Study Exploring the Supportive Effect of Acarbose in Weight Management

Study Overview
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Brief Summary
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This is a randomized, double-blind study in participants with overweight or obesity in which the effect of acarbose and the impact of dose on efficacy, safety and tolerability is investigated by comparing the EMP16 combination product with modified release (MR) orlistat, orlistat in its conventional dosage form and placebo.

Detailed Description
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The study will be conducted at 3 research sites in Sweden. A total of 320 randomized patients are expected to participate in the study for approximately 31 weeks, including a screening period of up to 5 weeks and a 26-weeks treatment period. EMP16 is indicated for people with obesity with an initial BMI ≥ 30 kg/m² or ≥ 27 kg/m² in the presence of other risk factors (e.g., hypertension, glucose dysregulation and T2DM, and/or dyslipidemia). Participants will be randomized to either of 5 arms: EMP16-120/40, 80 participants MR orlistat 120 mg, 80 participants Conventional orlistat 120 mg, 80 participants EMP16-60/20, 40 participants Placebo, 40 participants

Official Title
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A 26-week, Double-blind, Randomized Study in Participants With Overweight or Obesity Investigating the Added Contribution of Acarbose in EMP16 on Efficacy, Safety and Tolerability

Conditions
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Overweight or Obesity

Intervention / Treatment
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* Drug: EMP16-120/40
* Drug: MR orlistat 120 mg
* Drug: Conventional orlistat 120 mg,
* Drug: EMP16-60/20
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Willing and able to give written informed consent for participation in the study. Males or females (sex distribution 50:50, preferably ±5%) aged ≥18 years. BMI ≥ 30 or ≥ 27 kg/m² in the presence of other risk factors based on participant interview e.g., hypertension (either or not treated with antihypertensive agents), glucose dysregulation (defined as elevated fasting glucose ≥6.1 mmol/L or HbA1c >42mmol/mol), Type 2 Ddabetes that is treated with lifestyle changes (no medication allowed), and/or dyslipidemia (either or not treated with antihyperlipidemic agents). If indicated, plasma/serum total cholesterol, LDL, HDL, and/or TGs can be measured to verify eligibility as judged by the Investigator. No clinically significant abnormalities regarding physical examination, vital signs, ECG, and laboratory values at the time of the screening visit, as judged by the Investigator. Adequate renal function: creatinine <1.5 times upper limit of normal (ULN). Adequate hepatic function: aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase <2.5 times upper level of normal (ULN) and bilirubin <1.5 times ULN. Exclusion Criteria: Weight unstable (≥ 5% reported change during the previous 3 months) preceding screening and randomization. Subjects who are pregnant, who are currently breastfeeding, who intend to become pregnant within the period of the study, or who gave birth within the 6 months preceding the screening visit. Type 2 diabetes treated with medication. History or presence of any clinically significant disease, disorder, or history of surgery 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 including but not limited to: GI problems/diseases, e.g., diseases that affect intestinal absorption and peristalsis such as inflammatory bowel diseases, irritable bowel syndrome (IBS) and Hirschsprung's disease Cholestasis Chronical malabsorption syndrome Severe allergic, cardiac, or hepatic disease Previous GI surgery that might influence GI function significantly, such as previous bariatric surgery, and previous gallbladder surgery as judged by the investigator. Potential participants with well-treated chronic diseases (e.g., celiac disease and lactose intolerance) may be included in the study at the discretion of the Investigator. Significant clinical illness within the preceding 2 weeks of the first administration of IMP at the discretion of the Investigator. Any significant medical/surgical procedure or trauma within 4 weeks of the first administration of IMP at the discretion of the Investigator. Any planned major surgery within the duration of the study. Any use of drugs altering glucose metabolism and drugs used for diabetes (A10A and A10B) or drugs that are affected by, or that affect, orlistat and acarbose, within 2 weeks prior to the first administration of IMP. Regular use of prescribed or non-prescribed medication within 2 weeks prior to the first administration of IMP as judged by the Investigator. Patients who are on stable treatment with anti-depressants (e.g., selective serotonin re-uptake inhibitors, SSRI) for at least 2 months can be included at the discretion of the Investigator. Untreated high blood pressure (systolic blood pressure >160 mmHg and diastolic blood pressure >100 mmHg at the screening visit). Known hypersensitivity to any of the test substances. Malignancy within the past 5 years with the exception of in situ removal of basal cell carcinoma. Excessive intake of alcohol, as judged by the Investigator. Current or history of alcohol abuse and/or use of anabolic steroids or drugs of abuse. Positive screen for drugs of abuse, or positive screen for alcohol, at the screening visit (Visit 1). Any positive result at the screening visit (Visit 1) for serum hepatitis B surface antigen, hepatitis C antibody and Human Immunodeficiency Virus (HIV). Plasma donation within 1 month of the screening visit (Visit 1) or any blood donation (or corresponding blood loss) during the 3 months prior to the screening visit. Administration of another new chemical entity (defined as a compound which has not been approved for marketing) or has participated in any other clinical study that included drug treatment within 3 months of the first administration of IMP in this study. Participants consented and screened but not dosed in previous studies are not excluded. Investigator considers the potential participant unlikely to comply with study procedures, restrictions, and requirements.

