Obesity
Conditions
Keywords
obesity, overweight, magnetic resonance imaging, naltrexone, bupropion
Brief summary
The purpose of this study was to assess the effect of naltrexone SR/bupropion SR (NB) on brain function in response to food cues using functional magnetic resonance imaging in overweight or obese subjects.
Interventions
DRUGPlacebo
OTHERfMRI scan
fMRI to assess the effects of the drug/placebo on areas of the brain
Sponsors
Orexigen Therapeutics, Inc
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 45 Years
Healthy volunteers
No
Inclusion criteria
* Right-handed, female subjects, 18 to 45 years of age * Body mass index (BMI) ≥ 27 and ≤ 40 kg/m² * Free from clinically significant illness or disease as determined by medical history and physical examination * Able to provide proof of identity during the enrollment process * In good general health, without clinically significant medical history, physical examination findings or laboratory results * Laboratory values obtained within 30 days of study entry within normal range for healthy volunteers. * Normal urinalysis on initial screening day defined as: negative glucose, negative or trace protein, and negative or trace hemoglobin * Normotensive (systolic ≤140 mm Hg, diastolic ≤90 mm hg) * On no concomitant medications with the exception of oral contraceptives, vitamins, and over the counter pain, indigestion or allergy medication * All women of child bearing potential must be non-lactating, must have a negative STAT pregnancy test, and agree to use effective contraception methods throughout study period and for 30 days after discontinuation of study drug. The following are considered effective methods of contraception: Combination or progestin-only birth control pills (oral contraceptives), vaginal contraceptive rings, contraceptive patches, Depo Provera, intrauterine devices, barrier methods with spermicide (condom/foam, diaphragm/ spermicide), abstinence. (Subjects who have had a tubal ligation, hysterectomy or are post-menopausal for 2 years are considered NOT to be of child bearing potential) * For women not using hormonal methods of contraception, should be in the follicular phase of the menstrual cycle at the baseline visit. * Non-smoker and no use of tobacco or nicotine products for at least 6 months prior to baseline. On screening and study days, we will test the subjects' urine for presence of nicotinine/cotinine (STAT) test as confirmatory evidence of being a non-smoker in addition to their self-report. A Tobacco Questionnaire and Breath CO will also be administered for eligibility on the day of screening for confirmation purposes. * No clinically significant abnormality on ECG, baseline QTc \<470 * Able to comply with all required study procedures * Available for follow up for the duration of the study * Willing and able to give written informed consent
Exclusion criteria
* Obesity of known endocrine or genetic origin (e.g., untreated hypothyroidism, Cushing's syndrome, Prader Willi Syndrome, established Polycystic Ovary Syndrome) * Inability to participate in fMRI scanning sessions * History of occupational exposure to metal flakes in their bodies or eyes. * History of known indwelling ferromagnetic metals or fragments. * History of acute or chronic illness that requires medical therapy including active gastrointestinal conditions that might interfere with drug absorption * History or presence of hepatic, renal, cardiovascular or gastrointestinal diseases * Type I or Type II diabetes mellitus requiring pharmacotherapy * Active malignancy or history of malignancy (other than non-melanoma skin cancer or surgically cured cervical cancer) within 5 years of enrollment * Serious psychiatric illness, including lifetime history of psychiatric hospitalization, suicide attempt, bipolar disorder, schizophrenia or other psychosis, bulimia, or anorexia nervosa; current serious personality disorder, (e.g. borderline or antisocial), major depressive disorder within the previous two years, suicidal ideation or need for psychiatric treatment in the previous 6 months. * In need of medications for the treatment of a psychiatric disorder within the previous 6 months prior to randomization. * IDS-SR total score \>25 or scores \>1 in items 5 (sadness), 6 (irritability), 7 (anxiety/tension) or 18 (suicidality) * History of alcohol or drug abuse, current or within 2 years * Unable to abstain from caffeinated product consumption for at least 48 hours * History of surgical intervention for obesity * Use of drugs, herbs, or dietary supplements believed to significantly affect body weight or participation in a weight loss management program within one month prior to randomization. * History of hypersensitivity to bupropion or naltrexone * History of seizure disorder or predisposition to seizures (e.g., history of cerebrovascular accident, brain surgery, head trauma with ≥5 minutes loss of consciousness, concussion symptoms lasting ≥ 15 minutes, skull fracture, subdural hematoma, or febrile seizures) or need for therapy with anticonvulsant medication. * History of treatment with bupropion or naltrexone within 12 months * Positive urine drug screen - STAT test performed on each day of study. * Pregnant or breast-feeding * Planned surgical procedure or trip that can impact the conduct of the study * Use of investigational drug, device or procedure within 30 days * Any condition which in the opinion of the investigator makes the subject unsuitable for inclusion in this study * Participation in any previous clinical trial sponsored by Orexigen Therapeutics. * Study personnel, sponsor representatives and their immediate families.