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Rimonabant a Triple Threat to Diabetes

The novel weight-loss drug rimonabant (Acomplia, Sanofi-Aventis) has demonstrated repeatedly that it can significantly increase weight reduction, decrease waist size, and improve lipid levels in patients without diabetes (DOC News, July 2004 and February 2005). Data from the Rimonabant in Obesity-Diabetes (RIO-Diabetes) study, presented June 12 at the 65th Scientific Sessions of the American Diabetes Association (ADA), show the drug also helps alleviate the same problems in patients with type 2 diabetes.

The 1,047 participants in the multicenter, double-blind RIO-Diabetes trial were randomized to receive placebo or rimonabant at doses of 5 mg or 20 mg. The patients had a mean age 56 years, mean body mass index (BMI) 34, mean waist circumference 110 cm (43.3 in), and mean glycated hemoglobin (A1C) 7.5%. All patients had been treated with metformin or one of several sulfonylureas when they entered the trial and continued their antidiabetic therapy during the trial.

Results of the placebo versus 20-mg rimonabant were most significant and were reported at the ADA meeting. The 336 participants taking placebo lost an average 3.1 lb compared with 11.7 lb lost by the 20-mg rimonabant group.

The weight loss was less in people who did not have diabetes or the metabolic syndrome. The average difference in reduced waist circumference was 3.3 cm (1.3 in) and paralleled the weight loss results.

A1C rose 0.1% in the placebo group and fell 0.6% in the 20-mg rimonabant group. Almost 70% of those on 20-mg rimonabant reached the ADA-recommended target of <7%, compared with 47.6% of those on placebo.

HDL cholesterol rose 6.6 mg/dl in the patients on rimonabant, compared with a rise of 2.7 mg/dl for the placebo group. Triglycerides rose 3.6 mg/dl in those on placebo and declined 31.2 mg/dl in the rimonabant patients.

"[Rimonabant] offers new approaches to the management of type 2 diabetes mellitus, addressing multiple cardio-metabolic risk factors," concluded investigator André Scheen, MD, PhD, of the University of Liège in Belgium.

The most significant side effect was depression. Patients with a history of depression or who were taking antidepressants weren't included in the study.

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