Ages Eligible for Study
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Minimum Age: 18 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: This is a randomized, double-blind study in participants with overweight or obesity in which the effect of acarbose and the impact of dose on efficacy, safety and tolerability is investigated by comparing the EMP16 combination product with modified release (MR) orlistat, orlistat in its conventional dosage form and placebo.
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: EMP16-120/40<br>EMP16 120 mg orlistat/40 mg acarbose (referred to as EMP16-120/40), 80 participants. | Drug: EMP16-120/40<br>* EMP16 is supplied as oral MR capsules with the strength of 60 mg orlistat/20 mg acarbose. Dosage: week 1-2: 60 mg orlistat/20 mg acarbose (1 capsule per day), week 3-4: 60 mg orlistat/20 mg acarbose (1 capsule TID), week 5-26: 60 mg orlistat/20 mg acarbose (2 capsules TID).<br>|
| Active Comparator: MR orlistat<br>MR orlistat 120 mg, 80 participants. | Drug: MR orlistat 120 mg<br>* MR orlistat 120 mg is the same as EMP16-120/40 but without the acarbose component in matching oral capsules. Dosage:. week 1-2: 60 mg MR orlistat (1 capsule per day), week 3-4: 60 mg MR orlistat (1 capsule TID), week 5-26: 60 mg MR orlistat (2 capsules TID).<br>|
| Active Comparator: Conventional orlistat<br>Conventional orlistat 120 mg, 80 participants. | Drug: Conventional orlistat 120 mg,<br>* Orlistat in its conventional form will be Alli® 60 mg during week 1 to 4 and Xenical® 120 mg from week 5 and onwards in matching oral capsules. Dosage: week 1-2: 60 mg conventional orlistat (1 capsule per day), week 3-4: 60 mg conventional orlistat (1 capsule TID), week 5-26: 120 mg conventional orlistat plus placebo (1 capsule of each TID).<br>* Other names: Xenical;Drug: Placebo<br>* Dosage: week 1-2: Placebo (1 capsule per day), week 3-4: Placebo (1 capsule TID), week 5-26: Placebo (2 capsules TID)<br>|
| Experimental: EMP16-60/20<br>EMP16 60 mg orlistat/20 mg acarbose (referred to as EMP16-60/20), 40 participants. | Drug: EMP16-60/20<br>* Dosage: week 1-2: 60 mg orlistat/20 mg acarbose (1 capsule per day), week 3-4: 60 mg orlistat/20 mg acarbose (1 capsule TID), week 5-26: 60 mg orlistat/20 mg acarbose plus placebo (1 capsule of each TID)<br>Drug: Placebo<br>* Dosage: week 1-2: Placebo (1 capsule per day), week 3-4: Placebo (1 capsule TID), week 5-26: Placebo (2 capsules TID)<br>|
| Placebo Comparator: Placebo<br>Placebo, 40 participants | Drug: Placebo<br>* Dosage: week 1-2: Placebo (1 capsule per day), week 3-4: Placebo (1 capsule TID), week 5-26: Placebo (2 capsules TID)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Relative (%) change from baseline in body weight at week 26 | Efficacy endpoints | Baseline and week 26 | 
| Proportion of participants with ≥5% decrease in body weight at week 26 [Please note: This is an FDA required outcome, cannot use change] | Efficacy endpoints | Baseline and week 26 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Relative (%) change from baseline in body weight at week 26 (secondary and exploratory comparisons) | Efficacy endpoints | Baseline and week 26 | 
| Proportion of participants with ≥5% (secondary and exploratory comparisons) and ≥10% (all comparisons) decrease in body weight at week 18 and week 26 | Efficacy endpoints | Baseline, week 18 and 26 | 
| Absolute change from baseline in body weight at week 26 | Efficacy endpoints | Baseline and week 26 | 
| Relative (%) change from baseline in body weight during the 26-weeks treatment period | Efficacy endpoints | Baseline to week 26 | 
| Absolute change from baseline in body weight during the 26-weeks treatment period | Efficacy endpoints | Baseline to week 26 | 
