Login Register Cart 0
Generic placeholder image

Current Drug Therapy

Editor-in-Chief

ISSN (Print): 1574-8855
ISSN (Online): 2212-3903

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Comparison of Valvulopathy Risk with Lorcaserin and Phenterminetopiramate for Weight Loss

Author(s): Michael Guo, Mahyar Etminan* and Bruce Carleton

Volume 14, Issue 1, 2019

Page: [74 - 78] Pages: 5

DOI: 10.2174/1574885513666180503141557

Price: $65

Abstract

Background: Lorcaserin and phentermine-topiramate are two drugs marketed for obesity that have shown moderate efficacy after one year of use. However, concerns over risks of serious cardiovascular harms including valvulopathy have been brought up for both drugs, prompting an epidemiologic investigation to quantify this adverse outcome using real-world clinical data.

Objective: To compare rates of valvulopathy between the weight-loss drugs lorcaserin and phentermine-topiramate.

Methods: A retrospective cohort study using the PharMetrics database from the United States was conducted. From approximately 9 million subjects captured in the database from 2006 to 2016, we identified all patients who had received at least one prescription for lorcaserin or phentermine-topiramate. Users of either drug were followed to the first mutually exclusive diagnosis of non-congenital valvulopathy defined as having received an international classification for diseases, ninth revision clinical modification [ICD-9- CM] code for valvulopathy, or to the end of the study period. A Cox Proportional Hazards model was then constructed to compute adjusted hazard ratios (HRs) to compare the rates of valvulopathy between users of the two drugs.

Results: We identified 1,981 lorcaserin users and 1,806 phentermine-topiramate users. Rates of valvulopathy for lorcaserin and phentermine-topiramate cohorts were 26 and 24 per 1000-person-years, respectively. The crude and adjusted hazard ratios (HRs) comparing the two cohorts with respect to valvulopathy were 1.28 (95% CI: 0.73,2.26) and 1.16 (95% CI: 0.65-2.05), respectively.

Conclusion: Our analysis suggests comparable rates of valvulopathy between lorcaserin and phentermine-topiramate users. Clinicians are advised to consider the risk of valvular disease when medically managing obesity.

Keywords: Valvulopathy, lorcaserin, phentermine, topiramate, cohort study, non-congenital.

« Previous Next »
Graphical Abstract

[1]
Ogden CL, Caroll MD, Kit BK, Flegal KM. Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. JAMA 2014; 311(8): 806-14.
[2]
Danaei G, Ding EL, Mozaffarian D, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 2009; 6(4): e1000058.
[3]
American Medical Association. Two drugs for weight Loss. JAMA 2014; 312(9): 955-7.
[4]
Yanovski SZ, Yanovski JA. Long-term drug treatment for Obesity: A systematic and clinical review. JAMA 2014; 311(1): 74-86.
[5]
Jensen M, Ryan D, Apovian C, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the american college of cardiology/ american heart association task force on practice guidelines and the obesity society. Circulation 2014; 129(25)(Suppl. 2): S102-38.
[6]
Woloshin S, Schwartz LM. The new weight-loss drugs, lorcaserin and phentermine-topiramate: Slim pickings? JAMA Intern Med 2014; 174(4): 615.
[7]
Kenchaiah S, Evans J, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med 2002; 347(5): 305.
[8]
Rothman RB, Baumann MH, Savage JE. Evidence for possible involvement of 5-HT(2B) receptors in the cardiac valvulopathy associated with fenfluramine and other serotonergic medications. Circulation 2000; 102(23): 2836-41.
[9]
O’Neil PM, Smith SR, Weissman NJ, et al. Randomized placebo-controlled clinical trial of lorcaserin for weight loss in type 2 diabetes mellitus: The BLOOM-DM study. Obesity 2012; 20(7): 1426-36.
[10]
Fidler MC, Sanchez M, Raether B, et al. A one-year randomized trial of lorcaserin for weight loss in obese and overweight adults: The BLOSSOM trial. J Clin Endocrinol Metab 2011; 96(10): 3067-77.
[11]
Smith SR, Weissman NJ, Anderson CM, et al. Multicenter, placebo-controlled trial of lorcaserin for weight management. N Engl J Med 2010; 363(3): 245-56.
[12]
Gadde KM, Allison DB, Ryan DH, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): A randomised, placebo-controlled, phase 3 trial. Lancet 2011; 377(9774): 1341-52.
[13]
Allison DB, Gadde KM, Garvey WT, et al. Controlled-release phentermine/topiramate in severely obese adults: A randomized controlled trial (EQUIP). Obesity 2012; 20(2): 330-42.
[14]
Connolly HM, Crary JL, McGoon MD, et al. Valvular heart disease associated with fenfluramine-phentermine. N Engl J Med 1997; 337(9): 581-8.
[15]
Center for Disease Control. Cardiac valvulopathy associated with exposure to fenfluramine or dexfenfluramine: U.S. Department of health and human services interim public health recommendations. MMWR Morb Mortal Wkly Rep 1997; 46(45): 1061-6.
[16]
Bang WD, Kim JY, Yu HT, et al. Pulmonary hypertension associated with use of phentermine. Yonsei Med J 2010; 51(6): 971-3.
[17]
Yosefy C, Berman M, Beeri R. Cusp tear in bicuspid aortic valve possibly caused by phentermine. Int J Cardiol 2006; 106(2): 262-3.
[18]
Fitzgerald LW, Burn TC, Brown BS, et al. Possible role of valvular serotonin 5-HT(2B) receptors in the cardiopathy associated with fenfluramine. Mol Pharmacol 2000; 57(1): 75-81.
[19]
Grosso S, Biardi P, Battaglini M, et al. Topiramate effects on plasma serotonin levels in children with epilepsy. Epilepsy Res 2008; 81(2-3): 148-54.
[20]
DiNicolantonio JJ, Chatterjee S, O’Keefe JH, Meier P. Lorcaserin for the treatment of obesity? A closer look at its side effects. Open Heart 2014; 1(1): e000173.
[21]
US Food and Drug Administration. Belviq (lorcaserin hydrochloride) package insert. Available from:. https:// www.accessdata.fda.gov/drugsatfda_docs/label/2012/022529lbl.pdf (Accessed on August 2017).
[22]
Smith SR, Prosser WA, Donahue DJ, Morgan ME, Anderson CM, Shanahan WR. Lorcaserin (APD356) a selective 5-HT(2C) agonist reduces body weight in obese men and women. Obes (Silver Spring) 2009; 17(3): 494-503.
[23]
Thomsen WJ, Grottick AJ, Menzaghi F, et al. Lorcaserin, a novel selective human 5-hydroxytryptamine2C agonist: In vitro and in vivo pharmacological characterization. J Pharmacol Exp Ther 2008; 352(2): 577-87.
[24]
US Food and Drug Administration. Qsymia (phentermine and topiramate extended-release) package insert. httpswwwqsymiacompdfprescribing-Informationpdf. (Accessed on Aug, 2017).

Rights & Permissions Print Cite
Article Metrics
67
3
1
1
© 2024 Bentham Science Publishers | Privacy Policy