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Aftermath Of Fen-Phen Confirming Original Reports

DURHAM, NC -- Oct. 20, 1998 -- While there are anecdotal reports of some former fen-phen patients getting worse while others are getting better, all former fen-phen users still require continued medical monitoring, according to an expert in preventive medicine and nutrition at Mayo Clinic.

Donald Hensrud, M.D., from the Mayo Clinic, Rochester, MN., discussed the pharmacological treatment of obesity at the American Medical Association's 17th annual science reporters conference.

Fenfluramine and dexfenfluramine (fenfluramine was combined with phentermine to produce the popular fen-phen diet drug) are the diet drugs that were pulled from the market last year because of their association with valvular heart disease and pulmonary hypertension. Essentially these drugs worked by increasing the release of serotonin in brain synapses (connection between two nerve cells). This has an effect on appetite and feeling satisfied.

"Recent studies have confirmed the association of fenfluramine and dexfenfluramine with valvular heart disease. Twelve to 25 percent of people who took these drugs alone or in combination with phentermine developed valvular heart disease," Hensrud said. "It appears that the longer people took these drugs, the greater was the likelihood of developing valvular heart disease."

Dr. Hensrud stressed the need for longitudinal studies to ascertain what happens over time to people who have valvular heart disease. According to Dr. Hensrud, the medical community needs to know if the disease progresses, remains the same or improves with time. He added that there are not any comprehensive studies yet, but there are some anecdotal reports of people who have been seen at Mayo or other places. Studies are in progress, including one at Mayo.

"After fen-phen was pulled from the market, we were still seeing people with symptomatic valvular heart disease -- however, not many compared to the large number of people who were taking these drugs," he explained. "The total number of people with this disease appears to be declining over time, which suggests that in mild cases it stays the same or could even improve. In severe cases the disease may continue to progress. We don't have any good data other than just our impression from the people we are seeing."

In the Mayo fen-phen weight loss study, as expected, most people did regain some or most of the weight they lost. A minority of the fen-phen patients were able to maintain their weight loss, Dr. Hensrud said.