Evaluation of Liraglutide 3.0mg in Patients With Poor Weight-loss and a Suboptimal Glucagon-like Peptide-1 Response (BARIOPTIMISE)

• ClinicalTrials.gov Identifier: NCT03341429
• Recruitment Status: Completed
• First Posted: November 14, 2017
• Last Update Posted: November 5, 2020
• Sponsor: University College, London
• Information provided by (Responsible Party): University College, London

Study Description

Brief Summary:

A double-blinded, randomised, placebo-controlled trial of liraglutide 3.0 mg in patients with poor weight-loss and a suboptimal glucagon-like peptide-1 response following bariatric surgery

Condition or disease	Intervention/treatment	Phase
Obesity	Drug: Liraglutide Pen Injector [Saxenda]; Drug: Placebo	Phase 4

Detailed Description:

Subjects with poor weight loss response (<20% of their total weight) following 1 year or more primary gastric bypass or primary sleeve gastrectomy, will be identified from the trial site (University College London Hospital) and participant identification centre (Whittington Hospital) and invited to attend a screening visit. The screening assessment will be undertaken only upon patients providing informed consent to undergo such procedure. Information regarding medical history and concomitant medications will be gathered. In addition, full physical examination, blood test and a meal test will be performed. All female participants of childbearing potential will be tested for pregnancy. Once all data related to the screening visit has been acquired, the investigator will review the participants' eligibility for BARI-OPTIMISE trial. Patients with suboptimal GLP-1 response and fulfilling the inclusion and exclusion criteria will be invited to take part in the trial and asked to sign a second consent form. Assurance of adequate use of contraceptive throughout the trial period will be obtained before a written informed consent is sought. Consented participants will then be asked to attend a baseline visit.

During the baseline visit, data such as body weight, body composition, physical function, physical activity level and health-related quality of life will be collected. Adverse events will be reviewed and a meal test will be repeated. Upon completion of all the baseline procedures, participants will be randomised to receive either subcutaneous injection of liraglutide 3.0 mg or identical placebo for 24 weeks. Participants will be counselled for a calorie-reduced diet and to increase their level of physical activity. Participants will also be taught how to self-administer the treatment (by subcutaneous injection). For safety purpose, subject visits will be carried out at weeks 2, 4, 8, 17 and 24 of the treatment initiation. At all these visits, targeted physical examination will be performed and adverse events will be assessed. End-of-study visit will be over the phone 4 weeks after the end of treatment (i.e. week 28).

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 70 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: This study is a double-blind, randomised, placebo-controlled, two-arm, parallel group, single-site trial
• Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Masking Description: The investigator who will conduct the follow-up assessments and the trial subjects will be blinded to participants' allocation and will not be involved in delivering any of the intervention. The statistician conducting the data analysis will be blind to group allocation.
• Primary Purpose: Treatment
• Official Title: BARI-OPTIMISE: a Double-blinded, Randomised, Placebo-controlled Trial of Liraglutide 3.0 mg in Patients With Poor Weight-loss and a Suboptimal Glucagon-like Peptide-1 Response Following Bariatric Surgery
• Actual Study Start Date: August 22, 2018
• Actual Primary Completion Date: November 28, 2019
• Actual Study Completion Date: June 11, 2020

Arms and Interventions

Arm	Intervention/treatment
Experimental: Treatment; Daily subcutaneous injection of liraglutide 3.0 mg Study dosing of liraglutide: Week 1: 0.6 mg once daily Week 2: 1.2 mg once daily Week 3: 1.8 mg once daily Week 4: 2.4 mg once daily Week 5-24: 3.0 mg once daily In addition to the daily injection of liraglutide/placebo, participants in both groups will be advised to cut down approximately 500 calories from their usual food intake and to achieve a minimum of 150 minutes per week of physical activity.	Drug: Liraglutide Pen Injector [Saxenda]; Daily injection of GLP-1 agonist (liraglutide 3.0 mg) for obese patients presenting poor weight loss (<20%) after bariatric surgery and suboptimal GLP-1 levels.; Other Name: Saxenda
Placebo Comparator: Control; Daily subcutaneous injection of placebo; the same dosage regimen as treatment to be followed. In addition to the daily injection of liraglutide/placebo, participants in both groups will be advised to cut down approximately 500 calories from their usual food intake and to achieve a minimum of 150 minutes per week of physical activity.	Drug: Placebo; Daily subcutaneous injection

Outcome Measures

Primary Outcome Measures :

1. %WL [ Time Frame: 24 weeks ]
   The primary objective of this trial is to compare the efficacy of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration, as an adjunct to diet and exercise, on %WL in participants with poor weight-loss and a sub-optimal active GLP-1 response following primary RYGB or SG at the end of the 24-week treatment period.

