Liraglutide (Saxenda(R)) in Adolescents With Obesity After Sleeve Gastrectomy

Sponsor

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (NIH)

Overall Status

Recruiting

CT.gov ID

NCT04883346

Collaborator

(none)

Enrollment

Location

Arm

39.4

Anticipated Duration (Months)

1.3

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Background:

Metabolic Bariatric Surgery, including a surgery called vertical sleeve gastrectomy, is the most effective weight loss treatment for severe obesity. However, many adolescents who have this surgery still have obesity 1 year later or regain weight. Researchers want to see if a drug can help.

Objective:

To learn if liraglutide can help adolescents who still have obesity 1 year or more after vertical sleeve gastrectomy lose additional weight.

Eligibility:

Healthy adolescents ages 12-20.99 years who are 1-10 years post vertical sleeve gastrectomy and have a BMI of 30 kg/m2 or >=95th percentile for age and sex.

Design:

Participants will be screened with:

Medical history

Physical exam

Questionnaires about their mood and feelings about their weight

Blood and urine tests

Nutrition counseling. They will keep a diet log.

A test where they view and respond to pictures of food

Wrist accelerometer set-up. They will wear an accelerometer (a device like a watch) on their wrist for 14 days. It will measure their physical activity.

Some screening tests will be repeated during the study.

Participants will have an oral glucose tolerance test. They will ingest a sweet liquid. Blood samples will be taken.

Participants will take liraglutide daily for 16 weeks. They will learn how to inject it under their skin.

Participants will have a body scan to measure muscle and fat.

Participants will be invited to eat as much as they want at a buffet meal at NIH. How much food they eat will be calculated. They will assess their appetite and mood before and after the meal.

Participation will last for 7 months. Participants will have 7 study visits....

Condition or Disease	Intervention/Treatment	Phase
Obesity Status Post Sleeve Gastrectomy	Drug: Liraglutide	Phase 2

Detailed Description

Study Description:

This trial is an open-label Phase II non-randomized pilot study conducted at the NIH Clinical Center to investigate the efficacy of daily subcutaneous injection of liraglutide, a glucagon-like peptide-1 (GLP1) analogue to promote reduction of body mass index (BMI) in adolescents who continue to have obesity (BMI (Bullet)30 or BMI >=95th percentile for age and sex) 1 year or more after vertical sleeve gastrectomy (SG). We hypothesize that administration of liraglutide will be associated with reduction in BMI in such adolescents.

Objectives:

Primary objective: To determine the effect size for the change in BMI of liraglutide 3.0 mg daily subcutaneously at 16 weeks in adolescents who have obesity after SG, in order to use the observed changes to determine the sample size of a subsequent randomized, controlled investigation.

Hypothesis:

The Primary Endpoint is estimation of required sample size for a later randomized controlled trial through calculation of effect size for change in body mass index (BMI) from baseline to 16 weeks of liraglutide. The hypothesis is: The data will be sufficient to calculate the effect size for change in BMI from baseline to 16 weeks for a 2-group experiment (placebo versus liraglutide).

Secondary objectives:

To study the effects of 16 weeks of liraglutide 3.0 mg subcutaneously on change in mean BMI and fat mass in adolescents who underwent vertical sleeve gastrectomy (SG) >=1y prior to study initiation but still have obesity or have a recrudescence of obesity despite surgery. To compare the effects of liraglutide on BMI and fat mass in enrolled participants who had a poor initial response to SG (<20% BMI reduction at BMI nadir) vs. those with a typical post-SG weight loss (>=20% BMI reduction at BMI nadir).

Additional Objectives:

To examine the effects of daily subcutaneous liraglutide in enrolled participants on changes in body composition, metabolic syndrome markers, energy intake, glucose tolerance, gastrointestinal (GI)

hormone concentrations, appetite, free living physical activity, mood, suicidality, weight related quality of life, self-perception of body image, and secretome.

Endpoints:

Primary Endpoint: Estimation of required sample size for a later RCT through calculation of effect size for change in body mass index (BMI) from baseline to 16 weeks of liraglutide.

Key Secondary Endpoints:

Changes in BMI and fat mass after 16 weeks of liraglutide Comparison of changes in BMI and fat mass after 16 weeks of liraglutide in participants who had a poor initial response to SG (<20% BMI reduction at BMI nadir) vs. those with a typical post-S weight loss (>=20% BMI reduction at BMI nadir) Tolerability and safety of liraglutide 3.0 mg.

