we will not sell the 50,000 I.U. vitamin D capsules as an over-the-counter supplement. Practitioners should document these prescriptions and the instructions and cautions in the patient record. We’ll also document these in our dispense log.
Patients must be informed of vitamin D toxicity and that no one should take the 50,000 continuously Patients should also be informed that vitamin D alone is not sufficient treatment for influenza and this too should be documented in the record.
Vitamin D Toxicity:
Be sure to inform patients that other physicians, especially pediatricians, are apt to be horrified by these doses for fear of toxicity. I’ll be happy to discuss these recommendations with anyone, including any doubting physicians.
So what about toxicity? Dr. Cannell has pointed out that between 1955 to 1990, all infants in East Germany received 600,000 IU of Vitamin D every three months for a total of 3,600,000 IU at age 18 months. At one time rheumatologists thought that arthritis might respond to high dose vitamin D. A 1948 paper from Johns Hopkins is remarkable for the dosage the doctors prescribed for arthritis and for the toxicity those doses sometimes caused. In their series of 10 toxic patients, the dose ranged from a low to 150,000 IU/day to a high of 600,000 IU/day and it took anywhere from 2 to 18 months for these daily doses to cause clinical toxicity. Clinical toxicity was manifested by weight loss, malaise and fatigue, followed by anorexia, nausea and vomiting. As Dr. Cannell writes, “if you have these symptoms, you are not vitamin D toxic unless you are taking at least 50,000 IU per day for many months, in which case you have not understood anything I have ever written.”
Worried about toxicity?
Serum calcium levels will be elevated in patients with vitamin D toxicity. If serum calcium is normal the patient is not toxic. Calcium levels are more reliable for checking for toxicity (and considerably less expensive) than are vitamin D levels.
By Dr. Ed Hendricks on August 13, 2009
The following went out to all staff at the Center for Weight Management today. In view of the intense interest in the Swine Flu I’m posting it here for our patients and others. Please post your questions and comments.
Swine Flu or H1N1 Influenza:
Classes at Granite Bay High School started on Monday, August 10, 2009. Yesterday parents of students were notified that “Swine Flu” had been diagnosed in three students on the second day of classes. The H1N1 flu is now among us and we should be prepared to deal with it among our patients, our staff and our families.
A visit to CDC web pages today yielded the following information. “When the novel H1N1 flu outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the novel H1N1 flu outbreak, including the numbers of confirmed and probable cases of disease. From April 15, 2009 to July 24, 2009, states reported a total of 43,771 confirmed and probable cases of novel influenza A (H1N1) infection. Of these cases reported, 5,011 people were hospitalized and 302 people died.” The mortality rate during that time was 0.7% and the hospitalization rate 11%. A mortality rate of 0.7% means about 7 persons die out of 1,000 infected. This mortality rate is lower than usual for an influenza epidemic but these data are for summer months when the mortality rate is typically lower.
Of interest is the “secondary attack rate” meaning the rate of infection following close contact with an infected person at home, at work or at school. The CDC reports “a secondary attack rate in household contacts for acute-respiratory-illness (ARI) was 18 % to 19% and 8% to 12% for influenza-like-illness (ILI). ARI is defined as two or more of the following four symptoms: fever, cough, sore throat, and rhinorrhea (runny nose). ILI is defined as fever and cough or sore throat. In general, these household secondary attack rates are slightly lower than what occurs in seasonal influenza.” The secondary attack rate in the household can be lowered by the use of antiviral medications for the infected family member to reduce viral shedding. Secondary infection rates can also be reduced by treating contacts with an antiviral drug as discussed below.
Also of interest is that obesity may be a risk factor for flu complications.
Prevention: What can one do to avoid this flu? Wash your hands often, avoid infected persons if possible, get the vaccine as soon as it becomes available, and take vitamin D. More information about vitamin D is written below.
Symptoms: The symptoms of H1N1 flu virus in people are similar to the symptoms of seasonal flu, although vomiting and diarrhea has been reported more commonly with H1N1 flu infection than is typical for seasonal flu. Symptoms include fever (93%), cough (83%), shortness of breath (54%), fatigue/weakness (40%), chills (37%) and myalgias (muscle soreness) (36%).
Treatment: The swine flu or H1N1 influenza virus is sensitive or susceptible to the neuraminidase inhibitor antiviral medications, zanamivir (Relenza Inhalation Powder) and oseltamivir (Tamiflu). It is resistant to the adamantane antiviral medications, amantadine (Symmetrel) and rimantadine (Flumadine). For treatment and prophylaxis to be effective it should be initiated as soon as possible after exposure. If time lapse between exposure and therapy or prophylaxis was 2 or more days, choose Relenza over Tamiflu. Each Relenza prescription comes with an inhalation device – no special inhalation equipment is necessary.
