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le Roux CW, Steen O, Lucas KJ, Startseva E, Unseld A, Hennige AM. Glucagon and GLP-1 receptor dual agonist survodutide for obesity: a randomised, double-blind, placebo-controlled, dose-finding phase 2 trial. Lancet Diabetes Endocrinol 2024; 12:162-173. [PMID: 38330987 DOI: 10.1016/s2213-8587(23)00356-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/16/2023] [Accepted: 11/16/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Obesity is a widespread and chronic condition that requires long-term management; research into additional targets to improve treatment outcomes remains a priority. This study aimed to investigate the safety, tolerability, and efficacy of glucagon receptor-GLP-1 receptor dual agonist survodutide (BI 456906) in obesity management. METHODS In this randomised, double-blind, placebo-controlled, dose-finding phase 2 trial conducted in 43 centres in 12 countries, we enrolled participants (aged 18-75 years, BMI ≥27 kg/m2, without diabetes) and randomly assigned them by interactive response technology (1:1:1:1:1; stratified by sex) to subcutaneous survodutide (0·6, 2·4, 3·6, or 4·8 mg) or placebo once-weekly for 46 weeks (20 weeks dose escalation; 26 weeks dose maintenance). The primary endpoint was the percentage change in bodyweight from baseline to week 46. Primary analysis included the modified intention-to-treat population (defined as all randomly assigned patients who received at least one dose of trial medication and who had analysable data for at least one efficacy endpoint) and was based on the dose assigned at randomisation (planned treatment), including all data censored for COVID-19-related discontinuations; the sensitivity analysis was based on the actual dose received during maintenance phase (actual treatment) and included on-treatment data. Safety analysis included all participants who received at least one dose of study drug. The trial is registered with ClinicalTrials.gov (NCT04667377) and EudraCT (2020-002479-37). FINDINGS Between March 30, 2021, and Nov 11, 2021, we enrolled 387 participants; 386 (100%) participants were treated (0·6 mg, n=77; 2·4 mg, n=78; 3·6 mg, n=77; 4·8 mg, n=77; placebo n=77) and 233 (60·4%) of 386 completed the 46-week treatment period (187 [61%] of 309 receiving survodutide; 46 [60%] of 77 receiving placebo). When analysed according to planned treatment, mean (95% CI) changes in bodyweight from baseline to week 46 were -6·2% (-8·3 to -4·1; 0·6 mg); -12·5% (-14·5 to -10·5; 2·4 mg); -13·2% (-15·3 to -11·2; 3·6 mg); -14·9% (-16·9 to -13·0; 4·8 mg); -2·8% (-4·9 to -0·7; placebo). Adverse events occurred in 281 (91%) of 309 survodutide recipients and 58 (75%) of 77 placebo recipients; these were primarily gastrointestinal in 232 (75%) of 309 survodutide recipients and 32 (42%) of 77 placebo recipients. INTERPRETATION All tested survodutide doses were tolerated, and dose-dependently reduced bodyweight. FUNDING Boehringer Ingelheim.
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Affiliation(s)
- Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Oren Steen
- LMC Diabetes and Endocrinology, Toronto, ON, Canada
| | - Kathryn J Lucas
- Diabetes and Endocrinology Consultants, Morehead City, NC, USA
| | | | - Anna Unseld
- Boehringer Ingelheim Pharma GmbH, Biberach an der Riß, Germany
| | - Anita M Hennige
- Boehringer Ingelheim International GmbH, Biberach an der Riß, Germany.
