Lorcaserin, a new weight loss drug, has been found to reduce weight by 5% or more, according to a study published in the New England Journal of Medicine. The drug was also found to reduce cardiovascular risk factors such as lipid levels, insulin resistance and blood pressure.

The study was conducted over a 2 year period and involved 3182 obese or overweight people between 18 and 65 years of age. The double-blind, placebo-controlled randomized clinical trial was designed to evaluate the efficacy and safety (including safety of cardiac valves) of lorcaserin.

In addition to receiving either placebo or lorcaserin twice a day, subjects also received diet and exercise counseling. At the end of the first year, patients in the placebo group continued to receive placebo but those in the lorcaserin group were randomly assigned to receive placebo or continue on with lorcaserin.

Of those who continued in the lorcaserin group, 67.9% continued to maintain their 5% or more weight loss while only 50.3% if subjects who were switched to placebo managed to maintain their weight loss.

How the medication works

Weight loss medications work by either altering fat metabolism (Orlistat) or by stimulating the sympathetic nervous system (Meridia). Weight loss drugs in the latter category are known as sympathomimetic, (sim-path-o-mi-me-tic) meaning they mimic the effects of the sympathetic nervous system, often referred to as the “fight or flight” system. However, there have been problems associated with these types of medications in the past – mainly cardiac.

Certain neurons that help regulate appetite are controlled by the release of specific sub-types of serotonin in the brain. Many of you may be familiar with the category of medications known as “selective serotonin re-uptake inhibitors” or SSRIs which are a common, highly successful group of medications given to treat depression.

Previous weight loss medications worked by non-selectively inhibiting the re-uptake of serotonin – hence some negative side-effects were noted. Lorcaserin inhibits the re-uptake of serotonin in the brain and induces early satiety by targeting a specific serotonin receptor known as 5-HT2c.

Limitations of the study

Nearly 50% of people dropped out of the study at the end of the first year – a rate that is consistent with other long-term studies on obesity. In addition, there were certain exclusions to the study including people who had the following disorders:

• Moderate to severe mitral regurgitation
• Mild or greater aortic regurgitation
• Diabetes (a diagnosis of impaired glucose tolerance did not exclude people)
• Systolic blood pressure greater than 140 or a diastolic greater than 90
• Depression or other psychiatric disorder that had been treated with prescription medications within 2 years of the study
• Pregnancy and lactation

What next?

Subjects in this study were repeatedly monitored for any heart valve problems with regular echocardiograms and there was no significant increase in valvular problems. Lorcaserin is awaiting approval from the FDA and because of it’s fairly benign side effect profile (headache, dizziness and nausea which resolved with time), it will most likely be approved.

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