Liraglutide 3mg (Saxenda) on Weight, Body Composition, Hormonal and Metabolic Parameters in Obese Women With PCOS

Study Overview
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Brief Summary
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There is a growing need to develop pharmacologic interventions to improve metabolic function in women with polycystic ovary syndrome (PCOS). Given that PCOS is a frequent condition and weight loss is essential but difficult to achieve, it is important to study if the effect on body weight reported in other studies can be confirmed in a selected population of hyperandrogenic patients, especially with medications currently approved for weight reduction. High dose liraglutide alone results in significant weight reduction in obese women without PCOS. There is limited data on weight loss with high dose liraglutide in non-diabetic females with PCOS treated with this agent . Studies on the effect of anti-obesity medication combined with lifestyle changes on body weight and composition and androgen excess in obese women diagnosed with PCOS are lacking. The investigators aim to elucidate the most efficacious weight reduction regime in obese PCOS women. The investigators further hope to determine which treatment(s) addressing the multifaceted disturbances of this disorder in patients with PCOS and obesity emerges as the preferable therapy.

Detailed Description
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The drug, liraglutide 3.0 mg was approved for chronic weight management in management in obese adults with an initial BMI of 30 kg/m2 or greater or in overweight adults BMI of 27 kg/m2 or greater with at least one weight-related co-morbid condition as an adjunct to a reduced-calorie diet and increased physical activity. Liraglutide is an acylated human glucagon-like peptide -1 (GLP-1) analog that binds to and activates the GLP-1 receptor. It lowers body weight through decreased caloric intake while stimulating insulin secretion and reducing glucagon via a glucose-dependent mechanism. For obesity management, patients may lose weight with GLP-1 receptor agonists due to other unique actions. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) can slow gastric emptying and increase satiety. While predictors of weight loss success for the general population are available (protein intake, weight loss medications), predictors of weight loss success may differ between normal and hyperandrogenic women. Glucagon-like peptide 1 agonists are linked with dose dependent weight lowering potential in different obesity related populations. The weight loss effects of GLP-1RAs previously demonstrated in diabetic and obese non-diabetic patients, offer a unique opportunity to expand the medical options available to patients with PCOS. Given this lack of information, the aim of the present study was to investigate the effects of liraglutide 3mg vs. placebo on body composition as well as hormonal and metabolic features in non-diabetic obese women with PCOS.The non-diabetic obese female with PCOS offers a unique model to study the relationship between insulin resistance and adiposity. The investigators propose a double-blind, placebo-controlled 30-week trial designed to directly examine the therapeutic effects of liraglutide 3 mg (LIRA 3 mg) compared to placebo on body weight, hormonal and cardiometabolic parameters in obese non-diabetic women with PCOS. All patients will receive diet and lifestyle counseling, including advice on exercise commencing during the lead-in period and continuing throughout the study. In this study, the investigators will examine the efficacy of LIRA 3mg on body weight and body composition, reproductive function metabolic parameters and cardiovascular risk factors in a well-defined group of pre-menopausal obese non-diabetic women with hyperandrogenism, focusing on the relationship to obesity and insulin resistance.

Official Title
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A Randomized Placebo-controlled Double Blind Trial of Liraglutide 3 mg [Saxenda] on Weight, Body Composition, Hormonal and Metabolic Parameters in Obese Women With Polycystic Ovary Syndrome (PCOS)

Conditions
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Pre Diabetes, Polycystic Ovary Syndrome, Obesity Android

Intervention / Treatment
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* Drug: Liraglutide Pen Injector [Saxenda]
* Drug: Placebo Liraglutide Pen Injector


