Experiences with Glucagon-Like Peptide-1 Receptor Agonist in Children with Acquired Hypothalamic Obesity

• Published in: Obesity facts 2020-10, Vol.13 (4), p.361-370
• Main Authors: van Schaik, Jiska, Begijn, Dominique G.A., van Iersel, Laura, Vergeer, Yvonne, Hoving, Eelco W., Peeters, Babette, van Santen, Hanneke M.
• Format: Article
• Language: English
• Subjects: Adolescent; Antidiabetics; Body Mass Index; Body Weight; Case reports; Child; Diabetes; Exenatide - therapeutic use; Female; Gallstones; Gastrointestinal surgery; GLP-1 receptor agonists; Glucagon; Glucagon-Like Peptide-1 Receptor - agonists; glucagon-like peptide-1 receptor agonist; Glucose; Growth hormones; Humans; Hypoglycemia; Hypoglycemic Agents - therapeutic use; Hypothalamic Diseases - complications; Hypothalamic Diseases - drug therapy; hypothalamic dysfunction; Insulin; Insulin-like growth factors; Intervention; Obesity; Obesity - complications; Pain; Pancreatitis; Patients; Pediatrics; Peptides; Pilot projects; Research Article; Statistical analysis; suprasellar tumor; Tumors; Weight control; Weight Loss - drug effects
• ISSN: 1662-4025; 1662-4033
• DOI: 10.1159/000509302

Objective: Hypothalamic obesity (HO) in children after treatment for a tumor in the suprasellar region has severe implications. Previous studies have shown various effects of glucagon-like peptide-1 (GLP-1) receptor agonist in acquired HO, but in adults only. We present our experience of GLP-1 receptor agonist (exenatide) treatment during a 1-year period on body mass index (BMI) in children with acquired HO. Patients and Methods: Children with severe weight gain after treatment for suprasellar tumor were given 2 mg exenatide weekly for a 12-month period. All had undergone previous dietary intervention. BMI standard deviation score (SDS), weight change, and adverse effects were assessed. Results: Five children with a mean age of 15.4 years (range 13–18) and a mean follow-up time of 8.4 years (mean age of 7.0 years at the time of brain tumor diagnosis) were treated with GLP-1 receptor agonist. After 1 year, BMI SDS or absolute weight had not changed significantly compared to the period without treatment (BMI SDS change +0.005, 95% CI –0.07 to 0.08, p = 0.89, and absolute weight change +1.5 kg, 95% CI –0.08 to 3.1, p = 0.061). Only 1 patient experienced weight loss after 1 year (–5.4 kg, BMI SDS –0.33). All patients experienced mild side effects, such as injection pain or nausea, and 2 patients stopped treatment upon their own request after 8 and 11 months, respectively. Conclusions: In this small cohort, we found little effect of GLP-1 receptor agonist in the treatment for acquired HO. Future research should focus on the prevention of HO or, if prevention is not possible, on alternative, individualized interventions.