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    Clinical Trial Results:
    Effect of Oral Ladarixin 400 mg Twice a Day on Insulin Sensitivity. A Phase 2, Randomized, Double-blind, Placebo-controlled Explorative Study in Obese Patients With Prediabetes Eligible to Bariatric Surgery.

    Summary
    EudraCT number
    2020-003296-18
    Trial protocol
    IT  
    Global end of trial date
    26 May 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    01 Dec 2024
    First version publication date
    01 Dec 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    LDX0119
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Dompé farmaceutici S.p.A.
    Sponsor organisation address
    Via Santa Lucia, 6, Milan, Italy, 20122
    Public contact
    Dompé farmaceutici S.p.A., Clinical Development, Dompé farmaceutici S.p.A., +39 02 583831, clinical.trials@dompe.com
    Scientific contact
    Dompé farmaceutici S.p.A., Clinical Development, Dompé farmaceutici S.p.A., +39 02 583831, clinical.trials@dompe.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    30 Oct 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    26 May 2023
    Global end of trial reached?
    Yes
    Global end of trial date
    26 May 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The main objective was to explore whether ladarixin may improve insulin sensitivity in participants with prediabetes eligible for bariatric surgery with body mass index (BMI) ≥35 kg/m2. The safety of ladarixin was also evaluated. The study also aimed to explore changes in relevant metabolic and inflammatory markers/variables after ladarixin treatment.
    Protection of trial subjects
    The study was conducted in accordance with the Declaration of Helsinki (October 2013), ICH GCP E6(R2), IEC guidance, and all other applicable local regulatory requirements.
    Background therapy
    -
    Evidence for comparator
    A total of 25 participants (13 in the ladarixin arm and 12 in the placebo arm) received IMP; all completed IMP treatment including completion of the End of Cycle 1 and Follow-up visits. A total of 23 participants (12 randomized to ladarixin and 11 randomized to placebo) underwent bariatric surgery; 1 participant in each treatment group did not undergo surgery.
    Actual start date of recruitment
    23 Apr 2021
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Italy: 26
    Worldwide total number of subjects
    26
    EEA total number of subjects
    26
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    25
    From 65 to 84 years
    1
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    40 participants were screened for the study. Of these, 14 did not meet all inclusion/exclusion criteria.The remaining 26 were randomized: 13 to ladarixin and 13 to placebo. One patient randomized to placebo did not complete the Baseline visit due to unavailability of veins, and so didn't receive IMP and wasn't included in the analyses.

    Pre-assignment
    Screening details
    Potential participants were identified from those on the waiting list for bariatric surgery at one of the participating Surgery Units. After the surgeon had explained and discussed the study with a participant, any willing potential participants were referred to the CCS for consent and screening.

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor
    Blinding implementation details
    The appearance, including packaging and labelling, of IMP capsules (ladarixin and placebo) were matched so that the actual treatment could not be identified.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Ladarixin
    Arm description
    In this arm participants received Ladarixin 400 mg (2 x200 mg capsule), administered twice a day orally for 3 cycles of 14 days each, with a 14-day wash-out between cycles, for a total of 10 weeks from first to last dose. Please note that n=13 patients of this arm completed both End of Cycle 1 visit, and Follow-up visit.
    Arm type
    Experimental

    Investigational medicinal product name
    Ladarixin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, soft
    Routes of administration
    Oral use
    Dosage and administration details
    Ladarixin was provided as hard gelatine capsules for oral administration. Each active capsule contained 200 mg ladarixin. Capsules were to be taken at least two hours before or after meals.

    Arm title
    Placebo
    Arm description
    In this arm participants received matched placebo, administered twice a day orally for 3 cycles of 14 days each, with a 14-day wash-out between cycles, for a total of 10 weeks from first to last dose. Please note 1: One participant randomized to placebo did not complete the Baseline visit due to unavailability of veins, and consequently did not receive IMP. Please note 2: n=12 Completed both End of Cycle 1 visit and Follow-up visit.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, soft
    Routes of administration
    Oral use
    Dosage and administration details
    Matched placebo capsules were administered twice a day orally for 3 cycles of 14 days each, with a 14-day interval between cycles. Hence placebo was indistinguishable compared to active drug with respect of formulation, time and way of administration and posologic scheme.

