A Study of Distal Jejunal-release Dextrose in Obese Participants

Study Overview
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Brief Summary
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The primary purpose of the study is to evaluate the efficacy and safety of APHD-012 (distal jejunal-release dextrose [Aphaia technology, AT]) in obese participants.

Detailed Description
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This is a randomized, double-blind, placebo-controlled, parallel-group, phase II proof-of-concept study to be conducted in 150 adult obese male and female participants who are 18 to 70 years of age with or without one or more endocrine and/or metabolic conditions. The study aims to evaluate the efficacy and safety of distal jejunal-release dextrose (Aphaia technology, AT) in obese participants. Participants will be randomly assigned to receive either APHD-012 (distal jejunal-release dextrose or APH-012P (a matching placebo). There will be two cohorts in the study. Participants from Cohort 1 will receive study medication once daily for 12 months (360 days), and participants from Cohort 2 will receive study medication once daily for 6 months (180 days). Overall, 150 participants will be enrolled in the study: Cohort 1 (60 participants) - 6-month treatment period + 6-month maintenance treatment period Cohort 2 (90 participants) - 6-month treatment period

Official Title
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A Phase II, Randomized, Double-blind, Placebo-controlled, Parallel-group Proof-of-concept Study to Evaluate Efficacy and Safety of Distal Jejunal-release Dextrose (Aphaia Technology, AT) in Obese Subjects

Conditions
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Obese

Intervention / Treatment
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* Drug: APHD-012
* Drug: APHD-012P


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Body mass index 30.0-39.9 kg/m^2 and/or waist circumference: men >102 cm, women >88 cm Stable body weight: gain or loss in body weight ≤5 kg over last 3 months Obese participants with or without one or more of the following conditions: NAFLD - simple steatosis based on a FibroScan CAP™ test result at screening (CAP Score ≥238 decibel-milliwatts (dB/m) (Steatosis Grades 1-3) with no or mild fibrosis (F0-F1 fibrosis Score) NASH - steatohepatitis based on FibroScan fibrosis Score at screening (≥7.5 kPa and <14 kPa (Stage F2-F3) Confirmed medical history of metabolic syndrome Homeostatic Model Assessment of Insulin Resistance (HOMA IR) Score ≥2 Confirmed medical history of type 2 diabetes mellitus (T2DM) diagnosis or HbA1c ≥7.0 and <11 (based on screening values) High total cholesterol ≥240 mg/dL (based on screening values) Hypertension (participants with Stage 1 hypertension (systolic blood pressure [SBP] ≥130 mmHg <180 mmHg, diastolic blood pressure [DBP] ≥80 mmHg <110 mmHg) (based on screening values) If on medication to manage endocrine/metabolic conditions, must be on stable doses of medication ≥3 months prior to screening: Participants with T2DM may be treated with either diet and exercise alone, metformin, sulphonylurea, thiazolidinediones, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, and bromocriptine quick-release (QR) as single agents or combination therapy. As lipid-lowering medication participants may be treated with statins and fibrates, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, ezetimibe, or supplements like omega-3-fatty acids. As antihypertensive medication participants may be treated with beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin-II-inhibitors, diuretics, or calcium channel blockers. Normal GI function, or abnormalities which the clinical investigator does not consider a disqualification for participation in the study Exclusion Criteria: Incomplete Coronavirus Disease of 2019 (COVID-19) vaccination Treatment with weight loss medications in the past 3 months Proven history of bulimia or anorexia nervosa Treatment with injectable antidiabetic medications in the last 3 months (e.g. Glucagon-like peptide-1 [GLP-1] receptor agonists, insulin) Treatment with dipeptidyl peptidase-4 inhibitors in the last 3 months NASH with cirrhosis (fibrosis Score=F4 (≥14 kPa) as determined by screening FibroScan Confirmed medical history of liver cirrhosis, cholestatic disease, alcohol-related liver disease Type 1 diabetes mellitus, HbA1c ≥11, fasting plasma glucose levels ≥270 mg/dL Proliferative retinopathy or maculopathy Abnormal liver function tests: Transaminases: Alanine transaminase (ALT)/aspartate aminotransferase (AST) ≥5 x upper limit of normal (ULN) for participants with NAFLD or NASH (as determined by screening FibroScan) ALT/AST ≥2.5 x ULN for participants without NAFLD or NASH (as determined by screening FibroScan) Alkaline phosphatase (ALK) ≥2.5 x ULN Total bilirubin ≥2 x ULN Stage 4 hypertension (SBP ≥180, DBP ≥110) History or presence of any uncontrolled cardiovascular, pulmonary, hepatobiliary, renal, hematologic, gastrointestinal, endocrinologic, immunologic, dermatologic, neurological, psychiatric, metabolic, musculoskeletal, or malignant disease (except conditions accepted for inclusion) which the clinical investigator does not consider a disqualification for participation in the study

