IBI362 (LY3305677), a weekly-dose GLP-1 and glucagon receptor dual agonist, in Chinese adults with overweight or obesity: A randomised, placebo-controlled, multiple ascending dose phase 1b study

Linong Ji, Hongwei Jiang, Pei An, Huan Deng, Meng Liu, Li Li, Liqi Feng, Baili Song, Han Han-Zhang, Qingyang Ma, Lei Qian, Linong Ji, Hongwei Jiang, Pei An, Huan Deng, Meng Liu, Li Li, Liqi Feng, Baili Song, Han Han-Zhang, Qingyang Ma, Lei Qian

Abstract

Background: IBI362 (LY3305677) is a novel weekly-dose glucagon-like peptide-1 and glucagon receptor dual agonist being developed for the treatment of obesity and type 2 diabetes. The aim of this randomised, placebo-controlled, multiple ascending dose phase 1b study was to evaluate the safety, tolerability, pharmacokinetics and efficacy of IBI362 in Chinese adults with overweight or obesity.

Methods: This study enrolled adults with overweight (body mass index [BMI]≥24 kg/m2) accompanied by hyperphagia and/or at least one comorbidity or obesity (BMI≥28 kg/m2) from six study centres in China. Eligible participants were randomised 2:1 to receive once-weekly subcutaneous injection of IBI362 or placebo in each of the three ascending dose cohorts for 12 weeks with additional 8 weeks of safety follow-up. The dose-escalation regimens were: 3.0 mg cohort (1.0 mg weeks 1-4; 2.0 mg weeks 5-8; 3.0 mg weeks 9-12); 4.5 mg cohort (1.5 mg weeks 1-4; 3.0 mg weeks 5-8; 4.5 mg weeks 9-12); 6.0 mg cohort (2.0 mg weeks 1-4; 4.0 mg weeks 5-8; 6.0 mg weeks 9-12). The participants, investigators and study site personnel involved in treating and assessing participants within each cohort were masked to treatment allocation. The primary endpoints were safety and tolerability of IBI362. This study is registered with ClinicalTrials.gov, number NCT04440345.

Findings: Between June 15th, 2020 and January 15th, 2021, 12 participants were enrolled and randomised in each cohort. Throughout the study, no participant discontinued the treatment due to safety reason and no serious adverse event was reported. Gastrointestinal adverse events and decreased appetite were the most common adverse events and mostly mild in severity. Three participants receiving IBI362 reported mild and asymptomatic cardiac disorders revealed by electrocardiogram. Estimated percent changes in mean body weight from baseline to week 12 were -4.81% (95%CI -6.61 to -3.02), -6.40% (-8.23 to -4.58) and -6.05% (-7.91 to -4.18) for participants receiving IBI362 in the 3.0 mg, 4.5 mg and 6.0 mg cohort, respectively, compared with 0.60% (-0.86 to 2.07) for those receiving placebo.

Interpretation: IBI362 was well tolerated and showed a body weight-lowering effect in Chinese adults with overweight or obesity.

Funding: Innovent Biologics.

Conflict of interest statement

LJ and HJ report personal fees from Innovent Biologics, during the conduct of the study. LQ, HD, ML, PA, LL, LF, BS, HH-Z and QM are employees of Innovent Biologics.

© 2021 The Authors.

Figures

Fig. 1
Fig. 1
Trial profile.
Fig. 2
Fig. 2
Changes in body weight and waist circumference. A. Percent changes in body weight from baseline to week 12. B. Changes in waist circumference from baseline to week 12. C. Percent changes in body weight from baseline to week 12 for each participant. CFB = change from baseline. CI = confidence interval. LS = least squares.
Fig. 3
Fig. 3
Post-hoc analysis of changes in uric acid levels from baseline to week 12. Data are LS mean (95% CI) or mean (SD). P values are for treatment difference versus placebo (unadjusted for multiple comparisons). LS mean estimates were calculated from a MMRM model with corresponding baseline measures, visit, treatment and treatment by visit as fixed effects and unstructured covariance. Each dot represents CFB of one participant. CFB = change from baseline. Diff = difference. LS = least squares. CI = confidence interval. MMRM = mixed effect model for repeated measures. SD = standard deviation.

