Study to Evaluate ARD-101 in Adults Receiving Bariatric Surgery

Obesity Clinical Trial

Official title:

A Phase 2 Open Label Study to Evaluate the Safety, Tolerability, and Efficacy of ARD-101 in Subjects At Least One Year After Bariatric Surgery

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05215847
• Other study ID #: AARD-202
• Status: Completed
• Phase: Phase 2
• Start date: March 1, 2022
• Est. completion date: February 3, 2023

Study information

• Verified date: May 2023
• Source: Aardvark Therapeutics, Inc.
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to evaluate safety and efficacy of twice-daily ARD-101 in subjects at least one year after bariatric surgery (sleeve gastrectomy or gastric bypass).

Description:

This is a Phase 2, open-label study to investigate the safety and efficacy of twice-daily ARD-101 in subjects at least one year after bariatric surgery (sleeve gastrectomy or gastric bypass). This study has a planned enrollment of 30 subjects (approximately 15 for each preceding surgical procedure) and will be conducted in a single center in the United States.

The study will consist of a Screening Period (up to 28 days), a Treatment Period (28 days), and a Follow-up Period (EOS Visit within 14 days after receiving the last dose of ARD-101). The screening procedures will be initiated upon completion of the informed consent process. Following completion of screening procedures and confirmation of eligibility, subjects will be enrolled to receive ARD-101.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 12
• Est. completion date: February 3, 2023
• Est. primary completion date: February 3, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

• Male and female subjects, 18-75 years of age

• Willing and able to provide signed and dated informed consent prior to any study-related procedures and willing and able to comply with all study procedures

• Body Mass Index (BMI) of 35-60 kg/m2 during the Screening Period

• Status of at least 1-year post sleeve gastrectomy or gastric bypass surgery. Subjects must have a documented weight loss of at least 50% of their excess weight at their nadir, and must have regained at least 20% of their nadir weight loss. Excess weight is defined as maximum preoperative weight - weight corresponding to a BMI of 25 kg/m2

• Subjects with rescue surgery (e.g. gastric band to sleeve gastrectomy or gastric bypass; sleeve gastrectomy to gastric bypass) will be allowed, with time since second surgery of at least 12 months.

• Subjects with a history of revision procedures will be allowed if at least 6 months have passed since the procedure and weight has not deviated more than 5% in the 3 months prior to enrollment

• No abnormal findings or abnormalities of clinical significance in vital signs, physical examination, clinical laboratory tests (CBC, urinalysis, blood biochemistry, coagulation, pregnancy test (females), urine drug test, nicotine test, etc.), 12-lead electrocardiogram (ECG) during the Screening Period

• Serum creatinine, alkaline phosphatase, hepatic enzymes (aspartate aminotransferase, alanine aminotransferase) and total bilirubin (unless the subject has documented Gilbert syndrome) not exceeding 1.5-fold the upper laboratory norm and estimated Glomerular Filtration Rate (eGFR) >30 mL/min

• Standard 12-lead ECG parameters after 10minutes resting in supine position in the following ranges; 120 ms <PR <220 ms, QRS <120 ms, QTc <= 430 ms if male, <= 450 ms if female and normal ECG tracing unless the Investigator considers an ECG abnormality within described limits to be not clinically relevant

• Stable or well controlled blood pressure per Investigator's judgement during the Screening Period. Specifically: Vital signs after 10 minutes sitting in a chair (feet on floor, back supported):

i. 95 mmHg < systolic blood pressure (SBP) <160 mmHg, ii. 45 mm Hg < diastolic blood pressure (DBP) <100 mm Hg, iii. 40 bpm < heart rate (HR) <100 bpm.

• Prediabetes- defined as a fasting blood glucose between 100-125 mg/dL OR an HbA1c between 5.7-6.5% at screening

• Type 2 diabetes- Defined as previous diagnosis by a healthcare professional OR a fasting blood glucose > 126 mg/dL OR HbA1c > 6.5% at screening.

