Phase 2 Study to Evaluate Safety and Efficacy of RM-493 in Obese Participants

A Phase 2, Randomized, Double-blind, Placebo-controlled Study to Evaluate the Safety and Efficacy of RM-493, a Melanocortin 4 Receptor (MC4R) Agonist in Obese Patients

The purpose of this study is to evaluate the effects of RM-493 on mean percent body weight loss, and other weight loss parameters as well as Pharmacokinetic (PK) profile, and ambulatory blood pressure in obese participants. The study is designed to evaluate the efficacy and tolerability of a single dose of RM-493. The study drug (RM-493 and placebo) will be administered subcutaneously in a blinded fashion.

Study Overview

• Status: Completed
• Conditions: Overweight
• Intervention / Treatment: Drug: Setmelanotide; Drug: Placebo

• Study Type: Interventional
• Enrollment (Actual): 74
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Florida
    • Miami, Florida, United States
  • Kentucky
    • Lexington, Kentucky, United States
  • New York
    • Rochester, New York, United States
  • North Carolina
    • Raleigh, North Carolina, United States
  • Texas
    • Dallas, Texas, United States
  • Washington
    • Renton, Washington, United States

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Be between the age of 18 and 65.
2. Able to provide voluntary, written informed consent with comprehension of all aspects of the protocol, prior to any study procedures.
3. In good general health, without significant medical history, physical examination findings, or clinical laboratory abnormalities.
4. Body Mass Index: 35-50 Kg/m^2, inclusive. It is planned that approximately 20 (but no more than 50% of the total participants enrolled) of these participants will have a BMI ≥ 40 Kg/m^2
5. Stable body weight (+/- 5 Kg) during previous 6 months.
6. Blood pressure (<150/95 mmHg); may include stable dose (≥ 30 days of use) of up to two anti-hypertensive medications to achieve control that are intended to remain on a stable dose during the protocol.
7. Willingness and demonstrates ability to self-administer study medication subcutaneously via an infusion pump during the placebo practice period.
8. Willing to maintain a healthy diet and exercise regime throughout study as recommended by counseling at study start.
9. Females of childbearing potential must agree to be abstinent or else use any two of the following medically acceptable forms of contraception from the Screening Period through the completion of study treatment: hormonal, condom with spermicidal jelly, diaphragm or cervical cap with spermicidal jelly, or intrauterine device (IUD). Hormonal contraception must have started at least 3 months prior to screening. A female whose male partner has had a vasectomy must agree to use one additional form of medically acceptable contraception. Participants must agree to practice the above birth control methods for 30 days after completion of study treatment as a safety precaution.
10. Females of non-childbearing potential, defined as surgically sterile (status post hysterectomy, bilateral oophorectomy, or bilateral tubal ligation) or post-menopausal for at least 12 months (and confirmed with a screening follicle stimulating hormone (FSH) level in the post-menopausal range), do not require contraception during the study.
11. Males with female partners of childbearing potential must agree to use two medically acceptable forms of contraception as described above, with one of the two forms being condom with spermicide, from the Screening Period through 90 days after completion of study treatment. Males with female partners of childbearing potential who themselves are surgically sterile (status post vasectomy) must agree to use condoms with spermicide over the same period of time.

Exclusion Criteria:

1. Fasting blood glucose > than 140 mg/dL.
2. Haemoglobin A1c (HbA1c) ≥6.5%.
3. Thyroid stimulating hormone (TSH) level outside the normal range.
4. Creatinine > 1.5 times the upper limit of normal.
5. Liver function tests > 2 times the upper limit of normal.
6. Active or history of any significant medical condition including renal, hepatic, pulmonary, gastrointestinal, cardiovascular, genitourinary, endocrine, immunologic, metabolic, neurologic or hematological disease.