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Anstee QM, Lucas KJ, Francque S, Abdelmalek MF, Sanyal AJ, Ratziu V, Gadano AC, Rinella M, Charlton M, Loomba R, Mena E, Schattenberg JM, Noureddin M, Lazas D, Goh GB, Sarin SK, Yilmaz Y, Martic M, Stringer R, Kochuparampil J, Chen L, Rodriguez-Araujo G, Chng E, Naoumov NV, Brass C, Pedrosa MC. Tropifexor plus cenicriviroc combination versus monotherapy in nonalcoholic steatohepatitis: Results from the phase 2b TANDEM study. Hepatology 2023; 78:1223-1239. [PMID: 37162151 PMCID: PMC10521801 DOI: 10.1097/hep.0000000000000439] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND AND AIMS With distinct mechanisms of action, the combination of tropifexor (TXR) and cenicriviroc (CVC) may provide an effective treatment for NASH. This randomized, multicenter, double-blind, phase 2b study assessed the safety and efficacy of TXR and CVC combination, compared with respective monotherapies. APPROACH AND RESULTS Patients (N = 193) were randomized 1:1:1:1 to once-daily TXR 140 μg (TXR 140 ), CVC 150 mg (CVC), TXR 140 μg + CVC 150 mg (TXR 140 + CVC), or TXR 90 μg + CVC 150 mg (TXR 90 + CVC) for 48 weeks. The primary and secondary end points were safety and histological improvement, respectively. Rates of adverse events (AEs) were similar across treatment groups. Pruritus was the most frequently experienced AE, with highest incidence in the TXR 140 group (40.0%). In TXR and combination groups, alanine aminotransferase (ALT) decreased from baseline to 48 weeks (geometric mean change: -21%, TXR 140 ; -16%, TXR 140 + CVC; -13%, TXR 90 + CVC; and +17%, CVC). Reductions in body weight observed at week 24 (mean changes from baseline: TXR 140 , -2.5 kg; TXR 140 + CVC, -1.7 kg; TXR 90 + CVC, -1.0 kg; and CVC, -0.1 kg) were sustained to week 48. At least 1-point improvement in fibrosis stage/steatohepatitis resolution without worsening of fibrosis was observed in 32.3%/25.8%, 31.6%/15.8%, 29.7%/13.5%, and 32.5%/22.5% of patients in the TXR 140 , CVC, TXR 140 + CVC, and TXR 90 + CVC groups, respectively. CONCLUSIONS The safety profile of TXR + CVC combination was similar to respective monotherapies, with no new signals. TXR monotherapy showed sustained ALT and body weight decreases. No substantial incremental efficacy was observed with TXR + CVC combination on ALT, body weight, or in histological end points compared with monotherapy.
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Affiliation(s)
- Quentin M. Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Kathryn J. Lucas
- Diabetes and Endocrinology Consultants, Morehead City, North Carolina, USA
| | - Sven Francque
- Department of Gastroenterology Hepatology, Antwerp University Hospital, Antwerp, Belgium
- InflaMed Centre of Excellence, Laboratory for Experimental Medicine and Paediatrics, Translational Sciences in Inflammation and Immunology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | | | - Arun J. Sanyal
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Vlad Ratziu
- Sorbonne Université, Hôpital Pitié Salpêtrière, ICAN Paris, France
| | | | - Mary Rinella
- University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA
| | | | - Rohit Loomba
- University of California at San Diego, La Jolla, California, USA
| | - Edward Mena
- California Liver Research Institute, Pasadena, California, USA
| | - Jörn M. Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Center Mainz, Germany
| | | | - Donald Lazas
- Digestive Health Research and ObjectiveHealth, Nashville, Tennessee, USA
| | - George B.B. Goh
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Yusuf Yilmaz
- Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
- Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | | | | | | | - Li Chen
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | | | | | - Clifford Brass
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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Sanyal AJ, Lopez P, Lawitz EJ, Lucas KJ, Loeffler J, Kim W, Goh GBB, Huang JF, Serra C, Andreone P, Chen YC, Hsia SH, Ratziu V, Aizenberg D, Tobita H, Sheikh AM, Vierling JM, Kim YJ, Hyogo H, Tai D, Goodman Z, Schaefer F, Carbarns IRI, Lamle S, Martic M, Naoumov NV, Brass CA. Tropifexor for nonalcoholic steatohepatitis: an adaptive, randomized, placebo-controlled phase 2a/b trial. Nat Med 2023; 29:392-400. [PMID: 36797481 PMCID: PMC9941046 DOI: 10.1038/s41591-022-02200-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 12/29/2022] [Indexed: 02/18/2023]
Abstract
The multimodal activities of farnesoid X receptor (FXR) agonists make this class an attractive option to treat nonalcoholic steatohepatitis. The safety and efficacy of tropifexor, an FXR agonist, in a randomized, multicenter, double-blind, three-part adaptive design, phase 2 study, in patients with nonalcoholic steatohepatitis were therefore assessed. In Parts A + B, 198 patients were randomized to receive tropifexor (10-90 μg) or placebo for 12 weeks. In Part C, 152 patients were randomized to receive tropifexor 140 µg, tropifexor 200 µg or placebo (1:1:1) for 48 weeks. The primary endpoints were safety and tolerability to end-of-study, and dose response on alanine aminotransferase (ALT), aspartate aminotransferase (AST) and hepatic fat fraction (HFF) at week 12. Pruritus was the most common adverse event in all groups, with a higher frequency in the 140- and 200-µg tropifexor groups. Decreases from baseline in ALT and HFF were greater with tropifexor versus placebo at week 12, with a relative decrease in least squares mean from baseline observed with all tropifexor doses for ALT (tropifexor 10-90-μg dose groups ranged from -10.7 to -16.5 U l-1 versus placebo (-7.8 U l-1) and tropifexor 140- and 200-μg groups were -18.0 U l-1 and -23.0 U l-1, respectively, versus placebo (-8.3 U l-1)) and % HFF (tropifexor 10-90-μg dose groups ranged from -7.48% to -15.04% versus placebo (-6.19%) and tropifexor 140- and 200-μg groups were -19.07% and -39.41%, respectively, versus placebo (-10.77%)). Decreases in ALT and HFF were sustained up to week 48; however, similar trends in AST with tropifexor at week 12 were not observed. As with other FXR agonists, dose-related pruritus was frequently observed. Clinicaltrials.gov registration: NCT02855164.
