A Phase 3 interventional study of Placebo and Relamorelin in Gastroparesis and Diabetes Mellitus, sponsored by Allergan. Terminated at 216 sites in 14 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-07-29.
Sponsored by Allergan · Phase 3, Interventional, and Treatment
This study will evaluate the safety and efficacy of relamorelin compared to placebo in participants with diabetic gastroparesis. Participants will report daily severity scores of their diabetic gastroparesis symptoms.
Exclusion Criteria:
Following a 2-week placebo run-in, participants received placebo-matching relamorelin injected subcutaneously twice daily for up to 12 weeks.
Drug: Placebo
Following a 2-week placebo run-in, participants received relamorelin 10 μg injected subcutaneously twice daily for up to 12 weeks.
Drug: Relamorelin
Placebo injected subcutaneously twice daily.
Relamorelin 10 micrograms (μg) injected subcutaneously twice daily.
Change From Baseline to Week 12 in the Weekly Diabetic Gastroparesis Symptom Severity Score (DGSSS)
Participants assessed the severity of diabetic gastroparesis symptoms daily using the Diabetic Gastroparesis Symptom Severity Diary (DGSSD), recorded in an electronic diary (e-diary). The DGSSS was derived as the sum of the weekly averages of the 4 DGSSD items: nausea, abdominal pain, postprandial fullness and bloating. Each symptom was scored using an 11-point ordinal scale where: 0=no or not at all uncomfortable to 10=worst possible or most uncomfortable for a total possible DGSSS of 0 (best) to 40 (worst). A negative change from Baseline indicates improvement. Baseline was defined as the average of the 2 weekly DGSSS from the Run-in Period.
Time frame: Baseline (Day-14 to Day-1) to Week 12
Percentage of Participants Meeting the Vomiting Responder Criterion During Each of the Last 6 Weeks of the 12-week Treatment Period
The number of vomiting episodes in the previous 24 hours were assessed daily by the participant using the DGSSD and were recorded in the e-diary. A Vomiting Responder was defined as a participant with zero weekly vomiting episodes during each of the last 6 weeks of the 12-week Treatment Period.
Time frame: Week 6 to Week 12
Percentage of Participants Meeting the Nausea Responder Criterion During Each of the Last 6 Weeks of the 12-week Treatment Period
A Nausea Responder was defined as a participant with improvement (decrease) of at least 2-points in the weekly symptom scores for nausea at each of the last 6 weeks of the 12-week Treatment Period. Nausea was one of the items of the DGSSD assessed daily and recorded in the e-diary by the participant using an 11-point ordinal scale where: 0=no nausea to 10=worst possible nausea.
Time frame: Baseline (Day-14 to Day-1) to (Week 6 to Week 12)
Percentage of Participants Meeting the Abdominal Pain Responder Criterion During Each of the Last 6 Weeks of the 12-week Treatment Period
An Abdominal Pain Responder was defined as a participant with an improvement (decrease) of at least 2-points in the weekly symptom scores for abdominal pain at each of the last 6 weeks of the 12-week Treatment Period. Abdominal pain was one of the items of the DGSSD assessed daily and recorded in the e-diary by the participant using an 11-point ordinal scale where: 0=no abdominal pain to 10=the worst possible abdominal pain and was recorded in an e-diary.
Time frame: Baseline (Day-14 to Day-1) to (Week 6 to Week 12)
Percentage of Participants Meeting the Bloating Responder Criterion During Each of the Last 6 Weeks of the 12-week Treatment Period
A Bloating Responder was defined as a participant with an improvement (decrease) of at least 2-points in the weekly symptom scores for bloating at each of the last 6 weeks of the 12-week Treatment Period. Bloating was one of the items of the DGSSD assessed daily and recorded by the participant in the e-diary using an 11-point ordinal scale where: 0=no bloating and 10=the worst possible bloating and was recorded in the e-diary.