    Number of subjects in period 1 [1]
    Ladarixin Placebo
    Started
    13
    12
    Completed
    13
    12
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: 40 participants were screened for the study. Of these, 14 did not meet all inclusion/exclusion criteria.The remaining 26 were randomized: 13 to ladarixin and 13 to placebo. One patient randomized to placebo, though, did not complete the Baseline visit due to unavailability of veins, and so didn't receive IMP and wasn't included in the analyses (n=25).

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Ladarixin
    Reporting group description
    In this arm participants received Ladarixin 400 mg (2 x200 mg capsule), administered twice a day orally for 3 cycles of 14 days each, with a 14-day wash-out between cycles, for a total of 10 weeks from first to last dose. Please note that n=13 patients of this arm completed both End of Cycle 1 visit, and Follow-up visit.

    Reporting group title
    Placebo
    Reporting group description
    In this arm participants received matched placebo, administered twice a day orally for 3 cycles of 14 days each, with a 14-day wash-out between cycles, for a total of 10 weeks from first to last dose. Please note 1: One participant randomized to placebo did not complete the Baseline visit due to unavailability of veins, and consequently did not receive IMP. Please note 2: n=12 Completed both End of Cycle 1 visit and Follow-up visit.

    Reporting group values
    Ladarixin Placebo Total
    Number of subjects
    13 12 25
    Age categorical
    Intention to Treat (ITT) set: Defined as all participants who were randomized and received at least 1 dose of IMP (either ladarixin or placebo). Subjects were analyzed according to their randomized treatment, regardless of the treatment actually received. The ITT set was used to present efficacy data.
    Units: Subjects
        Adults (18-64 years)
    12 12 24
        From 65-84 years
    1 0 1
    Age continuous
    Intention to Treat (ITT) set: Defined as all participants who were randomized and received at least 1 dose of IMP (either ladarixin or placebo). Subjects were analyzed according to their randomized treatment, regardless of the treatment actually received. The ITT set was used to present efficacy data.
    Units: years
        arithmetic mean (standard deviation)
    50.4 ( 9.16 ) 47.7 ( 6.02 ) -
    Gender categorical
    Intention to Treat (ITT) set: Defined as all participants who were randomized and received at least 1 dose of IMP (either ladarixin or placebo). Subjects were analyzed according to their randomized treatment, regardless of the treatment actually received. The ITT set was used to present efficacy data.
    Units: Subjects
        Female
    6 4 10
        Male
    7 8 15
    Subject analysis sets

    Subject analysis set title
    Ladarixin - ITT set
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Defined as all participants who were randomized and received at least 1 dose of IMP (either ladarixin or placebo). Participants were analyzed according to their randomized treatment, regardless of the treatment actually received. The ITT set was used to present efficacy data.

    Subject analysis set title
    Ladarixin - SAF
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Safety Analysis (SAF) set: Defined as all participants in the RND set who received any IMP (either ladarixin or placebo). Subjects were analyzed according to the treatment they actually received. The SAF set was used to present safety data.

    Subject analysis set title
    Placebo - ITT set
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Intention to Treat (ITT) set: Defined as all participants who were randomized and received at least 1 dose of IMP (either ladarixin or placebo). Participants were analyzed according to their randomized treatment, regardless of the treatment actually received. The ITT set was used to present efficacy data.

    Subject analysis set title
    Placebo - SAF set
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Safety Analysis (SAF) set: Defined as all participants in the RND set who received any IMP (either ladarixin or placebo). Subjects were analyzed according to the treatment they actually received. The SAF set was used to present safety data.

    Subject analysis sets values
    Ladarixin - ITT set Ladarixin - SAF Placebo - ITT set Placebo - SAF set
    Number of subjects
    13
    13
    12
    12
    Age categorical
    Intention to Treat (ITT) set: Defined as all participants who were randomized and received at least 1 dose of IMP (either ladarixin or placebo). Subjects were analyzed according to their randomized treatment, regardless of the treatment actually received. The ITT set was used to present efficacy data.
    Units: Subjects
        Adults (18-64 years)
    12
    12
    12
    12
        From 65-84 years
    1
    1
    0
    0
    Age continuous
    Intention to Treat (ITT) set: Defined as all participants who were randomized and received at least 1 dose of IMP (either ladarixin or placebo). Subjects were analyzed according to their randomized treatment, regardless of the treatment actually received. The ITT set was used to present efficacy data.
    Units: years
        arithmetic mean (standard deviation)
    50.4 ( 9.16 )
    50.4 ( 9.16 )
    47.7 ( 6.02 )
    47.7 ( 6.02 )
    Gender categorical
    Intention to Treat (ITT) set: Defined as all participants who were randomized and received at least 1 dose of IMP (either ladarixin or placebo). Subjects were analyzed according to their randomized treatment, regardless of the treatment actually received. The ITT set was used to present efficacy data.
    Units: Subjects
        Female
    6
    6
    4
    4
        Male
    7
    7
    8
    8

