Lorcaserin, an adjunctive therapy for weight management, might slow progression to diabetes and promote remission.
Lorcaserin (Belviq), a selective serotonin 2C–receptor agonist, modulates appetite and facilitates modest weight loss. Although related drugs have caused serious cardiovascular (CV) side effects, data from a large, FDA-mandated, postmarketing CV safety trial (NEJM JW Cardiol Oct 2018 and N Engl J Med 2018; 379:1107) suggest that lorcaserin does not confer excess CV risk. Investigators now report metabolic outcomes from that trial.
Researchers randomized 12,000 obese or overweight patients with established CV disease or multiple CV risk factors to lorcaserin (10 mg) or placebo twice daily. Patients (median age, 64; 64% men; median body-mass index, 35 kg/m2) were categorized at baseline as diabetic (57%), prediabetic (33%), or normoglycemic (10%). All patients were encouraged to participate in a standardized weight management program, and diabetes medications could be adjusted freely by local clinicians who were masked to treatment assignment.
During a median 3.3 years of follow-up, the incidence of diabetes was significantly lower in nondiabetic patients assigned to lorcaserin than in those assigned to placebo (6.7% vs. 8.4%). Diabetic patients in the lorcaserin group were significantly more likely to achieve persistent glycosylated hemoglobin (HbA1c) levels below 6.5% than were those in the placebo group (7.1% vs. 6.0%). Hypoglycemic events were similar in both diabetic groups, with most events occurring in patients who used insulin or a sulfonylurea.
Source: NEJM journal watch
