Rimonabant Shows Promise for Prevention of Type 2 Diabetes

September 19, 2005

Sept. 19, 2005 (Athens)— Rimonabant, a selective CB1 endocannabinoid receptor antagonist, may have potential in the prevention of type 2 diabetes, according to a study presented here at the 41st annual meeting of the European Association for the Study of Diabetes.

Julio Rosenstock, MD, from the Dallas Diabetes Center in Texas, presented one-year data from the rimonabant prediabetes subgroup of patients who were enrolled in the RIO-Lipids, RIO-Europe, and RIO-North America phase 3 studies. These studies were multicenter, randomized, double-blind, placebo-controlled trials that asssessed 5 or 20 mg of rimonabant in overweight/obese patients. The primary end point of these pivotal studies was weight loss, and secondary end points included waist circumference, glycemic control, and lipid parameters.

For the prediabetes subgroup analysis of 1,290 subjects, prediabetes was defined as impaired fasting glucose (100-125 mg/dL).

Improvements among prediabetes subjects for multiple cardiometabolic risk factors, including high-density lipoprotein (HDL) cholesterol and triglyceride levels, insulin resistance, waist circumference, and body weight were highly consistent with the published data on rimonabant.

Significant weight loss was seen in subjects with prediabetes taking rimonabant 5 mg (–3.2 kg, P = .002) and 10 mg (–6.9 kg; P < .001) compared with –1.7 kg for placebo. HDL cholesterol and triglyceride levels improved significantly in subjects taking 20 mg of rimonabant.

There was a clear but not statistically significant trend for subjects with prediabetes taking riomonabant 20 mg to revert from impaired fasting glucose to normal glucose tolerance (46.5% for patients in the rimonabant group vs 39.2% for those in the placebo group).

"This is a useful indicator of what could be expected from a larger, long-term prospective study with rimonabant in subjects with prediabetes," Paul Z. Zimmet, from the International Diabetes Institute in Caulfield, Victoria, Australia, told Medscape.

"Since two key drivers behind the development of type 2 diabetes are abdominal obesity and insulin resistance, and rimonabant improves both of these, this investigational drug could have an important role in therapy for the prevention of both type 2 diabetes and indeed cardiovascular disease," Dr. Zimmet concluded.

The study was supported by an educational grant from Sanofi-Aventis.

EASD 2005: Abstract 37. Sept. 12-15, 2005.

Reviewed by Gary D. Vogin, MD

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