WO2000025806A1 - Method for weight control - Google Patents

Method for weight control Download PDF

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Publication number
WO2000025806A1
WO2000025806A1 PCT/US1999/026169 US9926169W WO0025806A1 WO 2000025806 A1 WO2000025806 A1 WO 2000025806A1 US 9926169 W US9926169 W US 9926169W WO 0025806 A1 WO0025806 A1 WO 0025806A1
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WO
WIPO (PCT)
Prior art keywords
leptin
organic
weight
reducing
appetite suppressing
Prior art date
Application number
PCT/US1999/026169
Other languages
French (fr)
Inventor
Louis J. Aronne
Original Assignee
Aronne Louis J
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Aronne Louis J filed Critical Aronne Louis J
Publication of WO2000025806A1 publication Critical patent/WO2000025806A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/22—Hormones
    • A61K38/2264—Obesity-gene products, e.g. leptin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides

Definitions

  • the present invention relates to a method for reducing the weight of an obese patient using a combination of pharmacological agents. It is known that the ob gene elaborates a substance known as leptin which has been identified as a component in controlling body weight by acting as an agonist to receptors in the brain to regulate body weight and fat deposition. This substance appears to provide a negative afferent signal in a feedback loop which affects appetite and controls body weight.
  • leptin levels are elevated which suggests that there is a resistance to effects of leptin which points to the conclusion that the level of leptin is involved in the obesity of the particular subject.
  • the present invention is directed to a method of reducing the weight of an obese subject which is based on the combined administration of leptin or a leptin mimetic and a synthetic organic appetite suppressing compound according to a dosage schedule which is based on :
  • the invention is directed to a method of providing a therapeutic regimen which is based on the combined administration of leptin or a leptin mimetic and a organic appetite suppressing compound.
  • Leptin which is also known as OB, is a peptide hormone which is a natural agonist for regulating body weight and fat deposition. Leptin is produced by adipose tissue and has been described by Zhang et al, Nature (Lond.), 372:425-431 (1994), which is incorporated by reference. The gene which codes for human leptin has been cloned and recombinant leptin is commercially available. In addition, an extended acting form of leptin may be employed which is glycolated leptin that is prepared by pegelation of leptin. Other leptin mimetics are described in U.S. 5,756,461, which is incorporated by reference.
  • the initial dose of leptin or the leptin mimetic will be an effective amount for appetite suppression which will usually be between 0.05 to 0.5mg/kg given in divided doses, either 1 or 2 times per day parenterally, preferably by subcutaneous injection or at less frequent intervals when long acting leptin mimetic compounds are administered.
  • each patient When the maintenance phase of the combined leptin or leptin mimetic and organic appetite suppressant treatment is entered, where it is necessary to maintain a determined level of leptin or leptin mimetic, then each patient must be titrated to determine the necessary maintenance dose within the broadly stated range.
  • the organic appetite suppressing compound may be administered initially with leptin or a leptin mimetic or it may be used without leptin or a leptin mimetic for a short term, i.e. about 14-30 days during which a plateau in weight loss is detected or for a longer term up to about 3 to about 6 months at which time the plateau effect may be detected.
  • the term plateau is used to describe the phenomenon where an appetite suppressant is administered but the subject's rate of weight loss shows a detectable change and there is substantial failure to lose additional weight.
  • the organic appetite suppressing compounds include sibutramine, fenfluramine, phentermine, dexfenfluramine, diethylpropion, phendimetrazine, ephedrine, caffeine and mixtures thereof.
  • the preferred organic appetite suppressing compounds are those which are made synthetically rather than those which are obtained from natural sources.
  • the compound sibutramine is described in U.S. 4,929,629. This compound may be administered orally at a dose of 5 to 30mg per patient, daily, preferably in
  • This compound may be administered orally at a dose of 8 to 30mg per patient, daily, preferably in 1 to
  • the compound diethylpropion is described in U.S. 3,001,910. This compound may be administered orally at a dose of 25 to 75mg per patient, daily preferably in 1 to 3 divided doses .
  • the compound fenfluramine is described in U.S.
  • This compound may be administered orally at a dose of 20 to 120mg per patient ,, daily, preferably in 1 to 3 divided doses.
  • the compound dexfluramine is described in U.S.
  • This compound may be administered orally at a dose of 15 to 30mg per patient, daily, preferably in 1 to 2 divided doses.
  • the compound mazindol is described in U.S. 3,763,178. This compound may be administered orally at a dose of 1 to 2mg per patient, daily, preferably in 1 to 2 divided doses.
  • the compound phendimetrazine is described in U.K. 791,416. This compound may be administered orally at a dose of 30 to 60mg per patient, daily, preferably in 1 to 2 divided doses.
  • Ephedrine may be administered orally at a dose of 12.5 to 75mg per patient, daily, preferably in 1 to 3 divided doses.
  • Compounds which are known serotonin reuptake inhibitors may also be utilized as synthetic organic appetite suppressants. It is understood that if the organic appetite suppressing compound is formulated in a 12 hour or 24 hour oral dosage forms, it will not be necessary to take more than one or two doses per day.
  • An obese patient is treated as follows: Therapy is commenced by administering leptin at a dose of 0.01 to 0.3mg/kg 1 to 2 times per day by subcutaneous injection and by administering sibutramine orally at a dose of lOmg per day given orally as a single dose. After 14-30 days the serum leptin level is determined and the dose of leptin is adjusted to provide a level of which is essentially the same as the base line level of leptin which is determined for each patient at the start of therapy. The treatment with sibutramine is continued with the adjusted dose of leptin.
  • the level of leptin is monitored on a monthly basis and the dose is adjusted to maintain a leptin level in the patients originally determined baseline level of serum leptin. serum while monitoring the patient for weight loss.

