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The Lowering Weight in Severe Obesity by Embolization of the Gastric Artery Trial (LOSEIT)

Primary Purpose

Obesity, Morbid

Status
Completed
Phase
Not Applicable
Locations
Czechia
Study Type
Interventional
Intervention
Endobar Infusion Catheter System
Behavioral therapy
Sponsored by
Endobar Solutions LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Obesity, Morbid focused on measuring Obesity, Embolization, Left Gastric Artery

Eligibility Criteria

21 Years - 66 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • • BMI 35.0-50.0 kg/m2 at time of screening

    • Women of childbearing potential must agree to use at least one form of birth control (prescription hormonal contraceptives, diaphragm, IUD, condoms with or without spermicide, or voluntary abstinence) from time of study enrollment through study exit.
    • Willing and able to provide informed consent

Exclusion Criteria:

  • • Previous bariatric, gastric pancreatic, hepatic, and/or splenic surgery

    • History of duodenal or gastric ulcers or regularly taking medications (therapy >1 day per week) that can cause ulcers (e.g., non-steroidal anti-inflammatory drugs)
    • Prior radiation to the upper abdomen
    • Prior embolization to the stomach, spleen or liver
    • Portal venous hypertension
    • Active H. pylori infection
    • Uncontrolled hypertension (> 160/100 with or without medication).
    • Diabetes (determined by medical history, fasting blood glucose or results of an oral glucose tolerance test)
    • Serum triglyceride > 400 mg/dL at screening.
    • Class 4 or 5 surgical risk based on standard ASA criteria (Saklad M. Grading of patients for surgical procedures. Anesthesiol. 1941; 2:281-4).
    • Severe pulmonary or cardiovascular disease defined as a history or evidence of serious cardiovascular disease, including myocardial infarction, acute coronary syndrome, coronary revascularization, heart failure requiring medications, history of sudden cardiac death, or NYHA (New York Heart Association) class III or IV heart failure (defined below):

      • Class III: patients with marked limitation of activity; they are comfortable only at rest.
      • Class IV: patients who should be at complete rest, confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest.
    • Coagulation disorders (platelets < 100,000, PT > 2 seconds above control or INR > 1.5 at screening).
    • Anemia (Hb < 10.0 g/dL) at screening.
    • Malignancy in the last 5 years (except for non-melanoma skin cancer).
    • Evidence of other significant organ system dysfunction (e.g. cirrhosis, renal failure)
    • Pregnant or lactating.
    • History of substance abuse in last 3 years.
    • Thyroid Stimulating Hormone (TSH) >2.0 x upper limit of normal at screening.
    • Taking prescription or over-the-counter medications for weight loss in the last 3 months before screening, or planning to participate in a commercial weight loss program in the next 5 years.
    • Taking diuretic medication for congestive heart failure or edema.
    • Evidence of significant mucosal inflammation, ulceration or ischemia detected on endoscopy, and those with unsuitable left gastric anatomy as judged by the study site physician will be excluded
    • Psychiatric illness that could affect compliance with the study, as judged by the site principle investigator.
    • Unable to complete screening requirements (compliance with visits and dietary record)
    • Taking medication once or more per week that causes weight gain (e.g. atypical antipsychotics, monoamine oxidase inhibitors, lithium, selected anticonvulsants, tamoxifen, glucocorticoids)
    • Chronic abdominal pain that would potentially complicate management.
    • Unstable weight (>3% change; self-reported) over the previous 2 months at time of screening.
    • Subjects whom the site investigator, research team, or the study medical monitor feel is not able to participate in the study for any reason, including poor general health or unable/unwilling to follow the study protocol.

Sites / Locations

  • OB klinika a.s., Pod Krejcárkem 975

Arms of the Study

Arm 1

Arm 2

Arm Type

Sham Comparator

Experimental

Arm Label

Sedation and subcutaneous lidocaine

interventional: bariatric embolization

Arm Description

Lidocaine injected at the femoral artery site. This patients will undergo behavioral therapy for 6 months and will crossover and will receive bariatric embolization.

