A new study published in the journal Circulation reports that apart from improving glycemic control in overweight and obese patients at high cardiovascular disease (CVD) risk, lorcaserin reduced the rate of new onset or progressive renal impairment. The findings of the trial were presented at the American Heart Association Scientific Sessions 2018.
Obesity is thought to increase renal hyperfiltration, thereby increasing albuminuria and progression of renal disease. Obesity is thought to increase renal hyperfiltration, thereby increasing albuminuria and progression of renal disease. The effect of pharmacologically-mediated weight loss on renal outcomes is not well-described.
Benjamin Scirica and associates conducted CAMELLIA-TIMI 61 randomized trial which included 12,000 overweight or obese patients with or at high risk for atherosclerotic CV disease to lorcaserin or placebo on a background of lifestyle modification. The primary renal outcome was a composite of new or worsening persistent micro or macro-albuminuria, new or worsening chronic kidney disease, doubling of serum creatinine, end-stage renal disease, renal transplant or renal death.
The key study findings included are:
- At baseline, 23.8% of patients had an estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2and 19.0% had albuminuria (urinary albumin:creatinine ratio ≥30mg/g).
- Lorcaserin reduced the risk of the primary renal composite outcome (4.2% per year versus 4.9% per year).
- The benefit was consistent across subpopulations at increased baseline CV and renal risk.
- Lorcaserin improved both eGFR and UACR within the first year after randomization.
- The effect of lorcaserin on weight, HbA1c, and systolic blood pressure was consistent regardless of baseline renal function.
- There was no excess in cardiovascular events in patients assigned to lorcaserin compared to placebo, regardless of renal function.
- After adjustment for baseline characteristics, those with evidence of kidney disease were at increased risk of major CV events (HR 1.25, , 1.56 in patients with an eGFR 60-90 ml/kg/1.73m2 53 and HR 1.51, 1.95 with an eGFR <60 ml/kg/1.73m2,), compared to patients with eGFR >=90, and HR 1.46, 1.74 for microalbuminuria and HR 2.10, 2.80 for macroalbuminuria, compared to <30 mg/g).
The study concluded that Lorcaserin, a selective serotonin 2C receptor agonist that promotes appetite suppression, led to sustained weight loss without any increased risk for major adverse cardiovascular (CV) events and improved established measures of renal function across all subpopulations.
For full information log on to https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.038341