Abstract

A method for reducing the weight of an obese subject which comprises the combined administration of leptin and/or a leptin mimetic and a synthetic organic appetite suppressing compound according to a dosage schedule which is based on: (a) administering an effective dose of an organic appetite suppressing compound alone or in combination with leptin and/or a leptin mimetic in an amount that will suppress the subjects appetite; and (b) administering an effective dose of said organic appetite suppressing compound and leptin and or/a leptin mimetic at an effective dose which will substantially maintain the subjects leptin level at a level of leptin which will sustain a continued weight reduction in said subject.

Description

METHOD FOR WEIGHT CONTROL
BACKGROUND OF THE INVENTION:
The present invention relates to a method for reducing the weight of an obese patient using a combination of pharmacological agents. It is known that the ob gene elaborates a substance known as leptin which has been identified as a component in controlling body weight by acting as an agonist to receptors in the brain to regulate body weight and fat deposition. This substance appears to provide a negative afferent signal in a feedback loop which affects appetite and controls body weight.
In obese individuals, leptin levels are elevated which suggests that there is a resistance to effects of leptin which points to the conclusion that the level of leptin is involved in the obesity of the particular subject.
When humans lose weight, there is commonly observed a phenomenon of a weight loss plateau in which an individual reaches a weight below which they cannot lose weight despite substantial efforts. This is seen after a mean weight loss of 5 to 15% of total body weight. Some patients who have lost large amounts of weight exhibit symptoms which are similar to symptoms that are seen in animals having demonstrated leptin deficiencies. This has led to questions of whether or not weight loss plateau is due to a deficiency in the level of leptin in a subject.
Studies that have involved the administration of recombinant leptin have shown that exogenous leptin can initially induce some weight loss but eventually the continued administration of leptin fails to induce weight loss. The present inventor has discovered that if controlled amounts of leptin or a leptin mimetic are used in combination with a synthetic organic compound that is known to inhibit the appetite, the problem of resistance to the effects of leptin can be reduced or eliminated.
SUMMARY OF THE INVENTION
The present invention is directed to a method of reducing the weight of an obese subject which is based on the combined administration of leptin or a leptin mimetic and a synthetic organic appetite suppressing compound according to a dosage schedule which is based on :
(a) administering an effective dose of an organic appetite suppressing compound alone or in combination with leptin or a leptin mimetic in an amount that will suppress the subjects appetite;
(b) when the subjects rate of weight loss shows a detectable change, administering an effective dose of said leptin or a leptin mimetic at an effective dose which will substantially maintain the subjects total level of leptin, i.e. that which is produced endogenously and leptin or leptin mimetic which has been administered from an exogenous source at a level of total leptin which will sustain a continued weight reduction in said subject . The total level of leptin should be maintained at a level which is no higher than the subjects original base level before any treatment is initiated although, if desired, maintaining a higher total level of leptin will still enable a subject to continue to lose weight. It is a primary object of the invention to provide a method of inducing weight loss in an obese subject which utilizes leptin or a leptin mimetic in combination with a organic appetite suppressing compound. It is also an object of the invention to provide a method of inducing weight loss in an obese subject which avoids the plateau syndrome and provide a means for continuous weight loss. It is also an object of this invention to provide a improved means of controlling the dosing of leptin or a leptin mimetic for inducing continuous weight loss . It is also an object of this invention to provide a means of reducing the dose of leptin or a leptin mimetic which is required to induce weight loss.
It is also an object of this invention to provide an improved method for achieving higher amounts of weight loss in patients as compared to the weight loss that is induced using organic appetite suppressing compounds .
These and other objects of the invention will become apparent from a review of the specification.
DETAILED DESCRIPTION OF THE INVENTION
The invention is directed to a method of providing a therapeutic regimen which is based on the combined administration of leptin or a leptin mimetic and a organic appetite suppressing compound.