Time frame: Baseline (Day-14 to Day-1) to (Week 6 to Week 12)
Percentage of Participants Meeting the Postprandial Fullness Responder Criterion During Each of the Last 6 Weeks of the 12-week Treatment Period
A Postprandial Fullness Responder was defined as a participant with an improvement (decrease) of at least 2-points in the weekly symptom scores for Postprandial Fullness at each of the last 6 weeks of the 12-week Treatment Period. Postprandial Fullness was one of the items of the DGSSD assessed daily and recorded by the participant in the e-diary using an 11-point ordinal scale where: 0=no feeling of fullness until finishing a meal (best) to 10=feeling full after only a few bites (worst).
Time frame: Baseline (Day-14 to Day-1) to (Week 6 to Week 12)
Number of Participants Who Experienced One or More Treatment-Emergent Adverse Events (TEAE)
An adverse event (AE) is any untoward medical occurrence in a patient or clinical study participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study treatment. A TEAE is an AE that begins or worsens after receiving study drug.
Time frame: Up to approximately 16 weeks
Number of Participants With Potential Clinically Significant (PCS) Clinical Laboratory Results
Clinical Laboratory tests included Hematology, Chemistry and Urinalysis tests. The investigator determined if the results were clinically significant. Only those categories where at least 1 person had a non-PCS value at Baseline and met the PCS criterion at least once during postbaseline are reported.
Time frame: Up to 12 weeks
Number of Participants With Clinically Meaningful Trends for Vital Signs
Vital Signs included assessments of heart rate, respiratory rate, systolic and diastolic blood pressure, and body temperature. The investigator determined if the results were clinically significant.
Time frame: Up to 12 weeks
Number of Participants With Clinically Significant Abnormal Electrocardiogram (ECG) Results
A standard 12-lead ECG was performed. The investigator determined if the abnormal results were clinically significant.
Time frame: Up to 12 weeks
Number of Participants With a ≥1% Increase in Glycosylated Hemoglobin A1c (HBA1c)
HbA1c is also known as glycosylated hemoglobin. It is the concentration of glucose bound to hemoglobin as a percentage of the absolute maximum that can be bound.
Time frame: Baseline (Day 1) up to 12 weeks
Number of Participants With Anti-relamorelin Antibody Testing Results by Visit
A blood sample was collected that was sent to a laboratory for an anti-relamorelin antibody screening test. A positive screening test was confirmed by an immunodepletion assay. The number of participants in each of the following categories are reported: Negative Screening Test, Positive Screening Test, Negative Confirmatory Test, and Positive Confirmatory Test at each time point.
Time frame: Baseline (Day 1), Day 14, Day 28, Day 84, and End of Treatment (Up to Day 84)
| Milestone | Placebo | Relamorelin 10 μg |
|---|---|---|
| Started | 167 | 169 |
| Safety population | 163 | 163 |
| Completed | 147 | 146 |
| Not completed | 20 | 23 |
| Withdrew: Adverse event | 3 | 7 |
| Withdrew: Withdrawal by subject | 8 | 9 |
| Withdrew: Lost to follow-up | 3 | 1 |
| Withdrew: Protocol deviation | 6 | 5 |
| Withdrew: Reason not specified | 0 | 1 |
Participants assessed the severity of diabetic gastroparesis symptoms daily using the Diabetic Gastroparesis Symptom Severity Diary (DGSSD), recorded in an electronic diary (e-diary). The DGSSS was derived as the sum of the weekly averages of the 4 DGSSD items: nausea, abdominal pain, postprandial fullness and bloating. Each symptom was scored using an 11-point ordinal scale where: 0=no or not at all uncomfortable to 10=worst possible or most uncomfortable for a total possible DGSSS of 0 (best) to 40 (worst). A negative change from Baseline indicates improvement. Baseline was defined as the average of the 2 weekly DGSSS from the Run-in Period.
