Exenatide Use for Weight Management in the Obese Non-Diabetic Patient

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 660-676-Clinical Obesity Treatment
Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-667
Lance Micheel Freeman*1 and Neel L Shah2
1The University of Texas Medical School, Houston, TX, 2UT Med School - Houston, Houston, TX
Background:  The obesity epidemic is a health problem with staggering implications for affected individuals and society as a whole.  In a small randomized controlled trial of obese non-diabetic women taking Exenatide for weight loss, Dushay et al (1) discovered 3 response categories as early as 4 weeks into treatment - high responders who lost >5% of their body weight, moderate responders who lost <5% of their body weight and non-responders who did not lose weight.

Clinical case:  A 27 year old female who presented to a university endocrinology clinic as a self-referral for an inability to lose weight.  Other medical problems included PCOS, infertility, insulin resistance, hyperlipidemia, and depression.  The patient weighed 238 lbs at her initial visit with a BMI of 37.3%.  The patient reported weighing 150 lbs approximately 5 years ago.  The patient noted steady weight gain over several years with a rapid weight gain of 30 lbs over the preceding 6 months.  The recent weight gain coincided with smoking cessation.  The patient was exercising 5 days a week and employed the use of a personal trainer. 

Workup showed a recent HgbA1c of 5.2%, and normal thyroid function tests.  Cushing’s disease was ruled out with a 24 hour urine free cortisol value of 35.4 ug/24hr.  She denied any history of pancreatitis, EtOH abuse, or gallstones.  Multiple pharmacologic therapies were discussed including their risks and benefits.  Diet and exercise counseling was given.  The patient chose Exenatide as her therapy of choice.  The patient understood that this medication was not currently approved for weight loss and accepted the risks involved with treatment.

Exenatide 5 mcg twice daily was initiated with breakfast and dinner.  At her 8 week follow-up visit the patient had lost 11 lbs [4.6%].  Blood glucose levels were monitored, ranging from 80–120 mg/dL, and no hypoglycemic events were reported.  She denied nausea, abdominal pain, or bloating.

Conclusion:   This case illustrates the dramatic weight loss that can be seen in non-diabetic patients taking Exenatide.  Additionally, Exenatide may offer the possibility of continuous long term weight loss which is advantageous when compared to current FDA approved therapies (2).  In this case, the patient has experienced robust weight loss with minimal side effects. Proper candidate selection and side effect profiles need to be addressed prior to using Exenitide as a potential management option for weight loss.

(1) Dushay, J., Gao, C., Gopalakrishnan, GS., Crawley, M., Mitten, EK., Wilker, E., Mallington, J., & Maratos-Flier, E.  Short-term exenatide treatment leads to significant weight loss in a subset of obese women without diabetes.  Diabetes Care. 2012 Jan; 35(1): 4-11.     (2) Folli, F., Mendoza,RG.  Potential use of exenatide for the treatment of obesity. Expert Opinion on Investigating Drugs. 2011 Dec; 20 (12): 1717-1722.

Nothing to Disclose: LMF, NLS

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm