CONTEMPO: A Trial to Learn How Safe AZD9550 is in People With Type 2 Diabetes Who Are Overweight or Obese

Sponsor

AstraZeneca (Industry)

Overall Status

Recruiting

CT.gov ID

NCT06151964

Collaborator

(none)

Enrollment

Locations

Arms

15.5

Anticipated Duration (Months)

17.6

Patients Per Site

1.1

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

AZD9550 is in early development for the treatment of non-alcoholic-steatohepatitis, a type of liver disease that commonly affects overweight and obese patients who have T2DM.

The purpose of this study is to investigate the safety, tolerability, and effects of increasing doses of AZD9550 in overweight and obese participants aged 18 through 65 years living with T2DM, and to investigate how AZD9550 is absorbed, distributed, and eliminated from the body.

Condition or Disease	Intervention/Treatment	Phase
Non-alcoholic Steatohepatitis (NASH)	Drug: AZD9550 Drug: Placebo	Phase 1/Phase 2

Detailed Description

This Phase I/II, randomised, single-blind, placebo-controlled, multiple-ascending-dose (MAD) study will assess the safety and tolerability of AZD9550 and characterise the pharmacokinetics (PK) and pharmacodynamics (PD) of AZD9550 following subcutaneous (SC) administration to overweight and obese participants living with type 2 diabetes mellitus (T2DM), including men and women of non-childbearing potential. Inclusion of participants receiving placebo is appropriate for benchmarking the safety and tolerability of AZD9550. A randomised and single-blind study design has been chosen to minimise bias and includes placebo to facilitate identification of effects related to administration of study intervention rather than the study procedures or situation.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

88 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Intervention Model Description:

The study will randomise approximately 90 participants and will be conducted in 4 parts (A to D). Part D will be conducted exclusively in Japan. Part A: Approximately 45 participants will be screened to achieve 16 randomised to study intervention: Cohort 1 (n = 8) and Cohort 2 (n = 8). The study duration will be approximately 100 days. Part B: Approximately 90 participants will be screened to achieve 30 randomised to study intervention. The study duration will be approximately 107 days. Part C: Approximately 90 participants will be screened to achieve 30 randomised to study intervention: Cohort 1 (n = 12) and Cohort 2 (n = 18). The study duration will be approximately 240 days. Part D: Approximately 35 participants will be screened to achieve 12 randomised to study intervention. The study duration will be approximately 240 days.The study will randomise approximately 90 participants and will be conducted in 4 parts (A to D). Part D will be conducted exclusively in Japan. Part A: Approximately 45 participants will be screened to achieve 16 randomised to study intervention: Cohort 1 (n = 8) and Cohort 2 (n = 8). The study duration will be approximately 100 days. Part B: Approximately 90 participants will be screened to achieve 30 randomised to study intervention. The study duration will be approximately 107 days. Part C: Approximately 90 participants will be screened to achieve 30 randomised to study intervention: Cohort 1 (n = 12) and Cohort 2 (n = 18). The study duration will be approximately 240 days. Part D: Approximately 35 participants will be screened to achieve 12 randomised to study intervention. The study duration will be approximately 240 days.

Masking:

Triple (Participant, Care Provider, Investigator)

Masking Description:

This study is single-blind with regard to treatment (AZD9550 or placebo). This means that the participant, Investigator, Study Monitor, and the clinical unit staff will remain blinded during each part of the study and the randomisation code will only be available at each predefined decision point before the SRC meeting in order to review the data unblinded, if necessary. The sponsor will be unblinded throughout the study. AZD9550 and placebo will as far as possible be matched for formulation, appearance, and volume. Participants randomised to placebo will receive the same volume of injection (SC cohorts) as participants on active treatment.

Primary Purpose:

Treatment

Official Title:

A Phase I/II, Randomised, Single-blind, Placebo-controlled, Multiple-ascending-dose Study to Evaluate the Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of AZD9550 in Overweight and Obese Participants With Type 2 Diabetes Mellitus

Actual Study Start Date :

Sep 29, 2023

Anticipated Primary Completion Date :

Jan 13, 2025

Anticipated Study Completion Date :