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Female gender 18-45 years of age BMI ≥30 kg/m2 or BMI ≥27 kg/m2 with one or more obesity-associated co-morbid conditions (e.g. hypertension, and dyslipidemia) PCOS- NIH criteria hyperandrogenism and irregular menstrual cyclicity Non-diabetic as determined by a 75 gram oral glucose tolerance test (OGTT) and hemoglobin A1C. Non-diabetic is inclusive of women with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or both (IFG/IGT). Participants with diabetes will be excluded Willing to use effective contraception consistently during therapy which is defined as: an intrauterine device, tubal sterilization, or male partner vasectomy, or combination of two barrier methods with one being male condom. Written consent for participation in the study Exclusion Criteria: Presence of significant systemic disease, cerebrovascular disease, clinically significant cardiac abnormalities or heart problems including congestive heart failure, unstable angina or acute myocardial infarction, current infectious liver disease, acute stroke or transient ischemic attacks, history of pancreatitis, or diabetes mellitus (Type 1 or 2) Any hepatic diseases in the past (infectious liver disease, viral hepatitis, toxic hepatic damage, jaundice of unknown etiology) or severe hepatic insufficiency and/or significant abnormal liver function tests defined as aspartate aminotransferase (AST) >3x upper limit of normal (ULN) and/or alanine aminotransferase (ALT) >3x ULN Renal impairment (e.g., serum creatinine levels ≥1.4 mg/dL for women, or eGFR <60 mL/min/1.73 m2) or history of unstable or rapidly progressing renal disease or end stage renal disease. Uncontrolled thyroid disease (documented normal TSH), Cushing's syndrome, congenital adrenal hyperplasia or clinically significant elevations in prolactin levels. The clinical significance of prolactin levels will be determined by the treating physician Significantly elevated triglyceride levels (fasting triglyceride > 400 mg %) Untreated or poorly controlled hypertension (sitting blood pressure > 160/95 mm Hg) Use of hormonal medications, the use of medications that cause clinically significant weight gain or loss (prescription or OTC) and medications known to exacerbate glucose tolerance (such as isotretinoin, hormonal contraceptives, GnRH analogues, glucocorticoids, anabolic steroids, C-19 progestins) including herbal medicines for at least 8 weeks. Use of anti-androgens that act peripherally to reduce hirsutism such as 5-alpha reductase inhibitors (finasteride, spironolactone, flutamide) for at least 4 weeks Prior history of a malignant disease requiring chemotherapy Family or personal history of familial medullary thyroid carcinoma or multiple endocrine neoplasia type 2 Known hypersensitivity or contraindications to use GLP1 receptor agonists Use of metformin, thiazolidinediones, GLP-1 receptor agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium/glucose co-transporter 2 (SGLT2) inhibitors or weight loss medications (prescription or OTC) stopped for at least 4 weeks Prior use of medication to treat diabetes except gestational diabetes Eating disorders (anorexia, bulimia) or gastrointestinal disorders Suspected pregnancy (documented negative serum pregnancy test), desiring pregnancy in next 15 months, breastfeeding, or known pregnancy in last three months Active or prior history of substance abuse (smoke or tobacco use within past 6 months) or significant intake of alcohol Previous bariatric surgery or device intervention for obesity Patient not willing to use barrier contraception during study period (unless sterilized or have an IUD) History of major depressive or other severe psychiatric disorders Inability or refusal to comply with protocol Currently participating or having participated in an experimental drug study in previous three months

