Trial to compare the efficacy and safety of once-weekly lonapegsomatropin with placebo and a daily somatropin product in adults with growth hormone deficiency

Phase 1

Conditions: Adult Growth Hormone Deficiency (AGHD)
MedDRA version: 20.0Level: PTClassification code 10056438Term: Growth hormone deficiencySystem Organ Class: 10014698 - Endocrine disorders
Therapeutic area: Diseases [C] - Hormonal diseases [C19]

Registration Number: EUCTR2020-000929-42-IT

Lead Sponsor: Ascendis Pharma Endocrinology Division A/S

Brief Summary: Not available

Detailed Description: Not available

Recruitment & Eligibility

Status: Authorised-recruitment may be ongoing or finished

Sex: All

Target Recruitment: 240

Inclusion Criteria

1. Age between 23 and 75 years, inclusive, at screening.
2. AGHD Diagnosis Criteria
For adult-onset AGHD: documented history of structural hypothalamic-pituitary disease, hypothalamic-pituitary surgery, cranial irradiation, 1-4 non-GH pituitary hormone deficiencies, a proven genetic cause of GHD, or traumatic brain injury (TBI).
Subjects with childhood-onset GHD must have had GH axis re assessed at final height.
In subjects with TBI as a cause of GHD, GHD must be confirmed by GH stimulation testing performed at least 12 months after the injury.
For all subjects, documentation of test results must be available before randomization. Stimulation test protocols and results are subject to review and approval by the Medical Monitor.
A. For all countries except Japan: Subjects must satisfy at least one of the following criteria:
a. Insulin tolerance test: peak GH =5 ng/mL
b. Glucagon stimulation test according to body mass index (BMI)
i. BMI =30 kg/m2: peak GH =3 ng/mL
ii. BMI >30 kg/m2: peak GH =1 ng/mL
c. Three or four pituitary axis deficiencies (ie, adrenal, thyroid, gonadal, and/or vasopressin; not including GH) with IGF-1 SDS = -2.0 at screening as measured by central laboratory,
d. Macimorelin test: peak GH =2.8 ng/mL
e. Growth hormone-releasing hormone (GHRH) + arginine test according to BMI:
i. BMI <25 kg/m2, peak GH <11 ng/mL
ii. BMI =25–=30 kg/m2, peak GH <8 ng/mL
iii. BMI >30 kg/m2, peak GH <4 ng/mL
B. For Japan only: Subjects with adult-onset AGHD and deficiency of one or more other pituitary hormones need to satisfy at least one of the following criteria, while subjects with isolated GHD and no evidence of intracranial structure disorder (structural hypothalamic-pituitary disease) or with adult-onset AGHD without deficiency of other pituitary hormones need to satisfy at least 2 of the following criteria:
a. Insulin tolerance test: peak GH =1.8 ng/mL
b. Glucagon test: peak GH =1.8 ng/mL
c. Growth Hormone-Releasing Peptide-2 (GHRP-2) tolerance test: peak GH =9 ng/mL
3. IGF-1 SDS = -1.0 at screening as measured by central laboratory.
4. hGH treatment-naïve or no exposure to hGH therapy or GH secretagogue for at least 12 months prior to screening.
5. For subjects on hormone replacement therapies for any hormone deficiencies other than GH (eg, adrenal, thyroid, estrogen, testosterone) must be on adequate and stable doses for =6 weeks prior to and throughout screening.
6. For subjects not on glucocorticoid replacement therapy, documentation of adequate adrenal function at screening defined as: morning (6:00-10:00AM) serum cortisol >15.0 ng/mL (measured at central laboratory) and/or Adrenocorticotrophic Hormone (ACTH) stimulation test or ITT with serum cortisol >18.0 ng/mL at or within 26 weeks prior to screening.
7. For males not on testosterone replacement therapy: morning (6:00 10:00AM) total testosterone within normal limits for age as measured by the central laboratory at screening.
8. On a stable diet and exercise regime at screening with no intention to modify diet or exercise pattern during the trial, ie, no weight reduction program intended during the trial or within the last 90 days prior to or through screening.
9. No plans to undergo bariatric surgery during the trial.
10. Normal fundoscopy at screening (without signs/symptoms of intracranial hypertension or diabetic retinopathy stage 2 / moderate or above). For subjects with a diagnosis of diabetes mellitus at screening, this must be documented with a fundus photogr

Exclusion Criteria

1. Known Prader-Willi Syndrome and/or other genetic diseases that may have an impact on an endpoint; individual cases to be discussed by the Investigator with the Medical Monitor.
2. Diabetes mellitus at screening if any of the following criteria are met:
a. Poorly controlled diabetes, defined as HbA1c >7.5% at screening according to central laboratory
b. Diabetes mellitus (defined as HbA1c =6.5% and/or fasting plasma glucose =126 mg/dL and/or plasma glucose =200 mg/dL two hours after oral glucose tolerance test) diagnosed <26 weeks prior to screening
c. Change in diabetes regimen (includes dose adjustment) within <90 days prior and throughout screening
d. Use of any diabetes drugs other than metformin and/or DPP 4 inhibitors for a cumulative duration of greater than 4 weeks within 12 months prior to screening
e. Diabetes-related complications at screening (ie, nephropathy as judged by the investigator, neuropathy requiring pharmacological treatment, retinopathy stage 2 / moderate and above within 90 days prior to screening or during screening)
3. Active malignant disease or history of malignancy. Exceptions to this exclusion criterion:
a. Resection of in situ carcinoma of the cervix uteri
b. Complete eradication of squamous cell or basal cell carcinoma of the skin
c. Subjects with GHD attributed to treatment of intracranial malignant tumors or leukemia, provided that a recurrence-free survival period of at least 5 years prior to screening is documented in the subject’s file based on a Magnetic Resonance Imaging (MRI) result
4. Evidence of growth of pituitary adenoma or other benign intracranial tumor within the last 12 months before screening.
5. Subjects with acromegaly without remission / with documented remission less than 24 months prior to screening.
6. Subjects with Cushing’s disease without remission / with documented remission less than 24 months prior to screening.
7. Subjects with prior cranial irradiation or hypothalamic-pituitary surgery: the procedure took place less than 12 months prior to screening.
8. Any disease or condition that, in the judgement of the investigator, may make the subject unlikely to comply with the requirements of the trial or any condition that presents undue risk from the investigational product or procedures.
9. Participation in another interventional clinical trial involving an investigational compound within 26 weeks prior to screening or in parallel to this trial.

Study & Design

Study Type: Interventional clinical trial of medicinal product

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Main Objective: To evaluate the efficacy of once-weekly lonapegsomatropin compared to placebo at 38 weeks in adults with growth hormone deficiency (GHD).;Secondary Objective: 1. To evaluate the safety and tolerability of once-weekly lonapegsomatropin in adults with GHD.<br>2. To evaluate the pharmacokinetics (PK) of once-weekly lonapegsomatropin in adults with GHD.<br>3. To evaluate the pharmacodynamics (PD) of once-weekly lonapegsomatropin in adults with GHD.;Primary end point(s): Change from baseline in trunk percent fat (as assessed by dual-energy x ray absorptiometry [DXA]) at Week 38.;Timepoint(s) of evaluation of this end point: at week 38

Secondary Outcome Measures

Name	Time	Method
Secondary end point(s): • Change from baseline in trunk fat mass at Week 38 (as assessed by DXA).<br>• Change from baseline in total body lean mass at Week 38 (as assessed by DXA).<br>;Timepoint(s) of evaluation of this end point: at week 38

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