Jan 13, 2025

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Part A: AZD9550 Multiple repeat doses of AZD9550 given as 4 once weekly SC doses for 4 weeks to 2 sequential cohorts in overweight/obese participants with T2DM, evaluating 2 low dose levels of AZD9550	Drug: AZD9550 Part A: A constant dose Part B: Doses of AZD9550 that increase each week Part C: Doses of AZD9550 that increase every 2 weeks, then every 4 weeks Part D: Doses of AZD9550 that increase every 2 weeks, then every 4 weeks
Experimental: Part B: AZD9550 Once weekly up-titration over 5 doses of AZD9550 in overweight/obese participants with T2DM	Drug: AZD9550 Part A: A constant dose Part B: Doses of AZD9550 that increase each week Part C: Doses of AZD9550 that increase every 2 weeks, then every 4 weeks Part D: Doses of AZD9550 that increase every 2 weeks, then every 4 weeks
Experimental: Part C: AZD9550 Bi-weekly/monthly up-titration of AZD9550 for 24 weeks in overweight/obese participants with T2DM.	Drug: AZD9550 Part A: A constant dose Part B: Doses of AZD9550 that increase each week Part C: Doses of AZD9550 that increase every 2 weeks, then every 4 weeks Part D: Doses of AZD9550 that increase every 2 weeks, then every 4 weeks
Experimental: Part D: AZD9550 Bi-weekly/monthly up-titration of AZD9550 for 24 weeks in overweight/obese with T2DM Japanese participants (Part D).	Drug: AZD9550 Part A: A constant dose Part B: Doses of AZD9550 that increase each week Part C: Doses of AZD9550 that increase every 2 weeks, then every 4 weeks Part D: Doses of AZD9550 that increase every 2 weeks, then every 4 weeks
Experimental: Part A: placebo Multiple repeat doses of placebo given as 4 once weekly SC doses for 4 weeks to 2 sequential cohorts in overweight/obese participants with T2DM, evaluating 2 low dose levels of AZD9550	Drug: Placebo Matching administration volumes for SC injection
Experimental: Part B: placebo Once weekly up-titration over 5 doses of placebo in overweight/obese participants with T2DM	Drug: Placebo Matching administration volumes for SC injection
Experimental: Part C: placebo Bi-weekly/monthly up-titration of placebo for 24 weeks in overweight/obese participants with T2DM.	Drug: Placebo Matching administration volumes for SC injection
Experimental: Part D: placebo Bi-weekly/monthly up-titration of placebo for 24 weeks in overweight/obese with T2DM Japanese participants (Part D).	Drug: Placebo Matching administration volumes for SC injection

Outcome Measures

Primary Outcome Measures

Number and percentage of participants with any AE, SAEs, AEs leading to discontinuation of study intervention, AEs with outcome of death, and AEs leading to withdrawal from study. [Day - 35 to Day 205]
Number and percentage of participants with clinically significant changes from baseline in Vital Sign Parameters. [Day - 35 to Day 205]
Number and percentage of participants with clinically significant changes in ECG parameters. [Day - 35 to Day 205]
Number and percentage of participants with clinically significant changes from baseline in Clinical Laboratory Parameters [Day - 35 to Day 205]
Area Under Concentration-Time Curve of AZD9550 following repeat weekly SC doses [Day 1 to Day 65]
AUC from 0 to the time of the last measured concentration (AUClast) at first dose and last dose AUC over a dosing interval (AUCtau) at first dose and last dose
Maximum observed concentration of AZD9550 following repeat weekly SC doses [Day 1 to Day 65]
• Cmax at first dose and last dose
Half life of AZD9550 following repeat weekly SC doses [Day 1 to Day 65]
• t1/2 at first dose and last dose
Terminal phase elimination rate constant of AZD9550 following repeat weekly SC doses [Day 1 to Day 65]
• λz at first dose and last dose
Time to maximum observed concentration of AZD9550 following repeat weekly SC doses [Day 1 to Day 65]
• tmax at first dose and last dose
Apparent oral clearance of AZD9550 following repeat weekly SC doses [Day 1 to Day 65]
• CL/F at first dose and last dose
Apparent volume of distribution of AZD9550 following repeat weekly SC doses [Day 1 to Day 65]
• Vz/F at first dose and last dose
Drug accumulation ratio for AUC of AZD9550 following repeat weekly SC doses [Day 1 to Day 65]
• Rac AUC at last dose
Drug accumulation ratio for Cmax of AZD9550 following repeat weekly SC doses [Day 1 to Day 65]
• Rac Cmax at last dose