    End points

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    End points reporting groups
    Reporting group title
    Ladarixin
    Reporting group description
    In this arm participants received Ladarixin 400 mg (2 x200 mg capsule), administered twice a day orally for 3 cycles of 14 days each, with a 14-day wash-out between cycles, for a total of 10 weeks from first to last dose. Please note that n=13 patients of this arm completed both End of Cycle 1 visit, and Follow-up visit.

    Reporting group title
    Placebo
    Reporting group description
    In this arm participants received matched placebo, administered twice a day orally for 3 cycles of 14 days each, with a 14-day wash-out between cycles, for a total of 10 weeks from first to last dose. Please note 1: One participant randomized to placebo did not complete the Baseline visit due to unavailability of veins, and consequently did not receive IMP. Please note 2: n=12 Completed both End of Cycle 1 visit and Follow-up visit.

    Subject analysis set title
    Ladarixin - ITT set
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Defined as all participants who were randomized and received at least 1 dose of IMP (either ladarixin or placebo). Participants were analyzed according to their randomized treatment, regardless of the treatment actually received. The ITT set was used to present efficacy data.

    Subject analysis set title
    Ladarixin - SAF
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Safety Analysis (SAF) set: Defined as all participants in the RND set who received any IMP (either ladarixin or placebo). Subjects were analyzed according to the treatment they actually received. The SAF set was used to present safety data.

    Subject analysis set title
    Placebo - ITT set
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Intention to Treat (ITT) set: Defined as all participants who were randomized and received at least 1 dose of IMP (either ladarixin or placebo). Participants were analyzed according to their randomized treatment, regardless of the treatment actually received. The ITT set was used to present efficacy data.

    Subject analysis set title
    Placebo - SAF set
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Safety Analysis (SAF) set: Defined as all participants in the RND set who received any IMP (either ladarixin or placebo). Subjects were analyzed according to the treatment they actually received. The SAF set was used to present safety data.

    Primary: Change from baseline to follow-up in Insulin Sensitivity Index – Matsuda (ISI-M) from 3-hours Oral Glucose Tolerance Test (OGTT), calculated by Matsuda 1999

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    End point title
    Change from baseline to follow-up in Insulin Sensitivity Index – Matsuda (ISI-M) from 3-hours Oral Glucose Tolerance Test (OGTT), calculated by Matsuda 1999
    End point description
    As the trial was exploratory, no primary endpoint was defined. The insulin sensitivity Index by Matsuda (ISI-M) in general is assessed via the 3h-OGTT, the main analysis, but also via the 2h-OGTT. Generally speaking, these are standard diagnostic tests for diabetes and is commonly used to evaluate whole body glucose tolerance. Participation in the trial requires a somewhat more frequent and prolonged (up to 3 hours) sampling to betted define post-load changes in glucose, insulin, proinsulin and c-peptide levels for research purposes. Insulin Sensitivity Index-Matsuda (ISI-M) calculated by [Matsuda, 1999]: ISI− M= 10,000 / √( FPG*FPI ) * (MPG*MPI) where FPG = fasting plasma glucose (mmol/dL); FPI = fasting plasma insulin (mIU/L) MPG = mean plasma glucose (mmol/dL); MPI = mean plasma Insulin (mIU/L)
    End point type
    Primary
    End point timeframe
    Follow-up (Day 72). More precisely ISI-M from 2h-(OGTT) is calculated considering the timepoints Basal, 30, 60, 90, 120 minutes and ISI-M from 3h-(OGTT) is calculated considering the timepoints Basal, 10, 20, 30, 60 , 90, 120 and 180 minutes.
    End point values
    Ladarixin - ITT set Placebo - ITT set
    Number of subjects analysed
    12
    11
    Units: Index of sensitivity
    arithmetic mean (standard deviation)
        ISI-M
    0.37 ( 0.925 )
    0.25 ( 1.057 )
        ISI-M (2h OGTT)
    0.32 ( 0.923 )
    0.19 ( 0.992 )
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    ISI- M (3-hours OGTT)
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    23
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.39 [1]
    Method
    t-test, 1-sided
    Confidence interval
    Notes
    [1] - The comparison between treatment groups was carried-out using t-test for unpaired data.
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    ISI-M from 2-hours OGTT
    Comparison groups
    Placebo - ITT set v Ladarixin - ITT set
    Number of subjects included in analysis
    23
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.375 [2]
    Method
    t-test, 1-sided
    Confidence interval
    Notes
    [2] - The comparison between treatment groups will be carried-out using t-test for unpaired data.

