Pharmacokinetics, safety, tolerability and efficacy of cotadutide, a glucagon-like peptide-1 and glucagon receptor dual agonist, in phase 1 and 2 trials in overweight or obese participants of Asian descent with or without type 2 diabetes

Aim To evaluate the safety and pharmacokinetics of cotadutide, a dual glucagon-like peptide-1 (GLP-1) and glucagon receptor agonist, in overweight Asian participants with or without type 2 diabetes (T2D). Materials and Methods In the phase 1, randomized, blinded, single-ascending dose study, 24 Japanese and eight Chinese healthy adults (body mass index [BMI] 23-40 kg/m(2)) received one subcutaneous dose of cotadutide (50-150 or 100 mu g, respectively) or placebo. The primary endpoint was safety. In the phase 2a, randomized, double-blinded, parallel dose-ranging study with forced uptitration, 61 Japanese adults with T2D (BMI 24-40 kg/m(2); HbA1c 7.0%-10.5%) received cotadutide (100, 200, 300 mu g) or placebo for 48 days. Co-primary endpoints were safety/tolerability, change in glucose AUC(0-4h) and body weight. Results Significant reductions from baseline to day 48 were observed with cotadutide for glucose AUC(0-4h) (33.6%-42.1% reduction vs. +2.5% with placebo; 95% CIs: 100 mu g -45.7%, -33.7%; 200 mu g -35.6%, -23.7%; 300 mu g -45.0%, -30.8%; placebo 3.4%, 8.3%) and body weight (1.3%-2.5% decrease vs. +0.8% with placebo; 95% CIs: 100 mu g -3.4%, -0.8%; 200 mu g -4.7%, -2.0%; 300 mu g -4.6%, -2.1%; placebo -2.1%, 0.4%). The most common adverse events with cotadutide were mild gastrointestinal symptoms with no serious adverse events. Increased pulse rate with cotadutide versus placebo is consistent with GLP-1 monoagonists. Conclusions Once-daily cotadutide was effective and well tolerated up to 300 mu g in overweight Japanese patients with T2D. Further evaluation in Asian populations is warranted.

Automated summary

The study demonstrated that cotadutide significantly reduced glucose AUC(0-4h) and body weight in Japanese patients with T2D, with mild gastrointestinal symptoms as the main adverse events and good overall tolerability.