Treating PCOS With Semaglutide vs Active Lifestyle Intervention
Status:
Recruiting
Sponsors
University of Colorado, Denver
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Abstract:
Girls with obesity and polycystic ovarian syndrome will receive either glucagon like peptide-1 receptor agonist therapy or a dietary intervention for 12 weeks to decrease the metabolic syndrome, in particular to lower hepatic fat and improve insulin sensitivity.
Description:
In obese girls with polycystic ovarian syndrome, testosterone and obesity combine to create unique pathology to increase metabolic disease including fatty liver and insulin resistance, which may be mediated by altered glucagon like peptide-1 activity. The investigators will treat girls with obesity and polycystic ovarian syndrome for 4 months with a glucagon like peptide-1 receptor agonist compared to dietary intervention to primarily lower hepatic fat and secondarily improve whole body and adipose insulin sensitivity. Mechanisms of hepatic metabolism, including rates of de novo lipogenesis and relative mitochondrial flux will also be assessed.
Last Verified:April/30/2020
First Submitted:April/14/2019
Estimated Enrollment Submitted:April/15/2019
First Posted:April/17/2019
Last Update Submitted:May/3/2020
Last Update Posted:May/5/2020
Actual Study Start Date:May/2/2019
Estimated Primary Completion Date:June/30/2024
Estimated Study Completion Date:June/30/2024
Condition or disease:PCOS
Adolescent Obesity
NAFLD
Intervention/treatment:
Drug: GLP-1 Intervention
Other: Diet Intervention
Phase:Phase 2/Phase 3
Study design:
Study Type:Interventional
Allocation:Randomized
Primary Purpose:Treatment
Masking:None (Open Label)
Arm group:
ArmIntervention/treatment
Active Comparator: Diet Intervention
Weight loss with dietary intervention
Other: Diet Intervention
Prescribed weight loss diet to match weight loss in Drug arm
Experimental: GLP-1 Intervention
Participants will take a daily oral tablet of semaglutide for 4 months.
Drug: GLP-1 Intervention
Once daily oral tablet of semaglutide for 4 months
Eligibility Criteria:
Ages Eligible for Study:12 Years to 12 Years
Sexes Eligible for Study:Female
Accepts Healthy Volunteers:Yes
Criteria:

Inclusion Criteria:

1. Sedentary- less than 2 hours of moderate (jogging, swimming etc) exercise a week.

2. BMI equal or greater than the 90th percentile for age and gender

3. PCOS per the most stringent NIH criteria adapted for adolescents (irregular menses >12 months post-menarche and clinical or biochemical hypertestosteronemia

4. Participants cannot be on hormonal contraception, so participants should remain abstinent or use reliable non-hormonal contraception (e.g. copper IUD) for the entire study period. For participants who receive semaglutide, they should avoid pregnancy for at least 2 months after stopping medication to avoid fetal exposure to the medication.

Exclusion Criteria:

1. Diagnosed with or have a family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Family history of medullary thyroid cancer or thyroid nodule palpated by endocrinologist at screening.

2. Use of medications known to affect insulin sensitivity: metformin (cannot have been used in the 3 months prior to screening), oral glucocorticoids within 10 days, atypical antipsychotics, immunosuppressant agents, HIV medications, hormonal contraception (cannot have been used in the 6 months prior to screening). Dermal patch or vaginal ring contraception methods.Weight loss medications or stimulants. Use of other products containing other GLP-1 agonists.

3. Currently pregnant or breastfeeding women. Development of pregnancy during the study period will necessitate withdrawal from the study.

4. Severe illness requiring hospitalization within 60 days.

5. Diabetes, defined as Hemoglobin A1C > 6.4%

6. BMI percentile less than the 90th percentile for age and sex. Weight >325 lbs. or <84 lbs.

7. Anemia, defined as Hemoglobin < 11 mg/dL

8. Diagnosed major psychiatric or developmental disorder limiting informed consent.

9. Implanted metal devices that are not compatible with MRI

10. Use of blood pressure medications.

11. Known liver disease other than NAFLD or AST or ALT >100 IU/L.

12. Personal history of pancreatitis

13. Known renal disease of any severity or an eGFR at screening of <45ml/min/1.73m2

14. History of severe GI disease (e.g. gastroparesis)

15. History of gallstones

16. Untreated thyroid disease

17. History of hypersensitivity to semaglutide

18. Other causes of hyperandrogenism (example: tumor, CAH) or amenorrhea (untreated thyroid disease, tumor, primary ovarian failure, prolactinoma).

19. Active symptoms or undergoing treatment for anorexia nervosa or binging/purging disorder

Outcome:
Primary Outcome Measures
1. Change in Hepatic Fat Fraction [Baseline and 12 weeks]
Change from baseline in presence/severity of hepatic fat fraction will be measured with MRI, and calculated via the Dixon method as the proton density hepatic fat fraction, which ranges from 0-75%.
Secondary Outcome Measures
1. Change in Rate of De Novo Lipogenesis [Baseline and 12 weeks]
Change from baseline of the rate of overnight de novo lipogenesis will be measured utilizing stable isotope methods with deuterated water, and expressed as the rate of newly synthesized lipids in the serum triglyceride fraction.
2. Change in Whole Body Insulin Sensitivity [Baseline and 12 weeks]
Participants will undergo a 75 gram oral glucose tolerance test, and the change from baseline in whole body insulin sensitivity will be expressed as Si, calculated via the oral minimal model.
3. Change in Adipose Insulin Sensitivity [Baseline and 12 weeks]
Change from baseline of adipose insulin sensitivity will be calculated as the percent suppression of free fatty acids, and the nadir of free fatty acids during the oral glucose tolerance test.
Other Outcome Measures
1. Evaluation of Mitochondrial function via change in ratios of direct to indirect hepatic carbon flux in newly synthesized triglycerides [Baseline and 12 weeks]
OSTT with UC13 glycerol baseline and 12 weeks
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