Secondary Outcome Measures :

1. %fat [ Time Frame: 24 weeks ]
   To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on % body fat assessed using DXA scanning
2. Skeletal muscle mass [ Time Frame: 24 weeks ]
   To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on skeletal muscle mass assessed using DXA scanning
3. Bone mineral density [ Time Frame: 24 weeks ]
   To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on bone mineral density assessed using DXA scanning
4. Glucose level [ Time Frame: 24 weeks ]
   To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on fasted and meal-stimulated levels of glucose assessed using blood test
5. Insulin [ Time Frame: 24 weeks ]
   To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on fasted and meal-stimulated levels of insulin assessed using blood test
6. HbA1c [ Time Frame: 24 weeks ]
   To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on fasted and meal-stimulated levels of HbA1c assessed using blood test
7. Leptin [ Time Frame: 24 weeks ]
   To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on fasted and meal-stimulated levels of leptin assessed using blood test
8. Gut Hormones [ Time Frame: 24 weeks ]
   To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on fasted and meal-stimulated levels of gut hormones assessed using blood test
9. Adipokines [ Time Frame: 24 weeks ]
   To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on fasted and meal-stimulated levels of adipokines assessed using blood test
10. physical functional assessment [ Time Frame: 24 weeks ]
    To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on physical functioning assessed using the 6-minute walk test (6-MWT)
11. physical function assessment [ Time Frame: 24 weeks ]
    To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on physical functioning assessed using the sit-to-stand test (STS Test)
12. physical function assessment [ Time Frame: 24 weeks ]
    To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on physical functioning assessed using hand-grip strength
13. physical function assessment [ Time Frame: 24 weeks ]
    To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on physical functioning assessed using the Paffenbarger Physical Activity Questionnaire (PPAQ)
14. HRQoL [ Time Frame: 24 weeks ]
    To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on health related quality of life assessed using an adapted Client Service Receipt Inventory (CSRI)
15. HRQoL [ Time Frame: 24 weeks ]
    To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on health related quality of life assessed using EuroQol-5D (ED5DEQ-5D)
16. HRQoL [ Time Frame: 24 weeks ]
    To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on health related quality of life assessed using Impact of weight on quality of life-lite (IWQOL-Lite)
17. HRQoL [ Time Frame: 24 weeks ]
    To compare the effect of 24-weeks of subcutaneous liraglutide 3.0 mg versus placebo administration as an adjunct to diet and exercise at the end of the 24-week treatment period on health related quality of life assessed using Beck depression inventory (BDI)

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 64 Years (Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Patients, 1 year or more after primary RYGB or primary SG, with poor weight-loss (<20% WL) that is not caused by either a surgical or psychological problem.
2. Adults, 18-64 years inclusive.
3. Suboptimal nutrient-stimulated GLP-1 response assessed by a meal test. Suboptimal active GLP-1 response is defined as a ≤2-fold increase in active GLP-1 circulating levels between time 0 and time 30 minutes.
4. Females of childbearing potential and males must be willing to use an effective method of contraception (hormonal or barrier method of birth control, abstinence) from the time consent is signed until 6 weeks after treatment discontinuation.
5. Females of childbearing potential must have a negative pregnancy test within 7 days prior to being registered for trial treatment. NOTE: Subjects are considered not of child bearing potential if they are surgically sterile (i.e. they have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are postmenopausal.
6. ≤5 % variation in body weight over preceding 3 months.
7. Fluent in English and able to understand and complete questionnaires.
8. Willing and able to provide written informed consent and comply with the trial protocol.

