The results from the two-year BLOOM ( Behavioral modification and Lorcaserin for Overweight and Obesity Management ) trial have been published in the New England Journal of Medicine ( NEJM ). Lorcaserin used in conjunction with behavioral modification caused significantly greater weight loss and improved maintenance of weight loss compared to placebo. Lorcaserin also improved values for biomarkers that may be predictive of future cardiovascular events, including lipid levels, insulin resistance, levels of inflammatory markers and blood pressure.
At the end of year 1 of the BLOOM trial, using Intent-to-Treat with Last Observation Carried Forward analysis ( ITT-LOCF ), the proportion of patients achieving at least 5% body weight loss in the Lorcaserin group ( 47.5% ) was more than twice that achieved by the placebo group ( 20.3% ). Nearly three times as many patients achieved at least 10% weight loss in the Lorcaserin group ( 22.6% ) than in the placebo group ( 7.7% ). Lorcaserin patients who completed the first year of the trial according to the protocol lost an average of 8.2% of their baseline weight, or approximately 18 pounds, at the end of year 1 as compared to approximately 7 pounds in the placebo group. In year 2, patients who continued to take Lorcaserin were significantly better able to maintain their year 1 weight loss than those who were switched to placebo.
In year 1, Lorcaserin caused significant decreases in waist circumference, body mass index ( BMI ), glycemic parameters, high-sensitivity C-reactive protein, and fibrinogen levels compared to placebo. Total cholesterol, LDL cholesterol and triglyceride levels at year 1 were significantly lower in the Lorcaserin group than in the placebo group.
Lorcaserin did not increase heart rate or blood pressure; rather, heart rate, systolic blood pressure and diastolic blood pressure decreased slightly but significantly with Lorcaserin treatment compared to placebo. Quality of life, measured by the Impact of Weight on Quality of Life-Lite questionnaire, improved in both treatment groups, with a greater improvement in the Lorcaserin group than in the placebo group.
At the end of year 1, 55.4% of patients in the Lorcaserin group and 45.1% of patients in the placebo group remained enrolled in the study, and 7.1% and 6.7% of patients, respectively, discontinued the study due to an adverse event. Among the most frequent adverse events reported with Lorcaserin were headache ( 18.0% vs. 11.0%, Lorcaserin vs. placebo ); dizziness ( 8.2% vs. 3.8% ); and nausea ( 7.5% vs. 5.4% ). The rates of serious adverse events were similar in both treatment groups.
The rates of depression and the incidence of anxiety and suicidal thoughts were low in both treatment groups.
Lorcaserin caused no significant increase compared to placebo in the incidence of new cardiac valvulopathy.
BLOOM, the first of three Lorcaserin Phase 3 trials, is a double-blind, randomized, placebo-controlled trial involving 3,182 patients in 98 sites in the United States. The trial evaluated 10 mg of Lorcaserin dosed twice daily versus placebo over a two-year treatment period in obese patients ( BMI 30 to 45 ) with or without co-morbid conditions and overweight patients ( BMI 27 to less than 30 ) with at least one co-morbid condition, such as hypertension, cardiovascular diseases or glucose intolerance. All patients received diet and exercise counseling, and the trial did not include any dose titration or run-in period. Patients were randomized in a 1:1 ratio to Lorcaserin or placebo at baseline.
At week 52, 856 patients taking Lorcaserin were re-randomized in a 2:1 ratio to continue Lorcaserin or switch to placebo, and 697 patients on placebo were continued on placebo. Patients underwent echocardiography at screening, and at 6, 12, 18 and 24 months after initiating dosing in the trial; patients with FDA-defined valvulopathy were excluded from enrolling in the trial.
Lorcaserin is a new chemical entity that is believed to act as a selective serotonin 2C receptor agonist. The serotonin 2C receptor is expressed in the brain, including the hypothalamus, an area involved in the control of appetite and metabolism. Stimulation of the serotonin 2C receptor in the hypothalamus is associated with feeding behavior and satiety.
Source: Arena Pharmaceuticals, 2010
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