Secondary Outcome Measures

PD effect of AZD9550 on fasting glucose compared to placebo [From baseline to Week 4]
• Absolute change in fasting glucose
PD effect of AZD9550 on fasting lipid profile compared to placebo [From baseline to Week 4]
• Absolute and percentage change in fasting lipid profile, high-density lipoprotein, low-density lipoprotein, triglycerides, and beta-hydroxybutyrate
Absolute and percentage change in body weight from baseline [From baseline to Week 4]
Incidence of anti-AZD9550 antibodies [From Day 1 to Day 65]
• Incidence of ADA to AZD9550
Absolute change in percentage body fat from baseline [From baseline to Week 4]
PD effect of AZD9550 on fasting glucose compared to placebo [From baseline to Week 5]
• Absolute change in fasting glucose
PD effect of AZD9550 on fasting lipid profile compared to placebo [From baseline to Week 5]
• Absolute and percentage change in fasting lipid profile, high-density lipoprotein, low-density lipoprotein, triglyceride, and beta-hydroxybutyrate
Effect of AZD9550 on hepatic fat fraction versus placebo at Week 5 [From baseline to Week 5]
Change in hepatic fat fraction as measured by MRI-PDFF Percent change in fasting hepatic fat fraction as measured by MRI-PDFF
PD effect of AZD9550 on glucose metabolism following a MMTT compared to placebo [From baseline to Week 5]
Percent change in glucose AUC(0-4h) measured by MMTT Percent change in insulin AUC(0-4h) measured by MMTT Percent change in c-peptide AUC(0-4h) measured by MMTT
Area Under concentration-time Curve of AZD9550 following repeat weekly SC doses [Day 1 to Day 72]
AUC from 0 to the time of the last measured concentration (AUClast) at the last dose AUC over a dosing interval (AUCtau) at first dose and last dose
Incidence of anti-AZD9550 antibodies [Day 1 to Day 72]
• Incidence of ADA to AZD9550
PD effect of AZD9550 on fasting glucose compared to placebo [From baseline to Week 24]
• Absolute change in fasting glucose
PD effect of AZD9550 on fasting lipid profile compared to placebo [From baseline to Week 24]
• Absolute and percentage change in fasting lipid profile, high-density lipoprotein, low-density lipoprotein, triglycerides, and beta-hydroxybutyrate
The effect of AZD9550 on hepatic fat fraction versus placebo after 13 and 24 weeks of treatment [From baseline to Weeks 13 and 24]
Change in hepatic fat fraction as measured by MRI-PDFF Percent change in hepatic fat fraction as measured by MRI-PDFF
Effects of AZD9550 compared to placebo on body weight [From baseline to Week 24]
Change in body weight Percent change in body weight
Change in daily (24 hours) average glucose levels as measured by CGM [From baseline to Day 176]
Change in fasting hepatic glycogen concentration adjusted for liver volume as measured by MRS [From baseline to Weeks 13 and 24]
Area Under concentration-time Curve of AZD9550 following repeat weekly SC doses [Day 1 to Day 169]
AUC from 0 to the time of the last measured concentration (AUClast) at the first doses of each dose level and the last dose of MTD AUC over a dosing interval (AUCtau) at the first doses of each dose level and the last dose of MTD
Incidence of anti-AZD9550 antibodies [Day 1 to Day 205]
• Incidence of ADA to AZD9550
Effect of AZD9550 on beta-hydroxybutyrate levels in blood versus placebo [From baseline to Week 24]
• Absolute change in beta-hydroxybutyrate levels in blood
Change in daily (24 hours) average glucose levels as measured by CGM [From baseline to Weeks 1, 2, 3, 4, 5, and 6]
Change in 7-day average glucose levels as measured by CGM [From baseline to Weeks 1, 2, 3, 4, 5, and 6]
Change in coefficient of variation of glucose levels as measured by CGM over 7 days [From baseline to Weeks 1, 2, 3, 4, 5, and 6]
Change in percentage time spent in hyperglycaemia (> 140 mg/dL), normoglycaemia (70 -140 mg/dL), and clinically significant hypoglycaemia (< 54 mg/dL) as measured by CGM over 24 hours [From baseline to Weeks 1, 2, 3, 4, 5, and 6]
Change in percentage time spent in hyperglycaemia (> 140 mg/dL), normoglycaemia (70 -140 mg/dL), and clinically significant hypoglycaemia (< 54 mg/dL) as measured by CGM over 7 days [From baseline to Weeks 1, 2, 3, 4, 5, and 6]
Change in fasting hepatic glycogen concentration adjusted for liver volume as measured by MRS [From baseline to Week 5]
Percentage change in fasting hepatic glycogen concentration adjusted for liver volume as measured by MRS [From baseline to Week 5]
Change in fasting hepatic glycogen concentration unadjusted for liver volume as measured by MRS [From baseline to Week 5]
Percentage change in fasting hepatic glycogen concentration unadjusted for liver volume as measured by MRS [From baseline to Week 5]
Change in liver volume as measured by MRI [From baseline to Week 5]
Absolute change in body weight [From baseline to Week 5]
Percent change in body weight [From baseline to Week 5]
Proportion of participants achieving ≥ 5% body weight loss [From baseline to Week 5]
Proportion of participants achieving ≥ 10% body weight loss [From baseline to Week 5]
