New centrally acting agents for appetite control: from biological mechanisms to clinical efficacy

Abstract

Background:

Obesity is one of the major problems of health policy in different countries. Pharmacological attempts have been made to help affected people without a definitive solution. Some agents – either with peripheral or central effect – are available in the market. On July 2012, the FDA approved two novel preparations for obese patients: (1) topiramate–phentermine – the first one an anticonvulsant and the second one a sympathomimetic amine – and (2) lorcaserin, a 5-HT2CR agonist. Both preparations emerged as new options for weight management.

Scope:

Based on the complex biology of eating behavior, in this review we discuss the features, mechanisms of action, pharmacokinetics, advantages and possible disadvantages of these new agents.

Conclusion:

With differences in efficacy (higher for the topiramate–phentermine combination), both preparations are active in reducing appetite and body weight, as well as in improving comorbidities. Additional information will be collected from Phase IV surveillance. Focus on cardiovascular, neuropsychiatric (for both introductions) and embrio-fetal safety (especially for topiramate) is expected.

Keywords::

• Appetite control
• Lorcaserin
• Obesity
• Pharmacological treatment
• Topiramate
• phentermine

Transparency

Declaration of funding

The authors received no payment in preparation of this paper.

Declaration of financial/other relationships

G.D.G., N.C., L.V., and C.G. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.