• In patients randomized to intervention bariatric embolization will be performed using Endobar Infusion Catheter System. After procedure patients will undergo behavioral therapy

Outcomes

Primary Outcome Measures

Weight Loss
Difference in percent total body weight (% TBWL) loss at 6 months between the Sham Control and Endobar Therapy groups. This is calculated as the difference in body weight from baseline to 6 months, relative to the baseline weight (i.e, initial weight - 6 month weight / initial weight) x 100%). The mean (i.e., average) total body weight loss of both groups was compared to assess whether there was a meaningful difference. Percent total body weight loss (%TBWL) at 12 months in the group randomized to the initial Endobar Therapy alone. This is calculated as the difference in body weight from baseline to 12 months, relative to the baseline weight (i.e, initial weight - 12 month weight / initial weight) x 100%).
Number of Patients With Adverse Events
The Incidence of device-, procedure- and therapy-related adverse events up to 12 months post-procedure.
Absolute Weight Loss (kg)
6-month change: The absolute difference in the initial and 6-month weight (kg) (i.e., initial - 6 month weight). These changes were averaged for each group and compared between the two groups to assess whether there was a meaningful difference. 12-month change: The absolute difference in the initial and 12-month weight (kg) (i.e., initial - 12 month weight).

Secondary Outcome Measures

Percent Excess Body Weight (%EBWL) Loss
Percent excess body weight loss (% EBWL) is calculated by dividing the absolute weight loss divided by baseline excess weight and multiplying by 100% (i.e., excess weight / initial weight x 100%). Excess weight is defined as the difference between current weight and ideal weight. %EBWL was calculated for the following time points: 6 months: absolute weight loss was the difference from baseline to 6 months. %EBWL was averaged for each group and compared to assess whether there was a meaningful difference between the groups. 12 months: absolute weight loss was the difference from baseline to 12 months. Note, excess weight was determined from ideal body weights based on a BMI=25 kg/m2.
Number of Patients With Weight Loss ≥5%
Proportion of subjects who achieve ≥5% total body weight loss from baseline vs. those who do not
6 Month Change in Lipids
6-month change (from baseline) in lipids for both groups. Unit of Measure: mg/dL
6 and 12 Month Change in Blood Pressure
Change in absolute blood pressure levels from baseline to 6 months for both groups and baseline to 12 months for the initial treatment group. Unit of Measure: mmHg

Full Information

First Posted
May 9, 2017
Last Updated
September 11, 2022
Sponsor
Endobar Solutions LLC
Collaborators
OB KLINIKA a.s. Pod Krejcárkem 975 Praha 3 - Žižkov Tel.: +420 255 725 110, Na Homolce Hospital, High Tech Med Consult Frimlova 1322/4e 15500 Prague 5 Czech Republic
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1. Study Identification

Unique Protocol Identification Number
NCT03185949
Brief Title
The Lowering Weight in Severe Obesity by Embolization of the Gastric Artery Trial
Acronym
LOSEIT
Official Title
Efficacy and Safety of EndoBar Bariatric Embolization for Weight Management in People With Obesity
Study Type
Interventional

2. Study Status

Record Verification Date
September 2022
Overall Recruitment Status
Completed
Study Start Date
February 8, 2017 (Actual)
Primary Completion Date
December 1, 2018 (Actual)
Study Completion Date
December 1, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Endobar Solutions LLC
Collaborators
OB KLINIKA a.s. Pod Krejcárkem 975 Praha 3 - Žižkov Tel.: +420 255 725 110, Na Homolce Hospital, High Tech Med Consult Frimlova 1322/4e 15500 Prague 5 Czech Republic