7. Participants with a history of the following:

   1. Uncontrolled hypertension;
   2. Diabetes requiring medical treatment, presently or in the past;
   3. Major depressive disorder within the last 2 years;
   4. Any lifetime history of a suicide attempt;
   5. Any suicidal behavior in the last month;
   6. Other severe psychiatric disorders (e.g. schizophrenia, bipolar disorder, severe eating disorders including bulimia).
8. A patient health questionnaire - 9 (PHQ-9) score of ≥15.
9. Any suicidal ideation of type 4 or 5 on the columbia suicide severity rating scale (C-SSRS).
10. Prior bariatric surgery.
11. Treated with anorectic agents or drugs with anorexia as a frequent side event.
12. Taking 3 or more anti-hypertensive medications.
13. Acute illness or history of illness, which in the opinion of the Investigator, could pose a threat or harm to the participant or obscure interpretation of laboratory test results or interpretation of study data.
14. History of human immunodeficiency virus (HIV) infection.
15. History of significant drug hypersensitivity or anaphylaxis.
16. History of hypersensitivity to proteins (e.g., allergy shots).
17. Any clinically significant abnormalities on screening laboratories as determined by the Investigator.
18. Abnormal 12-lead electrocardiogram (ECG) at screening or pre-dose (Day 1), except minor deviations deemed to be of no clinical significance by the Investigator. QTc must be < 450 ms.
19. Received any experimental drugs or devices or have participated in a clinical study within 30 days prior to dosing.
20. Hospitalization for surgery within the 3 months prior to screening except for minor outpatient procedures, or any planned hospitalizations during the study period.
21. Poor venous access or inability to tolerate venipuncture.
22. Inability to attend all study visits or comply with protocol requirements including fasting and restrictions on concomitant medication intake.
23. Participation in weight loss programs during the study period, including nutritional supplements/ replacements other than as recommended by nutritional counseling provided at study start.

24. Use of prescription medications on a regular basis with the following exceptions:

    1. Contraceptives (must be on for ≥3 months);
    2. Hormone replacement therapy (must be on stable dose for ≥3 months);
    3. Antihypertensives (<3 medications on a stable dose for ≥ 30 days);
    4. Statins (dose must be ≤ half the maximum dose; must be on a stable dose ≥3 months);
    5. Fibrates (must be on stable dose for ≥3 months);
    6. Niacin (must be on stable dose for ≥3 months);
    7. Thyroxin (stable dose for ≥ 30 days);
    8. The last use of any other prescription medication must have been greater than 5 half-lives for the specific medication or at least 14 days prior to randomization, whichever is longer.
25. Women who are pregnant or are breast feeding.
26. Previously randomized and dosed in this study or previously exposed to RM-493.
27. History of alcohol or drug abuse within 5 years of Screening Visit.
28. Any other reason, which in the opinion of the Investigator would confound proper evaluation of the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Setmelanotide; Participants received 1 milligram (mg) setmelanotide every day by continuous subcutaneous infusion using the Omnipod insulin pump for a duration of 90 days.	Drug: Setmelanotide; Daily subcutaneous infusion; Other Names: RM-493
Placebo Comparator: Placebo; Participants received placebo matching setmelanotide every day by continuous subcutaneous infusion using the Omnipod insulin pump for a duration of 90 days.	Drug: Placebo; Daily subcutaneous infusion

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent Change From Baseline in Body Weight	The mean percent change from baseline in body weight at Day 90 was analyzed.	Baseline and Day 90