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Posterior Insula | Baseline, 4 weeks | Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo. |
| Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Superior Frontal | Baseline, 4 weeks | Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo. |
| Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Anterior Cingulate | Baseline, 4 weeks | Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo. |
| Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Hippocampal Region 1 | Baseline, 4 weeks | Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo. |
| Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Hippocampal Region 2 | Baseline, 4 weeks | Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo. |
| Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Superior Parietal | Baseline, 4 weeks | Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent Change in Body Weight | Baseline, 4 weeks | — |
| Dutch Eating Behavior Questionnaire - Change in Restrained Eating Subscale Score | Baseline, 4 weeks | The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale, where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The Restrained Eating subscale consisted of 10 items and the scores ranged from 10 (worse outcome) to 50 (better outcome). |
| Dutch Eating Behavior Questionnaire - Change in Emotional Eating A Subscale Score | Baseline, 4 weeks | The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale, where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The Emotional Eating A subscale (clearly labeled emotions) consisted of 9 items and the scores ranged from 9 (better outcome) to 45 (worse outcome). |
| Dutch Eating Behavior Questionnaire - Change in Emotional Eating B Subscale Score | Baseline, 4 weeks | The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale, where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The Emotional Eating B subscale (diffuse emotions) consisted of 4 items and the scores ranged from 4 (better outcome) to 20 (worse outcome). |
| Dutch Eating Behavior Questionnaire - Change in External Eating Subscale Score | Baseline, 4 weeks | The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The External Eating subscale consisted of 10 items and the scores ranged from 10 (better outcome) to 50 (worse outcome). |
| Change in Question 19 From 21-Item COE (Control of Eating) Questionnaire | Baseline, 4 weeks | Question 19: Generally, how difficult has it been to control your eating? Scoring: 0=not at all difficult; 100=extremely difficult |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| NB32 Naltrexone SR 32 mg/day plus bupropion SR 360 mg/day
fMRI scan: fMRI to assess the effects of the drug/placebo on areas of the brain | 23 |
| Placebo Placebo tablets
fMRI scan: fMRI to assess the effects of the drug/placebo on areas of the brain | 23 |
| Total | 46 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 3 | 1 |
| Overall Study | Lost to Follow-up | 0 | 1 |
| Overall Study | Noncompliance | 0 | 1 |
Baseline characteristics
| Characteristic | NB32 | Placebo | Total |
|---|---|---|---|
| Age, Continuous | 30.96 years STANDARD_DEVIATION 7.68 | 30.39 years STANDARD_DEVIATION 8.46 | 30.67 years STANDARD_DEVIATION 7.99 |
| BMI | 32.96 kg/m^2 STANDARD_DEVIATION 4.3 | 31.80 kg/m^2 STANDARD_DEVIATION 3.1 | 32.38 kg/m^2 STANDARD_DEVIATION 3.75 |
| Race/Ethnicity, Customized American Indian or Alaska Native | 0 participants | 0 participants | 0 participants |
| Race/Ethnicity, Customized Asian | 1 participants | 1 participants | 2 participants |
| Race/Ethnicity, Customized Black or African American | 12 participants | 8 participants | 20 participants |
| Race/Ethnicity, Customized Native Hawaiian or Other Pacific Islander | 0 participants | 0 participants | 0 participants |
| Race/Ethnicity, Customized Other | 7 participants | 5 participants | 12 participants |
| Race/Ethnicity, Customized Unknown or Not Reported | 0 participants | 1 participants | 1 participants |
| Race/Ethnicity, Customized White | 3 participants | 8 participants | 11 participants |
| Sex: Female, Male Female | 23 Participants | 23 Participants | 46 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
| Weight | 87.70 kg STANDARD_DEVIATION 15.83 | 89.59 kg STANDARD_DEVIATION 13.34 | 88.64 kg STANDARD_DEVIATION 14.5 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 10 / 23 | 2 / 22 |
| serious Total, serious adverse events | 0 / 23 | 0 / 22 |
