Setmelanotide (RM-493), Melanocortin-4 Receptor (MC4R) Agonist, in Bardet-Biedl Syndrome (BBS) and Alström Syndrome (AS) Patients With Moderate to Severe Obesity

Inclusion Criteria:

1. BBS clinical diagnosis as per Beales, 1999 (with either 4 primary features or 3
primary and 2 secondary features) Or AS diagnosis as per Marshall, 2007 (using major
and minor age adjusted criteria).

2. Greater than or equal to ≥6 years of age.

3. Obese, defined as BMI ≥30 kg/m2 for patients ≥16 years of age or weight >97th
percentile for age and sex on growth chart assessment for patients 6 to 15 years of
age.

4. Study participant and/or parent or guardian is able to communicate well with the
Investigator, to understand and comply with the requirements of the study, and is able
to understand and sign the written informed consent/assent.

5. Female participants of child-bearing potential must be confirmed non-pregnant and
agree to use contraception as outlined in the protocol. Female participants of
non-childbearing potential, defined as: surgically sterile (status post hysterectomy,
bilateral oophorectomy, or bilateral tubal ligation), post-menopausal for at least 12
months (and confirmed with a screening follicle stimulating hormone (FSH) level in the
post-menopausal lab range), or failure to have progressed to Tanner Stage V and/or
failure to have achieved menarche, do not require contraception during the study.

6. Male participants with female partners of childbearing potential must agree to use a
double barrier method contraception if they become sexually active during the study or
within 90 days following their participation in the study. Male patients must also not
donate sperm during and for 90 days following their participation in the study.

Exclusion Criteria:

1. Recent intensive (within 2 months) diet and/or exercise regimen with or without the
use of weight loss agents (including herbal medications) that has resulted in >2%
weight loss. These patients may be reconsidered approximately 1 month after cessation
of such intensive regimens.

2. Current or prior (within prior 2 months) use of any medication, including those
approved to treat obesity, that could impact the efficacy results of this study (eg,
orlistat, lorcaserin, phentermine-topiramate, naltrexone-bupropion, liraglutide).
Patients on a stable dose and regimen (for at least 2 months) of medication to treat
attention deficit hyperactivity disorder (ADHD) may be enrolled in the study as long
as they agree to remain on the same dose and regimen during the study.

3. Prior gastric bypass surgery resulting in >10% weight loss durably maintained from the
baseline pre-operative weight with no evidence of weight regain. Specifically,
patients may be considered if surgery was not successful, resulted in <10% weight loss
compared to pre-operative baseline weight, or there is clear evidence of weight regain
after an initial response to bariatric surgery. All patients with a history of
bariatric surgery must be discussed with, and receive approval from, the Sponsor prior
to enrollment.

4. Diagnosis of schizophrenia, bipolar disorder, personality disorder or other Diagnostic
and Statistical Manual of Mental Disorders fifth edition (DSM-V) disorders that the
Investigator believes will interfere significantly with study compliance.
Neurocognitive disorders affecting ability to consent will not be disqualifying as
long as an appropriate guardian able to give consent has been appointed.

5. In patients with no significant neurocognitive deficits:

- A PHQ-9 score of ≥15 and/or

- Any suicidal ideation of type 4 or 5 on the C-SSRS, any lifetime history of a
suicide attempt, or any suicidal behavior in the last month.

6. Current, clinically significant pulmonary, cardiac, or oncologic disease considered
severe enough to interfere with the study and/or confound the results. Any patient
with a potentially clinically significant disease should be reviewed with the Sponsor
to determine eligibility.

7. History of significant liver disease or liver injury, or a current liver assessment
due to abnormal liver tests (as indicated by abnormal liver function tests, alanine
transaminase [ALT], aspartate transaminase [AST], alkaline phosphatase, or serum
bilirubin >1.5x the upper limit of normal [ULN] for any of these tests) for an
etiology other than non-alcoholic fatty liver disease (NAFLD). Thus, any underlying
etiology besides NAFLD, including diagnosed non-alcoholic steatohepatitis (NASH),
other causes of hepatitis, or history of hepatic cirrhosis is exclusionary, but the
presence of NAFLD is not be exclusionary.

8. Moderate to severe renal dysfunction defined as <30 mL/min (Appendix 11.6).

9. History or close family history (parents or siblings) of skin cancer or melanoma
(excluding non-invasive basal or squamous cell lesion), or patient history of
ocular-cutaneous albinism.

10. Significant dermatologic findings relating to melanoma or pre-melanoma skin lesions
(excluding non-invasive basal or squamous cell lesion), determined as part of
comprehensive skin evaluation performed by a qualified dermatologist during screening.
Any concerning lesions identified during the screening period will be biopsied and
results must be known to be benign prior to enrollment. If the pre-treatment biopsy
results are of concern, the patient should be excluded from the study.

11. Patient is, in the opinion of the Study Investigator, not suitable to participate in
the study.

12. Participation in any clinical study with an investigational drug/device within 3
months prior to the first day of dosing.

13. Significant hypersensitivity to study drug.

14. Inability to comply with QD injection regimen.