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.
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
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
320
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).
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).
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).
CTC Ebbepark
Linköping, Sweden
CTC Karolinska
Solna, Sweden
Clinical Trial Consultants (CTC)
Uppsala, Sweden
Relative (%) change from baseline in body weight at week 26
Efficacy endpoints
Time frame: 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
Time frame: Baseline and week 26
Relative (%) change from baseline in body weight at week 26 (secondary and exploratory comparisons)
Efficacy endpoints
Time frame: 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
Time frame: Baseline, week 18 and 26
Absolute change from baseline in body weight at week 26
Efficacy endpoints
Time frame: Baseline and week 26
Relative (%) change from baseline in body weight during the 26-weeks treatment period
Efficacy endpoints
Time frame: Baseline to week 26
Absolute change from baseline in body weight during the 26-weeks treatment period
Efficacy endpoints
Time frame: Baseline to week 26
Absolute change from baseline in body mass index (BMI) measured as weight (kg) divided by height (m) squared
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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)
Dosage: week 1-2: Placebo (1 capsule per day), week 3-4: Placebo (1 capsule TID), week 5-26: Placebo (2 capsules TID)
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in waist circumference
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in sagittal diameter
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in percentage body fat
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in Quality of life as measured by the questionnaire Rand-36 (9 different domains)
Efficacy endpoints
Time frame: 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
Time frame: 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.
Time frame: 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
Time frame: 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
Time frame: Baseline and week 26
Absolute change from baseline in fasting hemoglobin A1c (HbA1c)
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in fasting glucose
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in fasting insulin
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in fasting total cholesterol
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in fasting high-density lipoprotein (HDL)
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in fasting low-density lipoprotein (LDL)
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in fasting triglycerides (TGs)
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in fasting Apolipoprotein A1 (ApoA1)
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in fasting Apolipoprotein B (ApoB)
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in fasting high sensitivity C-reacting protein (hs-CRP)
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in fasting albumin
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in homeostatic model assessment (HOMA) index
Efficacy endpoints
Time frame: 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)
Time frame: 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
Time frame: Baseline and week 26
Absolute change from baseline in systolic and diastolic blood pressure
Efficacy endpoints
Time frame: Baseline and week 26
Absolute change from baseline in heart rate
Efficacy endpoints
Time frame: Baseline and week 26
Tolerability, assessed by conventional adverse event (AE) reporting (with special focus on oily spotting and fecal incontinence)
Safety \& tolerability endpoints
Time frame: 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
Time frame: 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)
Time frame: Baseline and week 26