Outcome results
Primary
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Anterior Cingulate
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Time frame: Baseline, 4 weeks
Population: ITT (Intent-to-Treat): Included all subjects who were randomized, had a baseline measurement, and had at least one post-baseline fMRI measurement during the defined treatment phase.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Placebo | Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Anterior Cingulate | -0.42 percent activation |
| NB32 | Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Anterior Cingulate | 0.16 percent activation |
90% CI: [0.4, 0.8]
Primary
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Hippocampal Region 1
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Time frame: Baseline, 4 weeks
Population: ITT (Intent-to-Treat): Included all subjects who were randomized, had a baseline measurement, and had at least one post-baseline fMRI measurement during the defined treatment phase.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Placebo | Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Hippocampal Region 1 | -0.16 percent activation |
| NB32 | Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Hippocampal Region 1 | 0.60 percent activation |
90% CI: [0.5, 1]
Primary
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Hippocampal Region 2
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Time frame: Baseline, 4 weeks
Population: ITT (Intent-to-Treat): Included all subjects who were randomized, had a baseline measurement, and had at least one post-baseline fMRI measurement during the defined treatment phase.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Placebo | Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Hippocampal Region 2 | -0.79 percent activation |
| NB32 | Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Hippocampal Region 2 | 0.21 percent activation |
90% CI: [0.74, 1.24]
Primary
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Posterior Insula
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Time frame: Baseline, 4 weeks
Population: ITT (Intent-to-Treat): Included all subjects who were randomized, had a baseline measurement, and had at least one post-baseline fMRI measurement during the defined treatment phase.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Placebo | Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Posterior Insula | -0.16 percent activation |
| NB32 | Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Posterior Insula | 0.30 percent activation |
90% CI: [0.31, 0.57]
Primary
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Superior Frontal
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Time frame: Baseline, 4 weeks
Population: ITT (Intent-to-Treat): Included all subjects who were randomized, had a baseline measurement, and had at least one post-baseline fMRI measurement during the defined treatment phase.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Placebo | Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Superior Frontal | -0.35 percent activation |
| NB32 | Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Superior Frontal | 0.34 percent activation |
90% CI: [0.5, 0.9]
Primary
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Superior Parietal
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Time frame: Baseline, 4 weeks
Population: ITT (Intent-to-Treat): Included all subjects who were randomized, had a baseline measurement, and had at least one post-baseline fMRI measurement during the defined treatment phase.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Placebo | Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Superior Parietal | -0.56 percent activation |
| NB32 | Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Superior Parietal | 0.74 percent activation |
90% CI: [0.95, 1.65]
Secondary
Change in Question 19 From 21-Item COE (Control of Eating) Questionnaire
Question 19: Generally, how difficult has it been to control your eating? Scoring: 0=not at all difficult; 100=extremely difficult
Time frame: Baseline, 4 weeks
Population: ITT (Intent-to-Treat): Included all subjects who were randomized, had a baseline measurement, and had at least one post-baseline fMRI measurement during the defined treatment phase.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change in Question 19 From 21-Item COE (Control of Eating) Questionnaire | -13.55 units on a scale | Standard Error 4.67 |
| NB32 | Change in Question 19 From 21-Item COE (Control of Eating) Questionnaire | -4.14 units on a scale | Standard Error 4.41 |
p-value: 0.1695% CI: [-22.7, 3.89]ANCOVA
Secondary
Dutch Eating Behavior Questionnaire - Change in Emotional Eating A Subscale Score
The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale, where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The Emotional Eating A subscale (clearly labeled emotions) consisted of 9 items and the scores ranged from 9 (better outcome) to 45 (worse outcome).