• Patients with type 2 diabetes treated with metformin may be enrolled. However, patients with type 2 diabetes on any other therapy will be excluded.

• Female subjects must have negative serum pregnancy test and must not be lactating. For females able to bear children, a hormonal (i.e., oral, implantable, or injectable) and single barrier method (i.e., sponge), or a double-barrier method of birth control (i.e., condom with spermicide) or abstinence must be used/practiced throughout the study and for 90 days following last dose of study medication; for effective form of birth control.

• Females of non-childbearing potential, defined as surgically sterile (status post hysterectomy, bilateral oophorectomy, bilateral tubal ligation, bilateral salpingectomy, or bilateral tubal occlusion) or post-menopausal for at least 12 months (may be confirmed with a screening follicle stimulating hormone (FSH) level in the post-menopausal lab range), do not require contraception during the study.

• Males with female partners of childbearing potential must agree to a double-barrier method if participants become sexually active during the study and for 90 days following the last dose of the study medication. Male subjects must not donate sperm for 90 days following their participation in the study.

Exclusion Criteria:

• Any relevant gastrointestinal (GI) surgery (excluding the gastric bypass or sleeve gastrectomy) per Investigator judgement

• History of significant drug hypersensitivity or anaphylaxis

• Participation in a weight loss program or clinical trial for weight loss within the 3 months prior to enrollment

• Received any experimental drugs or devices or have participated in a clinical study within 30 days prior to enrollment

• Diabetes treatment (unless metformin as outlined), or chronic oral steroids, or treatment with immune modulators, anti-obesity drugs, chronic opiate therapy, or antipsychotic medications

• Currently receiving any drug-based therapy for weight management

• Thyroid-stimulating hormone (TSH) level is outside of normal limit during the Screening Period

• The presence of diseases with abnormal clinical manifestations that need to be excluded based on their possible contribution to weight loss or weight gain, including but not limited to nervous, cardiovascular, blood and lymphatic system, immune, renal, hepatic, gastrointestinal, respiratory, metabolic and skeletal diseases during the Screening Period

• History of myocardial infarction, unstable angina, arterial revascularization, stroke, New York Heart Association Functional Class II-IV heart failure, or transient ischemic attack within 6 months prior to Visit 1

• Any malignancy not considered cured (except focal, treated basal cell carcinoma and squamous cell carcinoma of the skin); a participant is considered cured if there has been no evidence of cancer recurrence in the previous 5 years

• History of major depressive disorder or history of other severe psychiatric disorders (e.g., schizophrenia or bipolar disorder) within the last 2 years.

• Donated =200 mL of blood (blood components) or had massive blood loss, received blood transfusion or blood products within 3 months prior to enrollment

• Planned sperm/egg donation within 6 months post enrollment

• Positive urine drug test (morphine, methamphetamine, ketamine, ecstasy, and cannabis) during the Screening Period

• History of consuming more than 14 units of alcoholic beverages per week or of alcoholism or drug/chemical/substance abuse within past 2 years prior to enrollment (Note: one unit = 12 ounces of beer, 4 ounces of wine or 1 ounce of spirits)

• Smoking any amount within 3 months prior to enrollment

• Excessive consumption of tea, coffee, and/or caffeinated beverages (more than 8 cups, 250 mL for each cup) every day within 3 months prior to enrollment

• Symptomatic viral, bacterial (including upper respiratory infection), or fungal (non-cutaneous) infection within 1 week prior to enrollment

• History of human immunodeficiency virus antibody, hepatitis C antibody or hepatitis B virus surface antigen

• A history of psychiatric and psychological condition that, in the judgment of the investigator, may interfere with the planned treatment and follow-up, affect subject compliance or place the subject at high risk from treatment-related complications

• Poor venous access or inability to tolerate venipuncture

• Any condition or active drug treatment that the investigator or primary physician believes may not be appropriate for participating in the study

