Rimonabant (Accomplia) (still) on the Horizon

Revised: January 11, 2007

According to Bruce Goldfarb, writing in the February, 2005 issue “Doc News" (http://www.consultantlive.com) published by the American Diabetes Association, there is a new drug on the horizon for the treatment of obesity. In “New Drug Helps Achieve Long-Term Weight Loss,” he describes the research presented at the November American Heart Association Scientific Sessions held in November, 2004.

According to Goldfarb, the new drug dampens the brain’s craving for flavorful foods and nicotine, helping people lose weight and keep it off over a long-term study. Unlike other medications that often lose their effectiveness after a few months of treatment. The new drug is generically called rimonabant, trade name Accomplia and is being developed by Sanofi-Aventis. In the studies presented, Accomplia treated patients maintain weight loss during a 2-year follow-up period. The study, Rimonabant in Obesity (RIO)-North America trial, which involved over 3000 patients throughout the U.S. and Canada, was directed by Xavier Pi-Sunyer, chief of endocrinology at St. Lukes-Roosevelt Medical Center in New York City.

According to the study, Rimonabant is the first of a novel category of drugs known as selective cannabinoid (CB) receptor blockers. The recently discovered endocannabinoids are a system of receptors and chemical messengers believed to play a role in weight regulation and lipid metabolism.

According to the report, CB receptors in the brain stimulate the ingestion of palatable foods, a mechanism possibly responsible for the “munchies.” Activation of the CB system in peripheral tissues has been shown to stimulate fat accumulation. In the RIO-North America trial, 60 per cent of patients given Rimonabant lost more than 5 per cent of their body weight, and 33 per cent of subjects lost more than 10 per cent. Subjects taking the drug lost an average of 19 pounds, compared with 5.1 pounds in the placebo group.

Beyond the loss of weight, patient on Rimonabant had an improvement of their high-density lipoproteins (HDL) by 24 per cent, compared with a 13.8 per cent rise in the placebo group. Clearly, rimonabant has some widespread actions - all positive - on the metabolic status of the obese patient. I, as one physician, really think this entire concept is very exciting.

Despite these early reports of success,the FDA is requesting - as it often does with new drug - much more study by the manufacturer. The drug, as Accomplia, is already approved by the European Union and is readily available in England and other countries overseas. Our FDA - still with some egg on the faces after the Pondimin (remember "ohen-fen?") fiasco is demanding more patient experience and research on how Rimonabant works and its long-term effects before it will release the drug to the American consumer. Positive effects on smoking cessation also appear to be associated with Rimonabant use. Imagine: quit smoking and NOT gain weight!

You should also read "Has Obesity Met Its Match?" - a consumer-directed article on remonibant on Business Week. There are several Internet sites already carrying news of this developing drug and one of the better ones is on BlogSpot.com.