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EBM Verdict
General medicine
Lorcaserin in obesity: minimal benefits and ill-defined harms
  1. Igho J Onakpoya1,
  2. Jeffrey K Aronson2
  1. 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2 Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
  1. Correspondence to Dr Igho J Onakpoya, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; igho.onakpoya{at}phc.ox.ac.uk

https://doi.org/10.1136/bmjebm-2018-111128

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    A recent lorcaserin trial investigated ‘the long-term cardiovascular and metabolic safety and efficacy of lorcaserin’ in subjects at high cardiovascular risk. The large number of exclusions, the minimal weight reductions observed and the selective reporting of harms leave major uncertainties about lorcaserin’s benefit-harm profile. 

    Lorcaserin has recently been hailed in news media as the new ‘holy grail’ in managing obesity. Is this true? Or are we being misled?

    This claim is based on the results of a study of lorcaserin in 12 000 overweight or obese subjects with high cardiovascular risk profiles.1 The authors concluded that lorcaserin generated sustained weight loss without increased risks of major cardiovascular events. However, the benefits appear to have been exaggerated, and the harms downplayed or poorly reported.2

    Lorcaserin (Belviq) is a selective 5HT2C receptor agonist, developed for use as a weight-reducing agent. In 2012, it gained US marketing approval for obesity after initial hesitancy by the Food and Drug Administration (FDA), because of concerns about harms.3 Concerns about the risks of tumours, …

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    Footnotes

    • Contributors IJO and JKA both contributed equally to the text.

    • Competing interests IJO and JKA are coauthors of a previously published systematic review and meta-analysis that assessed the benefits and harms of centrally acting antiobesity medicines. IJO holds grant funding from the NIHR School of Primary Care Research (NIHR Evidence Synthesis working group Project No 390).

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.