| score on a scale | Placebo | Relamorelin 10 μg |
|---|---|---|
| Baseline | 25.1 ± 5.53 | 24.5 ± 5.99 |
| Change from Baseline to Week 12 | -10.0 ± 8.89 | -9.3 ± 8.17 |
The number of vomiting episodes in the previous 24 hours were assessed daily by the participant using the DGSSD and were recorded in the e-diary. A Vomiting Responder was defined as a participant with zero weekly vomiting episodes during each of the last 6 weeks of the 12-week Treatment Period.
| percentage of participants | Placebo | Relamorelin 10 μg |
|---|---|---|
| Percentage of Participants Meeting the Vomiting Responder Criterion During Each of the Last 6 Weeks of the 12-week Treatment Period | 19.5 | 21.8 |
A Nausea Responder was defined as a participant with improvement (decrease) of at least 2-points in the weekly symptom scores for nausea at each of the last 6 weeks of the 12-week Treatment Period. Nausea was one of the items of the DGSSD assessed daily and recorded in the e-diary by the participant using an 11-point ordinal scale where: 0=no nausea to 10=worst possible nausea.
| percentage of participants | Placebo | Relamorelin 10 μg |
|---|---|---|
| Percentage of Participants Meeting the Nausea Responder Criterion During Each of the Last 6 Weeks of the 12-week Treatment Period | 34.1 | 29.7 |
An Abdominal Pain Responder was defined as a participant with an improvement (decrease) of at least 2-points in the weekly symptom scores for abdominal pain at each of the last 6 weeks of the 12-week Treatment Period. Abdominal pain was one of the items of the DGSSD assessed daily and recorded in the e-diary by the participant using an 11-point ordinal scale where: 0=no abdominal pain to 10=the worst possible abdominal pain and was recorded in an e-diary.
| percentage of participants | Placebo | Relamorelin 10 μg |
|---|---|---|
| Percentage of Participants Meeting the Abdominal Pain Responder Criterion During Each of the Last 6 Weeks of the 12-week Treatment Period | 28.0 | 27.9 |
A Bloating Responder was defined as a participant with an improvement (decrease) of at least 2-points in the weekly symptom scores for bloating at each of the last 6 weeks of the 12-week Treatment Period. Bloating was one of the items of the DGSSD assessed daily and recorded by the participant in the e-diary using an 11-point ordinal scale where: 0=no bloating and 10=the worst possible bloating and was recorded in the e-diary.
| percentage of participants | Placebo | Relamorelin 10 μg |
|---|---|---|
| Percentage of Participants Meeting the Bloating Responder Criterion During Each of the Last 6 Weeks of the 12-week Treatment Period | 26.2 | 27.9 |
A Postprandial Fullness Responder was defined as a participant with an improvement (decrease) of at least 2-points in the weekly symptom scores for Postprandial Fullness at each of the last 6 weeks of the 12-week Treatment Period. Postprandial Fullness was one of the items of the DGSSD assessed daily and recorded by the participant in the e-diary using an 11-point ordinal scale where: 0=no feeling of fullness until finishing a meal (best) to 10=feeling full after only a few bites (worst).
| percentage of participants | Placebo | Relamorelin 10 μg |
|---|---|---|
| Percentage of Participants Meeting the Postprandial Fullness Responder Criterion During Each of the Last 6 Weeks of the 12-week Treatment Period | 22.6 | 25.5 |
An adverse event (AE) is any untoward medical occurrence in a patient or clinical study participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study treatment. A TEAE is an AE that begins or worsens after receiving study drug.
| Participants | Placebo | Relamorelin 10 μg |
|---|---|---|
| Number of Participants Who Experienced One or More Treatment-Emergent Adverse Events (TEAE) | 68 | 70 |
Clinical Laboratory tests included Hematology, Chemistry and Urinalysis tests. The investigator determined if the results were clinically significant. Only those categories where at least 1 person had a non-PCS value at Baseline and met the PCS criterion at least once during postbaseline are reported.
