Metreleptin

How it works

It is a leptin receptor agonist that replaces deficient leptin signalling, helping to regulate appetite, energy balance, insulin sensitivity and lipid metabolism.

Prescribing in practice

• Anti-metreleptin antibodies with neutralising activity can develop and may reduce efficacy or be associated with severe infections, so it must be used under specialist supervision with awareness of this risk.
• There is a recognised risk of T-cell lymphoma reported in acquired generalised lipodystrophy, so the benefit-risk balance must be assessed by a specialist.
• Improved insulin sensitivity may cause hypoglycaemia, so concomitant insulin or insulin secretagogues may need dose reduction.

Monitoring

Monitor metabolic response (glycaemic control, triglycerides), blood glucose for hypoglycaemia and for signs of infection or lymphoproliferative disease.

Counselling the patient

• This is a specialist medicine used alongside a structured diet to control metabolic complications.
• Report any signs of infection or unexplained illness promptly.
• Diabetes treatments may need adjusting, so be alert to symptoms of low blood sugar.

Evidence & guidelines

Metreleptin is approved for leptin replacement in generalised lipodystrophy on the basis of improvements in metabolic parameters in this rare population.