    Other pre-specified: Change from baseline to follow-up in Homeostasis Model of Assessment of Insulin Resistance (HOMA-IR).

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    End point title
    Change from baseline to follow-up in Homeostasis Model of Assessment of Insulin Resistance (HOMA-IR).
    End point description
    As the trial was exploratory, no primary endpoint was defined. Homeostasis model assessment of insulin resistance (HOMA-IR) is a method to measure insulin resistance, an early stage of type 2 diabetes that increases the risk of many chronic diseases. The index practically says how much insulin the body needs to keep blood sugar levels in check. HOMA-IR calculated by [Mari, 2001] is defined as: (fasting plasma insulin(mIU/L)x fasting plasma glucose (mg/dL))/405 where fasting plasma glucose (mg/dL) and fasting plasma insulin (mIU/L) are defined as above in the ISI-M formula details. In general, HOMA-IR values between 0.5 and 1.4 are considered normal, ≥1.9 are indicative of early IR, and ≥2.9 indicate IR.
    End point type
    Other pre-specified
    End point timeframe
    Follow-up (Day 72).
    End point values
    Ladarixin - ITT set Placebo - ITT set
    Number of subjects analysed
    13
    12
    Units: index of insulin resistance
        arithmetic mean (standard deviation)
    0.64 ( 3.999 )
    -0.98 ( 3.404 )
    Statistical analysis title
    Ladarixin vs placebo
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.144
    Method
    t-test, 1-sided
    Confidence interval

    Other pre-specified: Change from baseline to follow-up in C-peptide area under the curve (AUC) from 3-hours OGTT.

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    End point title
    Change from baseline to follow-up in C-peptide area under the curve (AUC) from 3-hours OGTT.
    End point description
    As the trial was exploratory, no primary endpoint was defined. Area under the curve (AUC) values for plasma C-peptide (CP) concentration/level is a common method to measure beta cell loss in Type 1 diabetes (T1D). CP typically rises in the first weeks to months after diagnosis and then falls over time. Both the starting level of CP, reflecting beta cell reserve, and its rate of decline, indicating disease progression, vary considerably between patients. In the study C-peptide AUC was assessed through 3h-OGTT (meaning that C-peptide AUC was calculated considered the timepoints: Basal, 10 min, 20 min, 30 min, 60 min, 90 min, 120 min, 180 min). More in detail, C-peptide AUC was calculated using the trapezoidal rule.
    End point type
    Other pre-specified
    End point timeframe
    Follow-up (Day 72).
    End point values
    Ladarixin - ITT set Placebo - ITT set
    Number of subjects analysed
    12
    11
    Units: ng*H/ml
        arithmetic mean (standard deviation)
    4.84 ( 352.279 )
    -70.68 ( 348.731 )
    Statistical analysis title
    Ladarixin vs placebo
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    23
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.306 [3]
    Method
    t-test for unpaired data
    Confidence interval
    Notes
    [3] - The comparison between treatment groups was carried-out using t-test for unpaired data.

