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Efficacy and tolerability of rimonabant in overweight or obese patients with type 2 diabetes: a randomised controlled
André J Scheen1, Nick Finer, Priscilla Hollander
1Division of Diabetes, Nutrition and Metabolic Disorders, CHU Sart Tilman, University of Liege, Liege, Belgium. andre.scheen@chu.ulg.ac.be
Background:
Rimonabant, a selective cannabinoid type 1 receptor blocker, reduces bodyweight and improves cardiovascular and metabolic risk factors in non-diabetic overweight or obese patients. The aim of the RIO-Diabetes trial was to assess the efficacy and safety of rimonabant in overweight or obese patients with type 2 diabetes that was inadequately controlled by metformin or sulphonylureas.
Methods:
1047 overweight or obese type 2 diabetes patients (body-mass index 27-40 kg/m2) with a haemoglobin A1c (HbA1c) concentration of 6.5-10.0% (mean 7.3% [SD 0.9] at baseline) already on metformin or sulphonylurea monotherapy were given a mild hypocaloric diet and advice for increased physical activity, and randomly assigned placebo (n=348), 5 mg/day rimonabant (360) or 20 mg/day rimonabant (339) for 1 year. Two individuals in the 5 mg/day group did not receive double-blind treatment and were thus not included in the final analysis. The primary endpoint was weight change from baseline after 1 year of treatment. Analyses were done on an intention-to-treat basis. This trial is registered at ClinicalTrials.gov, number NCT00029848.
Findings:
692 patients completed the 1 year follow-up; numbers in each group after 1 year were much the same. Weight loss was significantly greater after 1 year in both rimonabant groups than in the placebo group (placebo: -1.4 kg [SD 3.6]; 5 mg/day: -2.3 kg [4.2], p=0.01 vs placebo; 20 mg/day: -5.3 kg [5.2], p<0.0001 vs placebo). Rimonabant was generally well tolerated. The incidence of adverse events that led to discontinuation was slightly greater in the 20 mg/day rimonabant group, mainly due to depressed mood disorders, nausea, and dizziness.
Interpretation:
These data indicate that 20 mg/day rimonabant, in combination with diet and exercise, can produce a clinically meaningful reduction in bodyweight and improve HbA1c and a number of cardiovascular and metabolic risk factors in overweight or obese patients with type 2 diabetes inadequately controlled by metformin or sulphonylureas.
Insights
Rimonabant significantly reduced bodyweight in overweight or obese patients with type 2 diabetes. The 20 mg/day dose improved glycemic control and metabolic risk factors when combined with diet and exercise.
Area of Science:
- Metabolic disease research
- Pharmacological interventions
- Diabetes management
Background:
- Rimonabant, a cannabinoid type 1 receptor blocker, has shown efficacy in reducing bodyweight and improving metabolic profiles in non-diabetic individuals.
- Type 2 diabetes often coexists with obesity, necessitating effective weight management strategies to improve glycemic control and reduce cardiovascular risk.
Purpose of the Study:
- To evaluate the efficacy and safety of rimonabant in overweight or obese patients with type 2 diabetes.
- To assess rimonabant's impact on bodyweight, glycemic control (HbA1c), and cardiovascular risk factors in this patient population.
Main Methods:
- A 1-year, double-blind, randomized controlled trial involving 1047 overweight or obese type 2 diabetes patients inadequately controlled on metformin or sulphonylureas.
- Participants received a hypocaloric diet, increased physical activity, and were randomly assigned to placebo, 5 mg/day rimonabant, or 20 mg/day rimonabant.
- The primary endpoint was weight change from baseline after 1 year, with intention-to-treat analysis.
Main Results:
- Weight loss was significantly greater in both rimonabant groups compared to placebo after 1 year (20 mg/day: -5.3 kg).
- Rimonabant was generally well-tolerated, although adverse events leading to discontinuation were slightly higher in the 20 mg/day group (mood disorders, nausea, dizziness).
Conclusions:
- 20 mg/day rimonabant, combined with lifestyle interventions, offers a clinically meaningful reduction in bodyweight for overweight or obese type 2 diabetes patients.
- This treatment approach also demonstrates improvements in HbA1c and key cardiovascular and metabolic risk factors.
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