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Genetic ObesityPhase 2NCT04963231

DAYBREAK: A Study of Setmelanotide in Participants With Specific Gene Variants in the Melanocortin-4 Receptor (MC4R) Pathway

A Phase 2 study testing Setmelanotide in people with Genetic Obesity, run by Rhythm Pharmaceuticals, Inc. at 36 sites in 8 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

The purpose of this study was to evaluate the safety and efficacy of once daily subcutaneous (SC) administration of setmelanotide in participants with obesity and specific gene variants in the MC4R pathway. Read more about this study

Who is it for?
Ages 6 to 65 years
Conditions the study is for
Genetic Obesity
What is being tested?
Setmelanotide
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
164 participants
Where
36 sitesin 8 countries
Study dates
30 Nov 2021to 30 Sep 2024
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 6 to 65 years
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Participants must have had a pre-identified genetic variant in an established MC4R pathway gene that contributes to obesity
  • Age 6 to 65 years, inclusive
  • Obesity, defined as Body Mass Index (BMI) ≥40 kilograms per square meter (kg/m^2) for participants ≥18 years of age or BMI ≥97th percentile for age and gender for participants 6 to <18 years of age
  • Study participant and/or parent or guardian were able to understand all study procedures and provide consent/assent
  • Use of highly effective contraception
  • Symptoms or behaviors of hyperphagia

Who cannot join

  • Participants with the following genetic variants: biallelic Bardet-Biedl Syndrome (BBS); biallelic Alström Syndrome 1 (ALMS1); homozygous, heterozygous, or compound heterozygous variants in MC4R, Pro-opiomelanocortin (POMC), Proprotein convertase subtilisin/kexin type 1 (PCSK1), Leptin receptor (LEPR), nuclear receptor coactivator 1 (NCOA1; steroid receptor coactivator-1 [SRC1]) or SRC homology 2 B adapter protein 1 (SH2B1) genes as well as 16p11.2 chromosomal deletions that included the SH2B1 gene
  • Recent intensive diet and/or exercise regimen with or without the use of weight loss agents including herbal medications that had resulted in weight loss >2% within previous 3 months
  • Bariatric surgery within the previous 6 months
  • Documented diagnosis of current unstable major psychiatric disorder or a documented worsening of psychiatric condition that required changes in treatment within 2 years
  • Any suicidal ideation of type 4 or 5 on the Columbia-Suicide Severity Rating Scale (C-SSRS) or Patient Health Questionnaire 9 (PHQ 9) score of ≥15 during Screening, any suicide attempt in participant's lifetime years, or any suicidal behavior in the last month.
  • Current, clinically significant pulmonary, cardiac, or oncologic disease considered severe enough to interfere with the study
Show all 17Show fewer
  • Has significant features of (or meets the diagnostic criteria for) a genetic syndrome that is associated with obesity
  • Glycated hemoglobin (HbA1C) >10.0% at Screening
  • History of significant liver disease
  • Glomerular filtration rate (GFR) <30 milliliter per minute (mL/min) at Screening
  • History or close family history of melanoma or participant history of oculocutaneous albinism
  • Significant dermatologic findings relating to melanoma or pre-melanoma skin lesions
  • Participation in any clinical study with an investigational drug/device within 3 months prior to the first day of dosing
  • Participants previously enrolled in a clinical study involving setmelanotide or any previous exposure to setmelanotide
  • Significant hypersensitivity to any excipient in the study drug
  • Females who were breastfeeding or nursing
  • Other protocol defined Inclusion/Exclusion criteria applied.

Trial locations and contacts

36 sites in 8 countries.