| Absolute change from baseline in body mass index (BMI) measured as weight (kg) divided by height (m) squared | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in waist circumference | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in sagittal diameter | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in percentage body fat | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in Quality of life as measured by the questionnaire Rand-36 (9 different domains) | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in Quality of life as measured by the questionnaire EQ-5D-5L (measured as one summative value) | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in self reported meal pattern. Short questionnaire where points are depending on adherence to the Nordic Nutrition recommendations | Efficacy endpoints. | Baseline and week 26 | 
| Absolute change from baseline in self reported sleep, where higher points are given for good sleep duration and good sleep quality | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in self reported physical activity, where higher points are given for longer duration of moderate and intense physical activity | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in fasting hemoglobin A1c (HbA1c) | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in fasting glucose | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in fasting insulin | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in fasting total cholesterol | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in fasting high-density lipoprotein (HDL) | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in fasting low-density lipoprotein (LDL) | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in fasting triglycerides (TGs) | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in fasting Apolipoprotein A1 (ApoA1) | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in fasting Apolipoprotein B (ApoB) | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in fasting high sensitivity C-reacting protein (hs-CRP) | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in fasting albumin | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in homeostatic model assessment (HOMA) index | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in Visceral adiposity index (VAI) | Efficacy endpoints VAI Males = (WC/(39.38+(1.88*BMI)))*(TG/1.03)*(1.31/HDL) VAI Females = (WC/(36.58+(1.89*BMI)))*(TG/0.81)*(1.52/HDL) | Baseline and week 26 | 
| Absolute change from baseline in Fatty liver index (FLI) | Efficacy endpoints. Measured as FLI = 100*e to the power of y /(1+e to the power of y) y= 0.953*ln(TG)+0,139*BMI+0.718*ln(GGT)+0.053*WC-15.3745 | Baseline and week 26 | 
| Absolute change from baseline in systolic and diastolic blood pressure | Efficacy endpoints | Baseline and week 26 | 
| Absolute change from baseline in heart rate | Efficacy endpoints | Baseline and week 26 | 
| Tolerability, assessed by conventional adverse event (AE) reporting (with special focus on oily spotting and fecal incontinence) | Safety & tolerability endpoints | IMP administration until the end-of-study visit. Assessed at all nine visits (both outpatient and telephone visits) | 
| Number of withdrawals from study (total and gastrointestinal [GI] related) | Safety & tolerability endpoints | Visit 1 until the end-of-study visit. Assessed at all nine visits (both outpatient and telephone visits) | 
| Absolute change from baseline in fasting liver enzymes | Safety & tolerability endpoints (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and gamma-glutamyl transferase) | Baseline and week 26 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Overweight, Obesity