because of adverse events as compared with placebo (25.9 percent on the drug, versus 12 percent on placebo.) There was also considerable amount of individual variability in how some patients responded well, and others didn’t. The adverse events were predictable for a drug that works on the central nervous system—nausea, headache, constipation, and dizziness.
By shedding pounds, researchers expect a number of other positive things happen for patients’ overall health. Waist sizes shrank, cholesterol and triglyceride levels dropped, depression rates came down, and self-esteem went up. Contrave patients didn’t have any increased risk of suicidal thinking, a rare but obviously problematic effect that ultimately stopped a weight loss drug developed by Sanofi-Aventis from making it to the U.S. market a couple years ago.
Orexigen remains optimistic that it will win FDA approval of Contrave, although Pi-Sunyer said he’s not so sure. “I don’t think it’s quite as good as (Vivus’) Qnexa, and it’s almost as good as (Arena’s) lorcaserin, he says.
Ultimately, he’s not sure any of these drugs will tap the market’s demand for obesity medicines. A hit drug in this disease would need to help people shed between 10 percent and 15 percent more of their body weight than a placebo, particularly because consumers will have to pay for these drugs out of their own pockets instead of getting insurance to pay, Pi-Sunyer says. Drugs like this will probably cost $150 a month, which will force many patients to really ask whether it’s worth the expense.
“I’m not sure any of the three drugs will make a dent in the problem,” Pi-Sunyer says. “When people have to pay for this out of their own pocket, they want something truly effective.”
Even so, when I asked him if he’d prescribe the drug to his patients if it were available today on the market, he said yes. “Since some people get a much better effect than others, I’d have them try it for a couple months and then stop if it’s not working” Pi-Sunyer says.