Exclusion Criteria:

1. Had a surgical procedure other than gastric bypass and sleeve gastrectomy.
2. Pregnant or lactating mothers.
3. Participation in other clinical intervention trial.
4. Lifetime history of suicidal behaviour or severe depression assessed by direct questioning.
5. Clinically significant medical abnormalities (e.g., unstable hypertension, clinically significant ECG abnormalities, liver cirrhosis, AST or ALT > 3x the upper normal limit).
6. Heart rate ≥ 100 beats/minute at screening on two separate measurements.
7. Uncontrolled hypertension (systolic blood pressure ≥ 160 mmHg or diastolic blood pressure ≥ 100 mmHg).
8. Renal impairment (estimated glomerular infiltration rate (eGFR <30 ml/min 1.73 m2)
9. Known or suspected hypersensitivity to liraglutide 3.0 mg and placebo or any of the excipients involved in their formulation.
10. Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2.
11. Personal history of pancreatitis.
12. Uncontrolled hypothyroidism or hyperthyroidism.
13. History of stroke, unstable angina, acute coronary syndrome, congestive heart failure New York Heart Association class III-IV within the preceding 12 months.
14. History of arrhythmias.
15. Inflammatory bowel disease.
16. Diabetic gastroparesis.
17. Concomitant GLP-1 receptor agonist usage.
18. Concomitant usage of medications that cause weight gain or weight loss.
19. Concomitant usage of DPPIV-inhibitors.
20. Insulin usage.

Contacts and Locations

Locations

United Kingdom

UCLH

London, United Kingdom, NW1 2BU

Sponsors and Collaborators

University College, London

Investigators

• Principal Investigator: Rachel L Batterham, PhD FRCP; UCL

More Information

Publications:

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Fruhbeck G, Toplak H, Woodward E, Yumuk V, Maislos M, Oppert JM; Executive Committee of the European Association for the Study of Obesity. Obesity: the gateway to ill health - an EASO position statement on a rising public health, clinical and scientific challenge in Europe. Obes Facts. 2013;6(2):117-20. doi: 10.1159/000350627. Epub 2013 Apr 3. No abstract available.

Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, Bucher HC, Nordmann AJ. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013 Oct 22;347:f5934. doi: 10.1136/bmj.f5934.

Manning S, Pucci A, Carter NC, Elkalaawy M, Querci G, Magno S, Tamberi A, Finer N, Fiennes AG, Hashemi M, Jenkinson AD, Anselmino M, Santini F, Adamo M, Batterham RL. Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass. Surg Endosc. 2015 Jun;29(6):1484-91. doi: 10.1007/s00464-014-3829-7. Epub 2014 Sep 20.

Batterham RL, Cummings DE. Mechanisms of Diabetes Improvement Following Bariatric/Metabolic Surgery. Diabetes Care. 2016 Jun;39(6):893-901. doi: 10.2337/dc16-0145.

Jimenez A, Casamitjana R, Flores L, Viaplana J, Corcelles R, Lacy A, Vidal J. Long-term effects of sleeve gastrectomy and Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus in morbidly obese subjects. Ann Surg. 2012 Dec;256(6):1023-9. doi: 10.1097/SLA.0b013e318262ee6b.

Arterburn DE, Bogart A, Sherwood NE, Sidney S, Coleman KJ, Haneuse S, O'Connor PJ, Theis MK, Campos GM, McCulloch D, Selby J. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2013 Jan;23(1):93-102. doi: 10.1007/s11695-012-0802-1.

Lee MH, Lee WJ, Chong K, Chen JC, Ser KH, Lee YC, Chen SC. Predictors of long-term diabetes remission after metabolic surgery. J Gastrointest Surg. 2015 Jun;19(6):1015-21. doi: 10.1007/s11605-015-2808-1. Epub 2015 Apr 4.

Laurino Neto RM, Herbella FA, Tauil RM, Silva FS, de Lima SE Jr. Comorbidities remission after Roux-en-Y Gastric Bypass for morbid obesity is sustained in a long-term follow-up and correlates with weight regain. Obes Surg. 2012 Oct;22(10):1580-5. doi: 10.1007/s11695-012-0731-z.

Sundbom M, Hedberg J, Marsk R, Boman L, Bylund A, Hedenbro J, Laurenius A, Lundegardh G, Moller P, Olbers T, Ottosson J, Naslund I, Naslund E; Scandinavian Obesity Surgery Registry Study Group. Substantial Decrease in Comorbidity 5 Years After Gastric Bypass: A Population-based Study From the Scandinavian Obesity Surgery Registry. Ann Surg. 2017 Jun;265(6):1166-1171. doi: 10.1097/SLA.0000000000001920.