Leptin, which is also known as OB, is a peptide hormone which is a natural agonist for regulating body weight and fat deposition. Leptin is produced by adipose tissue and has been described by Zhang et al, Nature (Lond.), 372:425-431 (1994), which is incorporated by reference. The gene which codes for human leptin has been cloned and recombinant leptin is commercially available. In addition, an extended acting form of leptin may be employed which is glycolated leptin that is prepared by pegelation of leptin. Other leptin mimetics are described in U.S. 5,756,461, which is incorporated by reference. The initial dose of leptin or the leptin mimetic will be an effective amount for appetite suppression which will usually be between 0.05 to 0.5mg/kg given in divided doses, either 1 or 2 times per day parenterally, preferably by subcutaneous injection or at less frequent intervals when long acting leptin mimetic compounds are administered. When the maintenance phase of the combined leptin or leptin mimetic and organic appetite suppressant treatment is entered, where it is necessary to maintain a determined level of leptin or leptin mimetic, then each patient must be titrated to determine the necessary maintenance dose within the broadly stated range.
The organic appetite suppressing compound may be administered initially with leptin or a leptin mimetic or it may be used without leptin or a leptin mimetic for a short term, i.e. about 14-30 days during which a plateau in weight loss is detected or for a longer term up to about 3 to about 6 months at which time the plateau effect may be detected. The term plateau is used to describe the phenomenon where an appetite suppressant is administered but the subject's rate of weight loss shows a detectable change and there is substantial failure to lose additional weight.
The organic appetite suppressing compounds include sibutramine, fenfluramine, phentermine, dexfenfluramine, diethylpropion, phendimetrazine, ephedrine, caffeine and mixtures thereof. The preferred organic appetite suppressing compounds are those which are made synthetically rather than those which are obtained from natural sources.
The compound sibutramine is described in U.S. 4,929,629. This compound may be administered orally at a dose of 5 to 30mg per patient, daily, preferably in
1 to 2 divided doses . The compound phentermine is. escribed in U.S.
2,408,345. This compound may be administered orally at a dose of 8 to 30mg per patient, daily, preferably in 1 to
2 divided doses.
The compound diethylpropion is described in U.S. 3,001,910. This compound may be administered orally at a dose of 25 to 75mg per patient, daily preferably in 1 to 3 divided doses . The compound fenfluramine is described in U.S.
3.198.833. This compound may be administered orally at a dose of 20 to 120mg per patient ,, daily, preferably in 1 to 3 divided doses. The compound dexfluramine is described in U.S.
3.198.834. This compound may be administered orally at a dose of 15 to 30mg per patient, daily, preferably in 1 to 2 divided doses.
The compound mazindol is described in U.S. 3,763,178. This compound may be administered orally at a dose of 1 to 2mg per patient, daily, preferably in 1 to 2 divided doses.
The compound phendimetrazine is described in U.K. 791,416. This compound may be administered orally at a dose of 30 to 60mg per patient, daily, preferably in 1 to 2 divided doses.
Ephedrine may be administered orally at a dose of 12.5 to 75mg per patient, daily, preferably in 1 to 3 divided doses. Compounds which are known serotonin reuptake inhibitors may also be utilized as synthetic organic appetite suppressants. It is understood that if the organic appetite suppressing compound is formulated in a 12 hour or 24 hour oral dosage forms, it will not be necessary to take more than one or two doses per day.
All of the patents which are mentioned above are incorporated by reference.
EXAMPLE
An obese patient is treated as follows: Therapy is commenced by administering leptin at a dose of 0.01 to 0.3mg/kg 1 to 2 times per day by subcutaneous injection and by administering sibutramine orally at a dose of lOmg per day given orally as a single dose. After 14-30 days the serum leptin level is determined and the dose of leptin is adjusted to provide a level of which is essentially the same as the base line level of leptin which is determined for each patient at the start of therapy. The treatment with sibutramine is continued with the adjusted dose of leptin. Subsequently, the level of leptin is monitored on a monthly basis and the dose is adjusted to maintain a leptin level in the patients originally determined baseline level of serum leptin. serum while monitoring the patient for weight loss. While certain preferred and alternative embodiments of the invention have been set forth for purposes of disclosing the invention, modifications to the disclosed embodiments may occur to those who are skilled in the art. Accordingly, the appended claims are intended to cover all embodiments of the invention and modifications thereof which do not depart from the spirit and scope of the invention.

