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Obesity: European patients protected against lorcaserin, a psychotropic drug sold as an appetite suppressant

It is unjustifiable to expose patients to the dangers of lorcaserin, which has no tangible effect on the complications of obesity or even on weight. The European Medicines Agency was right to refuse it a marketing authorisation.

Treatment of obesity or just excess weight depends first and foremost on a reduction in calorie intake and an increase in physical exercise. No drug has a favourable harm-benefit balance and no drug has a proven efficacy in reducing the clinical complications associated with obesity, especially cardiovascular complications. Many drugs claim to promote weight loss, but very few of these were still on the market by the end of 2013.

In 2013, lorcaserin was refused a European marketing authorisation after being licensed in the USA in 2012 as an aid to weight loss for some patients, to supplement physical exercise and dietary measures.

In obese patients, the results of three clinical trials comparing lorcaserin to placebo concur and corroborate those of other trials on appetite suppressants: one year’s treatment is required before an average weight loss of just over 3 kg is observed, which is little for patients initially weighing around 100 kg, and the weight is regained after halting treatment.

The adverse effects of lorcaserin observed during clinical trials were chiefly digestive (dry mouth, nausea) and neuropsychiatric (dizziness, fatigue, headaches, euphoria). There is an excessive risk of damage to the heart valves, leading to valvular heart disease. The duration of the trials was too short to rule out a risk of cancer.

Lorcaserin does not offer hope to obese patients.

©Prescrire 1 May 2014

"Lorcaserin. In obesity: unacceptable risks" Prescrire Int 2014; 23 (149): 117-120. (Pdf, subscribers only)

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