Enhancing Weight Loss Maintenance With GLP-1RA (BYDUREON™) in Adolescents With Severe Obesity
| Status: | Recruiting |
|---|---|
| Conditions: | Obesity Weight Loss |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 12 - 17 |
| Updated: | 3/27/2019 |
| Start Date: | December 2015 |
| End Date: | January 2025 |
Long-term weight loss maintenance is seldom achieved by individuals with obesity owing to
numerous biological adaptations involving appetite, satiety, and energy expenditure in the
post- weight loss setting. Following a loss in body weight, peripheral and central mechanisms
convey a sense that energy reserves have dwindled, activating a strong counter response to
increase caloric intake. Adolescents with severe obesity are not immune to the vexing issue
of weight regain. Indeed, only 2% are able to achieve and maintain clinically-meaningful
weight loss with lifestyle modification therapy. Therefore, novel treatment paradigms focused
on long-term weight loss maintenance are urgently needed. Pharmacotherapy has the potential
to prevent weight regain by targeting specific counter-regulatory mechanisms in the post-
weight loss setting. One of the most promising candidates is the glucagon like peptide-1
receptor agonist (GLP-1RA) class, which greatly enhanced weight loss maintenance following a
short-term low calorie diet among adults with obesity. The rationale for focusing on GLP-1RA
treatment (BYDUREON™) to prevent weight regain is supported by the multiple central and
peripheral mechanisms of action targeted by this class of drug; many of which specifically
address the biological adaptations known to induce relapse. The investigators have strong
preliminary data demonstrating that GLP-1RA treatment reduces BMI in adolescents with severe
obesity. Moreover, the investigators and others have shown that although meal replacement
therapy (structured meals of known caloric content) can elicit robust short-term weight loss
among adolescents with severe obesity, weight regain is a pervasive problem. Therefore, in
this clinical trial, our innovative approach will utilize GLP-1RA treatment to target weight
regain following short-term meal replacement therapy in youth with severe obesity.
Participants who achieve ≥5% BMI reduction during the meal replacement phase will be
randomized to GLP-1RA treatment or placebo for an additional 52 weeks while simultaneously
engaging in lifestyle modification therapy. Importantly, this study will also allow us to
examine the extent to which GLP-1RA treatment addresses mechanisms of weight regain,
investigate other pleiotropic benefits of GLP-1RA, and identify predictors of weight loss
response.
numerous biological adaptations involving appetite, satiety, and energy expenditure in the
post- weight loss setting. Following a loss in body weight, peripheral and central mechanisms
convey a sense that energy reserves have dwindled, activating a strong counter response to
increase caloric intake. Adolescents with severe obesity are not immune to the vexing issue
of weight regain. Indeed, only 2% are able to achieve and maintain clinically-meaningful
weight loss with lifestyle modification therapy. Therefore, novel treatment paradigms focused
on long-term weight loss maintenance are urgently needed. Pharmacotherapy has the potential
to prevent weight regain by targeting specific counter-regulatory mechanisms in the post-
weight loss setting. One of the most promising candidates is the glucagon like peptide-1
receptor agonist (GLP-1RA) class, which greatly enhanced weight loss maintenance following a
short-term low calorie diet among adults with obesity. The rationale for focusing on GLP-1RA
treatment (BYDUREON™) to prevent weight regain is supported by the multiple central and
peripheral mechanisms of action targeted by this class of drug; many of which specifically
address the biological adaptations known to induce relapse. The investigators have strong
preliminary data demonstrating that GLP-1RA treatment reduces BMI in adolescents with severe
obesity. Moreover, the investigators and others have shown that although meal replacement
therapy (structured meals of known caloric content) can elicit robust short-term weight loss
among adolescents with severe obesity, weight regain is a pervasive problem. Therefore, in
this clinical trial, our innovative approach will utilize GLP-1RA treatment to target weight
regain following short-term meal replacement therapy in youth with severe obesity.
Participants who achieve ≥5% BMI reduction during the meal replacement phase will be
randomized to GLP-1RA treatment or placebo for an additional 52 weeks while simultaneously
engaging in lifestyle modification therapy. Importantly, this study will also allow us to
examine the extent to which GLP-1RA treatment addresses mechanisms of weight regain,
investigate other pleiotropic benefits of GLP-1RA, and identify predictors of weight loss
response.
