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Wednesday, March 10, 2004 - Page updated at 12:00 A.M.
Pill helps people slim down, quit smoking at same time
By Daniel Q. Haney
As government officials in Washington launched a campaign against obesity yesterday, doctors at a medical conference here described the new drug as provocative and perhaps ideal for some people.
The drug, which could be available in a year or two, works by an entirely new approach by blocking the same primeval circuitry in the brain that gives pot smokers the munchies.
The development could offer a well-timed, one-two punch against Americans' gravest health concerns. Smoking is the country's top killer, but it is rapidly being overtaken by obesity and inactivity. The two problems combined kill more than 800,000 Americans a year. A similar pattern is occurring worldwide, even in developing countries.
Doctors who heard data on the new pill said that although better living habits still should be the foundation of good health, a new pill could be an important boost for those who cannot accomplish it through willpower alone.
"We tell people to diet and exercise, and that advice doesn't seem to be very effective," said Dr. Raymond Gibbons of the Mayo Clinic, who called the latest results "very provocative."
Two reports on the drug, called rimonabant, were released in New Orleans at a meeting of the American College of Cardiology. The research was financed by the drug's developer, the French firm Sanofi-Synthelabo, which plans to seek U.S. approval to sell it under the brand Acomplia after more studies are finished next year.
One study found the drug helped people drop 20 pounds in a year, while the other concluded it doubles smokers' success at quitting, at least in the short run. Doctors said the drug is likely to be marketed both for dieting and smoking cessation, but it is likely to be especially appealing to people beset by both problems.
Doctors say the drug is also noteworthy because it takes a fresh approach to helping people overcome their yen for food and tobacco. It is the first of a class of medicines that block the so-called endocannabinoid system.
Marijuana makes people ravenous by stimulating this circuitry. The same biological machinery serves crucial, everyday purposes by helping the brain regulate hunger and probably other urges, including alcohol craving.
Overeating and smoking can overstimulate this system, which, in turn, propels people to eat and smoke even more. By temporarily blocking the body's ability to receive these signals, experts think they can return the system's working to normal.
After a year, those who got the higher of two doses of rimonabant had lost an average of 20 pounds and trimmed three inches from their waists. Nearly half of them took off 10 percent of their body weight. By comparison, those on placebos lost five pounds.
Those getting rimonabant improved in other ways, too. Their levels of HDL, the so-called "good" cholesterol, rose 23 percent, while their triglycerides fell 15 percent.
Despres said people taking the drug simply felt less hungry.
A study by Dr. Robert Anthenelli of the University of Cincinnati tested the drug for 10 weeks on 787 smokers who wanted to quit their pack-a-day habit but could not. A longer follow-up will see how well they stay off, but in the short run, 28 percent shunned cigarettes for at least a month, compared with 16 percent on a placebo.
Especially important, Anthenelli said, is that those on the drug gained little or no weight, and a third of the successful quitters took off pounds at the same time. Ordinarily, smokers gain six to 10 pounds when they quit.
Some people had minor digestive side effects at first, but they usually went away.
"The drug shows promise," said Dr. Sidney Smith, cardiovascular chief at the University of North Carolina. "However, I strongly believe lifestyle changes should be the foundation of what we do. I would not want to see patients turn to a pill as the first approach."
In all, seven large studies with rimonabant are in the works. They involve 6,600 volunteers who want to lose weight and 6,500 who want to quit smoking.
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