| Participants | Placebo | Relamorelin 10 μg |
|---|---|---|
| Eosinophils Absolute Cell Count [10^9/liter(L)]: >3×Upper Limit of Normal Value (ULN) | 0 | 1 |
| Hematocrit (RATIO): <0.9×Lower Limit of Normal Value (LLN) | 2 | 2 |
| Hemoglobin (g/L): <0.9×LLN | 10 | 4 |
| Lymphocytes Absolute Cell Count (10^9/L): >1.5×ULN | 1 | 0 |
| Lymphocytes Absolute Cell Count (10^9/L): <0.8×LLN | 2 | 1 |
| Mean Corpuscular Volume [femtoliter (fL)]: >1.1×ULN | 2 | 0 |
| Neutrophils Absolute Cell Count (10^9/L): >1.5×ULN | 0 | 1 |
| Neutrophils Absolute Cell Count (10^9/L): <0.8×LLN | 2 | 3 |
| Platelet Count (Thrombocytes) (10^9/L): >1.5×ULN | 0 | 1 |
| Red Blood Cell Count (10^12/L): >1.1×ULN | 0 | 1 |
| Red Blood Cell Count (10^12/L): <0.9×LLN | 1 | 1 |
| White Blood Cell Count (10^9/L): >1.5×ULN | 1 | 1 |
| Bicarbonate (HCO3) (mmol/L): >1.1×ULN | 3 | 1 |
| Bicarbonate (HCO3) (mmol/L): >0.9×LLN | 3 | 1 |
| Blood Urea Nitrogen [millimoles(mmol/L)]: >1.2×ULN | 11 | 11 |
| Calcium (mmol/L): <0.9×LLN | 0 | 1 |
| Cholesterol, Total, Non-Fasting (mmol/L) | 0 | 1 |
| Creatinine [micromoles(μmol/L)]: >1.3×ULN | 7 | 8 |
| Glucose-Chemistry, Fasting (mmol/L): >2.5×ULN | 10 | 21 |
| Glucose-Chemistry, Fasting (mmol/L): <0.9×LLN | 3 | 1 |
| Glycohemoglobin A1C: Increase of >=0.5% | 91 | 125 |
| Glycohemoglobin A1C: Increase of >=1% | 91 | 124 |
| Phosphorus (mmol/L): >1.1×ULN | 2 | 5 |
| Phosphorus (mmol/L): <0.9×LLN | 0 | 1 |
| Triglycerides, Fasting (mmol/L): >=3×ULN | 5 | 5 |
| Uric Acid (Urate) (μmol/L): >1.1×ULN | 10 | 18 |
| Uric Acid (Urate) (μmol/L): <0.9×LLN | 1 | 3 |
Vital Signs included assessments of heart rate, respiratory rate, systolic and diastolic blood pressure, and body temperature. The investigator determined if the results were clinically significant.
| Participants | Placebo | Relamorelin 10 μg |
|---|---|---|
| Number of Participants With Clinically Meaningful Trends for Vital Signs | 0 | 0 |
A standard 12-lead ECG was performed. The investigator determined if the abnormal results were clinically significant.
| Participants | Placebo | Relamorelin 10 μg |
|---|---|---|
| Number of Participants With Clinically Significant Abnormal Electrocardiogram (ECG) Results | 4 | 3 |
HbA1c is also known as glycosylated hemoglobin. It is the concentration of glucose bound to hemoglobin as a percentage of the absolute maximum that can be bound.
| Participants | Placebo | Relamorelin 10 μg |
|---|---|---|
| Glycohemoglobin A1C: Increase of >=0.5% | 91 | 125 |
| Glycohemoglobin A1C: Increase of >=1% | 91 | 124 |
A blood sample was collected that was sent to a laboratory for an anti-relamorelin antibody screening test. A positive screening test was confirmed by an immunodepletion assay. The number of participants in each of the following categories are reported: Negative Screening Test, Positive Screening Test, Negative Confirmatory Test, and Positive Confirmatory Test at each time point.