Related Conditions & MeSH terms

• Bariatric Surgery
• Obesity
• Weight Gain

Intervention

Drug:
• ARD-101
Twice daily, oral administration

Locations

Country	Name	City	State
United States	Altman Clinical and Translational Research Institute, University of California, San Diego	San Diego	California

Sponsors (2)

Lead Sponsor	Collaborator
Aardvark Therapeutics, Inc.	University of California, San Diego

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Categorical Weight Loss	Proportion of subjects who lose < 5% and = 5% initial weight	Run-in Visit (baseline), Day 28
Other	Circulating Levels of Glucagon-like peptide (GLP)-1 (pmol) during Mixed-Meal Tolerance Test (MMTT) at Baseline and on Day 28, and Prior to and Post Dosing on Day 1	Circulating levels of glucagon-like peptide (GLP)-1 (pmol) prior to (negative timepoints) and post (positive timepoints) the Ensure meal given for mixed-meal tolerance test (MMTT) at baseline (run-in visit) and on day 28, and pre-dosing and 1 and 2 hours post the first dosing on day 1.	Run-in Visit (baseline), Day 1, Day 28
Other	Circulating Levels of Cholecystokinin (CCK) (pg/mL) during MMTT at Baseline and on Day 28, and Prior to and Post Dosing on Day 1	Circulating levels of cholecystokinin (CCK) (pg/mL) prior to (negative timepoints) and post (positive timepoints) the Ensure meal given for MMTT at baseline (run-in visit) and on day 28, and pre-dosing and 1 and 2 hours post the first dosing on day 1.	Run-in Visit (baseline), Day 1, Day 28
Other	Circulating Levels of Peptide YY (PYY) (pg/mL) during MMTT at Baseline and on Day 28, and Prior to and Post Dosing on Day 1	Circulating levels of peptide YY (PYY) (pg/mL) prior to (negative timepoints) and post (positive timepoints) the Ensure meal given for MMTT at baseline (run-in visit) and on day 28, and pre-dosing and 1 and 2 hours post the first dosing on day 1.	Run-in Visit (baseline), Day 1, Day 28
Other	Circulating Levels of Amylin (pmol) during MMTT at Baseline and on Day 28, and Prior to and Post Dosing on Day 1	Circulating levels of amylin (pmol) prior to (negative timepoints) and post (positive timepoints) the Ensure meal given for MMTT at baseline (run-in visit) and on day 28, and pre-dosing and 1 and 2 hours post the first dosing on day 1.	Run-in Visit (baseline), Day 1, Day 28
Other	Circulating Levels of Glucose-dependent Insulinotropic Polypeptide (GIP) (pg/mL) during MMTT at Baseline and on Day 28, and Prior to and Post Dosing on Day 1	Circulating levels of glucose-dependent insulinotropic polypeptide (GIP) (pg/mL) prior to (negative timepoints) and post (positive timepoints) the Ensure meal given for MMTT at baseline (run-in visit) and on day 28, and pre-dosing and 1 and 2 hours post the first dosing on day 1.	Run-in Visit (baseline), Day 1, Day 28
Other	Circulating Levels of Ghrelin (pg/mL) during MMTT at Baseline and on Day 28, and Prior to and Post Dosing on Day 1	Circulating levels of ghrelin (pg/mL) prior to (negative timepoints) and post (positive timepoints) the Ensure meal given for MMTT at baseline (run-in visit) and on day 28, and pre-dosing and 1 and 2 hours post the first dosing on day 1.	Run-in Visit (baseline), Day 1, Day 28
Other	Circulating Levels of Leptin (ng/mL) during MMTT at Baseline and on Day 28, and Prior to and Post Dosing on Day 1	Circulating levels of leptin (ng/mL) prior to (negative timepoints) and post (positive timepoints) the Ensure meal given for MMTT at baseline (run-in visit) and on day 28, and pre-dosing and 1 and 2 hours post the first dosing on day 1.	Run-in Visit (baseline), Day 1, Day 28