36 sites in 8 countries

United States21 sites
  • Texas Tech

    Amarillo, Texas, 79106

  • University of Michigan

    Ann Arbor, Michigan, 48105

  • University of North Carolina

    Chapel Hill, North Carolina, 27517

  • Endocrine Associates of Dallas and Plano

    Dallas, Texas, 75231

  • Geisinger Clinic

    Danville, Pennsylvania, 17822

  • Metro Detroit Endocrinology Center

    Dearborn, Michigan, 48126

  • Hector Granados PA

    El Paso, Texas, 79907

  • Texas Children's Hospital

    Houston, Texas, 77030

  • Accurate Clinical Research

    Houston, Texas, 77065

  • Mississippi Center for Advanced Medicine

    Madison, Mississippi, 39110

  • Rio Grande Valley Endocrine Center

    McAllen, Texas, 78503

  • Mount Sinai

    New York, New York, 10029

  • Columbia University

    New York, New York, 10032

  • The Children's Hospital of Philadelphia

    Philadelphia, Pennsylvania, 19104

  • Mayo Clinic

    Rochester, Minnesota, 55905

  • Clinical Trials of Texas

    San Antonio, Texas, 78229

  • HonorHealth Bariatric Center

    Scottsdale, Arizona, 85258

  • Ten's Medical Center - Pediatric Endocrinology Clinic

    Staten Island, New York, 10308

  • InQuest Medical Reseacrh

    Suwanee, Georgia, 30071

  • Javara Research

    The Woodlands, Texas, 77382

  • UMass Memorial Medical Center

    Worcester, Massachusetts, 01655

Other trials in United States

Spain4 sites
  • Hospital Sant Joan de Deu

    Barcelona, 08950

  • Hospital Infantil Universitario Nino Jesus

    Madrid, 28009

  • Hospital Fundación Jimenez Díaz

    Madrid, 28040

  • Hospital General de Valencia

    Valencia, 46014

Other trials in Spain

United Kingdom4 sites
  • Bristol Royal Hospital for Children

    Bristol

  • University of Cambridge

    Cambridge

  • London Medical - The London Diabetes Centre

    London, NW1 2PG

  • University College London Hospitals NHS Foundation Trust

    London, WC1E 6JF

Other trials in United Kingdom

Germany3 sites
  • Charite - Universitatsmedizin Berlin

    Berlin

  • Universitaetsklinikum Leipzig

    Leipzig, 04103

  • Universitaetsklinikum Ulm

    Ulm, 89075

Other trials in Germany

Canada1 site
  • University of Alberta

    Edmonton, Alberta, T6G 2E1

Other trials in Canada

Greece1 site
  • University of Patras School of Medicine

    Pátrai

Other trials in Greece

Israel1 site
  • Chaim Sheba MC, Safra Children's Hospital

    Ramat Gan, 5265602

Other trials in Israel

Netherlands1 site
  • Erasmus Medisch Centrum

    Rotterdam, 3015 GD

Other trials in Netherlands

About this study

Official title: A 2-Stage (Open-Label Followed by Randomized Double-Blind, Placebo-Controlled Stage), Phase 2 Trial of Setmelanotide in Patients With Specific Gene Variants in the Melanocortin-4 Receptor Pathway

The purpose of this study was to evaluate the safety and efficacy of once daily subcutaneous (SC) administration of setmelanotide in participants with obesity and specific gene variants in the MC4R pathway.

Conditions
Genetic Obesity
Being tested
Setmelanotide, Placebo
Keywords
Melanocortin-4 Receptor, Genetic Obesity, Leptin

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • SetmelanotideDrug

    SC injection

  • PlaceboDrug

    SC injection

Study groups in NCT04963231
Study groupRoleWhat they receive
Stage 1: Setmelanotide (Open-Label)ExperimentalParticipants received once daily SC injection of setmelanotide from Day 1 to Week 16 in an open-label treatment stage (Stage 1). Participants ≥12 years of age started on setmelanotide 2.0 milligrams (mg) once daily for approximately 2 weeks, then increased to 3.0 mg once daily. Participants <12 years of age started on setmelanotide 1.0 mg once daily for approximately 1 week, then increased to 2.0 mg once daily for approximately 1 week, then increased to 3.0 mg once daily.
Receives: Drug: Setmelanotide
Stage 2: Setmelanotide (Double-Blind)ExperimentalParticipants from Stage 1 who were eligible for Stage 2 received once daily SC injection of setmelanotide 3.0 mg from Week 16 to Week 40 in a double-blind treatment Stage (Stage 2).
Receives: Drug: Setmelanotide
Stage 2: Placebo (Double-Blind)Placebo comparatorParticipants from Stage 1 who were eligible for Stage 2 received once daily SC injection of matching placebo 3.0 mg from Week 16 to Week 40 in a double-blind treatment Stage (Stage 2).
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Stage 1: Number of Participants by Genotype Who Demonstrated a Significant Clinically Meaningful Response to Setmelanotide at the End of Stage 1

    BMI was calculated using participant's weight and height assessments, using the following formula: BMI = Kilogram (kg)/ square meter (m^2).

    A significant clinically meaningful response was defined as achieving a ≥5% reduction in BMI from Baseline.

    Data are provided for overall and according to participants with specified primary gene. Baseline was defined as the last available measurement taken prior to the start of treatment Stage 1 administration.

    Measured: Baseline to Week 16

Secondary outcomes (9)
  1. Mean Change in BMI From Baseline to the End of Stage 1 in All Participants, Per Genotype

    BMI was calculated using participant's weight and height assessments, using the following formula: BMI = kg/m^2.

    Data are provided for overall and according to participants with specified primary gene.

    Baseline was defined as the last available measurement taken prior to the start of treatment Stage 1 administration.

    Measured: Baseline, Week 16

  2. Mean Change in BMI From Baseline to the End of Stage 1 in Participants ≥18 Years Old, Per Genotype

    BMI was calculated using participant's weight and height assessments, using the following formula: BMI = kg/m^2 Data are provided for overall and according to participants with specified primary gene.

    Baseline was defined as the last available measurement taken prior to the start of treatment Stage 1 administration.

    Measured: Baseline, Week 16

  3. Percent Change in BMI From Baseline to the End of Stage 1 in All Participants, Per Genotype

    BMI was calculated using participant's weight and height assessments, using the following formula: BMI = kg/m^2 Data are provided for overall and according to participants with specified primary gene.