| Participants | Relamorelin 10 μg |
|---|---|
| Screening Test (Baseline) — Negative | 133 |
| Screening Test (Baseline) — Positive | 16 |
| Confirmatory Test (Baseline) — Negative | 13 |
| Confirmatory Test (Baseline) — Positive | 2 |
| Screening Test (Day 14) — Negative | 124 |
| Screening Test (Day 14) — Positive | 13 |
| Confirmatory Test (Day 14) — Negative | 13 |
| Confirmatory Test (Day 14) — Positive | 0 |
| Screening Test (Day 28) — Negative | 115 |
| Screening Test (Day 28) — Positive | 16 |
| Confirmatory Test (Day 28) — Negative | 15 |
| Confirmatory Test (Day 28) — Positive | 1 |
| Screening Test (Day 84) — Negative | 95 |
| Screening Test (Day 84) — Positive | 16 |
| Confirmatory Test (Day 84) — Negative | 14 |
| Confirmatory Test (Day 84) — Positive | 1 |
| Screening Test (End of Treatment) — Negative | 13 |
| Screening Test (End of Treatment) — Positive | 2 |
| Confirmatory Test (End of Treatment) — Negative | 2 |
| Confirmatory Test (End of Treatment) — Positive | 0 |
| Screening Test (Unscheduled) — Negative | 2 |
| Screening Test (Unscheduled) — Positive | 2 |
| Confirmatory Test (Unscheduled) — Negative | 1 |
| Confirmatory Test (Unscheduled) — Positive | 1 |
Collected over Up to approximately 16 weeks. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Placebo | 0/167 (0%) | 15/163 (9.2%) | 9/163 (5.5%) |
| Relamorelin 10 μg | 0/169 (0%) | 16/163 (9.8%) | 9/163 (5.5%) |
| Event | Placebo | Relamorelin 10 μg |
|---|---|---|
| PneumoniaInfections and infestations | 3/163 | 2/163 |
| DiverticulitisInfections and infestations | 0/163 | 2/163 |
| Urinary tract infectionInfections and infestations | 2/163 | 1/163 |
| SepsisInfections and infestations | 2/163 | 0/163 |
| FallInjury, poisoning and procedural complications | 2/163 | 2/163 |
| Acute kidney injuryRenal and urinary disorders | 2/163 | 1/163 |
| Acute respiratory failureRespiratory, thoracic and mediastinal disorders | 2/163 | 0/163 |
| AnaemiaBlood and lymphatic system disorders | 0/163 | 1/163 |
| LeukopeniaBlood and lymphatic system disorders | 1/163 | 0/163 |
| ThrombocytopeniaBlood and lymphatic system disorders | 1/163 | 0/163 |
| Event | Placebo | Relamorelin 10 μg |
|---|---|---|
| HyperglycaemiaMetabolism and nutrition disorders | 9/163 | 9/163 |
ITT Population included all randomized participants.
| Age, Continuous(years) | Placebo | Relamorelin 10 μg | Total |
|---|---|---|---|
| Mean | 55.4 ± 10.78 | 56.3 ± 11.47 | 55.9 ± 11.13 |
| Sex: Female, Male(Participants) | Placebo | Relamorelin 10 μg | Total |
|---|---|---|---|
| Female | 107 | 115 | 222 |
| Male | 60 | 54 | 114 |
| Ethnicity (NIH/OMB)(Participants) | Placebo | Relamorelin 10 μg | Total |
|---|---|---|---|
| Hispanic or Latino | 51 | 53 | 104 |
| Not Hispanic or Latino | 116 | 116 | 232 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Race (NIH/OMB)(Participants) | Placebo | Relamorelin 10 μg | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 1 | 1 |
| Asian | 26 | 24 | 50 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 25 | 19 | 44 |
| White | 116 | 125 | 241 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 0 | 0 |
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