    Other pre-specified: Change from baseline of mean Proinsulin / C-peptide ratio

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    End point title
    Change from baseline of mean Proinsulin / C-peptide ratio
    End point description
    As the trial was exploratory, no primary endpoint was defined. Proinsulin/C-peptide ratio was calculated using the following formula [Truyen, 2005]: Proinsulin/C-peptide ratio (%) = 100 × proinsulin (pmol/l; ELISA) / [total C-peptide (pmol/l;ECLIA)−proinsulin (pmol/l; ELISA)]. Note: in this study the method ECLIA (Electrochemiluminescence Immunoassay) was used for the laboratory range of C-peptide, but this was confirmed by the Sponsor to be comparable to the TRFIA (Time Resolved Fluorescence Immunoassay) reported in the paper reference [Truyen, 2005]. Please note: Basal value is defined as the mean of Basal #1 (i.e., 15 min before glucose administration) and Basal #2 (i.e., Time 0, just before glucose administration);
    End point type
    Other pre-specified
    End point timeframe
    Follow-up (Day 72). More precisely Proinsulin / C-peptide ratio is calculated considering the timepoints Basal and 10 min, 20 min, 30 min, 60 min, 90 min, 120 min, 120 and 180 min post-dose.
    End point values
    Ladarixin - ITT set Placebo - ITT set
    Number of subjects analysed
    13 [4]
    11
    Units: ratio
    arithmetic mean (standard deviation)
        Basal
    0.350 ( 1.7621 )
    -0.525 ( 2.4090 )
        10 min post-dose
    0.632 ( 1.4440 )
    -0.538 ( 1.8403 )
        20 min post-dose
    0.333 ( 0.9718 )
    -0.423 ( 1.4235 )
        30 min post-dose
    0.208 ( 0.8459 )
    -0.250 ( 1.4432 )
        60 min post-dose
    -0.046 ( 0.6417 )
    0.004 ( 1.2131 )
        90 min post-dose
    0.023 ( 0.6575 )
    0.057 ( 1.0675 )
        120 min post-dose
    0.233 ( 0.9068 )
    -0.380 ( 1.6122 )
        180 min post-dose
    0.265 ( 1.0406 )
    -1.378 ( 2.9115 )
    Notes
    [4] - Please note : for 10, 20 and 30 min post-dose n=12
    No statistical analyses for this end point

    Other pre-specified: Number of participants with Impaired Glucose Tolerance (IGT)

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    End point title
    Number of participants with Impaired Glucose Tolerance (IGT)
    End point description
    IGT, defined as Nathan 2007, is a post-load glucose [level] of 140-199 mg/dL, inclusive, at 2 hours of the OGTT. This means that For each study visit, a patient was considered having IGT when at 2-hour post-load glucose level of 140-199 mg/dL was observed during OGTT.
    End point type
    Other pre-specified
    End point timeframe
    At Baseline (Day 0) and Follow-up (Day 72) visits.
    End point values
    Ladarixin - ITT set Placebo - ITT set
    Number of subjects analysed
    13
    12
    Units: count of partecipants
    number (not applicable)
        Baseline (Day 0)
    6
    3
        Follow-up (Day 72)
    4
    5
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    Baseline
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.271 [5]
    Method
    Chi-squared
    Confidence interval
    Notes
    [5] - Comparison between treatment groups is carried out using a Chi-square test
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    Folllow-up (Day 72)
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.459 [6]
    Method
    Chi-squared
    Confidence interval
    Notes
    [6] - Comparison between treatment groups is carried out using a Chi-square test

    Other pre-specified: Change from Baseline in Hormones values [Amylin (active & total), Ghrelin, Incretines (GIP, GLP-1), Glucagon, Leptin, Pancreatic Polypeptide, Adiponectin, Resistin, Adipsin, Plasminogen Activator Inhibitor (PAI 1)].