Other	Circulating Levels of Adiponectin (mcg/mL) during MMTT at Baseline and on Day 28, and Prior to and Post Dosing on Day 1	Circulating levels of adiponectin (mcg/mL) prior to (negative timepoints) and post (positive timepoints) the Ensure meal given for MMTT at baseline (run-in visit) and on day 28, and pre-dosing and 1 and 2 hours post the first dosing on day 1.	Run-in Visit (baseline), Day 1, Day 28
Other	Circulating Levels of Glucagon (pg/mL) during MMTT at Baseline and on Day 28, and Prior to and Post Dosing on Day 1	Circulating levels of glucagon (pg/mL) prior to (negative timepoints) and post (positive timepoints) the Ensure meal given for MMTT at baseline (run-in visit) and on day 28, and pre-dosing and 1 and 2 hours post the first dosing on day 1.	Run-in Visit (baseline), Day 1, Day 28
Other	Serum Levels of Glucose (mg/dL) during MMTT at Baseline and on Day 28	Serum levels of glucose (mg/dL) prior to (negative timepoints) and post (positive timepoints) the Ensure meal given for MMTT at baseline (run-in visit) and on day 28.	Run-in Visit (baseline), Day 28
Other	Serum Levels of Insulin (uIU/mL) during MMTT at Baseline and on Day 28	Serum levels of insulin (uIU/mL) prior to (negative timepoints) and post (positive timepoints) the Ensure meal given for MMTT at baseline (run-in visit) and on day 28.	Run-in Visit (baseline), Day 28
Other	Serum Levels of C-peptide (ng/mL) during MMTT at Baseline and on Day 28	Serum levels of C-peptide (ng/mL) prior to (negative timepoints) and post (positive timepoints) the Ensure meal given for MMTT at baseline (run-in visit) and on day 28.	Run-in Visit (baseline), Day 28
Other	Serum Levels of Free Fatty Acids during MMTT at Baseline and on Day 28	Serum levels of free fatty acids (FFA) prior to (negative timepoints) and post (positive timepoints) the Ensure meal given for MMTT at baseline (run-in visit) and on day 28.	Run-in Visit (baseline), Day 28
Other	Circulating Levels of Interleukin (IL)-1 beta (pg/mL) during MMTT	Circulating levels of interleukin (IL)-1 beta (pg/mL) at run in visit and end of treatment (day 28) performed during the MMTT	Run-in Visit (baseline), Day 28
Other	Circulating Levels of IL-6 (pg/mL) during MMTT	Circulating levels of IL-6 (pg/mL) at run in visit and end of treatment (day 28) performed during the MMTT	Run-in Visit (baseline), Day 28
Other	Circulating Levels of IL-10 (pg/mL) during MMTT	Circulating levels of IL-10 (pg/mL) at run in visit and end of treatment (day 28) performed during the MMTT	Run-in Visit (baseline), Day 28
Other	Circulating Levels of IL-12 p40 (pg/mL) during MMTT	Circulating levels of IL-12 p40 (pg/mL) at run in visit and end of treatment (day 28) performed during the MMTT	Run-in Visit (baseline), Day 28
Other	Circulating Levels of IL-12 p70 (pg/mL) during MMTT	Circulating levels of IL-12 p70 (pg/mL) at run in visit and end of treatment (day 28) performed during the MMTT	Run-in Visit (baseline), Day 28
Other	Circulating Levels of IL-17 (pg/mL) during MMTT	Circulating levels of IL-17 (pg/mL) at run in visit and end of treatment (day 28) performed during the MMTT	Run-in Visit (baseline), Day 28
Other	Circulating Levels of Tumor Necrosis Factor (TNF)-alpha (pg/mL) during MMTT	Circulating levels of tumor necrosis factor (TNF)-alpha (pg/mL) at run in visit and end of treatment (day 28) performed during the MMTT	Run-in Visit (baseline), Day 28
Other	Circulating Levels of C Reactive Protein (CRP) (mg/L) during MMTT	Circulating levels of C reactive protein (CRP) (mg/L) at run in visit and end of treatment (day 28) performed during the MMTT	Run-in Visit (baseline), Day 28
