Comparison of efficacy and safety of leptin replacement therapy in moderately and severely hypoleptinemic patients with familial partial lipodystrophy of the dunnigan variety

Vinaya Simha, Lalitha Subramanyam, Lidia Szczepaniak, Claudia Quittner, Beverley Adams-Huet, Peter Snell, Abhimanyu Garg

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Abstract

Context: Leptin replacement therapy improves metabolic complications in patients with lipodystrophy and severe hypoleptinemia (SH), but whether the response is related to the degree of hypoleptinemia remains unclear. Objective: The aim of the study was to compare efficacy of leptin therapy in familial partial lipodystrophy, Dunnigan variety (FPLD) patients with SH (serum leptin <7th percentile of normal) vs. those with moderate hypoleptinemia (MH; serum leptin in 7th to 20th percentiles). Design, Setting, and Patients: We conducted an open-label, parallel group, observational study in 14 SH (mean±SD, serum leptin, 1.9±1.1 ng/ml) and 10MH(serum leptin, 5.3±1.0 ng/ml) women with FPLD. Intervention: Patients received 0.08 mg/kg · d of metreleptin by twice daily sc injections for 6 months. Main Outcome Measures: The primary outcome variable was change in fasting serum triglycerides. Other secondary variables were fasting plasma glucose and insulin, insulin sensitivity, hemoglobin A1c, and hepatic triglyceride content. Results: Median fasting serum triglycerides decreased from 228 to 183 mg/dl in the SH group (P = 0.04) and from 423 to 339 mg/dl in the MH group (P = 0.02), but with no difference between the groups (P value for interaction = 0.96). Hepatic triglyceride levels similarly declined significantly from 8.8 to 4.9% in the SH group and from 23.7 to 9.2% in the MH group (P value for interaction= 0.9). Loss of body weight and body fat occurred in both groups. Fasting glucose, insulin, glucose tolerance, and hemoglobin A1c levels did not change. K value on insulin tolerance test improved slightly in the SH group (0.98 to 1.24%; P = 0.01), but not in the MH group (1.1 to 1.27%; P = 0.4). Conclusion: Metreleptin replacement therapy is equally effective in FPLD patients with both SH and MH in reducing serum and hepatic triglyceride levels, but did not improve hyperglycemia.

Original languageEnglish (US)
Pages (from-to)785-792
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume97
Issue number3
DOIs
StatePublished - Mar 2012

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Familial Partial Lipodystrophy
Leptin
Triglycerides
Safety
Serum
Fasting
Insulin
Glucose
Hemoglobins
Therapeutics
Liver
Lipodystrophy
Labels
Hyperglycemia
Observational Studies
Insulin Resistance
Fats
Adipose Tissue
Plasmas
Body Weight

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Comparison of efficacy and safety of leptin replacement therapy in moderately and severely hypoleptinemic patients with familial partial lipodystrophy of the dunnigan variety. / Simha, Vinaya; Subramanyam, Lalitha; Szczepaniak, Lidia; Quittner, Claudia; Adams-Huet, Beverley; Snell, Peter; Garg, Abhimanyu.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 97, No. 3, 03.2012, p. 785-792.

Research output: Contribution to journalArticle

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abstract = "Context: Leptin replacement therapy improves metabolic complications in patients with lipodystrophy and severe hypoleptinemia (SH), but whether the response is related to the degree of hypoleptinemia remains unclear. Objective: The aim of the study was to compare efficacy of leptin therapy in familial partial lipodystrophy, Dunnigan variety (FPLD) patients with SH (serum leptin <7th percentile of normal) vs. those with moderate hypoleptinemia (MH; serum leptin in 7th to 20th percentiles). Design, Setting, and Patients: We conducted an open-label, parallel group, observational study in 14 SH (mean±SD, serum leptin, 1.9±1.1 ng/ml) and 10MH(serum leptin, 5.3±1.0 ng/ml) women with FPLD. Intervention: Patients received 0.08 mg/kg · d of metreleptin by twice daily sc injections for 6 months. Main Outcome Measures: The primary outcome variable was change in fasting serum triglycerides. Other secondary variables were fasting plasma glucose and insulin, insulin sensitivity, hemoglobin A1c, and hepatic triglyceride content. Results: Median fasting serum triglycerides decreased from 228 to 183 mg/dl in the SH group (P = 0.04) and from 423 to 339 mg/dl in the MH group (P = 0.02), but with no difference between the groups (P value for interaction = 0.96). Hepatic triglyceride levels similarly declined significantly from 8.8 to 4.9{\%} in the SH group and from 23.7 to 9.2{\%} in the MH group (P value for interaction= 0.9). Loss of body weight and body fat occurred in both groups. Fasting glucose, insulin, glucose tolerance, and hemoglobin A1c levels did not change. K value on insulin tolerance test improved slightly in the SH group (0.98 to 1.24{\%}; P = 0.01), but not in the MH group (1.1 to 1.27{\%}; P = 0.4). Conclusion: Metreleptin replacement therapy is equally effective in FPLD patients with both SH and MH in reducing serum and hepatic triglyceride levels, but did not improve hyperglycemia.",
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T1 - Comparison of efficacy and safety of leptin replacement therapy in moderately and severely hypoleptinemic patients with familial partial lipodystrophy of the dunnigan variety