Relenza Inhalation Powder treatment for adults & children ≥ 7 years infected with H1N1 influenza: 10 mg (two 5mg inhalations) twice daily for 5 days. Relenza prophylaxis if exposed to an infected person: 10 mg (two 5mg inhalations) daily for up to 10 to 28 days.
Tamiflu treatment for adults and adolescents ≥ 13 years infected with H1N1 influenza: 75 mg twice daily for 5 days. Tamiflu prophylaxis if exposed to an infected person: 75 mg daily for 10 days to 6 weeks.
As the recommendations indicate, either of these drugs can be used for prophylaxis during an epidemic for any patient or member of their family even in the absence of known exposure. At this point in the emerging epidemic we should not hesitate to write prescriptions for either drug if any patient requests them. I plan to prescribe Tamiflu for my family and hold it for use if needed. Later on in the epidemic the drugs may be hard to find or unobtainable.
Vitamin D3:
Vitamin D is an extremely important defense mechanism against influenza. Although definitive randomized placebo controlled clinical trials (RCTs) have not been reported, there is anecdotal evidence and limited trial evidence strongly suggesting that taking supplementary vitamin D is protective and reduces both the risk of influenza infection and the risk of complications if infection does occur. Vitamin D can be used as a supplementary, experimental treatment for and prophylaxis against influenza – it should not be used as the only agent in treatment or prophylaxis.
Vitamin D is toxic only in high doses taken for long periods of time. Rather than wait for definitive evidence from RCTs I make the following recommendations. These recommendations are adapted after those of John J. Cannell, M.D. of the Vitamin D Council. Patients should be informed that their other physicians probably would disagree with these recommendations. since knowledge of the importance of Vitamin D supplementation is not stressed in mainstream medicine.
As a daily routine in the absence of flu symptoms or exposure:
1. Every adult should take one 5,000 I.U. vitamin D capsule daily.
2. Children should take one 1,000 I.U. vitamin D capsule daily for each 25 pounds of weight. Thus a child weighing 75 pounds should take 3 capsules, etc.
If exposed to the flu I recommend increasing the vitamin D dose as follows:
1. Adults and adolescents should take one 50,000 I.U. capsule daily for 10 days. If re-exposed during the 10 days add another 10 days. (Don’t continue this dose indefinitely since this dose can produce vitamin D toxicity, but only after several months).
2. Children should take 10,000 I.U. per 25 pounds body weight for 10 days. If re-exposed during the 10 days add another 10 days. (Don’t continue this dose indefinitely since this dose can produce vitamin D toxicity, but only after several months).
If influenza symptoms develop, I recommend increasing the vitamin D intake as follows:
Adults, adolescents, and children should take 2,000 I.U. per Kg body weight per day for 7 days.
Examples for different weights:
Vitamin D dose for a 250 pound patient
Dose = 250 lb X 1 Kg/2.2 lb X 2,000 I.U./1 Kg = 236,367 I.U.
I’d round up to 250,000 I.U. or five 50,000 I.U. capsules per day for 7 days.
Dose = 200 lb X 1 Kg/2.2 lb X 2,000 I.U./1 Kg = 181,182I.U.
I’d round up to 200,000 I.U. or four 50,000 I.U. capsules per day for 7 days.
Vitamin D dose for a 85pound patient
Dose = 85 lb X 1 Kg/2.2 lb X 2,000 I.U./1 Kg = 72,272 I.U.
The 50,000 I.U. dose of vitamin D is a prescription and must be prescribed and dispensed by a physician or other practitioner. Practitioners should explain carefully such prescriptions to the patient (or to a parent if it is for a child or adolescent.) Since these high doses of vitamin D can lead to toxicity if continued for too long we do not sell the 50,000 I.U. vitamin D capsules as an over-the-counter supplement. Practitioners should document these prescriptions and the instructions and cautions in the patient record.
Patients should be informed that vitamin D alone is not sufficient treatment for influenza and this too should be documented in the record.
