Facial soft tissue volume decreases during metreleptin treatment in patients with partial and generalized...

Lipodystrophy (LD) patients suffer from loss or maldistribution of subcutaneous adipose tissue accompanied by dysregulation of several adipocyte-secreted factors, e.g., leptin. The effect of recombinant leptin (metreleptin) therapy on facial soft tissue volume in patients with non-human immunodeficiency virus LD has not been quantified to date.

Eight LD patients (six female, two male; six familial partial LD [FPLD], two generalized LD) were treated with metreleptin over 1 year. Anthropometric parameters and 3D stereophotogrammetric imaging of the patients´ faces were assessed at baseline and after 1 year of metreleptin treatment.

Median fat mass was significantly reduced during metreleptin treatment from 22.3 kg at baseline to 20.0 kg at 1 year (p = 0.031); however, body weight, body mass index, and waist-to-hip ratio were not significantly affected. Five of the six patients with FPLD lost between 4 and 114 cm³ of facial soft tissue volume in the pre-auricular, buccal, and submandibular area during metreleptin treatment whereas a slight volume gain was seen in one FPLD patient. The two patients with generalized LD developed a volume loss of 20 and 8 cm³ in the buccal region between baseline and 1 year of metreleptin therapy, respectively.

Metreleptin replacement leads to loss of facial soft tissue volume in FPLD and generalized LD. However, volume changes in most patients are not visible by the naked eye.