Successful naltrexone-bupropion treatment after several treatment failures in a patient with severe monogenic obesity
Mila S. Welling,
Mostafa Mohseni,
Eline S. van der Valk,
Johanna M. van Hagen,
Jan Steven Burgerhart,
Mieke M. van Haelst,
Elisabeth F.C. van Rossum
Affiliations
Mila S. Welling
Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, South-Holland, the Netherlands; Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, South-Holland, the Netherlands
Mostafa Mohseni
Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, South-Holland, the Netherlands; Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, South-Holland, the Netherlands
Eline S. van der Valk
Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, South-Holland, the Netherlands; Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, South-Holland, the Netherlands
Johanna M. van Hagen
Department of Human Genetics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, North-Holland, the Netherlands
Jan Steven Burgerhart
Department of Internal Medicine, University Medical Center Utrecht, 3584 CX Utrecht, Utrecht, the Netherlands
Mieke M. van Haelst
Department of Human Genetics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, North-Holland, the Netherlands
Elisabeth F.C. van Rossum
Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, South-Holland, the Netherlands; Obesity Center CGG, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, South-Holland, the Netherlands; Corresponding author
Summary: We describe the therapeutic journey of a 33-year-old patient with early-onset obesity (BMI 56.7 kg/m2) and hyperphagia due to a likely pathogenic heterozygous melanocortin-4 receptor (MC4R) gene variant.She was unsuccessfully treated with several intensive lifestyle interventions, gastric bypass surgery (−40 kg weight loss, followed by +39.8 kg weight regain), liraglutide 3 mg (−3.8% weight loss with sustained hyperphagia), and metformin treatment. However, naltrexone-bupropion treatment led to −48.9 kg (−26.7%) weight loss, of which −39.9 kg (−38.3%) was fat mass, in 17 months of treatment. Importantly, she reported improved hyperphagia and quality of life.We describe the potential beneficial effects of naltrexone-bupropion on weight, hyperphagia, and quality of life in a patient with genetic obesity. This extensive journey shows that various anti-obesity agents can be initiated, subsequently terminated when ineffective and substituted with other anti-obesity agents to identify the most efficient anti-obesity treatment.