Change in 7-day average glucose levels as measured by CGM [From baseline to Day 176]
Change in coefficient of variation of glucose levels as measured by CGM over 7 days [From baseline to Day 176]
Change in percentage time spent in hyperglycaemia (> 140 mg/dL), normoglycaemia (70 -140 mg/dL), and clinically significant hypoglycaemia (< 54 mg/dL) as measured by CGM over 24 hours [From baseline to Day 176]
Change in percentage time spent in hyperglycaemia (> 140 mg/dL), normoglycaemia (70 -140 mg/dL), and clinically significant hypoglycaemia (< 54 mg/dL) as measured by CGM over 7 days [From baseline to Day 176]
Percentage change in fasting hepatic glycogen concentration adjusted for liver volume as measured by MRS [From baseline to Weeks 13 and 24]
Change in fasting hepatic glycogen concentration unadjusted for liver volume as measured by MRS [From baseline to Weeks 13 and 24]
Percentage change in fasting hepatic glycogen concentration unadjusted for liver volume as measured by MRS [From baseline to Weeks 13 and 24]
Change in liver volume, visceral and SC fat as measured by MRI [From baseline to Weeks 13 and 24]
Anti-AZD9550 antibody titre among participants with positive serum antibodies to AZD9550 [From Day 1 to 65]
• Titre of ADA to AZD9550
Maximum observed concentration of AZD9550 following repeat weekly SC doses [Day to Day 72]
• Cmax at the last dose
Half life of AZD9550 following repeat weekly SC doses [Day 1 to Day 72]
• t1/2 at the last dose
Terminal phase elimination rate constant of AZD9550 following repeat weekly SC doses [Day 1 to Day 72]
• λz at the last dose
Time to maximum observed concentration of AZD9550 following repeat weekly SC doses [Day 1 to Day 72]
• tmax at the last dose
Apparent oral clearance of AZD9550 following repeat weekly SC doses [Day 1 to day 72]
• CL/F at the last dose
Apparent volume of distribution of AZD9550 following repeat weekly SC doses [Day 1 to Day 72]
• Vz/F at the last dose
Anti-AZD9550 antibody titre among participants with positive serum antibodies to AZD9550 [Day 1 to Day 72]
• Titre of ADA to AZD9550
Maximum observed concentration of AZD9550 following repeat weekly SC doses [Day 1 to Day 169]
• Cmax at the first doses of each dose level and the last dose of MTD
Half life of AZD9550 following repeat weekly SC doses [Day 1 to Day 169]
• t1/2 at the first doses of each dose level and the last dose of MTD
Terminal phase elimination rate constant of AZD9550 following repeat weekly SC doses [Day 1 to Day 169]
• λz at the first doses of each dose level and the last dose of MTD
Time to maximum observed concentration of AZD9550 following repeat weekly SC doses [Day 1 to Day 169]
• tmax at the first doses of each dose level and the last dose of MTD
Apparent oral clearance of AZD9550 following repeat weekly SC doses [Day 1 to Day 169]
• CL/F at the first doses of each dose level and the last dose of MTD
Apparent volume of distribution of AZD9550 following repeat weekly SC doses [Day 1 to day 169]
• Vz/F at the first doses of each dose level and the last dose of MTD
Anti-AZD9550 antibody titre among participants with positive serum antibodies to AZD9550 [Day 1 to Day 205]
• Titre of ADA to AZD9550
Change in visceral and subcutaneous fat as measured by MRI [From baseline to week 5]
The effect of AZD9550 on energy related and gluconeogenic metabolites versus placebo [From baseline to Week 24]
• Percent change in beta-hydroxybutyrate, lactate, and amino acid levels in blood
PD effect of AZD9550 on glucose metabolism compared to placebo [From baseline to Week 4]
• Percent change in fasting glucose, fasting insulin, and fasting c-peptide
PD effect of AZD9550 on glucose metabolism compared to placebo [From baseline to Week 5]
• Percent change in fasting glucose, fasting insulin, and fasting c-peptide
PD effect of AZD9550 on glucose metabolism compared to placebo [From baseline to Week 24]
• Percent change in fasting glucose, fasting insulin, and fasting c-peptide
PD effect of AZD9550 on fasting insulin compared to placebo [From baseline to Week 4]
• Absolute change in fasting insulin
PD effect of AZD9550 on fasting c-peptide compared to placebo [From baseline to Week 4]
• Absolute change in fasting c-peptide
PD effect of AZD9550 on fasting insulin compared to placebo [From baseline to Week 24]
• Absolute change in fasting insulin
PD effect of AZD9550 on fasting c-peptide compared to placebo [From baseline to Week 24]
• Absolute change in fasting c-peptide
PD effect of AZD9550 on fasting insulin compared to placebo [From baseline to Week 5]
• Absolute change in fasting insulin
PD effect of AZD9550 on fasting c-peptide compared to placebo [From baseline to Week 5]
• Absolute change in fasting c-peptide
Effect of AZD9550 on lactate levels in blood compared to placebo [From baseline to Week 24]
• Absolute change in lactate levels in blood
Effect of AZD9550 on amino acid levels in blood versus placebo [From baseline to Week 24]
• Absolute change in amino acid levels in blood

