Effects of Exenatide on Overweight Adolescents With Prader-Willi Syndrome
Prader-Willi Syndrome (PWS) is one of the most common genetic causes of obesity. Obesity is a major source of morbidity and mortality in this population. It can lead to sleep apnea, cor pulmonale, diabetes mellitus, and atherosclerosis. PWS has distinct characteristics that set it apart from other forms of obesity including insatiable appetite and food-seeking behavior which can be disruptive to home and school activities, and can cause severe social and psychological turmoil within families. PWS is also associated with unique hormonal abnormalities, most notably hyperghrelinemia. Ghrelin is a gut hormone produced in the stomach that stimulates food intake during a fast. It is hypothesized that the extremely high ghrelin levels in patients with PWS may cause or contribute to their insatiable appetite. Exenatide, a medication used in the treatment of type 2 diabetes mellitus in adults, appears to suppress ghrelin levels and cause weight loss. It was designed to mimic glucagon-like peptide 1 (GLP-1), an incretin hormone that stimulates insulin secretion and delays gastric emptying, among other effects. In the present study, the investigators will investigate the effects of a 6 month trial of exenatide in overweight adolescents with PWS. The investigators will quantify the changes in weight and body composition, as well as subjective measures of appetite, and concentrations of appetite-associated hormones. The investigators hypothesize that exenatide will improve weight, body composition, appetite, and plasma ghrelin levels during the treatment period.
|Study Design:||Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Effects of Exenatide on Obesity and Appetite in Overweight Patients With Prader-Willi Syndrome|
- Change in weight [ Time Frame: Weight at baseline, 1 month, 3 months and 6 months of treatment ] [ Designated as safety issue: No ]
- Change in Body Mass Index (BMI) [ Time Frame: BMI at baseline, 1 month, 3 months and 6 months of treatment ] [ Designated as safety issue: No ]
- Change in body composition [ Time Frame: Body composition at baseline and 6 months of treatment ] [ Designated as safety issue: No ]The investigators will measure body fat composition by whole body DEXA scan at baseline and after 6 months of treatment with exenatide.
- Change in appetite [ Time Frame: Appetite scored at baseline, 1 month, 3 months and 6 months of treatment ] [ Designated as safety issue: No ]The investigators will measure appetite scores using a syndrome-validated hyperphagia questionnaire administered at all visits except for the screening visit.
- Change in fasting and post-prandial levels of obesity-related hormones [ Time Frame: Levels will be measured at baseline, 1 month, 3 months, and 6 months of treatment. ] [ Designated as safety issue: No ]The investigators will measure serum fasting and post-prandial levels of obesity-realated hormones (ghrelin, peptide tyrosine tyrosine [PYY], pancreatic polypeptide [PP], leptin, glucose, and insulin) over a 6-month course of exenatide. The investigators will measure fasting and post-prandial serum/plasma levels of these analytes during a standardized mixed meal tolerance test (MMTT) prior to and then after 6 months of treatment. The investigators will also monitor fasting levels of these analytes after 1 and 3 months of treatment
|Study Start Date:||March 2012|
|Estimated Study Completion Date:||December 2013|
|Primary Completion Date:||May 2013 (Final data collection date for primary outcome measure)|
All subjects enrolled in this study will be given Exenatide for 6 months.
The investigators will give patients naive to GLP-1 agonists exenatide per manufacturer dosing recommendations for 6 months. The investigators will begin by giving 5 mcg subcutaneously twice a day for 1 month and then increase the dose to 10 mcg subcutaneously twice a day for the remainder of the study (5 months).
Other Name: Byetta
|United States, California|
|Children's Hospital of Los Angeles|
|Los Angeles, California, United States, 90027|
|Principal Investigator:||Debra Jeandron, MD||Children's Hospital Los Angeles|