By Dr. Ed Hendricks on March 30, 2009
Arena Pharmaceuticals released today the first report of their initial 2-year phase 3 clinical trial for Lorcaserin. Although Wall Street analyists generally issued pessimistic opinions, careful analysis reveals that the new drug meets or exceeds FDA standards for approval. Furthermore the weight loss results are robust with nearly 50% of patients losing 5% of initial weight and nearly 25% losing 10%. Typically there is a marked genetic variation in patient response to obesity treatment, something FDA trials tend to obscure. A high percentage of patients who lose more than 5 and 10% suggests a very large population of obese patients will respond with impressive weight loss with Lorcaserin. The drug triggers specific brain serotonin receptors known to diminish carbohydrate cravings and diminish food intake. Patients receiving agents known to stimulate these receptors often comment on how easy it is to diet and lose weight. This factor alone should make this drug a very popular one with patients. Serotonin precursors have been used for weight management for decades and are known by obesity treatment specialists to be both safe and effecetive for seleced patients. A new report published online in the journal Obesity indicates that about 20% of bariatric specialists are now treating some patients with 5-Hydroxytryptophan and Carbidopa, a combination known to trigger the same serotonon receptors as Lorcaserin.
Drop-out rates, typically at 50% at six months in lengthy obesity drug trials, were extraordinarily low indicating the patients who responded were highly satisfied with their results. This is a critical factor with any obesity drug since high drop-out rates generally mean patients won’t stick with a drug long enough to achieve success.
Also impressive was the paucity and lack of severity of adverse events. Early headache on nausea were the most frequent and were mild since evidently no patients dropped out because of such events. Intensve cardiac monitoring over the two years revealed absolutely no significant cardiac adverse reactions.
From the perspective of a medical weight management specialist, Lorcaserin appears to be a very promising new drug. Arena intends to report results of two more clinical trials this fall before applying for FDA approval for Lorcaserin. Check back here for updates as new information becomes available.
By Dr. Ed Hendricks on March 9, 2009
New Obesity Drug?
Something which could cause a great deal of excitement is on the horizon in obesity treatment. Arena Pharmaceuticals, a San Diego biotech firm, has an anti-obesity drug in development. The drug, named Lorcaserin, activates specific brain serotonin receptors which suppress appetite, reduce food intake, and produce weight loss. This late-stage developmental drug is still several years away from possible FDA approval. Arena has it on the FDA approval track and has big event scheduled to occur in late March, 2009 when the company will first report results of a Phase 3 clinical trial. The company hasn’t revealed any details of the 2-year Phase 3 trial as yet, but if the results are as impressive as those of the Lorcaserin Phase 2 trials, and if Phase 3 trials raise no safety issues then Lorcaserin may be the drug everyone has waiting for.
The two-drug combination of phentermine and fenfluramine or, “Phen/Fen,” activated these same serotonin receptors. For many patients Phen/Fen was a magical combination, which made food cravings, especially carbohydrate cravings, disappear and produced almost effortless weight loss. Unfortunately, a small number of patients developed cardiac valve leakage caused by the fenfluramine because fenfluramine activates all serotonin receptors including the 5-HT 2B receptors on cardiac valves. The fenfluramines were withdrawn from the market. Although the FDA was suspicious for a while that phentermine could have played a part in causing the heart valve problem, it is well documented now that phentermine has no adverse cardiovascular effects. Phentermine was exonerated and remains the most frequently prescribed anti-obesity drug.
Lorcaserin should be cardiac-safe because it activates one and only one specific serotonin receptor, the 5-HT 2C receptor but does not activate the cardiac 5-HT 2B receptor. Patients in the Phase 3 trial were monitored with echocardiograms and Arena will be announcing the analysis of that data along with the efficacy data in late March. The results of the 12-week Phase 2 trial were recently published in the medical journal Obesity (Smith SR, Prosser WA, Donahue DJ, Morgan ME, Anderson CM, Shanahan WR. Lorcaserin (APD356), a Selective 5-HT2C Agonist, Reduces Body Weight in Obese Men and Women. Obesity 2008;17:494-503.). Adverse effects were limited to headaches, nausea, and dizziness. Headaches usually started on day one, lasted a few hours and were mild. Nausea was also typically a drug start up effect and then disappeared. Dizziness occurred in about 7% of the patients in the trial. There were no significant cardiac or psychiatric adverse effects.
Weight loss appeared at 2 weeks and was progressive throughout the 12-week trial. The weight loss achieved at 12 weeks was comparable to the weight loss at 12 weeks of other weight loss drugs such as sibutramine. The non-responder rate was very low with nearly all patients losing weight in the Phase 2 trial. This is interesting because in the Phase 2 trial the patients were not put on diets and did not receive even advice on changing behaviors. In other words, nearly all the patients lost weight by merely taking the drug and doing nothing else. If the Phase 3 trial results in about 3,000 patients confirms and extends the Phase 2 trial results in about 400 patients, Lorcaserin could be the next blockbuster obesity drug. This preliminary Phase 2 report show results for 12 weeks only but a crucial question is what happens in the next 12 weeks of therapy and thereafter. This is why the Phase 3 trial results are eagerly awaited.