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    End point title
    Change from Baseline in Hormones values [Amylin (active & total), Ghrelin, Incretines (GIP, GLP-1), Glucagon, Leptin, Pancreatic Polypeptide, Adiponectin, Resistin, Adipsin, Plasminogen Activator Inhibitor (PAI 1)].
    End point description
    Blood sampling for assey of hormones values [Amylin (active & total), Ghrelin, Incretines (GIP, GLP-1), Glucagon, Leptin, Pancreatic Polypeptide, Adiponectin, Resistin, Adipsin, Plasminogen Activator Inhibitor (PAI 1)]were collected at the Baseline and Follow-up visits. Statistical tests on hormone parameters were performed as post-hoc analyses.
    End point type
    Other pre-specified
    End point timeframe
    Follow-up (Day 72)
    End point values
    Ladarixin - ITT set Placebo - ITT set
    Number of subjects analysed
    13
    12 [7]
    Units: mg/dL
    arithmetic mean (standard deviation)
        Amylin (active)
    0.59 ( 10.729 )
    -1.59 ( 5.178 )
        Amylin (total)
    1.76 ( 5.330 )
    -3.17 ( 9.059 )
        Ghrelin
    -5.96 ( 38.635 )
    -7.13 ( 48.601 )
        GIP
    2.77 ( 6.735 )
    -18.15 ( 45.297 )
        GLP-1
    -0.69 ( 24.662 )
    -27.16 ( 40.790 )
        Glucagon
    -2.88 ( 10.379 )
    -2.58 ( 33.154 )
        Leptin
    2291.66 ( 5951.559 )
    -3059.87 ( 6456.941 )
        Pancreatic Polypeptide
    3.04 ( 16.624 )
    -14.23 ( 55.437 )
        Adiponectin
    2014165.5 ( 9888777.93 )
    -2640019.05 ( 8322851.81 )
        Resistin
    -2067.7 ( 14974.71 )
    -7762.0 ( 12019.82 )
        Adipsin
    163756.9 ( 2060489.70 )
    -1875034.7 ( 1991483.67 )
        PAI1
    2088.0 ( 18852.63 )
    -8772.3 ( 29861.88 )
    Notes
    [7] - please note that for Amylin (active) n=11
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    Amylin (active) - please note that the total number of subjects in this comparison are 24 and not the 25 automatically reported by the system, since in the placebo arm n=11.
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.643 [8]
    Method
    Kruskal-wallis
    Confidence interval
    Notes
    [8] - The comparison between treatment groups was carried-out using Kruskal-Wallis test.
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    Amylin (total)
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.231 [9]
    Method
    Kruskal-wallis
    Confidence interval
    Notes
    [9] - The comparison between treatment groups was carried-out using Kruskal-Wallis test
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    Ghrelin
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.474 [10]
    Method
    t-test for unpaired data
    Confidence interval
    Notes
    [10] - The comparison between treatment groups was carried-out using t-test for unpaired data.
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    GIP
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.014 [11]
    Method
    Kruskal-wallis
    Confidence interval
    Notes
    [11] - The comparison between treatment groups was carried-out using Kruskal-Wallis test
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    GLP-1
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.092 [12]
    Method
    Kruskal-wallis
    Confidence interval
    Notes
    [12] - The comparison between treatment groups was carried-out using Kruskal-Wallis test
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    Glucagon
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.415 [13]
    Method
    Kruskal-wallis
    Confidence interval
    Notes
    [13] - The comparison between treatment groups was carried-out using Kruskal-Wallis test
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    Leptin
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.021 [14]
    Method
    t-test for unpaired data
    Confidence interval
    Notes
    [14] - The comparison between treatment groups was carried-out using t-test for unpaired data.
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    Pancreatic Polypeptide
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.277 [15]
    Method
    Kruskal-wallis
    Confidence interval
    Notes
    [15] - The comparison between treatment groups was carried-out using Kruskal-Wallis test
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    Adiponectin
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority [16]
    P-value
    = 0.109
    Method
    t-test for unpaired data
    Confidence interval
    Notes
    [16] - Treatment groups were compared using t-test for unpaired data
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    Resistin
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.624 [17]
    Method
    Kruskal-wallis
    Confidence interval
    Notes
    [17] - The comparison between treatment groups was carried-out using Kruskal-Wallis test
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    Adipsin
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.01 [18]
    Method
    t-test for unpaired data
    Confidence interval
    Notes
    [18] - The comparison between treatment groups was carried-out using t-test for unpaired data.
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    PAI-1
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.142 [19]
    Method
    t-test for unpaired data
    Confidence interval
    Notes
    [19] - The comparison between treatment groups was carried-out using t-test for unpaired data.

    Other pre-specified: Percent Change from baseline in Inflammatory Chemokine/cytokine [Interleukin IL-6, IL-8, IL-10, IP-10, MCP-1, GROα, MIP- 1α, and TNFα] and C-reactive protein values

