MetaVia reveals positive data for DA-1726 dual oxyntomodulin analog agonist

MetaVia has revealed positive results from the four-week multiple ascending dose (MAD) Part 2 of its Phase 1 clinical trial of DA-1726, a novel, dual oxyntomodulin (OXM) analog agonist that functions as a glucagon-like peptide-1 receptor (GLP1R) and glucagon receptor (GCGR), for the treatment of obesity.

In the 28-day, 36-subject MAD portion of the study, DA-1726 demonstrated excellent safety and tolerability, with positive clinical activity. The cohort receiving 32mg of DA-1726 with no titration demonstrated a maximum reduction in body weight from baseline ranging up to -6.3%, and a mean body weight reduction of -4.3% at Day 26 (p=0.0005, Figure 1). Four out of six subjects on the 32mg dose experienced mild gastrointestinal (GI) adverse events (AEs), most of which were resolved after 24 hours of occurrence. There were no treatment-related discontinuations or serious adverse events (SAEs) (Table 1).

"The Phase 1 MAD data underscore DA-1726's potential as a best-in-class obesity drug demonstrating compelling safety, tolerability and strong weight loss effects," stated Hyung Heon Kim, President and Chief Executive Officer of MetaVia. "The data also indicates strong clinical characteristics, with compelling tolerability and a maximum weight loss of -6.3% at the 32 mg dose, which is not yet the maximum tolerated dose, along with a mean weight reduction of -4.3% from baseline.”

Table 1: Subject Disposition

Although subjects in this study were exposed to study drug or placebo for a total of 26 days, no signs of plateau were observed. Given GLP-1R lowers glucose levels while GCGR increases them, the 3:1 ratio of DA-1726 may provide an optimal balance to achieve a sustainable and tolerable therapeutic effect in this class of drugs. Additionally, early satiety was observed in 83% (5 of 6) of patients on the 32 mg dose, which may be suggestive of efficacy and greater weight loss may be seen in longer duration studies.

With the mean baseline of 41 inches, DA-1726 showed a waist circumference reduction of 1.6 inches on average, with a maximum reduction of 3.9 inches by day 33, which the company believes is a result of GCGR breaking down the white adipose tissue. It is important to note that the mean waist circumference reductions were somewhat sustained with a 1.46 inch reduction almost a month after the last dosing. Further, DA-1726 demonstrated potentially best-in-class lowering of fasted glucose of -5.3 mg/dL and a maximum of -18 mg/dL at Day 26, allowing for a potential expansion into Type 2 Diabetes and obese MASH patients. Unlike amylin which reduces appetite, or GIP which controls AEs, glucagon has its own therapeutic target other than weight loss, mainly in the liver. DA-1726 shows strong signals that may benefit obese patients with at least one comorbidity, as per FDA guidance. Not all obese patients need to lose 30% of their weight and it is our goal to develop an obesity drug that can be used safely in all obese patients with different comorbidities.

Despite DA-1726's glucagon agonism, fasting plasma glucose (FPG) was well controlled and showed reduction without any hypoglycemic AEs in all cohorts. The pharmacokinetic (PK) results demonstrated a favourable exposure profile and dose proportionality to support the proposed weekly dosing of DA-1726. Of note, no significant cardiovascular signals were observed in heart rate and QTcF results of the subjects receiving DA-1726. Additionally, only four subjects experienced mild GI-related AEs after the first 32 mg dose, most of which resolved within 24 hours, demonstrating a potentially significantly better tolerability profile compared to other weight loss treatments on the market, the company stated.

"It is well known that many patients on current GLP-1 agonists discontinue treatment due to tolerability issues, with 20% to 30% stopping within the first month and up to 70% within a year. With DA-1726's balanced activation of GLP1R and glucagon receptors enhancing energy expenditure, we remain confident in its potential to become a best-in-class obesity drug, with the further potential to offer superior tolerability than currently marketed GLP-1 agonists and those in late-stage clinical trials,” added Kim. “Based on these results, we are currently planning to conduct a Phase 1 Part 3 study which will investigate DA-1726 on Wegovy® early drop-out patients. Our goal is to generate data showing the superiority of DA-1726 with respect to tolerability and safety, along with weight loss and other secondary endpoints. In parallel, based on the drug's clean safety profile, one or more additional cohorts with a higher dose will be added to the Phase 1 study in order to further explore the maximum tolerated dose, which will allow us to realize the full potential of DA-1726."

Table 2: GI Treatment Emergent Adverse Events, by Severity

DA-1726 demonstrated encouraging safety and tolerability following repeated dosing. Overall, 25% of subjects in the MAD study on DA-1726 experienced mostly mild (GI) related AEs, 12.5% of patients reported nausea (vs. 8.3% on placebo), 16.7% experienced vomiting (vs. 8.3% on placebo), 12.5% experienced constipation and 1 subject experienced abdominal distension (Table 2). GI AEs were mostly transient in nature and resolved spontaneously within 1-3 days. Early satiety was observed in five out of six subjects receiving the 32 mg dose. Considering that most patients started experiencing this AE after the third dose, the company believes these findings suggest signs of efficacy and that greater weight loss may be seen in longer duration studies.