Amylyx Pharmaceuticals plans to initiate a Phase 3 LUCIDITY clinical trial for avexitide, an investigational, first-in-class glucagon-like peptide-1 (GLP-1) receptor antagonist, for the treatment of post-bariatric hypoglycemia (PBH). LUCIDITY is designed to evaluate the FDA-agreed upon primary outcome of reduction in hypoglycemia events and to have similar inclusion and exclusion criteria to the previous Phase 2 trials of avexitide in PBH. Amylyx expects that the first study participant will be dosed in the first quarter of 2025, followed by expected completion of recruitment in 2025, and anticipates topline data in 2026.
LUCIDITY will be a multi-centre, randomised, double-blind, placebo-controlled Phase 3 clinical trial evaluating the efficacy and safety of avexitide in participants with PBH following Roux-en-Y gastric bypass (RYGB) surgery. The Phase 3 trial will be conducted at approximately 20 sites in the US. Approximately 75 participants will be randomised 3:2 to receive either 90mg of avexitide subcutaneously once daily or placebo.
The trial will include a three-week run-in period and a 16-week double-blind treatment period. Participants who complete the double-blind period of the planned study will be eligible to enter an open-label extension (OLE) period with a duration of 32 weeks. The primary efficacy objective of LUCIDITY will evaluate the reduction in the composite of Level 2 and Level 3 hypoglycemia events through Week 16. Safety and tolerability will also be evaluated.
“PBH is believed to result from an excessive GLP-1 response leading to persistent, recurrent, and debilitating hypoglycemia events that take a profound toll on someone’s quality of life. Avexitide is designed to bind to the GLP-1 receptor and inhibit the effects of excessive GLP-1 in PBH, mitigating hypoglycemia by decreasing insulin secretion and stabilizing blood glucose levels. We are excited to evaluate avexitide, which has FDA Breakthrough Therapy and Orphan Drug Designations, in the Phase 3 LUCIDITY trial, following two Phase 2 clinical studies that demonstrated compelling clinical data supporting avexitide’s ability to significantly reduce the rates of hypoglycemia events,” said Dr Camille L Bedrosian, Chief Medical Officer of Amylyx. “Our goal in Phase 3 is to align the trial design as closely as possible with the prior studies. Importantly, we believe LUCIDITY is well powered to detect a treatment effect. We look forward to continuing to collaborate with study investigators and the PBH community as we seek to initiate LUCIDITY and advance avexitide through the clinical development process.”
LUCIDITY was informed by data from five clinical trials of avexitide in people with PBH showing consistent, dose-dependent effects across studies. The five clinical trials include a Phase 1 trial, a single ascending dose trial, a multiple ascending dose trial, and two Phase 2 trials:
In the Phase 2 (PREVENT), 28-day, randomised, placebo-controlled crossover trial (n=18), results showed a significant reduction in rates of Level 2 and 3 hypoglycemia events in participants with PBH after RYGB surgery following treatment with 30 mg twice daily and 60 mg once daily of avexitide compared with placebo. PREVENT’s primary endpoint was met with statistical significance, showing both avexitide dosing regimens improved the lowest glucose level (nadir) after a meal as measured during formal mixed meal tolerance testing (MMTT). Mean plasma glucose nadir was increased by 21% (p=0.001) and 26% (p=0.0002) following avexitide 30 mg twice daily and 60 mg once daily dosing, respectively, compared to placebo.
In the Phase 2b, 28-day, open-label, investigator-initiated, crossover trial (n=16), 90 mg once daily and 45 mg twice daily of avexitide met its primary endpoint and significantly reduced rates of hypoglycemia events in participants following RYGB surgery and other upper-gastrointestinal surgeries. Participants in the Phase 2b trial receiving 90 mg once daily of avexitide, the dose Amylyx plans to evaluate in LUCIDITY, saw a statistically significant 53% reduction in Level 2 hypoglycemia events (p=0.004) and a statistically significant 66% reduction in Level 3 hypoglycemia events (p=0.0003).
Avexitide was generally well tolerated, with a favourable safety profile replicated across the clinical trials.
“We are excited to advance avexitide into a Phase 3 clinical trial, marking a pivotal step toward bringing this investigational therapy to people living with PBH,” said Joshua Cohen and Justin Klee, Co-CEOs of Amylyx. “The consistent data from five clinical trials of avexitide in PBH underscore avexitide’s potential to be the first therapy approved for people living with PBH.”
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