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

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
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Liraglutide Pen Injector (Saxenda)<br>Start injection liraglutide 0.6 mg subcutaneously (SC) 1week daily (QD), step up to 1.2 mg SC QD for 1week, to 1.8 mg SC QD for 1 week, 2.4 mg SC QD for 1week, to a final dose of 3.0 mg liraglutide SQ daily | Drug: Liraglutide Pen Injector [Saxenda]<br>* daily sc injection of liraglutide with final dose of 3mg daily<br>* Other names: Saxenda;|
| Placebo Comparator: Placebo liraglutide pen injector<br>Start injection of placebo liraglutide 0.6 mg subcutaneously (SC) 1week daily (QD), step up to 1.2 mg SC QD for 1week, to 1.8 mg SC QD for 1 week, 2.4 mg SC QD for 1week, to a final dose of 3.0 mg placebo liraglutide SQ daily | Drug: Placebo Liraglutide Pen Injector<br>* daily sc injection of placebo liraglutide with final dose of 3mg daily of placebo<br>* Other names: Placebo liraglutide 3 mg;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Absolute Body Weight (BW) | Treatment impact on change in body weight after 32 weeks of treatment. | 32 weeks of treatment | 
| Free Androgen Index (FAI) | Drug treatment effect on free androgen levels as calculated as FAI= total testosterone (T) concentrations divided by sex hormone binding globulin (SHBG) levels. A higher score indicates a worse outcome (more androgenic). | 32 weeks of treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body Mass Index (BMI) | Treatment effect in reducing body mass | 32 weeks of treatment | 
| Change in Percent Body Weight | Treatment effect on reducing body weight expressed as percent body weight loss from baseline | Change from baseline (time 0) to study end (32 weeks) | 
| 5% Weight Loss From Baseline | Frequency of patients achieving 5% weight loss from baseline with treatment | 32 weeks of treatment | 
| 10% Body Weight Loss From Baseline | Frequency of patients with at least 10% reduction in body weight from baseline | 32 weeks of treatment | 
| Abdominal Adiposity (Waist Circumference [WC] | Treatment effect on loss of WC (abdominal adiposity) with drug treatment | 32 weeks of treatment | 
| Waist-to-Hip Ratio | Change in central adiposity with treatment as measured by WHR. A reduction in ratio indicates a decrease in truncal fat. | 32 weeks of treatment | 
| Waist-to Height Ratio [WHtR]) | Treatment effect on loss of central adiposity as determined by WHt ratio. The lower the ratio indicates less abdominal adiposity. | 32 weeks of treatment | 
| Total Fat Mass Evaluated by DEXA | Treatment effect on reduction of fat mass (kg) | 32 weeks of treatment | 
| Total Body Fat (%) by DXA | Treatment effect on reduction of percent body fat by DXA | 32 weeks of treatment | 
| Android-Gynoid Ratio (AGR) by DXA | Treatment impact on AGR, measure of central adiposity, as determined by DXA. A lower AGR indicates a reduction in central adiposity. | 32 weeks of treatment | 
| Trunk/Leg Fat Ratio (TLR) by DXA | Treatment impact on TLR after 32 weeks. A reduction in TLR indicates a loss of central fat. | 32 weeks of treatment | 
| Menstrual Cycle Frequency | Drug treatment impact on normalization of cycle frequency (cycle every 28-30 days). All cycle data is expressed as number of menses annualized to one year. | 32 weeks of treatment | 
| Total Testosterone Concentrations (T) | Drug treatment effect on total testosterone concentrations | 32 weeks of treatment | 
| Adrenal Dehydroepiandrosterone Sulfate (DHEAS) | Treatment efficacy in reducing adrenal hyperandrogenism | 32 weeks of treatment | 
| Fasting Blood Glucose (FG) | Treatment effect on fasting glucose prior to an oral glucose tolerance test (OGTT) | 32 weeks of treatment | 
| OGTT Mean Blood Glucose (MBG) | Treatment effect on MBG measured during the oral glucose tolerance test. A decrease in MBG shows improvement in glycemia. | 32 weeks of treatment | 
| Fasting Insulin Sensitivity (HOMA-IR) | Treatment effect on the HOMA-IR which is an insulin resistance measured derived from fasting blood glucose and insulin . The higher the number the more insulin resistant. | 32 weeks of treatment | 
| Matsuda Insulin Sensitivity Index Derived From the OGTT (SI OGTT) | The SI OGTT is a measure of peripheral insulin sensitivity derived from the insulin and glucoses measured during an OGTT. A increase in SI OGTTindicates greater insulin sensitivity | 32 weeks of treatment | 
| Corrected First Phase Insulin Secretion (IGI/HOMA-IR) | Treatment effect on insulin secretion from 0 to 30 minutes after glucose load corrected for by fasting insulin sensitivity. A higher score shows improved first phase insulin secretion in response to glucose. | 32 weeks of treatment | 
| Insulin Secretion- Insulin Sensitivity Index (Oral Disposition Index-IS-SI) | Treatment effect on an estimation of Beta cell compensatory function, the IS-SI is derived by applying the concept of the disposition index to measurements obtained during the 2 hour OGTT and calculated as the index of insulin secretion factored by insulin sensitivity. A higher score shows improved pancreatic beta cell function relative to insulin sensitivity. | 32 weeks of treatment | 
| Total Cholesterol Levels | Treatment impact on improving total cholesterol levels | 32 weeks of treatment | 
| High Density Lipoprotein Cholesterol (HDL-C) | Impact of treatment on HDL levels after 32 weeks of treatment | 32 weeks of treatment | 
| Triglyceride Levels (TRG) | Drug effect of TRG levels after treatment | 32 weeks of treatment | 
| Triglyceride to HDL-Cholesterol Ratio (TRG/HDL-C) | Treatment impact on TRG/HDL-C ratio which is a simple measure to estimate insulin action. A decrease in ratio indicates improvement in insulin sensitivity. | 32 weeks of treatment | 
| Triglyceride and Glucose Index (TyG) | Treatment impact on the TyG index which estimates insulin resistance. A reduction in TyG indicates an improvement in insulin action. | 32 weeks of treatment | 
| Systolic Blood Pressure | Treatment impact on systolic blood pressure | 32 weeks of treatment | 
| Diastolic Blood Pressure (BP) | Treatment impact on reducing diastolic blood pressure | 32 weeks of treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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prediabetes, PCOS, GLP-1 agonist, weight loss