A pill for the 21st century

Butt out, get thin and reduce the risk of heart disease all at the same time with a new drug. Papers coming soon

By Charles Rowe

Two top-of-the-chart New Year's resolutions are to drop some weight and quit smoking. Both can be tough to do, especially when nicotine cravings send people reaching for the saturated fat. Help may soon be as near as the local pharmacy.

Pharmaceutical giant Sanofi-Synthelabo reports that early data from two large-scale advanced clinical trials of a drug called rimonabant indicate that it acts like marijuana in reverse, by curbing appetite and the craving for nicotine. Trade named Acomplia, aka the munchies drug, the tongue-in-cheek nickname comes from the findings. Rimonabant may act by blocking the binding of natural cannabinoids -- the stuff that gives marijuana its zing -- to various cells.

"Those who stay on the drug for a year show remarkable weight loss [of] 8kg ... [and] a reduction in waist circumference of 8cm," says Dr Jean-Pierre Despres, a professor of food and nutrition sciences at the Université de Laval in Quebec City.

Dr Despres' study involved over 1,000 moderately obese men and women who were prime candidates to develop diabetes. During a year on a carefully controlled diet, about a quarter of those who popped a placebo lost more than 5% of their body weight. Of those in the rimonabant group, a whopping 75% shed the same poundage and nearly half the folks shed over 10% of their body weight.

Better still, much of the weight loss consisted of unhealthy abdominal fat. The good news goes on and on. Fully half of those who were at risk of diabetes due to a combination of abdominal fat, high blood pressure and blood sugar levels, and low levels of "good" HDL cholesterol -- the so-called metabolic syndrome -- no longer had the syndrome after a year on rimonabant.

The curbed appetite even held up for those trying to quit smoking. Research by Dr Robert Anthenelli, an associate professor of psychiatry at the University of Cincinnati College of Medicine, found that rimonabant "roughly doubled the odds of quitting smoking." The 10-week trial involved nearly 800 men and women. Twenty percent of those taking a placebo managed to quit smoking for four weeks straight. Adding rimonabant to the mix upped the success rate to over 36%.

Those kicking the habit who took the drug gained 77% less weight than those who popped a placebo. "The dual effects on smoking cessation and reduced weight gain make rimonabant promising for treating tobacco dependence," said Dr Anthenelli.

The trial is being continued for another year in the US and Europe.

Douglas Greene, Sanofi-Synthelabo vice-president for regulatory affairs, is understandably enthusiastic. "[Rimonabant] is the first in a class of new medications that has effects on two major cardiovascular factors ... smoking and obesity. This represents a major advance for patients at risk of heart disease."

For now, the good news is tempered by the lack of publicly available data. That will change soon, as results of the various trials are presented at meetings and in scientific publications.