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Device Product Not Approved or Cleared by U.S. FDA
Yes
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
To evaluate the efficacy and safety of the Endobar gastric embolization system for the treatment of obesity before continuing to a larger Pivotal Trial. Investigational Device The investigational device in this clinical study is the Endobar Infusion Catheter System - a disposable system consisting of an occlusion balloon catheter, a Smart Manifold delivery system. Study Design/Planned Number of Subjects This study is a prospective, sham controlled, single-blind 12-month trial with 1:1 randomization. A maximum of 40 subjects (obese men and women who have a body mass index (BMI) of 35.0-50.0 kg/m2) will be enrolled in the study. Eligible subjects will be randomized to treatment with Endobar Therapy (n = 20) or sham procedure control (n = 20). Endobar Therapy involves catheter-based embolization of the left gastric artery. All subjects in both Endobar Therapy and Sham Control groups will receive Lifestyle Therapy (behavioral and diet education). At the end of 6 months all subjects randomized to the Sham Control group will receive catheter-based embolization of the left gastric artery. Both Endobar Therapy and Sham Control crossover to Endobar Therapy groups will be followed for a total of 12 months. Study Duration The duration of the study is expected to last approximately 18 months from the first enrollment . An additional 12 months to the study closeout after the last follow-up.
Detailed Description
STUDY OBJECTIVES Objective The objective of this study is to conduct a sham controlled randomized trial to evaluate the efficacy and safety of the Endobar System for the treatment of obesity. Efficacy, Safety, and secondary outcomes will be evaluated at 6 and 12 months to allow expansion of the investigation into a larger, pivotal clinical study. Study Design This is a prospective randomized, single blind, active treatment and sham controlled, single-center trial . After the informed consent and screening process are completed, all subjects who are eligible and wish to participate in the study will undergo baseline testing. Those who complete baseline testing will be randomized to either Endobar Therapy (ET) or Sham Treatment (ST) for 52 weeks. Both groups will be given lifestyle therapy for weight loss, which involves treatment with a behavioral education weight loss program delivered as 19 individual sessions in person over 52 weeks. Endobar Therapy involves catheter-based embolization of the left gastric artery. After 26 weeks, the ET group will continue to be monitored for an addition 26 weeks and the ST subjects will be given ET and monitored for 26 weeks. The duration of the entire study will be 52 weeks.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Obesity, Morbid
Keywords
Obesity, Embolization, Left Gastric Artery