Primary Objective Evaluate the effect of GLP-1RA treatment on the maintenance of weight loss
and durability of cardiometabolic risk factor improvements among adolescents with severe
obesity following a meal replacement induction period. The investigators hypothesize that
adolescents with severe obesity receiving GLP-1RA treatment following a short-term meal
replacement induction period will demonstrate superior maintenance of initial BMI reduction
52 weeks following randomization compared to those assigned to placebo (primary endpoint) and
that a higher proportion of those assigned to GLP-1RA treatment vs. placebo will maintain ≥5%
BMI reduction from baseline to the 52-week time point (secondary endpoint). Moreover, GLP-1RA
treatment will result in superior maintenance of initial reductions of body fat (total,
visceral, and subcutaneous), blood pressure, triglycerides/HDL ratio, inflammation, oxidative
stress, postprandial glucose-insulin response, insulin resistance, β cell dysfunction, and
arterial stiffness at 52 weeks.
Secondary Objectives Investigate the mechanisms by which GLP-1RA treatment facilitates weight
loss maintenance and identify predictors of response to treatment. The investigators
hypothesize that compared to placebo, GLP-1RA treatment following a period of meal
replacement will reduce appetite (and related hormones) and gastric emptying rate, and will
increase satiety (and related hormones) and resting energy expenditure at 26- and 52 weeks
following randomization. Moreover, based on our preliminary work, the investigator
hypothesize that appetite (and appetite-related hormones) following the meal replacement
period and female gender will be associated with superior weight loss maintenance with
GLP-1RA treatment.
and durability of cardiometabolic risk factor improvements among adolescents with severe
obesity following a meal replacement induction period. The investigators hypothesize that
adolescents with severe obesity receiving GLP-1RA treatment following a short-term meal
replacement induction period will demonstrate superior maintenance of initial BMI reduction
52 weeks following randomization compared to those assigned to placebo (primary endpoint) and
that a higher proportion of those assigned to GLP-1RA treatment vs. placebo will maintain ≥5%
BMI reduction from baseline to the 52-week time point (secondary endpoint). Moreover, GLP-1RA
treatment will result in superior maintenance of initial reductions of body fat (total,
visceral, and subcutaneous), blood pressure, triglycerides/HDL ratio, inflammation, oxidative
stress, postprandial glucose-insulin response, insulin resistance, β cell dysfunction, and
arterial stiffness at 52 weeks.
Secondary Objectives Investigate the mechanisms by which GLP-1RA treatment facilitates weight
loss maintenance and identify predictors of response to treatment. The investigators
hypothesize that compared to placebo, GLP-1RA treatment following a period of meal
replacement will reduce appetite (and related hormones) and gastric emptying rate, and will
increase satiety (and related hormones) and resting energy expenditure at 26- and 52 weeks
following randomization. Moreover, based on our preliminary work, the investigator
hypothesize that appetite (and appetite-related hormones) following the meal replacement
period and female gender will be associated with superior weight loss maintenance with
GLP-1RA treatment.
Inclusion Criteria:
- BMI ≥1.2 times the 95th percentile (based on sex and age) or BMI ≥35 kg/m2
- 12-17 years old
Exclusion Criteria:
- Type 1 or 2 diabetes mellitus
- Previous (within 6 months) or current use of medication(s) prescribed primarily for
weight loss (refer to appendix material for comprehensive list)
- If currently using weight altering drug(s) for non-obesity indication(s) (refer to
appendix material for comprehensive list), any change in drug(s) or dose within the
previous 6 months
- Previous bariatric surgery
- If currently using anti-hypertensive medication(s), lipid medication(s), and/or
medication(s) to treat insulin resistance (refer to appendix material for
comprehensive list), any change in drug(s) or dose within the previous 6 months
- If currently using CPAP/BIPAP (for sleep apnea), change in frequency of use or
settings within the previous 6 months
- History of treatment with growth hormone
- Neurodevelopmental disorder severe enough to impair ability to comply with study
protocol
- Clinical diagnosis of bipolar illness, schizophrenia, conduct disorder, and/or
substance use/abuse
- Females: currently pregnant, planning to become pregnant, or unwilling to use 2 or
more acceptable methods of contraception when engaging in sexual activity throughout
the study
- Tobacco use
- Liver/renal dysfunction
- ALT or AST >2 times the upper limit of normal
- Bicarbonate <18 mmol/L
- Creatinine >1.2 mg/dL
- History of pancreatitis
- Personal- and/or family history of medullary thyroid carcinoma
- Personal- and/or family history of multiple endocrine neoplasia type 2
- Calcitonin level >50 ng/L
- Bulimia nervosa
- Neurological disorder
- Hypothalamic obesity
- Obesity associated with genetic disorder (monogenetic obesity)
- Hyperthyroidism or uncontrolled hypothyroidism
- History of suicide attempt
- History of suicidal ideation or self-harm within the past year
- History of cholelithiasis
We found this trial at
1
site
Minneapolis, Minnesota 55455
(612) 625-5000
Principal Investigator: Aaron S Kelly, Ph.D.
Phone: 612-626-3813
Univ of Minnesota With a flagship campus in the heart of the Twin Cities, and...
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