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Advisory Panel Votes 8 to 8 on Whether to Keep Weight Loss Drug on the U.S. Market

Sept. 15, 2010 -- A divided FDA advisory panel voted eight to eight on whether the weight loss drug Meridia should be allowed to stay on the U.S. market.

The decision likely imperils the drug's future. The FDA is currently deciding whether the modest weight loss the drug delivers to most patients is worth an increased risk of cardiovascular events like stroke or heart attack.

Meridia, also known as sibutramine, was first approved in the U.S. in 1997, but lately has been facing controversy. A large study released last November shows that people who took the drug had an 11% risk of cardiovascular events, while those who took a placebo had a 10% risk.

The study, called the SCOUT trial, prompted regulators to order the drug off the market in Europe. Calls quickly mounted for the drug to be banned in the U.S.

Meridia: Risks vs. Benefits

Meridia has been shown to reduce weight in many patients. The average patient who responds to the drug loses 4% more body weight below what they might lose with a placebo, an amount considered a modest benefit. About one-fifth of patients lose more. But the drug also causes increases in heart rate and blood pressure, both of which pose a danger to patients with cardiovascular disease.

The drug is already not supposed to be used in patients with known cardiovascular disease. But experts said they were troubled that many patients with undiagnosed disease could be at greater risk if they use the drug to lose weight.

That essentially caused a conflict: the cardiovascular benefits of modest weight loss vs. a slightly increased risk of heart attack or stroke caused by the body's metabolism of the drug.

"The question has always been, of these competing forces, which ones will win out in terms of cardiovascular risk?" says Eric Colman, MD, deputy director of the FDA's Office of Metabolism and Endocrinology Products.

The FDA's own monitoring linked 14 deaths to the use of Meridia. Patients who died were 43 years old, on average, and 71% were women.

Ultimately, the 16-member advisory committee was divided on the tradeoff. Half urged the FDA to ban Meridia outright, while half said the agency should keep it on the market but with new warnings and significant restrictions on who can prescribe it.

"It's one of the few ways that you can lose weight and not get any of the benefits from doing so. That concerns me," says Lamont G. Weide, MD, PhD, a professor of medicine and diabetes expert at the University of Missouri, Kansas City and a member of the panel.

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