A randomized phase I study of BI 1820237, a novel neuropeptide Y receptor type 2 agonist, alone or in combination with low‐dose liraglutide in otherwise healthy men with overweight or obesity

Abstract Aims Pharmacotherapeutic options for obesity treatment include glucagon‐like peptide‐1 receptor (GLP‐1R) agonists, for example, liraglutide. However, an unmet need remains, particularly in patients with a high body mass index (BMI), as GLP‐1R agonists are associated with gastrointestinal adverse events (AEs) and some patients do not respond to treatment. Neuropeptide Y (NPY) and peptide YY bind G‐protein‐coupled Y receptors and represent attractive targets for modulating bodyweight. Materials and Methods This first‐in‐human, three‐part, partially blinded phase I study (NCT04903509) investigated the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics (PD) of single ascending doses of the peptidic NPY2R agonist BI 1820237, with/without low‐dose liraglutide: part 1 (participants randomized to receive BI 1820237: 0.075–2.4 mg or placebo), part 2 (BI 1820237: 1.2 mg or placebo) and part 3 (BI 1820237: 0.025–1.2 mg + liraglutide 0.6 mg or placebo + liraglutide 0.6 mg). Primary endpoint is the proportion of participants with drug‐related AEs. Secondary endpoints are tolerability, PK and PD. Results In total, 95 otherwise healthy men with increased BMI (25.0–34.9 kg/m 2 ) were randomized. Drug‐related AEs, mainly gastrointestinal events, were reported by 39.0% of participants ( n = 23) in parts 1 + 2 and 30.6% of participants ( n = 11) in part 3; one drug‐related AE (11.1%, part 3) was reported in a participant receiving placebo with liraglutide. Post‐dose paracetamol PK suggested that BI 1820237 and low‐dose liraglutide exhibited additive effects on gastric emptying. Conclusions BI 1820237 treatment was associated with transient nausea and vomiting at higher doses. No differences in tolerability were observed when combined with liraglutide; effects on gastric emptying appeared additive.