Breakthrough 'obesity drug' will cost NHS millions
Publisher: Keith Hall
Published: 28/06/2006 - 17:16:51 PM
Breakthrough obesity drug?
A new drug that promises to revolutionise the treatment of obesity and diabetes was launched in the UK today.
Rimonabant is the first drug to target a natural body system that governs a host of factors controlling appetite, weight, metabolism and energy use.
As an added bonus, it is said to combat a smoker's craving for nicotine.
But widespread use of the medicine would land the NHS with a fat bill.
Experts say that potentially 20% of Britain's population could be eligible for treatment with rimonabant.
At a cost of £55.20 per patient per month, if even a fraction of that group is treated - as is envisaged - the NHS could have to pay out billions.
The drug's manufacturers, Sanofi Aventis, argues that rimonabant represents good value for money when set against the £7 billion per year cost of tackling the problems connected with obesity and being overweight.
In reality, the drug is unlikely to become widely available until it is approved by the National Institute for Health and Clinical Excellence (Nice).
The watchdog body is not expected to issue guidance on rimonabant for another two years.
Professor Anthony Barnett, a diabetes specialist from the University of Birmingham, who took part in today's launch, said: "Primary Care Trusts often wait for Nice guidance. There is a very distinct possibility that there will be some limitations on its use, which I think will be a very great shame.
"The real question is, can we afford not to treat?"
In a series of trials involving more than 6,000 patients in the US and Europe, around a quarter of those taking rimonabant lost more than 10% of their initial body weight after a year.
About a half lost more than 5% of body weight. Waist circumference - seen by many experts as a more important measurement - was reduced by between six and seven centimetres.
Significant improvements in measures of glucose control, cholesterol and triglyceride blood fats were also seen.
These went far beyond what might be expected simply by losing weight. For example, levels of high-density lipoprotein "good" cholesterol, which reduce heart disease risk, showed an 8% to 9% increase, but only half of this was due to weight reduction.
There are also trial data suggesting that the drug can help people give up smoking by overcoming their cravings.
However at present it is only being marketed to tackle obesity.
Rimonabant, sold under the brand name Acomplia, is currently licensed for the treatment of obese patients, or overweight patients with associated risk factors such as type 2 diabetes or poor cholesterol and triglyceride readings.
Experts agree that treatments such as rimonabant are urgently needed as Britain's obesity rates continue to spiral upwards.
One in five adults in the UK - almost 10 million people - are clinically obese. Obesity is defined as having a Body Mass Index (BMI), a figure which relates weight and height, of 30 or over.
A person who is overweight has a BMI of 25 - 30, and someone of normal weight between about 18.5 and 24.9.
Professor Barnett said obesity rates in the UK were now climbing faster than anywhere else on Earth. The proportion of obese people in Britain was expected to overtake that in the United States in 20 years.
Dr David Haslam, GP and clinical director of the National Obesity Forum, said: "To me, that really rubs it in that we've got a very limited window of opportunity here to do something about the problem.
"Preventative measures aren't enough on their own. It brings into focus the priority that should be given to treatment as well as prevention.
"The launch of rimonabant is important news for patients who are overweight, with type 2 diabetes, or low HDL cholesterol or high triglycerides. These patients are at high risk of developing heart disease."
Other anti-obesity drugs are already available, but rimonabant is the only one to target the endocannabinoid (EC) system.
Discovered in the late 1980s, the EC is sensitive to natural cannabinoids - nature's version of the active substances in cannabis.
Rimonabant works by blocking molecular receptors that, when activated, trigger a cascade of biological events affecting food intake and energy use as well as fat and glucose metabolism.
Abdominal body fat is closely associated with the EC system. Fat accumulated around major organs acts as a factory producing harmful substances which prevent the body responding properly to insulin and promote heart disease.
Increasing numbers of doctors are calling for abdominal fat to be recognised as more important to health than BMI.
A person can have a BMI below the obesity limit while still having dangerous levels of abdominal fat, which can be easily assessed using a tape measure.
Dr Henry Purcell, head of obesity research at the Royal Brompton Hospital in London, said: "It's much more dangerous to have an apple shape than a pear shape."
Waistlines measuring more than 40 inches in men and 35 inches in women mark out those most at risk of developing heart disease and type 2 diabetes.
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