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in Body Weight	The mean change from baseline in body weight at day 90 was analyzed.	Baseline and Day 90
Percentage of Participants Who Lost ≥ 5% of Their Baseline Body Weight	The percentage of participants who lost ≥ 5% of their baseline body weight was analyzed. 95% confidence interval is calculated based on Clopper-Pearson.	Baseline up to Day 90
Number of Participants Who Consistently Achieved Targeted Plasma Concentration of ~6 Nanogram Per Milliliter (ng/mL)	Number of Participants Who Consistently Achieved Targeted Plasma Concentration of ~6 ng/mL were reported.	Day 1: pre-dose and 2-hours post-infusion, Day 7, 14, 28, 56, and 90
Percentage of Participants With Treatment Emergent Adverse Events	An adverse event (AE) was any untoward medical occurrence associated with the use of a drug in humans, whether or not considered drug related. An adverse event (also referred to as an adverse experience) could be any unfavorable and unintended sign (e.g., an abnormal laboratory finding), symptom, or disease temporally associated with the use of a drug, without any judgment about causality. A treatment-emergent AE was defined as an AE with an onset date on or after day 1.	From first dose of study drug (Day 1) until end of study (Up to 184 days)
Change From Baseline in Ambulatory Blood Pressure Monitoring Parameter (ABPM) - Systolic Blood Pressure	Summary of individual average data at daytime, nighttime and 24 hours was reported.	Baseline and Day 28
Change From Baseline in ABPM - Diastolic Blood Pressure	Summary of individual average data at daytime, nighttime and 24 hours was reported.	Baseline and Day 28
Change From Baseline in ABPM - Mean Arterial Blood Pressure	Summary of individual average data at daytime, nighttime and 24 hours was reported.	Baseline and Day 28
Change From Baseline in ABPM - Heart Rate	Summary of individual average data at daytime, nighttime and 24 hours was reported.	Baseline and Day 28
Change From Baseline in ABPM - Pulse Pressure	Summary of individual average data at daytime, nighttime and 24 hours was reported.	Baseline and Day 28
Percent Change From Baseline in Body Weight in Severely Obese Participants	The mean percent change from baseline in body weight in severely obese participants at Day 90 was analyzed.	Baseline and Day 90
Percentage of Participants Who Lost ≥ 5% of Their Baseline Body Weight in Severely Obese Participants	The percentage of participants who lost ≥ 5% of their baseline body weight loss in severely obese participants was analyzed. 95% confidence interval is calculated based on Clopper-Pearson confidence interval.	Baseline up to Day 90

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Effect of RM-493 on waist circumference	Measurement of change in waist circumference from Baseline to Day 90.	Baseline to Day 90
Effect of RM-493 on body composition as measured by Dual Energy X-Ray Absorptiometry.	Measurement of change in body composition as assessed by Dual Energy X-Ray Absorptiometry (DXA) from Baseline to Day 90.	Baseline to Day 90
Effect of RM-493 on hunger and satiety	Measurement of change in hunger and satiety as assessed using the Hunger and Satiety Visual Analog Scale (VAS) from Baseline to Day 90.	Baseline to Day 90
Effect of RM-493 on quality of life	Measurement of the effect of RM-493 on the quality of life as assessed using the Impact of Weight on Quality of Life - Lite questionnaire (IWQOL-Lite) from Baseline to Day 90.	Baseline to Day 90
Effect of RM-493 on depression/suicidality	Measurement of the change in the depression/suicidality score as assessed by Patient Health Questionnaire 9 (PHQ-9) and the Columbia Suicidality Severity Rating Scale (C-SSRS) from Baseline to Day 90.	Baseline to Day 90

Collaborators and Investigators

• Sponsor: Rhythm Pharmaceuticals, Inc.
• Investigators: Study Chair: David Meeker, MD, Rhythm Pharmaceuticals, Inc.

Study record dates

Study Major Dates

• Study Start (Actual): January 14, 2013
• Primary Completion (Actual): September 28, 2013
• Study Completion (Actual): September 28, 2013

Study Registration Dates

• First Submitted: December 11, 2012
• First Submitted That Met QC Criteria: December 11, 2012
• First Posted (Estimated): December 13, 2012

Study Record Updates

• Last Update Posted (Actual): August 14, 2023
• Last Update Submitted That Met QC Criteria: July 19, 2023
• Last Verified: July 1, 2023

More Information

Terms related to this study

• Keywords: Overweight
• Additional Relevant MeSH Terms: Overnutrition; Nutrition Disorders; Body Weight; Overweight
• Other Study ID Numbers: RM-493-003

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No