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Affiliation(s)
- Arun J Sanyal
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | | | - Eric J Lawitz
- Texas Liver Institute, University of Texas Health, San Antonio, TX, USA
| | - Kathryn J Lucas
- Diabetes and Endocrinology Consultants, Morehead City, NC, USA
| | | | - Won Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - George B B Goh
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | - Jee-Fu Huang
- Hepatitis Centre and Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Carla Serra
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS, Azienda Ospedaliero-Universitaria, Bologna, Italy
| | - Pietro Andreone
- University of Modena and Reggio Emilia, Modena, Italy
- Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Yi-Cheng Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | | | - Vlad Ratziu
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | | | | | - Aasim M Sheikh
- Gastrointestinal Specialists of Georgia, Marietta, GA, USA
| | - John M Vierling
- Advanced Liver Therapies, Baylor College of Medicine, Houston, TX, USA
| | - Yoon Jun Kim
- Seoul National University College of Medicine and Liver Research Institute, Seoul, Korea
| | - Hideyuki Hyogo
- JA Hiroshima General Hospital, Hiroshima, Japan
- Life Care Clinic Hiroshima, Hiroshima, Japan
| | - Dean Tai
- HistoIndex Pte. Ltd, Singapore, Singapore
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Abstract
OBJECTIVE To determine, in a preliminary study, whether women with hirsutism attributable to various causes would benefit from treatment with finasteride cream. METHODS Finasteride cream (0.25%) and placebo cream were administered to eight women with various degrees of facial hirsutism. The two creams were used on opposite sides of the face in an area of excessive hair growth. The side chosen for the finasteride cream versus placebo was randomized and blinded. In a 1 cm2 area on each side of the face, hair counts were done every 2 months throughout the 6-month study period. Hair thickness was also measured. RESULTS Hair follicles respond to testosterone by the conversion of this androgen to dihydrotestosterone through the action of 5a-reductase. Finasteride partially blocks this enzyme. Because of the easy solubility of this medication through the skin, a cream applied to the area of hair growth would be expected to decrease hirsutism locally. After a 6-month period, mean hair counts decreased significantly from 27.5 to 15.5 (P<0.05) in the finasteride-treated sites but showed no significant change from baseline in the placebo-applied sites. Moreover, the mean thickness of the measured hairs (in hundredths of millimeters) was significantly different between the placebo and finasteride-treated sites (4.33 versus 3.11, respectively; P<0.001). CONCLUSION In this study of women with facial hirsutism, topically applied finasteride significantly decreased hair growth and thickness, and no adverse effects were noted.
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Affiliation(s)
- K J Lucas
- Down East Medical Associates, Morehead City, North Carolina 28557, USA
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Abstract
One hundred twenty-one patients treated with 131I had a thyroid ultrasound to measure thyroid volume precisely. This volume measurement was used to determine the radioactive iodine dose. The average size (+/-SEM) of the thyroid glands measured in this manner was 39.7 cm3 +/- 1.9 cc. A significant correlation was found in the estimated size of the gland by the endocrinologists and the ultrasound volume. Of the 121 patients, 89 patients had the same 131I microcurie per gram of tissue factor to determine the radioactive iodine dose. This group of patients was further evaluated in this study. The average 131I dose (+/-SEM) given was 13.2 mCi +/- 0.5 mCi. The average time until hypothyroidism was achieved 2.85 +/- 0.14 months. Ultrasound provides a safe and precise way to determine actual thyroid size when calculating 131I doses.
