Weight loss pill Lorcaserin found to have low cardiovascular risk

By Dr Ananya Mandal, MD

Weight loss pills have been discovered and then withdrawn from the market because of the risks that they pose to the heart. Some of them have raised the risk of heart attacks, suicides, heart valve problems significantly and have been thus banned.

An existing pill called marketed as Belviq (Lorcaserin), that has been on the U.S. market since 2013, has been studied over the last five years for its cardiovascular safety. Lead study author Dr. Erin Bohula of Brigham and Women’s Hospital in Boston said, “patients and their doctors have been nervous about using drugs to treat obesity, and for good reason. There’s a history of these drugs having serious complications.” She explained that this new study shows Belviq to be safe on the heart.

Belviq or Lorcaserin is an appetite suppressant. It can stimulate the brain into feeling full and prevent overeating. Researchers have labelled it the “Holy grail” in weight management. It has been found to be three times as effective as diet and exercise alone. Lorcaserin acts by activating the satiety cells in the brain. These are called the POMC neurons. With age these neurons tend to become less effective and satiety is delayed. This is believed to be one of the major causes of obesity and becoming overweight as a person ages. Lorcaserin is known to stimulate these neurons and control the appetites and thus help lose weight. The cost of Belviq in the United States is around $220 to $290 per month. In the UK it costs around £220 a month.

The results of the study were presented at the European Society of Cardiology meeting in Munich yesterday (26th August 2018). The study results were published in the journal New England Journal of Medicineand were sponsored by Eisai Inc. – makers of Belviq. Quite a few of the researchers on the team were consultants for the company.

Obesity worldwide has reached epic proportions with 13 percent of all adults being obese and 39 percent being overweight. Increased body weight is associated with several health problems including diabetes, heart disease, dyslipidemia, bone and joint problems etc. Treatment mainly involves a healthy diet and regular exercise. Those with morbid obesity may benefit from bariatric surgeries along with conservative measures.

The study was conducted on around 12,000 participants for 40 months during which the Belviq users were found to lose around nine pounds which was twice as much as the participants who were administered placebo pills. The heart disease risk was not raised by Belviq but was not reduced by its use either, write the researchers.

The participants in this study were either obese or overweight and had the risk factors for heart disease including high blood cholesterol and high blood pressure. The participants were divided into two groups – one received Belviq pills twice a day while the other received placebo or dummy pills twice a day. All participants were also provided with lifestyle and diet advice.

By the end of one year, 39 percent and 17 percent of those using Belviq and placebo pills respectively lost at least 5 percent of their body weights. By the end of three years, 6 percent of the participants from either group developed a heart related issue or died of heart disease. Among Belviq users 8.5 percent developed diabetes while 10.3 percent of placebo users developed diabetes. Dizziness, nausea, headache, fatigue etc. were seen among 7 percent Belviq users compared to 4 percent placebo users. Among all the participants, 3,270 were tested for heart valve problems and the rates of these problems were similar for both placebo and Belviq. Suicidal thoughts or behaviour was seen among 21 Belviq users and 11 placebo users. This could be attributed to pre-existing depression among the participants says Bohula. She explained that the difference between the two groups in terms of suicidal thoughts and behaviour also remains clinically insignificant.

Drs. Julie Inglefinger and Clifford Rosen wrote an accompanying commentary with the article and they wrote that as of now Belviq, “may be best used on a cautious basis, according to the needs of individual patients.”