Sibutramine: targeting obesity
Leonidas H. Duntas1 and Dragan Micic2
1Endocrine Unit, Evgenidion Hospital, University of Athens, Greece, 2Center for Metabolic Disorders in Endocrinology, Institute of Endocrinology, Clinical Center of Serbia, Belgrade, Serbia

Sibutramine, a monoamine serotonin and norepinephrine neuronal reuptake inhibitor, has been established as a safe and efficient drug not only in reduction but also in maintenance of weight loss. Both continuous and intermittent long-term treatment of sibutramine combined with diet and exercise have been demonstrated as equally effective and safe in combating obesity and co-morbidities. In the STORM study, 77% of the patients achieved weight loss and most sustained their weight loss by continuing therapy for two more years. The results of the SCOUT trial will soon be published providing valuable data regarding the impact of sibutramine together with lifestyle intervention on cardiovascular morbidity and mortality in high risk patients. Sibutramine should be considered in the treatment of abdominal obesity since it modifies body fat distribution, reduces visceral adiposity and improves the insulin resistance score. An elevation of serum adiponectin by sibutramine has been associated with these changes. Sibutramine was also shown to be effective in the treatment of adolescent obesity, either alone or combined with behavioral therapy. Based on this multiple range of action, a combination treatment with other drugs targeting obesity, eating disorders and diabetes mellitus type 2 could in concert increase efficacy while increasing tolerability by decreasing the adverse events rate. Meanwhile, variability in response to therapy with sibutramine due to genetic variation has suggested a selection of patients based on candidate genes, which will considerably amplify the response to treatment.

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