COMMENTARY

A Safe Weight Loss Drug That Works

Charles P. Vega, MD

Disclosures

September 25, 2018

Hello. I'm Dr Charles Vega, and I am a clinical professor of family medicine at the University of California at Irvine. Welcome to Medscape Morning Report, our 1-minute news story for primary care.

Weight loss drugs are underused. That is the opinion voiced by numerous obesity medicine experts. Surveys of clinicians have found that only a small number of us use them. Why is that? Some suggest that it is a holdover from the "fen/phen" days, with safety fears causing clinicians to shy away from them.

Will the results of a 3-year randomized trial involving 12,000 overweight and obese patients put those fears to rest? The CAMELLIA-TIMI 61 trial was an industry-supported cardiovascular outcomes study of adults with established cardiovascular disease, type 2 diabetes, or cardiovascular risk factors. The mean age of the participants was 64 years and 60% were men. The study concluded that lorcaserin, sold under the brand name Belviq, did not increase the risk for major adverse cardiovascular events when compared with placebo.

For the first time, a rigorous outcome study has demonstrated cardiovascular safety for a pharmacologic weight loss agent.

And safety was not all. The drug, when added to diet and lifestyle, resulted in modest weight loss, with about double the number of treated patients losing 5% of body weight at 1 year—39% versus 17%. Additionally, among patients with prediabetes at baseline, the rate of new-onset diabetes was 19% lower in the active treatment group. Cardiovascular outcomes, however, while somewhat improved in the treatment group, did not significantly vary between the two groups.

Clearly this was a high-risk population and results may not be the same for obese patients without this much cardiovascular risk. But when diet and lifestyle alone are not working, are we doing our patients a disserve to not offer them this option?

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