Lorcaserin: A review of its preclinical and clinical pharmacology and therapeutic potential

Pharmacol Ther. 2020 Jan;205:107417. doi: 10.1016/j.pharmthera.2019.107417. Epub 2019 Oct 16.

Abstract

The selective 5-HT2C receptor agonist lorcaserin, in conjunction with lifestyle modification, was approved by the FDA in 2012 for weight management. It has been marketed in the US as Belviq® since 2013. This article provides a review of the preclinical and clinical pharmacology of lorcaserin, including its pharmacokinetic and safety profiles. Preclinical studies with lorcaserin initially focused on simple measures of food intake and body weight gain, but have now expanded to include studies on its effects on appetitive aspects of feeding behaviour and models of binge-eating. A significant number of studies have also shown that lorcaserin alters behaviours related to drug use and addiction, in rodents and non-human primates. Potential clinically-relevant effects of lorcaserin have also been reported in models of pain and seizure-like activity. Not surprisingly, the majority of clinical work with lorcaserin has focused on its effects on weight gain, and on physiological processes related to energy intake. However, results of clinical trials and experimental laboratory studies involving lorcaserin are now appearing which describe effects on a range of other behaviours and physiological functions. These include smoking cessation, cocaine self-administration, and behavioural and brain responses to food cues. All of this work suggests that lorcaserin may have therapeutic potential for a variety of disorders and conditions beyond obesity. Based on clinical experience, including the outcomes from several, large, well-powered clinical obesity trials at the approved 10mg BID dose both pre and post approval, a priori concerns about cardiac valvulopathy have largely been allayed. However, as with any recently approved first-in-class pharmacotherapy, there may be yet-unknown risks, as well as benefits, associated with use of lorcaserin. Nonetheless, the current safety profile and an expanding post approval safety data base should encourage further experimental laboratory-based and clinical trial-based research with lorcaserin in targeted populations to investigate its full therapeutic potential.

Keywords: 5-HT2C receptor; Binge eating disorder; Drug abuse; Impulsivity; Lorcaserin; Obesity; Precision medicine; Review; Reward; Safety; Serotonin 2C receptor; Smoking cessation.

Publication types

  • Review

MeSH terms

  • Animals
  • Anti-Obesity Agents / adverse effects
  • Anti-Obesity Agents / pharmacokinetics
  • Anti-Obesity Agents / pharmacology*
  • Behavior, Addictive / drug therapy
  • Benzazepines / adverse effects
  • Benzazepines / pharmacokinetics
  • Benzazepines / pharmacology*
  • Feeding Behavior / drug effects
  • Humans
  • Obesity / drug therapy
  • Serotonin 5-HT2 Receptor Agonists / adverse effects
  • Serotonin 5-HT2 Receptor Agonists / pharmacokinetics
  • Serotonin 5-HT2 Receptor Agonists / pharmacology*
  • Substance-Related Disorders / drug therapy

Substances

  • Anti-Obesity Agents
  • Benzazepines
  • Serotonin 5-HT2 Receptor Agonists
  • lorcaserin