Even if it is eventually approved by the FDA, the earliest date Lorcaserin might be available at pharmacies will likely be 2012. The FDA has been very slow to act on new drug applications lately and the agency has always been extremely slow in approving new obesity drugs. Overweight patients shouldn’t wait for a new drug before dealing with this illness.
It looks like Lorcaserin alone produces an average 3% weight loss at 12 weeks or about one third the weight loss our patients get on our Very Low Carbohydrate Diet program which includes a great deal of attention to behaviors and behavior modification without any weight loss drug. Our patients who have phentermine added, experience on average a 15% weight loss at 6 months. Although a 3% weight loss at the highest dosage at 12 weeks may seem low, one should remember this is in patients who aren’t even trying to lose weight – they just took the drug. I would expect Lorcaserin will be like any other drug in that it will do much better combined with a comprehensive weight loss program. Will Lorcaserin be a better drug than phentermine? We’ll see. It will most certainly be much more expensive than phentermine.
I’ll continue to watch for news on this exciting developmental drug and will post new information here in this Blog as it becomes available. Check back often.
By Dr. Ed Hendricks on February 25, 2009
If you have read the “Latest in Obesity Research” page on this website you’ll recall that last year we conducted a nationwide survey of obesity treatment specialists under the auspices of the American Society of Bariatric Physicians (ASBP). The survey discovered that phentermine is the most favored anti-obesity drug of obesity treatment specialists; the drug is the first choice of 97% of these specialists. Dr. Hendricks presented the survey results at the ASBP’s 58th annual symposium in Tampa last fall (Hendricks EJ. ASBP Membership Survey of Prescribing Practices. In: 58th Annual Obesity & Associated Conditions Symposium. Tampa, Florida: American Society of Bariatric Physicians; 2008). The results were also presented in October 2008 as a scientific poster at the Obesity Society’s Annual Scientific Meeting in Phoenix (Hendricks EJ, Greenway FL, Westman EC, et al. A Survey of Prescribing Practices of Medical Bariatricians, Abstract 840P. In: Annual Scientific Meeting. Phoenix, AZ: The Obesity Society; 2008). A manuscript detailing the results together with some additional data from our patients prepared by Dr. Frank Greenway has been accepted for publication by the journal Obesity (Hendricks EJ, Rothman RB, Greenway FL. How Physician Obesity Specialists Use Drugs to Treat Obesity. Obesity 2008;Submitted November 20, 2008, Manuscript ID 08-0897-Orig.R1.)
Our study of phentermine’s effects on blood pressure is still in progress. Preliminary results with a limited number of subjects suggest that in patients with normal blood pressure given phentermine blood pressure remains unchanged. On the other hand, we see blood pressures go down in patients with high blood pressures or with borderline high blood pressures. (What was once termed “borderline” is now called “prehypertension). Some preliminry data was presented at a scientific poster session at the Obesity Society meeting last fall (Hendricks EJ, Westman EC. Phentermine Therapy in Obesity Treatment: Effect on Blood Pressure 582P. Obesity 2008;16, Supplement 1:S216).
Recently Dr. Rothman came across a letter-to-the-editor in the International Journal of Cardiology which incorrectly maligned phentermine. We wrote a rebuttal letter defending phentermine which has just been published online (Rothman RB, Hendricks EJ. Phentermine Cardiovascular Safety. International journal of cardiology 2009;doi:10.1016/j.ijcard.2008.12.205). Perhaps you are aware that the length of time from submittal of a paper to a scientific journal to acceptance is commonly many months and that there is often then a lag of more months before the paper is actually published. Evidently the editor of the International Journal of Cardiology liked our letter – it was accepted the same day it was submitted and published online a month after it was submitted. If anyone would like a copy, you can stop by either office and pick one up or email us and we’ll send you a copy.
What about our newest studies? We have 5 new studies in progress and 3 others in planning stages. New studies underway include:
New studies at the planning stage include:
I’ll discuss these new studies in more detail in up-coming blog entries.
Contact our non–surgical weight loss clinic, which serves Sacramento, Roseville, and surrounding areas, to schedule an appointment.
2310 Professional Dr., St. 200
Roseville, California 95661
Phone:916.773.1191
Fax: 916.773.0498
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2621 Capitol Ave.
Sacramento, California 95816
Phone: 916.551.1999
Fax: 916.551.1998
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