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 65 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Males or females of non-childbearing potential age 18 through 65 years at the time of screening.
Parts A, B, C only: Participants with a diagnosis of T2DM and glucose control managed with diabetes diet and in addition to metformin treatment no more than one treatment option (with a stable dose 3 months prior to screening). Part D only: Participants who are diagnosed with T2DM, have inadequate glycaemic control with diet and exercise. Participants who are prescribed an oral anti-diabetic agent such as metformin, a DPP IV inhibitor, sulphonylurea, glinides, alphaglucosidase inhibitors, and an SGLT2 inhibitor may be eligible to enter the study following a washout of 4-weeks or 5-half lives (whichever is longer) washout period.
Participants with a screening HbA1c value within the target range of ≥48 to

≤69 mmol/mol (6.5% to 8.5%).

Body mass index from ≥27 (≥25 in Part D) to ≤39.9 kg/m2 (inclusive).
Contraceptive use by males or females should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.
Written informed consent and any locally required authorization (eg, European Union Data Privacy Directive) obtained from the participant prior to performing any protocol-related procedures, including screening evaluations
Ability to complete and meet all eligibility requirements for randomisation within 60 days after signing the ICF.
Venous access suitable for multiple cannulations.
Willing and able to self-administer weekly SC injections (Parts C and D only).

Exclusion Criteria:

Participants with T2DM treated with insulin.
Participants with T2DM treated with more than 2 anti-diabetic therapies.
Participants with T2DM treated with a GLP-1RA within 3 months of screening.
History of any clinically important disease or disorder which, in the opinion of the investigator, may either put the participant at risk because of participation in the study, or influence the results or the participant's ability to participate in the study.
Serum calcitonin suggestive of thyroid C-cell hyperplasia (calcitonin level > 50 ng/L), medullary thyroid carcinoma, or history or family history of multiple endocrine neoplasia at screening.
History or presence of GI, renal, or hepatic disease (with the exception of Gilbert's syndrome), or any other condition known to interfere with absorption, distribution, metabolism, or excretion of drugs, as judged by the investigator.
History of cancer within the last 10 years, with the exception of non-melanoma skin cancer.
Any clinically important illness (apart from T2DM), as judged by the investigator.
Any medical/surgical procedure, or trauma within 4 weeks prior to screening, at the discretion of the investigator.
Symptoms of insulinopenia or poor blood glucose control (eg, significant thirst, nocturia, polyuria, polydipsia, or weight loss).
Positive hepatitis B or hepatitis C virus serology at screening.
Positive human immunodeficiency virus test at screening or participant taking antiretroviral medications as determined by medical history or participant's verbal report.
At screening blood tests, any of the following:

AST ≥ 1.5 × ULN
ALT ≥ 1.5 × ULN
TBL ≥ 1.5 × ULN (with the exception of Gilbert's syndrome)
Haemoglobin below the lower limit of the normal range or any other clinically significant haematological abnormality as judged by the investigator.

Impaired renal function defined as estimated glomerular filtration rate (eGFR)

≤ 60 mL/minute/1.73m2 as defined by Chronic Kidney Disease Epidemiology Collaboration (2021).