Time frame: Baseline, 4 weeks
Population: ITT (Intent-to-Treat): Included all subjects who were randomized, had a baseline measurement, and had at least one post-baseline fMRI measurement during the defined treatment phase.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Dutch Eating Behavior Questionnaire - Change in Emotional Eating A Subscale Score | -1.16 units on a scale | Standard Error 0.77 |
| NB32 | Dutch Eating Behavior Questionnaire - Change in Emotional Eating A Subscale Score | 0.48 units on a scale | Standard Error 0.77 |
p-value: 0.13995% CI: [-3.84, 0.56]ANCOVA
Secondary
Dutch Eating Behavior Questionnaire - Change in Emotional Eating B Subscale Score
The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale, where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The Emotional Eating B subscale (diffuse emotions) consisted of 4 items and the scores ranged from 4 (better outcome) to 20 (worse outcome).
Time frame: Baseline, 4 weeks
Population: ITT (Intent-to-Treat): Included all subjects who were randomized, had a baseline measurement, and had at least one post-baseline fMRI measurement during the defined treatment phase.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Dutch Eating Behavior Questionnaire - Change in Emotional Eating B Subscale Score | -0.90 units on a scale | Standard Error 0.55 |
| NB32 | Dutch Eating Behavior Questionnaire - Change in Emotional Eating B Subscale Score | 0.45 units on a scale | Standard Error 0.55 |
p-value: 0.09495% CI: [-2.96, 0.24]ANCOVA
Secondary
Dutch Eating Behavior Questionnaire - Change in External Eating Subscale Score
The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The External Eating subscale consisted of 10 items and the scores ranged from 10 (better outcome) to 50 (worse outcome).
Time frame: Baseline, 4 weeks
Population: ITT (Intent-to-Treat): Included all subjects who were randomized, had a baseline measurement, and had at least one post-baseline fMRI measurement during the defined treatment phase.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Dutch Eating Behavior Questionnaire - Change in External Eating Subscale Score | -2.64 units on a scale | Standard Error 1.03 |
| NB32 | Dutch Eating Behavior Questionnaire - Change in External Eating Subscale Score | -0.16 units on a scale | Standard Error 1.03 |
p-value: 0.10295% CI: [-5.48, 0.51]ANCOVA
Secondary
Dutch Eating Behavior Questionnaire - Change in Restrained Eating Subscale Score
The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale, where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The Restrained Eating subscale consisted of 10 items and the scores ranged from 10 (worse outcome) to 50 (better outcome).
Time frame: Baseline, 4 weeks
Population: ITT (Intent-to-Treat): Included all subjects who were randomized, had a baseline measurement, and had at least one post-baseline fMRI measurement during the defined treatment phase.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Dutch Eating Behavior Questionnaire - Change in Restrained Eating Subscale Score | 1.47 units on a scale | Standard Error 0.86 |
| NB32 | Dutch Eating Behavior Questionnaire - Change in Restrained Eating Subscale Score | 1.87 units on a scale | Standard Error 0.86 |
p-value: 0.74495% CI: [-2.87, 2.07]ANCOVA
Secondary
Percent Change in Body Weight
Time frame: Baseline, 4 weeks
Population: ITT (Intent-to-Treat): Included all subjects who were randomized, had a baseline measurement, and had at least one post-baseline fMRI measurement during the defined treatment phase.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Percent Change in Body Weight | -0.99 percentage of body weight | Standard Error 0.44 |
| NB32 | Percent Change in Body Weight | -0.43 percentage of body weight | Standard Error 0.44 |
p-value: 0.3895% CI: [-1.83, 0.72]ANCOVA