    Baseline was defined as the last available measurement taken prior to the start of treatment Stage 1 administration.

    Measured: Baseline, Week 16

  4. Percent Change in BMI From Baseline to the End of Stage 1 in Participants ≥18 Years Old, Per Genotype

    BMI was calculated using participant's weight and height assessments, using the following formula: BMI = kg/m^2 Data are provided for overall and according to participants with specified primary gene.

    Baseline was defined as the last available measurement taken prior to the start of treatment Stage 1 administration.

    Measured: Baseline, Week 16

  5. Mean Change in Body Weight From Baseline to the End of Stage 1 in Participants ≥18 Years Old, Per Genotype

    Data are provided for overall and according to participants with specified primary gene.

    Baseline was defined as the last available measurement taken prior to the start of treatment Stage 1 administration.

    Measured: Baseline, Week 16

  6. Percent Change in Body Weight From Baseline to the End of Stage 1 in Participants ≥18 Years Old, Per Genotype

    Data are provided for overall and according to participants with specified primary gene.

    Baseline was defined as the last available measurement taken prior to the start of treatment Stage 1 administration.

    Measured: Baseline, Week 16

  7. Mean Change in BMI Z-score From Baseline to the End of Stage 1 in Participants <18 Years Old, Per Genotype

    BMI was calculated using participant's weight and height assessments, using the following formula: BMI = kg/m^2. The BMI Z-score indicated the number of standard deviations away from the mean. A Z-score of 0 is equal to the mean of a reference population (i.e., healthy, age and sex-matched individuals). A decrease of BMI Z-score indicates a reduction in BMI from Baseline whereas an increase of BMI-Z score indicates an increase in BMI from Baseline.

    Baseline was defined as the last available measurement taken prior to the start of treatment Stage 1 administration.

    Measured: Baseline, Week 16

  8. Percent Change in the Weekly Average of the Daily Maximal Hunger Score From Baseline to the End of Stage 1 in Participants ≥12 Years Old, Per Genotype

    Daily Hunger Questionnaire for participants ≥12 years of age is self-administered questionnaire and comprises three items. For the assessment of this endpoint, maximal hunger was corresponding to the following question: In the last 24 hours, how hungry did you feel when you were the most hungry? The response was scored separately and averaged on weekly basis. Participants rated their hunger on an 11-point numeric rating scale ranging from 0 to 10 (0 = not hungry at all, and 10 = hungriest possible).

    Weekly average at Week 16 was defined as average of the available score values within 7 days in Week 16.

    Baseline was defined as the average of the available score values within 7 days before or on the stage 1 open-label treatment.

    Results are reported by overall participant results and by specific gene cohort.

    Measured: Baseline, Week 16

  9. Number of Participants ≥12 Years Old, Who Achieved a ≥2 Point Reduction From Baseline to the End of Stage 1 in the Weekly Average of the Daily Maximal Hunger Score, Per Genotype

    Daily Hunger Questionnaire for participants ≥12 years of age is self-administered questionnaire and comprises three items. For the assessment of this endpoint, maximal hunger was corresponding to the following question: In the last 24 hours, how hungry did you feel when you were the most hungry? The response was scored separately and averaged on weekly basis. Participants rated their hunger on an 11-point numeric rating scale ranging from 0 to 10 (0 = not hungry at all, and 10 = hungriest possible).

    Weekly average at Week 16 was defined as average of the available score values within 7 days in Week 16.

    Baseline was defined as the average of the available score values within 7 days before or on the stage 1 open-label treatment.

    Results are reported by overall participant results and by specific gene cohort.

    Measured: Baseline, Week 16

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Jul 2021
  2. Study start30 Nov 2021
  3. Primary completion4 Aug 2023
  4. Study completion30 Sep 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
164 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04963231
Sponsor's protocol ID
RM-493-034
Status last verified
Jul 2025
First submitted
28 Jun 2021
Last updated
2 Jul 2025
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Trapp CM, Censani M. Setmelanotide: a promising advancement for pediatric patients with rare forms of genetic obesity. Curr Opin Endocrinol Diabetes Obes. 2023 Apr 1;30(2):136-140. doi: 10.1097/MED.0000000000000798. Epub 2023 Feb 1.

    PubMed 36722447
  • Cuda S, Censani M. Progress in pediatric obesity: new and advanced therapies. Curr Opin Pediatr. 2022 Aug 1;34(4):407-413. doi: 10.1097/MOP.0000000000001150. Epub 2022 Jul 5.

    PubMed 35797460

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Setmelanotide in people with Genetic Obesity, run by Rhythm Pharmaceuticals, Inc. at 36 sites in 8 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 17 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 2 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 36 sites in United States, Spain, United Kingdom, Germany, Canada and 3 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 24 Oct 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Stage 1: Number of Participants by Genotype Who Demonstrated a Significant Clinically Meaningful Response to Setmelanotide at the End of Stage 1 (time frame: Baseline to Week 16). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04963231, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Jul 2025.

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