Other	Body Fat Percentage	Body fat percentage measured by bioelectrical impedance scale	Run-in Visit (baseline), Days 1-28
Other	Change in the Percentage of Liver Fat Content	Change in the percentage of liver fat content assessed by magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF)	Run-in Visit (baseline), Day 28
Other	Change in Homeostatic Model Assessment for Insulin Resistance (HOMA-IR)	The change in homeostatic model assessment for insulin resistance (HOMA-IR) at the end of treatment from the baseline	Run-in Visit (baseline), Day 28
Other	Change in Fasting Blood Glucose	The change in fasting blood glucose at the end of treatment from the baseline	Run-in Visit (baseline), Day 28
Other	Change in Serum Bile Acids	Change in serum bile acids at the end of treatment compared to the baseline	Run-in Visit (baseline), Day 28
Other	Phenotypic Taste Test	Phenotypic taste test (using commercially available test strips) at baseline	Run-in Visit (baseline)
Other	Control of Eating and Food Cravings	Control of eating and food craving assessed by the Control of Eating Questionnaire (CoEQ), which is a 21-item questionnaire designed to assess the intensity and type of food cravings and subjective sensations of appetite and mood according to an individual's experience over the last 7 days. Items on the CoEQ are assessed by 100-mm visual analogue scales (VAS). Subjects will mark their level with a vertical line on the horizontal line of the VAS scale. The numerical value will start at 1.0 cm and end 10.0 cm. Use a ruler to determine the numerical value (to the tenth decimal) associated with the line marked by subjects. Higher score indicates less control of eating and food cravings.	Screening, Days 1, 15, and 28
Other	Change in Indirect Calorimetry	Change in indirect calorimetry between Day 1 and Day 28	Day 1, Day 28
Other	Area under the Curve (AUC) of Serum Level of Glucose (mg/dL) during MMTT	Changes in AUC of serum level of glucose (mg/dL) during MMTT between baseline and Day 28	Run-in Visit (baseline), Day 28
Other	Area under the Curve (AUC) of Serum Level of Insulin (uIU/mL) during MMTT	Changes in AUC of serum level of insulin (uIU/mL) during MMTT between baseline and Day 28	Run-in Visit (baseline), Day 28
Other	Area under the Curve (AUC) of Serum Level of C-peptide (ng/mL) during MMTT	Changes in AUC of serum levels of C-peptide (ng/mL) during MMTT between baseline and Day 28	Run-in Visit (baseline), Day 28
Other	Changes in Fecal Microbial Species and Their Relative Abundance	Changes in fecal microbial species and their relative abundance assessed by 16S rRNA gene sequencing	Day 1, Day 28
Primary	Relative Change in Body Weight (%)	The percent total weight change at the end of treatment from baseline	Run-in Visit (baseline), Day 28
Secondary	Incidence of treatment-emergent adverse events (TEAE)	The incidence of treatment-emergent adverse events (TEAE) during the treatment period	Days 1-28
Secondary	Change in Blood Lipid Concentrations	The change in blood lipid concentrations (total cholesterol, triglyceride, high density lipoprotein cholesterol, and low-density lipoprotein cholesterol) at the end of treatment from the baseline	Run-in Visit (baseline), Day 28
Secondary	Change in Waist Circumference	The change in waist circumference at the end of treatment from the baseline	Run-in Visit (baseline), Day 28
Secondary	Change in Hemoglobin A1c	The change in glycated hemoglobin (HbA1c) at the end of treatment from the baseline	Run-in Visit (baseline), Day 28