Any clinically important abnormalities in clinical chemistry, haematology, coagulation, or urinalysis results other than those specifically described as exclusion criteria herein, as judged by the investigator.
Significant late diabetic complications (macroangiopathy with symptoms of congestive heart disease or peripheral arterial disease, microangiopathy with symptoms of neuropathy, gastroparesis, retinopathy requiring treatment, nephropathy) detected in laboratory results or in clinical history/documentation as judged by the investigator.
Abnormal vital signs, after 10 minutes of supine rest, defined as any of the following:

Systolic BP < 90 mmHg or ≥ 150 mmHg
Diastolic BP < 50 mmHg or ≥ 90 mmHg
HR < 50 or > 85 bpm at resting state
Participants may be re-tested for the vital signs criteria only once if, in the investigator's judgment, they are not representative of the participant.

Any clinically important abnormalities in rhythm, conduction, or morphology of the resting ECG and any abnormalities in the 12-lead ECG that, as considered by the investigator, may interfere with the interpretation of QTc interval changes, including abnormal ST-T-wave morphology or left ventricular hypertrophy.
Participants with implantable cardiac defibrillator or a permanent pacemaker, and participants with symptomatic tachy- or brady-arrhythmias.
Participants with unstable angina pectoris or stable angina pectoris classified higher than Canadian Cardiovascular Society class II or an acute coronary syndrome/acute myocardial infarction or coronary intervention with percutaneous coronary intervention or coronary artery bypass grafting or stroke within 6 months.
History of hospitalisation caused by heart failure or a diagnosis of heart failure.
Known or suspected history of drug abuse within the past 3 years as judged by the investigator and /or a positive screen for drugs of abuse at screening or admission to the study unit.
History of severe allergy/hypersensitivity or ongoing clinically important allergy/hypersensitivity as judged by the investigator.
Whole blood or red blood cell donation, or any blood loss > 500 mL (or > 400 mL in Part D) during the 3 months prior to screening.
Psychiatric illness such that participants have been committed to an institution by way of official or judicial order.
History of lactic acidosis or ketoacidosis.
Use of any of the following medicinal products:

Use of systemic corticosteroids within 28 days prior to screening.
Use of compounds known to prolong the QTc interval.
Use of any herbal preparations or medicinal products licensed for control of body weight or appetite within 3 months prior to screening.

Use of drugs with enzyme inducing properties such as St John's Wort within 3 weeks prior to the first administration of study intervention.
Received another new chemical entity (defined as a compound that has not been approved for marketing), or has participated in any other clinical study that included drug treatment within at least 30 days or 5 half-lives prior to the first administration of study intervention in this study (whichever is longer). The period of exclusion to begin 30 days or 5 halflives of IMP after the final dose, or after the last visit, whichever is longest. Participants consented and screened, but not randomised into this study or a previous Phase 1 study, are not excluded.
Previous enrolment or randomisation in the present study.
Concurrent participation in another study of any kind is prohibited.
Ongoing weight loss diet (hypocaloric diet) or use of weight loss agents, unless the diet or treatment has been stopped at least 3 months prior to screening and the participant has had a stable body weight (± 5%) during the 3 months prior to screening.
Participants who are vegans, ones with medical dietary restrictions, or participants who are willingly conducting any diet likely to increase ketone levels (Atkins or any similar diet based on increased protein consummation or low carbohydrate content).
Excessive intake of caffeine-containing drinks or food (eg, coffee, tea, Coca-Cola/Pepsi or similar drink type, chocolate) as judged by the investigator.
Current smokers or those who have smoked or used nicotine products (including e-cigarettes) within the previous 3 months prior to screening.
Participants who cannot communicate reliably with the investigator or vulnerable participants (eg, kept in detention, protected adults under guardianship, trusteeship, or committed to an institution by governmental or juridical order).
The participant is an employee, or close relative of an employee, of AstraZeneca, the CRO, or the study site, regardless of the employee's role.
Judgment by the investigator that the participant should not participate in the study if the participant is unlikely to comply with study procedures, restrictions, and requirements.
Contra-indication to MRI: such as participants with pacemakers, metallic cardiac valves, magnetic material such as surgical clips, implanted electronic infusion pumps or other conditions that would preclude proximity to a strong magnetic field; participants with history of extreme claustrophobia or participant cannot fit inside the MRI scanner cavity (Parts B and C only).

Contacts and Locations

Locations

	Site	City	Country	Postal Code
1	Research Site	Graz	Austria	8036
2	Research Site	Vienna	Austria	1090
3	Research Site	Magdeburg	Germany	39120
4	Research Site	Neuss	Germany	41460
5	Research Site	Uppsala	Sweden	752 37