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Affiliation(s)
- K J Lucas
- The Leland Clinic, P.C., Atlanta, Georgia, USA.
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Abstract
To examine the role of kallikrein in the etiology of flushing in the carcinoid syndrome, chromogenic substrates specific for kallikrein were used to measure two isoenzymes of this substance. The plasma and glandular kallikrein levels were determined in 20 carcinoid patients and in 17 controls. Kallikrein levels were not significantly different between these two groups. Twelve carcinoid patients and six controls were given alcohol and the kallikrein activity was measured before and at 2, 5, and 10 minutes after alcohol ingestion; kallikrein activity did not change significantly. Kallikrein was absent from the primary tumors of seven patients with carcinoids. These studies, therefore, indicate that kallikrein with subsequent induction of bradykinin formation is not solely responsible for the flushing in the carcinoid syndrome.
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Feldman JM, Blinder RA, Lucas KJ, Coleman RE. Iodine-131 metaiodobenzylguanidine scintigraphy of carcinoid tumors. J Nucl Med 1986; 27:1691-6. [PMID: 3772504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Iodine-131 metaiodobenzylguanidine ([131I]MIBG) is concentrated in pheochromocytomas and can be detected by external imaging. We administered [131I]MIBG to 23 patients with carcinoid tumors to determine if it would be useful in scanning patients with these tumors. The carcinoid tumors of 14 of the 23 patients (61%) were visualized. Iodine-131 MIBG was concentrated most avidly by tumors of midgut origin (ileum, cecum); it was concentrated less avidly by some tumors of foregut origin (pancreas, stomach); it was not significantly concentrated by other tumors of foregut origin (bronchus). We conclude that 131I is a useful imaging agent for carcinoid tumors.
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Lucas KJ, Karounos DG, Ellis GJ, Morris MA, Pisetsky DS, Feinglos MN. The intravenous insulin tolerance test in type I diabetes. Res Commun Chem Pathol Pharmacol 1986; 53:331-45. [PMID: 3534980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The intravenous insulin tolerance test (ITT) allows general assessment of insulin sensitivity by determining the fall in plasma glucose after injection of 0.1 unit/kg regular insulin. To evaluate the usefulness of this test diagnostically in distinguishing Type I from Type II diabetes, 24 patients with Type I diabetes (defined as early age of onset, ideal body weight or less at onset, and insulin dependence) underwent ITTs. Seven patients had normal glucose disposal rates (Ki greater than or equal to 2.5. Nine patients had Ki less than 2.5 but greater than 1.0. Eight patients had Ki less than 1.0. The slopes did not correlate with the control of the diabetes (as assessed by measurement of glycosylated hemoglobin), the presence or titer of anti-insulin antibodies, the duration of the diabetes, the age of onset, the presence of complications, or the current insulin dose. These results indicate that varying amounts of insulin resistance may be present in Type I diabetes and cannot necessarily be explained by poor control or the presence of insulin antibodies.
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Lyles KW, Burkes EJ, Ellis GJ, Lucas KJ, Dolan EA, Drezner MK. Genetic transmission of tumoral calcinosis: autosomal dominant with variable clinical expressivity. J Clin Endocrinol Metab 1985; 60:1093-6. [PMID: 3998061 DOI: 10.1210/jcem-60-6-1093] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Tumoral calcinosis is a rare inherited metabolic disorder characterized by hyperphosphatemia, elevated serum 1,25-dihydroxyvitamin D levels and periarticular cystic and solid calcifications. Based on previous investigations, the inheritance of this disorder has been postulated to be autosomal recessive. This interpretation was based on finding clinically affected subjects in only single generations of kindreds. We investigated four generations of an affected kindred and found nine subjects with the disease. A unique dental lesion which is specific for this disorder and serves as a phenotypic marker was identified in two generations of the kindred. In all affected subjects, elevated serum 1,25-dihydroxyvitamin D levels were found, although each member did not have the classical clinical findings of tumoral calcinosis. The possibility that this disorder may be variably expressed and have multiple formes frustes has not been previously considered. Using the unique dental lesion as well as the classical clinical and biochemical abnormalities, we found that in this kindred, tumoral calcinosis is transmitted in an autosomal dominant mode, with variable clinical expressivity.
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