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Model Description
This study is a prospective, sham controlled, single-blind 12-month trial with 1:1 randomization. A maximum of 40 subjects (obese men and women who have a body mass index (BMI) of 35.0-50.0 kg/m2) will be enrolled in the study. Eligible subjects will be randomized to treatment with Endobar Therapy (n = 20) or sham procedure control (n = 20). Endobar Therapy involves catheter-based embolization of the left gastric artery. All subjects in both Endobar Therapy and Sham Control groups will receive Lifestyle Therapy (behavioral and diet education). At the end of 6 months all subjects randomized to the Sham Control group will receive catheter-based embolization of the left gastric artery. Both Endobar Therapy and Sham Control crossover to Endobar Therapy groups will be followed for a total of 12 months
Masking
ParticipantOutcomes Assessor
Masking Description
Interventional Group: These subjects will undergo catheter-based embolization. Sham Control Group: These subjects will not undergo femoral artery catheterization. Instead, lidocaine will be injected subcutaneously at the femoral artery site in the Sham Control group. Since all patients will have received at least sedation, they will not be aware of what has been done, and thus be blind to their treatment assignment
Allocation
Randomized
Enrollment
44 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Sedation and subcutaneous lidocaine
Arm Type
Sham Comparator
Arm Description
Lidocaine injected at the femoral artery site. This patients will undergo behavioral therapy for 6 months and will crossover and will receive bariatric embolization.
Arm Title
interventional: bariatric embolization
Arm Type
Experimental
Arm Description
• In patients randomized to intervention bariatric embolization will be performed using Endobar Infusion Catheter System. After procedure patients will undergo behavioral therapy
Intervention Type
Device
Intervention Name(s)
Endobar Infusion Catheter System
Intervention Description
Bariatric embolization with microspheres using Endobar Infusion Catheter System
Intervention Type
Behavioral
Intervention Name(s)
Behavioral therapy
Intervention Description
Healthy diet and exercise
Primary Outcome Measure Information:
Title
Weight Loss
Description
Difference in percent total body weight (% TBWL) loss at 6 months between the Sham Control and Endobar Therapy groups. This is calculated as the difference in body weight from baseline to 6 months, relative to the baseline weight (i.e, initial weight - 6 month weight / initial weight) x 100%). The mean (i.e., average) total body weight loss of both groups was compared to assess whether there was a meaningful difference. Percent total body weight loss (%TBWL) at 12 months in the group randomized to the initial Endobar Therapy alone. This is calculated as the difference in body weight from baseline to 12 months, relative to the baseline weight (i.e, initial weight - 12 month weight / initial weight) x 100%).
Time Frame
1) 6 months post-procedure/sham and 2) 12 months post-procedure
Title
Number of Patients With Adverse Events
Description
The Incidence of device-, procedure- and therapy-related adverse events up to 12 months post-procedure.
Time Frame
12 months post-randomization
Title
Absolute Weight Loss (kg)
Description
6-month change: The absolute difference in the initial and 6-month weight (kg) (i.e., initial - 6 month weight). These changes were averaged for each group and compared between the two groups to assess whether there was a meaningful difference. 12-month change: The absolute difference in the initial and 12-month weight (kg) (i.e., initial - 12 month weight).
Time Frame
6 months post-procedure/sham and 12 months post-procedure
Secondary Outcome Measure Information:
Title
Percent Excess Body Weight (%EBWL) Loss
Description
Percent excess body weight loss (% EBWL) is calculated by dividing the absolute weight loss divided by baseline excess weight and multiplying by 100% (i.e., excess weight / initial weight x 100%). Excess weight is defined as the difference between current weight and ideal weight. %EBWL was calculated for the following time points: 6 months: absolute weight loss was the difference from baseline to 6 months. %EBWL was averaged for each group and compared to assess whether there was a meaningful difference between the groups. 12 months: absolute weight loss was the difference from baseline to 12 months. Note, excess weight was determined from ideal body weights based on a BMI=25 kg/m2.
Time Frame
1) 6 months post-procedure/sham and 2) 12 months post-procedure
Title
Number of Patients With Weight Loss ≥5%
Description
Proportion of subjects who achieve ≥5% total body weight loss from baseline vs. those who do not
Time Frame
6 months post-procedure/sham
Title
6 Month Change in Lipids
Description
6-month change (from baseline) in lipids for both groups. Unit of Measure: mg/dL
Time Frame
6 months post-procedure/sham
Title
6 and 12 Month Change in Blood Pressure
Description
Change in absolute blood pressure levels from baseline to 6 months for both groups and baseline to 12 months for the initial treatment group. Unit of Measure: mmHg
Time Frame
6 months post-procedure/sham and 12 months post-procedure
Other Pre-specified Outcome Measures:
Title
Ghrelin Levels
Description
Unit of Measure: pg/mL
Time Frame
[Time Frame: 6-12 months]
Title
Glucagon-like Peptide 1 Concentrations
Description
Changes in Glucagon-like peptide 1 concentrations Unit of Measure: pg/mL
Time Frame
[Time Frame: 6-12 months]
Title
Oral Glucose Tolerance and Insulin Sensitivity
Description
Changes in OGTT and Insulin Sensitivity Unit of measure:milligrams/deciliter (mg/dL)
Time Frame
[Time Frame: 6-12 months]
Title
Insulin Sensitivity
Description
Unit of measure: mg/min
Time Frame
[Time Frame: 6-12 months]
Title
Changes in Mood (Depression/Anxiety)
Description
Unit of Measure: Beck Depression Index
Time Frame
[Time Frame: 6-12 months]
Title
Change in Quality-of-life
Description
Change in the subdomains and overall Quality of Life Unit of Measure: IWQOL
Time Frame
[Time Frame: 6-12 months]
Title
Change in Eating Behavior
Description
Unit of Measure: Eating Questionnaire Scores
Time Frame
[Time Frame: 6-12 months]
Title
Change in Volume of Meal Test Consumed to Achieve Satiation: Satiation Drink Test.
Description
Change in satiety and other parameters associated with this test Unit of Measure: numerical scale from 0-5
Time Frame
[Time Frame: 6-12 months]
Title
Results From Endoscopy
Description
Photos and clinical reports analyzed
Time Frame
12 months
Title
Gastric Motility/Emptying
Description
Unit of Measure: (t 1/2) in minutes
Time Frame
[Time Frame: 6-12 months]