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    End point title
    Percent Change from baseline in Inflammatory Chemokine/cytokine [Interleukin IL-6, IL-8, IL-10, IP-10, MCP-1, GROα, MIP- 1α, and TNFα] and C-reactive protein values
    End point description
    Blood sampling for assay of Inflammatory Chemokine/cytokine [Interleukin IL-6, IL-8, IL-10, IP-10, MCP-1, GROα, MIP- 1α, and TNFα] and C-reactive protein values. Please note that C-reactive protein unit of measure is mg/L. Statistical test for differences in inflammatory chemokines/cytokines and C-reactive protein levels between the 2 treatment groups were analyzed as post-hoc analyses.
    End point type
    Other pre-specified
    End point timeframe
    Follow-up (Day 72)
    End point values
    Ladarixin - ITT set Placebo - ITT set
    Number of subjects analysed
    13
    12
    Units: pg/ml
    arithmetic mean (standard deviation)
        IL-6
    -0.29 ( 1.852 )
    2.94 ( 16.432 )
        IL-8
    0.08 ( 0.642 )
    0.57 ( 6.121 )
        IL-10
    1.48 ( 7.505 )
    -3.27 ( 7.945 )
        IP-10
    -439.14 ( 2459.770 )
    -14.85 ( 112.707 )
        MCP-1
    16.95 ( 65.767 )
    -29.95 ( 126.927 )
        GROα
    -2.59 ( 3.956 )
    1.32 ( 17.881 )
        MIP-1α
    1.21 ( 13.042 )
    16.19 ( 75.687 )
        TNFα
    6.42 ( 18.309 )
    0.66 ( 36.345 )
        C-Reactive Protein
    -2.53 ( 2.378 )
    -2.07 ( 5.908 )
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    IL-6
    Comparison groups
    Placebo - ITT set v Ladarixin - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.744 [20]
    Method
    Kruskal-wallis
    Confidence interval
    Notes
    [20] - The comparison between treatment groups was carried-out using Kruskal-Wallis test.
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    IL-8
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.479 [21]
    Method
    Kruskal-wallis
    Confidence interval
    Notes
    [21] - The comparison between treatment groups was carried-out using Kruskal-Wallis test.
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    IL-10
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.504 [22]
    Method
    Kruskal-wallis
    Confidence interval
    Notes
    [22] - The comparison between treatment groups was carried-out using Kruskal-Wallis test.
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    IP-10
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.514 [23]
    Method
    Kruskal-wallis
    Confidence interval
    Notes
    [23] - The comparison between treatment groups was carried-out using Kruskal-Wallis test.
    Statistical analysis title
    Ladarixin vs placebo
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.134 [24]
    Method
    t-test for unpaired data
    Confidence interval
    Notes
    [24] - The comparison between treatment groups was carried-out using t-test for unpaired data.
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    GROα
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.061 [25]
    Method
    Kruskal-wallis
    Confidence interval
    Notes
    [25] - The comparison between treatment groups was carried-out using Kruskal-Wallis test.
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    MIP-1α
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.956 [26]
    Method
    Kruskal-wallis
    Confidence interval
    Notes
    [26] - The comparison between treatment groups was carried-out using Kruskal-Wallis test.
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    TNFα
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.624 [27]
    Method
    Kruskal-wallis
    Confidence interval
    Notes
    [27] - The comparison between treatment groups was carried-out using Kruskal-Wallis test.
    Statistical analysis title
    Ladarixin vs placebo
    Statistical analysis description
    C-reactive protein
    Comparison groups
    Ladarixin - ITT set v Placebo - ITT set
    Number of subjects included in analysis
    25
    Analysis specification
    Post-hoc
    Analysis type
    superiority
    P-value
    = 0.174 [28]
    Method
    Kruskal-wallis
    Confidence interval
    Notes
    [28] - The comparison between treatment groups was carried-out using Kruskal-Wallis test.

    Other pre-specified: Mean percent change from baseline in gut (faeces) Microbioma/microbiota Diversity Index values

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    End point title
    Mean percent change from baseline in gut (faeces) Microbioma/microbiota Diversity Index values
    End point description
    Gut (faeces) microbiome/microbiota “Diversity” defined as [Pellegrini, 2017]: The richness and evenness distribution of distinct types of organisms, calculated by the Shannon’s Diversity Index; should the Diversity be different between treatment groups, additional taxonomic details will be obtained from the centralized laboratory and presented (separate report attached to the CSR) up to the level where the difference between groups is evident
    End point type
    Other pre-specified
    End point timeframe
    Follow-up (Day 72)
    End point values
    Ladarixin - ITT set Placebo - ITT set
    Number of subjects analysed
    13
    12
    Units: mean percent
        arithmetic mean (standard deviation)
    4.40 ( 16.966 )
    2.08 ( 23.296 )
    No statistical analyses for this end point

    Other pre-specified: Percent Change from baseline in waist and waist/hip measurements.

