Belviq ® - lorcaserin Clinical Application Indications: Chronic weight management in: Adults with BMI ≥ 30kg/m 2 or BMI ≥ 27kg/m 2 and at least one weight related condition (HTN, HLD, T2DM) Place in therapy: As adjunct to diet and exercise for chronic weight management
Belviq ® - lorcaserin Clinical Application Pregnancy: Category X Lactation: Not recommended. Belviq® may increase prolactin.
Belviq ® - lorcaserin Drug Facts Pharmacology: The exact mechanisms is not known. Belviq® is believed to decrease food consumption and promote satiety by selectively activating 5-HT 2C receptors on anorexigenic proopiomelanocortin neurons located in the hypothalamus.
Belviq ® - lorcaserin Drug Facts Pharmacokinetics: A Bioavailability: Not been determined C max : hours D Loracersin distributes to the CSF and CNS in humans. Moderately bound (~70%) to human plasma proteins. M Extensively hepatic, producing two major inactive metabolites as well as minor metabolites. E Urine (92%, as metabolites), feces (2%, as metabolites). Half-life of ~ 11hrs, SS reached within 3 days after BID dosing, and accumulation is estimated to be approximately 70%.
Belviq ® - lorcaserin Drug Interactions Drug Interactions – Object Drugs: serotonergic effect of other serotonergic agents or agents that impair serotonin metabolism effect of CYP2D6 substrates Inhibits CYP2D6 metabolism
Belviq ® - lorcaserin Drug Interactions Drug Interactions – Precipitant Drugs: None given in the package insert.
Belviq ® - lorcaserin Monitoring Parameters Efficacy Monitoring: Loss of at least 5% of baseline body weight by week 12 Toxicity Monitoring: S/sx of serotonin syndrome S/sx of valvulopathy
Belviq ® - lorcaserin Prescription Information Dosing: 10mg po twice daily Cost: AWP $240 (60ct) Net Invoice Cost $202 Cardinal Health (12/21/14)
Belviq ® - lorcaserin Literature Review Purpose: To evaluate the safety and efficacy of lorcaserin for weight loss and maintenance of weight loss when administered with a lifestyle modification plan Design: Randomized, placebo- controlled, double-blind clinical trial Smith SR, et al., NEJM Jul 15;363(3):
Belviq ® - lorcaserin Literature Review Inclusion Exclusion InclusionExclusion 18 to 65 years oldModerate or more severe mitral regurgitation or mild or more severe aortic regurgitation BMI of 30 to 45 or BMI of 27 to 45 with at least 1 coexisting condition (HTN,HLD, CVD, impaired glucose tolerance, sleep apnea) Depression or other major psychiatric disease within 2 years before randomization that necessitated treatment with prescription medication Diabetes SBP > 140mmHg or DBP > 90 Pregnancy or lactation Smith SR, et al., NEJM Jul 15;363(3):
Belviq ® - lorcaserin Literature Review Baseline Characteristics: Characteristic Lorcaserin (n=1595) Placebo (n=1587) White 1081 (67.9)1046 (66.0) Female 1321 (82.9)1331 (84.0) Age 43.8 ± ± 0.3 Weight in kg ± ± 0.4 BMI 36.2 ± 0.1 Waist Circum. (cm) ± ± 0.3 Smith SR, et al., NEJM Jul 15;363(3):
Belviq ® - lorcaserin Literature Review Treatment Arms: Lorcaserin or placebo twice daily (1:1) x52 weeks Lorcaserin or placebo x52 weeks Placebo → Placebo Lorcaserin → lorcaserin or placebo (2:1) Efficacy: Weight loss Smith SR, et al., NEJM Jul 15;363(3):
Belviq ® - lorcaserin Literature Review Statistical Analysis: Echocardiographic safety end point was primary determinant of sample size 1879 patients (940 in each group) required for 80% power at the 5% level of significance 3182 patients recruited Modified ITT population (screening Echo and at least one post-baseline Echo) analyzed Smith SR, et al., NEJM Jul 15;363(3):
Belviq ® - lorcaserin Literature Review Primary Endpoint: Weight loss at 1 year Maintenance of weight loss at 2 years Secondary Endpoint: Waist circumference, BP, cholesterol, fasting insulin and glucose, CRP, fibrinogen, impact of weight on QOL Echocardiography Smith SR, et al., NEJM Jul 15;363(3):
Belviq ® - lorcaserin Literature Review Results: ITT Population End PointLorcaserin (n=1538) Placebo (n=1499) P-value Loss of ≥5% of body weight Patients (%) <0.001 Weight change (kg)-5.82 ± ± 0.1<0.001 Loss of ≥10% of body weight (%) <0.001 Waist circumference (cm)-6.8 ± ± 0.2<0.001 BMI-2.09 ± ± 0.05<0.001 Smith SR, et al., NEJM Jul 15;363(3):
Belviq ® - lorcaserin Literature Review Discussion: At year 1, 47.5% of lorcaserin group vs 20.3% of placebo had lost 5% or more of body weight Loss was maintained in more patients who continued to receive lorcaserin in year 2 (67.9%) vs placebo (50.3%) Rate of valvulopathy was NOT increased with use of lorcaserin Smith SR, et al., NEJM Jul 15;363(3):
Belviq ® - lorcaserin Literature Review ProsCons New agent for weight management as adjunct to reduced-calorie diet and exercise. Patients may have regained their weight after trial withdrawal (ITT population with LOCF) Over 50% of lorcaserin patients achieved goal 5% of body weight amounted to approximately 12 pounds Weight loss of 5% to 10% can have beneficial effects Assumed valvulopathy would develop in 5% of placebo within 1 year (only 2.3% found) – underpowered Increased valvulopathy and psychiatric issues not observed Rate of discontinuation was nearly 50% Applicability (white, females, healthy) Smith SR, et al., NEJM Jul 15;363(3):
Belviq ® - lorcaserin Summary Belviq ®, lorcaserin, is indicated for weight management in adults (BMI≥30 or BMI≥ RF) as an adjunct to diet and exercise Potentially increases effects of other serotonergic agents and may increase substrates metabolized by CYP2D6 Dosed 10mg po BID ADE include headache, dizziness, & fatigue Long-term data is lacking
Belviq ® - lorcaserin References 1. Accessed 09/14/ Belviq® Package Insert. Arena Pharmaceuticals. June Smith SR, et al., Multicenter, placebo-controlled trial of lorcaserin for weight management. N Engl J Med Jul 15;363(3):