ECE2023 Poster Presentations Diabetes, Obesity, Metabolism and Nutrition (159 abstracts)
Impact of exenatide on weight loss and eating behavior in adults with craniopharyngioma-related obesity: the Cranioexe randomized placebo-controlled trial
Blandine Gatta-Cherifi 1 , Kamel Mohammedi 1 , Tanguy Cariou 2 , Christine Poitou-Bernert 3 , Philippe Touraine 4 , Gerald Raverot 5 , Thierry Brue 6 , Philippe Chanson 7 , Frederic Illouz 8 , Grunenwald Solange 9 , Olivier Chabre 10 , Emmanuel Sonnet 11 , Thomas Cuny 12 , Jerome Bertherat 13 , Sebastien Czernichow 14 , Eric Frison 15 & Antoine Tabarin 16
1CHU de Bordeaux, Endocrinology, Bordeaux, France; 2Université de Bordeaux, Medical Informatic; 3Assistance Publique – Hôpitaux de Paris, Nutrition, Pitié Salpétrière, Paris, France; 4Assistance Publique des Hôpitaux de Paris, Endocrinology; 5Hospices Civils de Lyon - HCL, Endocrinology, Lyon, France; 6Hospitals Academics De Marseille, Marseille, France; 7Assistance Publique des Hôpitaux de Paris, Hôpital du Kremlin Bicêtre; 8CHU de Angers, Endocrinology, Angers, France; 9CHU de Toulouse, Endocrinology; 10CHU de Grenoble, Endocrinology; 11CHU de Brest, Brest, France; 12Hospitals Academics De Marseille, Endocrinology, Marseille, France; 13Assistance Publique des Hôpitaux de Paris, Hôpital Cochin, Endocrinology, Paris, France; 14Assistance Publique des Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Nutrition, Paris, France; 15Université de Bordeaux, Medical Informatic, Bordeaux, France; 16CHU de Bordeaux, Endocrinology, Bordeaux, France
Background: Hyperphagia leading to craniopharyngioma-related obesity (CRO) is a common and serious sequel of treatments of craniopharyngiomas. The few therapeutic approaches that have been tested until now for the control of eating behaviour and weight have poor efficacy. Glucagon-like peptide-1 (GLP-1) analogues might be an option.
Methods: This multicentre, randomised, double-blind superiority trial was conducted in France. Adults with CRO (BMI > 30 kg/m2) without sign of recurrence in the past year were included. After a 4-week run-in period with a lifestyle intervention, participants were randomized (1:1) to receive exenatide 5 µg x 2/day for 4 weeks increased to 10 µg x 2/day for the following 22 weeks or placebo injected subcutaneously twice a day, using a computer-generated randomisation sequence. The lifestyle intervention (hypocaloric diet and regular physical activity) was maintained during the 26-week follow-up. The primary outcome was mean change in body weight (kg) at week 26 in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT02860923.
Findings: Between January 2017 and February 2018, 41 participants were subjected to an intensive lifestyle intervention and randomly assigned to exenatide (n=20) or placebo (n=20). At week 26, weight decreased from baseline by a mean of - 3.8 (SD 4.3) kg for exenatide and -1.6 (3.8) kg for placebo. Adjusted mean treatment difference was -3.1 kg (95% CI -7.0 to 0.7, P=0.11) in favor of exenatide. The estimated treatment difference from baseline to week 26 was -2.3 (95% CI -4.5 to -0.2) for reduction of hunger score, -1.2 (95% CI -3.2 to +0.8) for reduction of disinhibition score and – 8.1 cm (95% CI -21.1 to 4.9) for reduction of waist circumference in favor of exenatide. Restriction score and quality of life did not significantly differ between groups. A heterogeneity in the response to therapeutic intervention was observed. Adverse events occurred in 19 (95%) participants in the exenatide group vs 14 (70%) in the placebo group.
Interpretation: The results of our study show that both lifestyle intervention and exenatide have an impact on body weight. Exenatide was not demonstrated superior to placebo, when combined with intensive lifestyle interventions. The heterogeneity in response suggest that GLP-1 receptor agonists might be an additional option in targeting both body weight loss and eating behavior, in a subset of CRO population.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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