Diabetes drug proves effective weight-loss aid

A diabetes drug approved in December 2014 for the treatment of obesity has shown promise in a trial of weight loss efficacy published in The New England Journal of Medicine

Once-daily liraglutide helped participants shed pounds.

Used at a higher dose than recommended for type 2 diabetes, liraglutide (sold by Novo Nordisk as Saxenda), taken as an adjunct to diet and exercise, was associated with reduced body weight and improved metabolic control.

The glucagon-like peptide-1 (GLP-1) mimetic at a 3.0 mg daily dose gave a mean average weight loss of 8.4 kg.

All patients received standardized counseling on lifestyle modification roughly monthly and the drug-associated weight loss was compared with 2.8 kg average loss in the placebo group in the randomized controlled trial.

"The mean differential weight loss of 5.6 kg between the liraglutide group and the placebo group is more than what was observed in previous studies of GLP-1 mimetics," says an editorial article about the findings in the same issue of the medical journal.

Written by Dr. Elias Siraj and Dr. Kevin Williams, the editorial explains that GLP-1 mimetics:

• Stimulate insulin secretion
• Lower postmeal glucagon levels
• Slow gastric emptying
• Reduce appetite.

The weight loss achieved with liraglutide was maintained over 56 weeks. A greater proportion of patients (63.2%) taking the daily drug than taking a placebo (27.1%) lost at least 5% of their body weight.

Also, 33.1% of participants taking liraglutide lost 10% of their body weight, compared with 10.6% of participants taking a placebo. Fifteen percent of body weight was lost by 14.4% of the patients taking liraglutide and 3.5% of the placebo group.

Liraglutide joins three other prescription drugs to have won approval from the Food and Drug Administration for use in weight loss in the past 3 years: lorcaserin (Belviq, a serotonin 2C receptor agonist); phentermine, a sympathomimetic amine anorectic, combined with topiramate, an antiepileptic (Qsymia); and naltrexone, an opioid antagonist, combined with bupropion, an aminoketone antidepressant (Contrave).

'No obesity cure'

No new safety concerns were identified in the trial for liraglutide, and the side effects observed were consistent with those in previous reports.

The most common side effects were gastrointestinal and mild.

"Given previous disappointments with various weight-loss strategies, these are welcome findings," conclude Drs. Siraj and Williams.

"Still, liraglutide is no cure. Most obese participants stayed obese, reversal of the metabolic syndrome was not quantified, and liraglutide may be required indefinitely, like statins, but with delivery by injection and at a nontrivial cost."

"Undoing the detrimental influences of our new environment requires practical strategies for eating less and moving more. Fortunately, even modest loss of body weight of 5% to 10% makes nearly all medical issues more manageable.

"On the basis of the current study, modest weight loss may now be easier to achieve, yet we await the results from studies with longer follow-up."

Written by Markus MacGill

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