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
66 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: • BMI 35.0-50.0 kg/m2 at time of screening Women of childbearing potential must agree to use at least one form of birth control (prescription hormonal contraceptives, diaphragm, IUD, condoms with or without spermicide, or voluntary abstinence) from time of study enrollment through study exit. Willing and able to provide informed consent Exclusion Criteria: • Previous bariatric, gastric pancreatic, hepatic, and/or splenic surgery History of duodenal or gastric ulcers or regularly taking medications (therapy >1 day per week) that can cause ulcers (e.g., non-steroidal anti-inflammatory drugs) Prior radiation to the upper abdomen Prior embolization to the stomach, spleen or liver Portal venous hypertension Active H. pylori infection Uncontrolled hypertension (> 160/100 with or without medication). Diabetes (determined by medical history, fasting blood glucose or results of an oral glucose tolerance test) Serum triglyceride > 400 mg/dL at screening. Class 4 or 5 surgical risk based on standard ASA criteria (Saklad M. Grading of patients for surgical procedures. Anesthesiol. 1941; 2:281-4). Severe pulmonary or cardiovascular disease defined as a history or evidence of serious cardiovascular disease, including myocardial infarction, acute coronary syndrome, coronary revascularization, heart failure requiring medications, history of sudden cardiac death, or NYHA (New York Heart Association) class III or IV heart failure (defined below): Class III: patients with marked limitation of activity; they are comfortable only at rest. Class IV: patients who should be at complete rest, confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest. Coagulation disorders (platelets < 100,000, PT > 2 seconds above control or INR > 1.5 at screening). Anemia (Hb < 10.0 g/dL) at screening. Malignancy in the last 5 years (except for non-melanoma skin cancer). Evidence of other significant organ system dysfunction (e.g. cirrhosis, renal failure) Pregnant or lactating. History of substance abuse in last 3 years. Thyroid Stimulating Hormone (TSH) >2.0 x upper limit of normal at screening. Taking prescription or over-the-counter medications for weight loss in the last 3 months before screening, or planning to participate in a commercial weight loss program in the next 5 years. Taking diuretic medication for congestive heart failure or edema. Evidence of significant mucosal inflammation, ulceration or ischemia detected on endoscopy, and those with unsuitable left gastric anatomy as judged by the study site physician will be excluded Psychiatric illness that could affect compliance with the study, as judged by the site principle investigator. Unable to complete screening requirements (compliance with visits and dietary record) Taking medication once or more per week that causes weight gain (e.g. atypical antipsychotics, monoamine oxidase inhibitors, lithium, selected anticonvulsants, tamoxifen, glucocorticoids) Chronic abdominal pain that would potentially complicate management. Unstable weight (>3% change; self-reported) over the previous 2 months at time of screening. Subjects whom the site investigator, research team, or the study medical monitor feel is not able to participate in the study for any reason, including poor general health or unable/unwilling to follow the study protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Martin Fried, MD
Organizational Affiliation
OB klinika a.s., Prague, Czech Republic
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Peter Neuzil, MD
Organizational Affiliation
Na Homolce Hospital, Prague, Czech Republic
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Vivek Reddy, MD
Organizational Affiliation
Mount Sinai Medical Center, New York, NY, USA
Official's Role
Principal Investigator
Facility Information:
Facility Name
OB klinika a.s., Pod Krejcárkem 975
City
Praha 3 - Žižkov
ZIP/Postal Code
130 00
Country
Czechia

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
33183504
Citation
Reddy VY, Neuzil P, Musikantow D, Sramkova P, Rosen R, Kipshidze N, Kipshidze N, Fried M. Transcatheter Bariatric Embolotherapy for Weight Reduction in Obesity. J Am Coll Cardiol. 2020 Nov 17;76(20):2305-2317. doi: 10.1016/j.jacc.2020.09.550.
Results Reference
derived

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The Lowering Weight in Severe Obesity by Embolization of the Gastric Artery Trial

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