References

    1. Jaacks L.M., Vandevijvere S., Pan A. The obesity transition: stages of the global epidemic. Lancet Diabetes Endocrinol. 2019;7(3):231–240.
    1. Obesity and overweight. (accessed April 2nd 2021).
    1. Zhang X., Zhang M., Zhao Z. Geographic variation in prevalence of adult obesity in China: results from the 2013-2014 National chronic disease and risk factor surveillance. Ann Intern Med. 2020;172(4):291–293.
    1. Bray G.A., Fruhbeck G., Ryan D.H., Wilding J.P. Management of obesity. Lancet. 2016;387(10031):1947–1956.
    1. Pilitsi E., Farr O.M., Polyzos S.A. Pharmacotherapy of obesity: available medications and drugs under investigation. Metabolism. 2019;92:170–192.
    1. Baggio L.L., Drucker D.J. Glucagon-like peptide-1 receptor co-agonists for treating metabolic disease. Mol Metab. 2020
    1. Alexiadou K., Tan T.M. Gastrointestinal peptides as therapeutic targets to mitigate obesity and metabolic syndrome. Curr Diab Rep. 2020;20(7):26.
    1. Finan B., Clemmensen C., Muller T.D. Emerging opportunities for the treatment of metabolic diseases: glucagon-like peptide-1 based multi-agonists. Mol Cell Endocrinol. 2015;418(Pt 1):42–54.
    1. Knerr P.J., Finan B., Gelfanov V., Perez-Tilve D., Tschop M.H., DiMarchi R.D. Optimization of peptide-based polyagonists for treatment of diabetes and obesity. Bioorg Med Chem. 2018;26(10):2873–2881.
    1. Pocai A. Action and therapeutic potential of oxyntomodulin. Mol Metab. 2014;3(3):241–251.
    1. Scott R., Minnion J., Tan T., Bloom S.R. Oxyntomodulin analogue increases energy expenditure via the glucagon receptor. Peptides. 2018;104:70–77.
    1. Lai-San Tham M.K.T., Benson C., Bray R., Tang C.C., Loghin C. American Diabetes Association 81st Scientific Sessions; 2021. A first-in-human single ascending dose study of oxyntomodulin analog LY3305677 in healthy subjects. Diabetes; 2021.
    1. Chen Am Y., COSKUN T.A.M.E.R., SONG M.I.N., ROELL W.C., BOKVIST K.B., MOYERS J.S., THOMAS M.K., VALENZUELA F., QU H. American Diabetes Association 81st Scientific Sessions; 2021: Diabetes. 2021. Novel dual glucagon and glucagon-like peptide-1 receptor agonist LY3305677 improves glucose control, reduces body weight, and increases energy expenditure in mice.
    1. Mukharji A., Drucker D.J., Charron M.J., Swoap S.J. Oxyntomodulin increases intrinsic heart rate through the glucagon receptor. Physiol Rep. 2013;1(5):e00112.
    1. Ambery P.D., Klammt S., Posch M.G. MEDI0382, a GLP-1/glucagon receptor dual agonist, meets safety and tolerability endpoints in a single-dose, healthy-subject, randomized, Phase 1 study. Br J Clin Pharmacol. 2018;84(10):2325–2335.
    1. Muller T.D., Finan B., Bloom S.R. Glucagon-like peptide 1 (GLP-1) Mol Metab. 2019;30:72–130.
    1. Tillner J., Posch M.G., Wagner F. A novel dual glucagon-like peptide and glucagon receptor agonist SAR425899: results of randomized, placebo-controlled first-in-human and first-in-patient trials. Diabetes Obes Metab. 2019;21(1):120–128.
    1. Blevins T., Pullman J., Malloy J. DURATION-5: exenatide once weekly resulted in greater improvements in glycemic control compared with exenatide twice daily in patients with type 2 diabetes. J Clin Endocrinol Metab. 2011;96(5):1301–1310.
    1. Wysham C., Blevins T., Arakaki R. Efficacy and safety of dulaglutide added onto pioglitazone and metformin versus exenatide in type 2 diabetes in a randomized controlled trial (AWARD-1) Diabetes Care. 2014;37(8):2159–2167.
    1. Salem V., Izzi-Engbeaya C., Coello C. Glucagon increases energy expenditure independently of brown adipose tissue activation in humans. Diabetes Obes Metab. 2016;18(1):72–81.
    1. Tan T.M., Field B.C., McCullough K.A. Coadministration of glucagon-like peptide-1 during glucagon infusion in humans results in increased energy expenditure and amelioration of hyperglycemia. Diabetes. 2013;62(4):1131–1138.
    1. Wilding J.P.H., Batterham R.L., Calanna S. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021
    1. Frias J.P., Davies M.J., Rosenstock J. Tirzepatide versus semaglutide once weekly in patients with Type 2 diabetes. N Engl J Med. 2021
    1. Asano M., Sekikawa A., Kim H. Pharmacokinetics, safety, tolerability, and efficacy of cotadutide, a GLP-1 and glucagon receptor dual agonist, in phase 1/2 trials in overweight or obese participants of Asian descent with or without T2D. Diabetes Obes Metab. 2021
    1. Alba M., Yee J., Frustaci M.E., Samtani M.N., Fleck P. Efficacy and safety of glucagon-like peptide-1/glucagon receptor co-agonist JNJ-64565111 in individuals with obesity without type 2 diabetes mellitus: a randomized dose-ranging study. Clin Obes. 2021;11(2):e12432.
    1. Al-Massadi O., Ferno J., Dieguez C., Nogueiras R., Quinones M. Glucagon Control on Food Intake and Energy Balance. Int J Mol Sci. 2019;20(16)
    1. Boland M.L., Laker R.C., Mather K. Resolution of NASH and hepatic fibrosis by the GLP-1R/GcgR dual-agonist Cotadutide via modulating mitochondrial function and lipogenesis. Nat Metab. 2020;2(5):413–431.
    1. Chu N.F., Wang D.J., Liou S.H., Shieh S.M. Relationship between hyperuricemia and other cardiovascular disease risk factors among adult males in Taiwan. Eur J Epidemiol. 2000;16(1):13–17.
    1. Qaseem A., Harris R.P., Forciea M.A. Clinical guidelines committee of the American college of P. management of acute and recurrent gout: a clinical practice guideline from the American college of physicians. Ann Intern Med. 2017;166(1):58–68.
    1. Wang H., Wang L., Xie R. Association of serum uric acid with body mass index: a cross-sectional study from Jiangsu Province, China. Iran J Public Health. 2014;43(11):1503–1509.
    1. Tonneijck L., Muskiet M.H.A., Smits M.M. Effect of immediate and prolonged GLP-1 receptor agonist administration on uric acid and kidney clearance: post-hoc analyses of four clinical trials. Diabetes Obes Metab. 2018;20(5):1235–1245.

Source: PubMed

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