Working... Menu

Energy Balance & Weight Loss in Craniopharyngioma-related or Other Hypothalamic Tumors in Hypothalamic Obesity (ECHO)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02664441
Recruitment Status : Active, not recruiting
First Posted : January 27, 2016
Last Update Posted : April 4, 2019
Children's Hospitals and Clinics of Minnesota
Vanderbilt University
Information provided by (Responsible Party):
Christian Roth, Seattle Children's Hospital

Brief Summary:
The proposed multicenter study will test the effect of glucagon-like peptide (GLP)-1 agonist exenatide once weekly extended-release (ExQW, Bydureon®) on clinical outcomes and metabolic parameters in a double-blind, placebo-controlled 36 week randomized trial with an 18 week open label extension. Following baseline testing, 48 patients will be randomly assigned with equal allocation to ExQW or matching placebo injection for 36 weeks, followed by an 18 week open label extension during which all patients receive ExQW. Changes of weight status, body composition, free-living total daily energy expenditure (EE) by doubly labeled water (DLW), activity by acetimetry, energy intake (questionnaires and food diary), as well as glucose tolerance and hormonal parameters of energy homeostasis and insulin resistance will be assessed before treatment and at the end of the placebo-controlled phase (week 36). Activity, metabolic outcomes, energy intake will be also assessed at study week 18 (mid treatment of randomized study), as well as week 54 (end of open label treatment).

Condition or disease Intervention/treatment Phase
Hypothalamic Obesity Drug: Exenatide Drug: placebo Phase 3

Detailed Description:

Excessive weight gain and its cardiometabolic sequela are frequent complications of hypothalamic tumors, a condition known as hypothalamic obesity (HO). Most tumors in this region are craniopharyngiomas (CP),1 which constitute 5-9% of childhood brain tumors. Patients with CP typically become obese and have more features of the metabolic syndrome compared to matched controls. Overall, a 3-19-fold higher cardiovascular mortality had been reported, and a recent nationwide population-based study in Sweden demonstrated increased rates for cerebral infarction (7-fold), death due to cerebrovascular diseases (5-fold), and type 2 diabetes mellitus (6-fold) in CP patients in comparison to the general population. Thus, early and effective management of obesity is vital for this population, which is more resistant to treatment than uncomplicated obesity. Recognized risk factors for severe obesity include large hypothalamic tumors or lesions affecting several medial and posterior hypothalamic nuclei that impact satiety signaling pathways. Structural damage in these nuclei often lead to uncontrolled appetite, rapid weight gain, central insulin and leptin resistance, decreased sympathetic activity, low energy expenditure (EE), and increased energy storage in adipose tissue. Recently, the investigators developed a semi-quantitative assessment of hypothalamic damage on brain magnetic resonance imaging (MRI) to predict the risk for HO development in CP.

Previous results of treating HO with a glucagon-like-peptide-1 receptor agonist (GLP1RA) in rats and humans provide promising proof-of-principle data to support this current randomized clinical trial. The primary hypothesis of this study is that drugs causing weight loss via intact hindbrain signaling pathways offer a desperately needed option for treatment of HO, even in very obese HO subjects with severe hypothalamic damage. Induction of weight loss by GLP1RAs is believed to be related to multiple mechanisms involving the gastrointestinal tract, vagus nerve, and the brain leading to increased satiety. Peripheral administration of GLP-1 or GLP1RA reduces blood glucose and energy intake in humans and rodents, and long-term treatment results in loss of body weight. Critically, the investigators do not know whether GLP1RA treatment affects EE and activity, or whether the site and size of brain lesions affect responses to GLP1RA treatment.

The investigators' previous clinical studies of the GLP1RA exenatide in obese adolescents and adults have generated the critical safety and efficacy data needed to design a clinical trial. In a pilot study conducted at Children's Hospitals and Clinics of MN, pretreatment hyperphagia was associated with BMI reduction. Using these data, the investigators have designed a prospective, multicenter trial that will examine the effects of GLP1RA on BMI, cardiovascular disease (CVD) risk factors, energy homeostasis and other factors in subjects with HO secondary to CP.

Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 48 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Glucagon-Like Peptide-1 Agonist Effects on Energy Balance in Hypothalamic Obesity
Study Start Date : March 2016
Estimated Primary Completion Date : December 2019
Estimated Study Completion Date : March 2020

Resource links provided by the National Library of Medicine

Drug Information available for: Exenatide

Arm Intervention/treatment
Active Comparator: Exenatide once weekly extended-release
Injections of glucagon-like peptide (GLP)-1 agonist exenatide once weekly extended-release (Bydureon®) for 36 weeks in randomized intervention followed by 18 weeks open label exenatide once weekly extended-release.
Drug: Exenatide
Weekly injections of active drug.
Other Name: Bydureon®

Placebo Comparator: Matching placebo
Weekly injections of placebo for 36 weeks followed by 18 weeks open label exenatide once weekly extended-release.
Drug: placebo
Weekly placebo injections

