Rimonabant (Acomplia)

12 Mar



The prevalence of obesity continues to rise. Current data indicate that the combined prevalence of overweight and obesity in adults in the U.S. is 66.3%. The prevalence for obesity alone in adults is 32.2%; for extreme obesity in adults, this figure is 4.8%. Approximately 17.1% of children and adolescents in the U.S. are overweight. Overweight is defined as a body mass index (BMI) of 25 to 29.9 kg/m2; obesity is defined as a BMI of 30 kg/m2 or greater. Obesity is a significant risk factor for the development of insulin resistance, type-2 diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, and stroke. Furthermore, it is a contributing factor for pulmonary hypertension, sleep apnea, nonalcoholic fatty liver disease, gallbladder disease, hyperuricemia and gout, osteoarthritis, and certain types.

The exact causes of obesity are unknown, but obesity is believed to be a complex interaction between genetic, environmental, and psychosocial factors. The goal of antiobesity treatment includes not only a reduction in weight but also in the disability and morbidity associated with obesity, thus leading to an improved quality of life for patients. Healthy lifestyle changes, including a reduced caloric intake and increased physical activity, are the mainstays of treatment. Because obesity is continuing to become more prevalent, there is a growing interest in finding alternative treatments, including pharmacological therapies.

Clinical practice guidelines from the American College of Physicians consist of five recommendations for the treatment of obesity:

  • All obese patients should be counseled on lifestyle and behavioral modifications.
  • Pharmacological therapy should be offered to patients who have failed to achieve weight loss through diet and exercise alone. Health care providers should discuss the side effects, lack of long-term safety data, and the temporary nature of the weight loss achieved before medication is prescribed.
  • Adjunctive drug therapy options include sibutramine (Meridia, Abbott), (Roche), phentermine (Adipex, Gate), di-ethylpropion (Tenuate, Sanofi-Aven-tis), fluoxetine (Prozac, Eli Lilly), and (GlaxoSmithKline).
  • Patients with a BMI of 40 kg/m2 or above who have failed to improve with diet and exercise, with or without adjunctive medications, and who have obesity-related comorbid conditions should be considered for surgery.
  • Patients should be referred to high-volume medical centers with surgeons experienced in bariatric surgery.

Rimonabant (Canadian Acomplia, Sanofi-Aven-tis) is a new investigational drug in a new class of therapeutic agents called can­nabinoid-1 (CB1) receptor blockers. In February 2006, the Food and Drug Administration (FDA) issued an approv-able letter for weight management. Final approval for weight loss is pending because of an undisclosed requirement by the FDA. The company has not chosen to reveal the content of the letter for this indication. However, rimonabant did receive marketing authorization by the European Commission on June 21, 2006. In Europe, this drug is indicated as an adjunct to diet and exercise for the treatment of obese or overweight patients with associated risk factors, such as type-2 or dyslipidemia.