Additional (exploratory) Endpoints: Change from baseline to 16 weeks of liraglutide in:

Proportion reducing BMI by at least 5% and 10%
BMI standard deviation score for age and sex (BMIz)
Body weight
Percentage total body fat mass by DXA
Appetite score using visual analog scale (VAS)
Attention bias to highly palatable images
Energy intake at buffet meal
Free living physical activity by accelerometry
Metabolic syndrome markers (waist circumference, systolic and diastolic blood pressure, lipids, fasting plasma glucose level)
Fasting plasma insulin and HOMA-IR index
2-hour oral glucose tolerance test (OGTT) insulin and glucose measurements
Hemoglobin A1C
Plasma GI hormones (GLP-1 and PYY) during OGTT
Weight related quality of life (QoL) score
Beck Depression Inventory total score
Body-Esteem Scale Score for Adolescents and Adults
Columbia Suicide Severity Rating Scale
Secretome analysis
Stool microbiome analysis

Study Design

Study Type:

Interventional

Anticipated Enrollment :

50 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Phase II Trial of Liraglutide (Saxenda(R), Novo Nordisk) in Adolescents With Obesity After Sleeve Gastrectomy: A Pilot Open-Label Study

Actual Study Start Date :

Jun 21, 2021

Anticipated Primary Completion Date :

Jul 1, 2023

Anticipated Study Completion Date :

Oct 1, 2024

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Liraglutide Treated with Liraglutide	Drug: Liraglutide Liraglutide by subcutaneous injection administered daily. Dose will be initiated at 0.6mg per day and increased to a maximum of 3.0 mg per day as tolerated.

Arm

Intervention/Treatment

Experimental: Liraglutide

Treated with Liraglutide

Drug: Liraglutide

Liraglutide by subcutaneous injection administered daily. Dose will be initiated at 0.6mg per day and increased to a maximum of 3.0 mg per day as tolerated.

Outcome Measures

Primary Outcome Measures

Change in BMI [16 weeks]
The change in BMI (kg/m2) measured from the baseline visit to the week 16 visit will be used to inform a power calculation for a subsequent trial.

Secondary Outcome Measures

Change in Fat Mass [16 weeks]
Change in fat mass (in kg) from baseline to the week 16 visit
Change in BMI [16 weeks]
The change in BMI (kg/m2) from baseline to the week 16 visit

Eligibility Criteria

Criteria

Ages Eligible for Study:

12 Years to 20 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

INCLUSION CRITERIA:

In order to be eligible to participate in this study, an individual must meet all of the following criteria:

Male or female, 12-20.999 years at screening visit
12 months or more status-post vertical sleeve gastrectomy with a maximum of 10 years after surgery
BMI 30 kg/m2 or greater than or equal to 95th percentile for age and sex
In good general health as evidenced by medical history
Ability to take subcutaneous medication and be willing to adhere to the daily subcutaneous liraglutide regimen
Ability to provide consent/assent before any trial-related activities as required per protocol
Stated availability for the duration of the study

EXCLUSION CRITERIA:

An individual who meets any of the following criteria will be excluded from participation in this study:

Current or recent (within 3 months of start of study drug initiation) use of weight loss medications such as phentermine, topiramate, lisdexamfetamine (prescribed specifically for weight loss; when prescribed for ADHD and dose is stable for last 3 months this medication will be allowed), orlistat, and naltrexone HCl/bupropion HCl, or liraglutide
Weight of more than 450 lbs. (because Dual-Energy X-ray Absorptiometry (DXA) scanning cannot be done in those exceeding this weight)
Current use of insulin or sulfonylurea or other medication affecting insulin secretion or GLP1 clearance such as a DPPIV inhibitor
Weight loss of more than 3% of body weight in the past 2 months
Current pregnancy, desire to become pregnant within study period, current lactation or, if sexually active, not willing to use adequate contraceptive measures
History of recurrent pancreatitis (greater than 2 episodes)
History of chronic kidney disease (eGFR <60)
History of gastroparesis
Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2
History of prior metabolic and bariatric surgery other than vertical sleeve gastrectomy
Current or prior use of any GLP-1 agonist medication during the 6 months before screening, including liraglutide.
Known or suspected allergy to trial medication, excipients, or related products
Treatment with another investigational drug or other experimental intervention within 3 months prior to enrollment in this trial
Individuals who have current substance abuse or a DSM 5 Axis I psychiatric disorder or DSM Axis II Mental Retardation diagnosis that in the opinion of the investigators would impede competence, compliance, or participation in the study
Suicidal ideation type 4 or 5, history of past suicide attempt, and suicidal behavior in the past month
Presence of a major medical illness not listed above