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Parallel Assignment Randomized, double-blind, placebo-controlled, parallel-group proof-of-concept efficacy and safety study
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: APHD-012<br>Participants will receive a single dose of APHD-012 12 g daily, under fasting conditions prior to main daily meals for 180 days (6 months) for Cohort 2 and for 360 days (12 months) for Cohort 1. | Drug: APHD-012<br>* Distal jejunal-release dextrose beads (Aphaia technology, AT)<br>* Other names: Distal jejunal-release dextrose beads;|
| Placebo Comparator: APHD-012P<br>Participants will receive a single dose of APHD-012P daily, under fasting conditions prior to main daily meals for 180 days (6 months) for Cohort 2 and for 360 days (12 months) for Cohort 1. | Drug: APHD-012P<br>* Distal jejunal-release placebo beads<br>* Other names: Placebo;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes from Baseline in Percent Weight Change Compared with Placebo | Bodyweight measurements will be done using standard personal balance referring to kilogram-Scale. Weighing will be done without shoes and with just underwear on. It is important that weighing is always done in the same way, preferably in the morning, before eating or drinking. | At Baseline and at each visit until Day 180 for Cohort 2 and Day 360 for Cohort 1 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Participants with ≥2.5% Baseline Body Weight Loss at 6 Months Compared with Placebo (Weight Loss Responders) | Body weight measurements will be done using standard personal balance referring to kilogram-Scale. Weighing will be done without shoes and with just underwear on. It is important that weighing is always done in the same way, preferably in the morning, before eating or drinking. | At Baseline and at each visit until Day 180 for Cohort 2 and Day 360 for Cohort 1 | 
| Percentage of Participants with ≥5% Baseline Body Weight Loss at 6 Months Compared with Placebo (Weight Loss Responders) | Body weight measurements will be done using standard personal balance referring to kilogram-Scale. Weighing will be done without shoes and with just underwear on. It is important that weighing is always done in the same way, preferably in the morning, before eating or drinking. | At Baseline and at each visit until Day 180 for Cohort 2 and Day 360 for Cohort 1 | 
| The Difference in Mean Absolute Weight Loss Compared with Placebo at 6 Months | Body weight measurements will be done using standard personal balance referring to kilogram-Scale. Weighing will be done without shoes and with just underwear on. It is important that weighing is always done in the same way, preferably in the morning, before eating or drinking. | At Baseline and at each visit until Day 180 for Cohort 2 and Day 360 for Cohort 1 | 
| Mean Absolute Change and Percent Change of Waist Circumference | Waist circumference measurements will be done using a standard measuring tape referring to centimeter Scale. | At Baseline and at each visit until Day 180 for Cohort 2 and Day 360 for Cohort 1 | 
| Mean Absolute Change and Percent Change of Systolic Blood Pressure and Diastolic Blood Pressure | Systolic blood pressure (SBP) and diastolic blood pressure (DBP) will be measured using a standard sphygmomanometer with the Riva-Rocci cuff and a stethoscope; alternatively, an automatic device with upper arm cuff can be used. Measurements are done in sitting position after 5 minutes of rest. | At Baseline and at each visit until Day 180 for Cohort 2 and Day 360 for Cohort 1 | 
| Mean Absolute Change and Percent Change of Heart Rate | Heart rate measurement will be obtained along with the blood pressure measurement. | At Baseline and at each visit until Day 180 for Cohort 2 and Day 360 for Cohort 1 | 
| Mean Absolute Change and Percent Change of Triglycerides and Cholesterol | Triglycerides and cholesterol (including total cholesterol, low-density lipoprotein [LDL], and high-density lipoprotein [HDL]) will be measured using standard clinical laboratory methods at the site laboratories. | At Baseline and at each visit until Day 180 for Cohort 2 and Day 360 for Cohort 1 | 
| Mean Absolute Change and Percent Change of Homeostatic Model Assessment of Insulin Resistance | Homeostasis model assessment-estimated insulin resistance (HOMA-IR) will be determined with standard clinical laboratory methods. | At Baseline and at each visit until Day 180 for Cohort 2 and Day 360 for Cohort 1 | 
| Mean Absolute Change and Percent Change of Fasting Plasma Glucose, Fasting Plasma Insulin and Glycated Hemoglobin | Fasting plasma glucose will be determined using a standard blood glucometer. Fasting plasma insulin will be determined with standard clinical laboratory methods. Glycated hemoglobin (HbA1c) will be measured using a standard enzyme-linked immunoassay (ELISA) method. HbA1c will be measured in participants with type two diabetes (T2DM). | At Baseline and at each visit until Day 180 for Cohort 2 and Day 360 for Cohort 1 | 
| Mean Absolute Change and Percent Change of Alanine Transaminase, Aspartate Transaminase and Gamma Glutamyl Transpeptidase | Liver enzymes (ALT, AST, GGT) will be measured using standard clinical laboratory methods. | At Baseline and at Day 90, at Day 180 for Cohort 2 and at Day 360 for Cohort 1 | 
| Mean Absolute Change and Percent Change of Fatty Liver Controlled Attenuation Parameter Score and Liver Fibrosis Score | Fatty liver Controlled Attenuation Parameter (CAP) Score will be measured in: Participants with Non-alcoholic fatty liver disease (NAFLD): Steatosis grade and; Participants with Non-alcoholic steatohepatitis (NASH): fibrosis Score category Fatty liver CAP Score and liver fibrosis Score will be measured using FibroScan™ equipment or equivalent. | At Baseline and at Day 90, at Day 180 for Cohort 2 and at Day 360 for Cohort 1 | 
| Number of Participants Reported with At least One Treatment Emergent Adverse Event (TEAE) | A treatment-emergent adverse event is defined as any event not present prior to the initiation of the drug treatment or any event already present that worsens in either intensity or frequency following exposure to the drug treatment | At each visit until Day 180 for Cohort 2 and until Day 360 for Cohort 1 | 
| Advance Understanding of Dose/Exposure - Response Relationships | Dose/Exposure - Response Relationships will be evaluated. | At Baseline, at Day 90, Day 180 and at Day 360 for Cohort 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Obese, Dextrose, Hypertension, NASH, 034B20, Distal jejunal-release dextrose, Endocrine disorders, Metabolic conditions, NAFLD