AU - Simha, Vinaya

AU - Subramanyam, Lalitha

AU - Szczepaniak, Lidia

AU - Quittner, Claudia

AU - Adams-Huet, Beverley

AU - Snell, Peter

AU - Garg, Abhimanyu

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N2 - Context: Leptin replacement therapy improves metabolic complications in patients with lipodystrophy and severe hypoleptinemia (SH), but whether the response is related to the degree of hypoleptinemia remains unclear. Objective: The aim of the study was to compare efficacy of leptin therapy in familial partial lipodystrophy, Dunnigan variety (FPLD) patients with SH (serum leptin <7th percentile of normal) vs. those with moderate hypoleptinemia (MH; serum leptin in 7th to 20th percentiles). Design, Setting, and Patients: We conducted an open-label, parallel group, observational study in 14 SH (mean±SD, serum leptin, 1.9±1.1 ng/ml) and 10MH(serum leptin, 5.3±1.0 ng/ml) women with FPLD. Intervention: Patients received 0.08 mg/kg · d of metreleptin by twice daily sc injections for 6 months. Main Outcome Measures: The primary outcome variable was change in fasting serum triglycerides. Other secondary variables were fasting plasma glucose and insulin, insulin sensitivity, hemoglobin A1c, and hepatic triglyceride content. Results: Median fasting serum triglycerides decreased from 228 to 183 mg/dl in the SH group (P = 0.04) and from 423 to 339 mg/dl in the MH group (P = 0.02), but with no difference between the groups (P value for interaction = 0.96). Hepatic triglyceride levels similarly declined significantly from 8.8 to 4.9% in the SH group and from 23.7 to 9.2% in the MH group (P value for interaction= 0.9). Loss of body weight and body fat occurred in both groups. Fasting glucose, insulin, glucose tolerance, and hemoglobin A1c levels did not change. K value on insulin tolerance test improved slightly in the SH group (0.98 to 1.24%; P = 0.01), but not in the MH group (1.1 to 1.27%; P = 0.4). Conclusion: Metreleptin replacement therapy is equally effective in FPLD patients with both SH and MH in reducing serum and hepatic triglyceride levels, but did not improve hyperglycemia.

AB - Context: Leptin replacement therapy improves metabolic complications in patients with lipodystrophy and severe hypoleptinemia (SH), but whether the response is related to the degree of hypoleptinemia remains unclear. Objective: The aim of the study was to compare efficacy of leptin therapy in familial partial lipodystrophy, Dunnigan variety (FPLD) patients with SH (serum leptin <7th percentile of normal) vs. those with moderate hypoleptinemia (MH; serum leptin in 7th to 20th percentiles). Design, Setting, and Patients: We conducted an open-label, parallel group, observational study in 14 SH (mean±SD, serum leptin, 1.9±1.1 ng/ml) and 10MH(serum leptin, 5.3±1.0 ng/ml) women with FPLD. Intervention: Patients received 0.08 mg/kg · d of metreleptin by twice daily sc injections for 6 months. Main Outcome Measures: The primary outcome variable was change in fasting serum triglycerides. Other secondary variables were fasting plasma glucose and insulin, insulin sensitivity, hemoglobin A1c, and hepatic triglyceride content. Results: Median fasting serum triglycerides decreased from 228 to 183 mg/dl in the SH group (P = 0.04) and from 423 to 339 mg/dl in the MH group (P = 0.02), but with no difference between the groups (P value for interaction = 0.96). Hepatic triglyceride levels similarly declined significantly from 8.8 to 4.9% in the SH group and from 23.7 to 9.2% in the MH group (P value for interaction= 0.9). Loss of body weight and body fat occurred in both groups. Fasting glucose, insulin, glucose tolerance, and hemoglobin A1c levels did not change. K value on insulin tolerance test improved slightly in the SH group (0.98 to 1.24%; P = 0.01), but not in the MH group (1.1 to 1.27%; P = 0.4). Conclusion: Metreleptin replacement therapy is equally effective in FPLD patients with both SH and MH in reducing serum and hepatic triglyceride levels, but did not improve hyperglycemia.

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