Primary Outcome Measures :
  1. Percent change of body mass index (BMI) as calculated by the formula: body weight in kg divided by height in meters². [ Time Frame: Baseline and 36 weeks ]

Secondary Outcome Measures :
  1. Changes in in body composition as assessed by body fat mass using dual energy x-ray absorptiometry (DEXA) [ Time Frame: Baseline and 36 weeks ]
  2. Changes in fat and total calorie intake assessed by free buffet meal analysis. [ Time Frame: Baseline and 36 weeks ]
  3. Changes in fasting glucose [ Time Frame: Baseline and 36 weeks ]
  4. Changes in HDL cholesterol and triglycerides assessed by fasting lipids [ Time Frame: Baseline and 36 weeks ]
  5. Changes in inflammation assessed by high sensitive cardio-reactive protein (hsCRP) [ Time Frame: Baseline and 36 weeks ]
  6. Changes of insulin resistance assessed by fasting insulin used for homeostasis model assessment of insulin resistance (HOMA-IR) using the formula insulin [mU/l] x glucose [mmol/l]) / 22.5 [ Time Frame: Baseline and 36 weeks ]
  7. Changes of circulating leptin levels [ Time Frame: Baseline and 36 weeks ]
  8. Changes of energy expenditure assessed by doubly labeled water analysis [ Time Frame: Baseline and 36 weeks ]
  9. Changes of energy intake assessed by Automated Self-Administered 24-Hour Dietary Recall (ASA24-Kids) [ Time Frame: Baseline and 36 weeks ]
  10. Changes in glucose 120 minutes following an oral glucose tolerance test [ Time Frame: Baseline and 36 weeks ]

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

Layout table for eligibility information
Ages Eligible for Study:   10 Years to 25 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Age 10-25 years at time of enrollment
  • Diagnosis of hypothalamic obesity with age- and sex adjusted BMI ≥ 95% or BMI ≥30 kg/m² if over 18 y
  • History of craniopharyngioma or another tumor located in the hypothalamic area
  • Hypothalamic lesion documented by neuroradiology
  • ≥ 6 months post-surgical or radiation treatment
  • Weight stable or increasing over 3 months prior to screening visit
  • Stable hormone replacement for at least 3 months prior to screening visit

Exclusion Criteria:

  • Renal impairment (GFR<60 ml/min/1.73m² using the Schwarz formula)
  • History of gastroparesis; pancreatitis or gallstones (unless status post cholecystectomy)
  • Family history of multiple endocrine neoplasia type 2 or familial medullary thyroid carcinoma metabolic disorders
  • Any insulin-treated diabetes mellitus, poorly controlled type 2 diabetes (HbA1c ≥ 10%), or any other chronic serious medical conditions such as cardiovascular disease, malignancy or hematologic disorder, complicated syndromic disorder, or psychiatric disorders (schizophrenia, major depression, history of suicide attempts)
  • Calcitonin >50 mg/L at screening
  • Initiation of weight loss medications within 3 months of screening visit
  • Previous donation of blood >10% of estimated blood volume within 3 months prior study
  • Current warfarin use
  • Current use of any other GLP1 receptor agonist
  • Untreated thyroid disorder or adrenal insufficiency
  • History of bariatric surgery or planned bariatric surgery until end of study
  • Pregnancy, lactation or expectation to conceive during study period
  • Subject unlikely to adhere to study procedures in opinion of investigator
  • Subject with contraindication to neuroimaging by MRI

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02664441

Layout table for location information
United States, Minnesota
Children's Hospitals adn Clinics of Minnesota
Minneapolis, Minnesota, United States, 55404
United States, Tennessee
Vanderbilt University School of Medicine
Nashville, Tennessee, United States, 37235
United States, Washington
Seattle Childrens
Seattle, Washington, United States, 98105
Sponsors and Collaborators
Seattle Children's Hospital
Children's Hospitals and Clinics of Minnesota
Vanderbilt University
Layout table for investigator information
Principal Investigator: Christian Roth, MD Seattle Childrens

Layout table for additonal information
Responsible Party: Christian Roth, Professor, Seattle Children's Hospital Identifier: NCT02664441     History of Changes
Other Study ID Numbers: R01DK104936-01A1 ( U.S. NIH Grant/Contract )
First Posted: January 27, 2016    Key Record Dates
Last Update Posted: April 4, 2019
Last Verified: April 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Keywords provided by Christian Roth, Seattle Children's Hospital:
Drug intervention
Young adults
Hypothalamic lesion
Change of weight status
Food intake
Energy expenditure
Hormonal changes
Glucagon-like peptide-1 agonist
Weight Loss
Energy balance

Additional relevant MeSH terms:
Layout table for MeSH terms
Nutrition Disorders
Body Weight
Signs and Symptoms
Glucagon-Like Peptide 1
Hypoglycemic Agents
Physiological Effects of Drugs
Anti-Obesity Agents
Hormones, Hormone Substitutes, and Hormone Antagonists
Gastrointestinal Agents