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    End point title
    Percent Change from baseline in waist and waist/hip measurements.
    End point description
    The waist and hip circumference are measures of the distribution of body fat (both subcutaneous and intra-abdominal). The Waist /Hip Ratio is calculated by dividing waist measurement by hip measurement.The formula is: WHR= waist circumference / hip circumference.
    End point type
    Other pre-specified
    End point timeframe
    Follow-up (Day 72)
    End point values
    Ladarixin - ITT set Placebo - ITT set
    Number of subjects analysed
    13
    12
    Units: cm
    arithmetic mean (standard deviation)
        Waist Circumference
    0.88 ( 2.900 )
    -1.748 ( 2.454 )
        Waist/Hip Circumference
    0.471 ( 1.7869 )
    -0.66 ( 5.558 )
    No statistical analyses for this end point

    Other pre-specified: Adverse events

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    End point title
    Adverse events
    End point description
    An AE was defined as any untoward medical occurrence in a patient/clinical investigation participant administered a medicinal product and which did not necessarily have a causal relationship with that treatment. An AE could therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of the medicinal product, whether or not considered related to the medicinal product. Any AEs which were considered to be reasonably likely to have been caused by the IMP were considered Adverse Drug Reactions (ADRs). Any AE reported as having had a possible, probable, or highly probable relationship to the study medication qualified as an ADR.
    End point type
    Other pre-specified
    End point timeframe
    AEs were monitored and recorded throughout the study, from the date of informed consent signed (week 0) to the end of study participation (early discontinuation or follow-up visit during week 11 (day 71-75))
    End point values
    Ladarixin - SAF Placebo - SAF set
    Number of subjects analysed
    13
    12
    Units: Count of partecipants
    number (not applicable)
        TEAE
    9
    4
        Non-serious TEAE
    9
    4
        Treatment-emergent SAE
    0
    0
        Serious ADR
    0
    0
        TEAE leading to treatment discontinuation
    0
    0
        TEAE leading to study discontinuation
    0
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    AEs were monitored and recorded throughout the study, from the date of informed consent signed (week 0) to the end of study participation (early discontinuation or follow-up visit during week 11 (day 71-75))
    Adverse event reporting additional description
    All TEAEs were mild or moderate in severity and none led to treatment or study discontinuation. The most frequently reported TEAEs in the ladarixin group were gastrointestinal disorders, most of which were considered ADRs. All ADRs in the ladarixin treatment group were mild in severity and treatment with ladarixin was continued unchanged.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23.0
    Reporting groups
    Reporting group title
    Ladarixin
    Reporting group description
    -

    Reporting group title
    Placebo
    Reporting group description
    -

    Serious adverse events
    Ladarixin Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 13 (0.00%)
    0 / 12 (0.00%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Ladarixin Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    9 / 13 (69.23%)
    4 / 12 (33.33%)
    Nervous system disorders
    Headache
         subjects affected / exposed
    0 / 13 (0.00%)
    2 / 12 (16.67%)
         occurrences all number
    0
    6
    Blood and lymphatic system disorders
    Neutropenia
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Hepatobiliary disorders
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Non-alcoholic steatohepatitis
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal disorders
    Gastrooesophageal reflux disease
         subjects affected / exposed
    3 / 13 (23.08%)
    0 / 12 (0.00%)
         occurrences all number
    3
    0
    Abdominal pain upper
         subjects affected / exposed
    2 / 13 (15.38%)
    0 / 12 (0.00%)
         occurrences all number
    2
    0
    Abdominal pain
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Dyspepsia
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 12 (0.00%)
         occurrences all number
    3
    0
    Respiratory, thoracic and mediastinal disorders
    Sleep apnoea syndrome
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Tachypnoea
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Endocrine disorders
    Autoimmune thyroid disorder
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Hypothyroidism
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Infections and infestations
    Helicobacter infection
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 12 (8.33%)
         occurrences all number
    1
    1
    Gastroenteritis
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Herpes zoster
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Metabolism and nutrition disorders
    Folate deficiency
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Hypertriglyceridaemia
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    15 Oct 2021
    Extension of IMP shelf-life from 24 to 36 months.
    09 Nov 2021
    Addition of INCO operational unit. INCO stands for Istituto Nazionale di Cura dell’Obesità (National Institute of Obesity Treatment)
    07 Oct 2022
    Extension of IMP shelf-life from 36 to 48 months
    07 Nov 2022
    Transfer of INCO operational unit from IRCCS Policlinic San Donato to IRCCS Galeazzi Hospital. IRCCS stands for Istituto di Ricovero e Cura a Carattere Scientifico (Scientific Institute for Research, Hospitalization and Healthcare)

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    No limitations or caveats are applicable to this summary of the results
    For support, Contact us.
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