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Acomplia poised for role in type-2 therapy

Sanofi-aventis’ drug rimonabant (Acomplia) may aid in controlling blood sugar levels in type-2 diabetes, offering a new avenue in diabetes management, reports a new study.

Sanofi-aventis’ drug rimonabant (Acomplia) may aid in controlling blood sugar levels in type-2 diabetes, offering a new avenue in diabetes management, reports a new study.

Results from the year-long RIO-Diabetes trial, published in The Lancet, found that rimonabant 20 mg once daily significantly improved several cardiometabolic risk factors in patients whose diabetes was uncontrolled by metformin or
sulfonylurea. Improvements were recorded in weight, HbA1c, HDL- cholesterol, triglycerides, systolic blood pressure and waist circumference.

50% of the improvements in HbA1c and HDL-cholesterol levels were independent of the weight loss achieved, indicating a direct effect of rimonabant on these parameters, say authors.

Professor Andre Scheen, of the University of Liege in Belgium, was the principle investigator on the study. “Today, most medications for type 2 diabetes are associated with weight gain,” he said. “These findings support the use of 20 mg per day of rimonabant, in addition to diet and exercise, as a new approach to reduce body weight and improve blood glucose control in overweight or obese patients with type 2 diabetes.”

1,047 patients, each with a BMI of between 27 kg/m2 and 40 kg/m2, were enrolled in the multinational study. Patients receiving rimonabant achieved a HbA1c reduction of 0.6%, compared to an increase of 0.1% on placebo. Overall, nearly 70% of rimonabant patients lowered their HbA1c levels to below 7%, compared to 48% of the placebo group.

“Rimonabant was able to reduce blood sugar levels in a patient population where further control or lowering is often difficult to attain,” said Dr Sheen. “For every 1% redution in HbA1c, there is an associated reduction of risk of 21% for any endpoint related to diabetes.”

Patients receiving rimonabant also achieved an average weight reduction of 5.3 kg compared to 1.4 kg in the placebo group.

However, reviewers of the data have suggested the trial’s findings are not conclusive. Dr Naveed Sattar, of the University of Glasgow, reviewed the results of the study when it was first presented at the American Diabetes Association meeting in June 2005. In an accompanying editorial in The Lancet, Dr Sattar said the improvement in blood levels may have been caused by factors other than rimonabant. He added more tests were required to assess the drug’s role in the treatment of type-2 diabetes, citing incidents of depression among trial participants and the study’s high dropout rate.

Rimonabant is the first drug to block endogenous cannabinoid binding to neuronal CB1 receptors, thus inhibiting appetite and leading to weight loss. If proved to offer clinical benefits beyond weight loss in diabetics, the global potential of the drug could be enormous.

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