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Obesity pharmacotherapy — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareObesity pharmacotherapyUSMLE Step 3

A patient with BMI 36 kg/m² completes dose escalation of naltrexone/bupropion and then takes the maintenance dose for 12 weeks with good adherence. Weight falls from 100 kg to 97 kg and adverse effects are minimal. Which label-based plan is appropriate?

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Correct answer: B — Discontinue naltrexone/bupropion because weight loss is below 5% after 12 weeks at maintenance

The best answer is “Discontinue naltrexone/bupropion because weight loss is below 5% after 12 weeks at maintenance”. The loss is 3% of baseline body weight. The FDA stop rule is assessed after 12 weeks at the maintenance dose, not after total treatment duration or a further dose-adjustment trial, because later clinically meaningful benefit is unlikely.

Reference: FDA Prescribing Information: CONTRAVE: https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/200063s020lbl.pdf