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A candidate-gene association study of topiramate-induced weight loss in obese patients with and without type 2 diabetes mellitus

Li, Qingqin S.a; Lenhard, James M.b; Zhan, Yipingc; Konvicka, Karelc; Athanasiou, Maria C.d; Strauss, Richard S.b; Francke, Stephana

doi: 10.1097/FPC.0000000000000185

Objective Clinical response to topiramate can vary greatly in obese patients. Identifying genetic variants associated with treatment response could help gain insight into the mechanism of action of topiramate. Little is known about the relationship between genetic variability and topiramate treatment response. We performed a large-scale candidate-gene study to identify genetic risk factors predictive of topiramate-induced weight loss.

Methods We collected DNA samples from patients who had previously participated in clinical trials to assess the efficacy of topiramate for the treatment of obesity. A custom chip containing single nucleotide polymorphisms from ∼480 candidate genes was utilized to genotype a discovery cohort of 445 obese patients from a clinical study. Variants predictive of topiramate-induced weight loss were identified and further tested in an independent replication cohort of drug-naive, obese patients with type 2 diabetes (N=139).

Results We identified a haplotype in INSR that may contribute to differential topiramate-induced weight loss. Carriers and noncarriers of an INSR haplotype lost 9.1 and 7.0% of body weight, respectively (P=6.5×10–6, Padj=0.001). This finding was replicated, with carriers and noncarriers losing 9.5 and 7.3% of body weight, respectively (PBonf=0.02), in the independent replication cohort. We also identified an SNP in HNF1A that may be associated with topiramate response and an SNP in GRIA3 that may be associated with nonpharmacologic treatment response.

Conclusion According to our preliminary findings, genetic variation in the INSR and HNF1A genes may differentially affect weight loss in obese individuals treated with topiramate and genes related to insulin action are implicated in modulating topiramate response. However, these findings need to be further replicated in additional larger samples.

aNeuroscience Therapeutic Area, Janssen Research & Development, LLC, Titusville, New Jersey

bCVM Therapeutic Area, Janssen Research & Development, LLC, Spring House, Pennsylvania

cPerlegen Sciences, Mountain View, California

dAthanasiou Consulting, LLC, Fond du Lac, Wisconsin, USA

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Correspondence to Qingqin S. Li, Neuroscience Therapeutic Area, Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA Tel: +1 609 730 4576; fax: +1 609 730 2069; e-mail:

Received June 19, 2015

Accepted October 2, 2015

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.