Combined agonism of nutrient receptors GPR40 and GPR119 with K-757 and K-833 results in weight loss and blood pressure reductions in obese subjects without type 2 diabetes mellitus.

Abstract

Aims: K-757 and K-833 are novel full agonists of GPR40 and GPR119, respectively, which are nutrient receptors co-expressed on both pancreatic beta cells and gut enteroendocrine cells that signal through complementary mechanisms. We sought to assess the effects beyond glucose control of co-agonism with K-757 and K-833.

Materials and methods: A Phase 1 study of the combination of K-757 and K-833 was conducted in overweight-obese participants to identify dose regimens causing maximal secretion of multiple gut hormones. Subsequently, a randomised, double-blind, parallel arm and 13-week Phase 2a study was conducted to assess the effects of K-757 alone and in combination with K-833, in comparison to placebo (n = 155 [51-52/arm]).

Results: Co-administration of K-757 120 mg twice daily (BID) and K-833 100 mg BID resulted in elevations of circulating glucagon-like peptide 1 (3.44×), active glucagon-like peptide 1 (5.06×), peptide YY (8.63×), glucagon dependent insulinotropic peptide (1.65×), cholecystokinin (3.06×) and oxyntomodulin (5.66×) relative to placebo. In Phase 2a, placebo-adjusted weight loss with the K-757 + K-833 combination and K-757 alone was -2.78% (p < 0.001) and -1.42% (p = 0.0756), respectively. Though blood pressure, an exploratory endpoint, was not elevated at baseline, placebo-adjusted reductions were observed with the combination (-6.9/-5.4 mmHg) and K-757 alone (-5.3/-3.2 mmHg). Gastrointestinal adverse events (AEs) and discontinuation due to AEs were more common in the active treatment arms. The combination and K-757 alone were otherwise well tolerated.

Conclusions: K-757, alone and in combination with K-833, elicited robust elevations in circulating concentrations of multiple satiety peptides, which elicited some weight loss and blood pressure reductions that suggest potential for metabolic benefit independent of weight loss.