Claims

I claim :
1. A method of reducing the weight of an obese subject which comprises the combined administration of leptin or a leptin mimetic and a synthetic organic appetite suppressing compound according to a dosage schedule which is based on:
(a) administering an effective dose of an organic appetite suppressing compound alone or in combination with leptin or a leptin mimetic in an amount that will suppress the subjects appetite; and
(b) administering an effective dose of said organic appetite suppressing compound and leptin at an effective dose which will substantially maintain the subjects leptin level at a level of leptin which will sustain a continued weight reduction in said subject.
2. A method of reducing the weight of an obese subject as defined in claim 1 wherein the organic appetite suppressing compound is sibutramine.
3. A method of reducing the weight of an obese subject as defined in claim 1 wherein the organic appetite suppressing compound is phentermine.
4. A method of reducing the weight of an obese subject as defined in claim 1 wherein the organic appetite suppressing compound is phendimetrazine.
5. A method of reducing the weight of an obese subject as defined in claim 1 wherein the organic appetite suppressing compound is fenfluramine.
6. A method of reducing the weight of an obese subject as defined in claim 1 wherein the organic appetite suppressing compound is dexfenfluramine .
7. A method of reducing the weight of an obese subject as defined in claim 1 wherein the organic appetite suppressing compound is caffeine.
8. A method of reducing the weight of an obese subject as defined in claim 1 wherein the organic appetite suppressing compound is ephedrine.
9. A method of reducing the weight of an obese subject as defined in claim 1 wherein the organic appetite suppressing compound is mazinol.
10. A method of reducing the weight of an obese subject as defined in claim 1 wherein a combination of organic suppressing compounds are employed.
11. A method as defined in claim 1 wherein leptin derived from recombinant DNA is employed.
12. A method as defined in claim 1 wherein a leptin mimetic is employed.
PCT/US1999/026169 1998-11-04 1999-11-04 Method for weight control WO2000025806A1 (en)

Applications Claiming Priority (2)

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US18687798A 1998-11-04 1998-11-04
US09/186,877 1998-11-04

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Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2007055743A2 (en) * 2005-11-01 2007-05-18 Amylin Pharmaceuticals, Inc. Treatment of obesity and related disorders
WO2009064298A1 (en) * 2007-11-14 2009-05-22 Amylin Pharmaceuticals, Inc. Methods for treating obesity and obesity related diseases and disorders
EP1814590B2 (en) † 2004-11-01 2013-12-11 Amylin Pharmaceuticals, Inc. Treatment of obesity and related disorders
US20220249505A1 (en) * 2020-03-03 2022-08-11 Red Mountain Holdings, Llc Appetite suppressant compositions and methods thereof

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5594101A (en) * 1995-03-03 1997-01-14 Eli Lilly And Company Anti-obesity proteins

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5594101A (en) * 1995-03-03 1997-01-14 Eli Lilly And Company Anti-obesity proteins

Non-Patent Citations (4)

* Cited by examiner, † Cited by third party
Title
AM. J. CLIN. NUTR., vol. 68, no. 1, 1998, pages 42 - 51 *
DATABASE CA ON STN (COLUMBUS, OHIO, USA); FISLER ET AL.: "D-fenfluramine in a rat model of dietary fat-induced obesity" *
DATABASE CA ON STN (COLUMBUS, OHIO, USA); RAMSEY ET AL.: "Energy expenditure, body composition and glucose metabolism in lean and obese rhesus monkeys treated with ephedrine and caffeine" *
PHARMACOL. BIOCHEM. BEHAV., vol. 45, no. 2, 1993, pages 487 - 493 *

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1814590B2 (en) † 2004-11-01 2013-12-11 Amylin Pharmaceuticals, Inc. Treatment of obesity and related disorders
WO2007055743A2 (en) * 2005-11-01 2007-05-18 Amylin Pharmaceuticals, Inc. Treatment of obesity and related disorders
WO2007055743A3 (en) * 2005-11-01 2007-08-02 Amylin Pharmaceuticals Inc Treatment of obesity and related disorders
WO2009064298A1 (en) * 2007-11-14 2009-05-22 Amylin Pharmaceuticals, Inc. Methods for treating obesity and obesity related diseases and disorders
US20220249505A1 (en) * 2020-03-03 2022-08-11 Red Mountain Holdings, Llc Appetite suppressant compositions and methods thereof
US11896598B2 (en) * 2020-03-03 2024-02-13 Red Mountain Med Spa, LLC Appetite suppressant compositions and methods thereof

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