Monday, September 15, 2014
On September 10, the US-FDA granted approval for Contrave, a fixed combination of bupropion and naltrexone, two centrally active compounds, also used in the treatment of addictions.
Then, on September 11, an advisory panel appointed by the FDA, voted strongly in favour of approving the GLP-1 agonist liraglutide at the 3.mg dose for the treatment of obesity.
These two new entities would bring the currently approved prescription medications for the treatment of obesity in the US to six – a dramatic change from just a couple of years ago.
This is still a long shot away from the many effective treatments we have for treating other common conditions (e.g. there are more than 20 prescription medications approved for treating diabetes and almost 100 compounds for the treatment of hypertension).
Why would we need this many different medications for obesity? For the simple reason that not everyone will respond favourably or tolerate all of these compounds.
Given that obesity is a remarkably heterogeneous disorder and that these drugs have distinctly different modes of action, I would not expect all of these medications to work in all individuals.
It is also important to note that all of these drugs work best when combined with intense behaviour modification – no pill will ever serve as a substitute for a healthy diet and a daily dose of moderate to vigorous physical activity. But we also know that the latter alone, will rarely produce sustainable weight loss in the long-term.
Obviously, given the chronic nature of obesity, medications for obesity will need to be used long-term in the same manner that we use medications to treat other chronic conditions (e.g. diabetes, hypertension, etc.).
This means that we will need more long-term data on the efficacy and safety of these compounds.
Nevertheless, there is reason to hope that for many people with obesity related health problems, these new obesity medications will provide much-needed therapeutic options.
Disclaimer: I have served as a paid consultant and/or speaker for the makers of Contrave and liraglutide.