Lassailly G, Caiazzo R, Buob D, Pigeyre M, Verkindt H, Labreuche J, Raverdy V, Leteurtre E, Dharancy S, Louvet A, Romon M, Duhamel A, Pattou F, Mathurin P. Bariatric Surgery Reduces Features of Nonalcoholic Steatohepatitis in Morbidly Obese Patients. Gastroenterology. 2015 Aug;149(2):379-88; quiz e15-6. doi: 10.1053/j.gastro.2015.04.014. Epub 2015 Apr 25.

Caiazzo R, Lassailly G, Leteurtre E, Baud G, Verkindt H, Raverdy V, Buob D, Pigeyre M, Mathurin P, Pattou F. Roux-en-Y gastric bypass versus adjustable gastric banding to reduce nonalcoholic fatty liver disease: a 5-year controlled longitudinal study. Ann Surg. 2014 Nov;260(5):893-8; discussion 898-9. doi: 10.1097/SLA.0000000000000945.

Mohos E, Jano Z, Richter D, Schmaldienst E, Sandor G, Mohos P, Horzov M, Tornai G, Prager M. Quality of life, weight loss and improvement of co-morbidities after primary and revisional laparoscopic roux Y gastric bypass procedure-comparative match pair study. Obes Surg. 2014 Dec;24(12):2048-54. doi: 10.1007/s11695-014-1314-y.

Raoof M, Naslund I, Rask E, Karlsson J, Sundbom M, Edholm D, Karlsson FA, Svensson F, Szabo E. Health-Related Quality-of-Life (HRQoL) on an Average of 12 Years After Gastric Bypass Surgery. Obes Surg. 2015 Jul;25(7):1119-27. doi: 10.1007/s11695-014-1513-6.

Dirksen C, Jorgensen NB, Bojsen-Moller KN, Kielgast U, Jacobsen SH, Clausen TR, Worm D, Hartmann B, Rehfeld JF, Damgaard M, Madsen JL, Madsbad S, Holst JJ, Hansen DL. Gut hormones, early dumping and resting energy expenditure in patients with good and poor weight loss response after Roux-en-Y gastric bypass. Int J Obes (Lond). 2013 Nov;37(11):1452-9. doi: 10.1038/ijo.2013.15. Epub 2013 Feb 19.

Gerner T, Johansen OE, Olufsen M, Torjesen PA, Tveit A. The post-prandial pattern of gut hormones is related to magnitude of weight-loss following gastric bypass surgery: a case-control study. Scand J Clin Lab Invest. 2014 Apr;74(3):213-8. doi: 10.3109/00365513.2013.877594. Epub 2014 Jan 28.

Blackman A, Foster GD, Zammit G, Rosenberg R, Aronne L, Wadden T, Claudius B, Jensen CB, Mignot E. Effect of liraglutide 3.0 mg in individuals with obesity and moderate or severe obstructive sleep apnea: the SCALE Sleep Apnea randomized clinical trial. Int J Obes (Lond). 2016 Aug;40(8):1310-9. doi: 10.1038/ijo.2016.52. Epub 2016 Mar 23.

Pajecki D, Halpern A, Cercato C, Mancini M, de Cleva R, Santo MA. Short-term use of liraglutide in the management of patients with weight regain after bariatric surgery. Rev Col Bras Cir. 2013 May-Jun;40(3):191-5. doi: 10.1590/s0100-69912013000300005. English, Portuguese.

• Responsible Party: University College, London
• ClinicalTrials.gov Identifier: NCT03341429
• Other Study ID Numbers: 17/0238
• First Posted: November 14, 2017
• Last Update Posted: November 5, 2020
• Last Verified: November 2020

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Plan Description: Participants who agree to, through the consent form, will have some of the study data, any remaining study samples and contact details shared with the ORBiS biobank run by the same Centre for Obesity Research and under the oversight of the same Chief Investigator.
• Supporting Materials: Study Protocol; Informed Consent Form (ICF)
• Time Frame: If participants agree by signing the option on the consent form, all of the listed above will be transferred to the ORBiS biobank at the end of the study and will be store there indefinitely, or till further use.

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by University College, London:

obesity; GLP-1; liraglutide; diabetes; bariatric surgery

Additional relevant MeSH terms:

Weight Loss; Body Weight; Body Weight Changes; Liraglutide; Hypoglycemic Agents; Physiological Effects of Drugs; Incretins; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists