A Phase 2, Double-Blind, Randomized, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Acmopatide (CT-868), a Fully Biased GLP-1/GIP Receptor Agonist, in Adults With Type 1 Diabetes and Overweight or Obesity

OBJECTIVE: To evaluate the efficacy and safety of acmopatide, a signal-biased glucagon-like peptide 1/glucose-dependent insulinotropic polypeptide receptor agonist, in adults with type 1 diabetes (T1D) and overweight/obesity. RESEARCH DESIGN AND METHODS: In this phase 2, 16-week, randomized, double-blind, placebo-controlled, multicenter study, adults with T1D (HbA1c 7.0-10.0%; BMI ≥27 kg/m2) were randomized 1:1:1:1 to once-daily subcutaneous acmopatide (1.8, 4.1, or 6.6 mg) or volume-matched placebo. The primary end point was change from baseline (CFB) in HbA1c (%) at week 16; secondary end points included percent CFB in body weight and insulin dose. RESULTS: Overall, 111 participants were randomized (placebo n = 29, acmopatide 1.8 mg n = 27, 4.1 mg n = 28, 6.6 mg n = 27). Mean (SD) baseline HbA1c was 7.5% (0.6), and mean BMI was 34.3 (5.6) kg/m2. Acmopatide improved HbA1c (least squares [LS] mean CFB -0.4 to -0.6% vs. -0.3% with placebo; nominally significant placebo-adjusted difference for 4.1 mg: -0.3% [90% CI -0.6 to -0.1]; P = 0.020). HbA1c <7.0% was achieved by 55.6% of participants receiving acmopatide 4.1 mg vs. 33.3% receiving placebo. Acmopatide-treated participants demonstrated reductions in body weight (LS mean CFB -3.3 to -6.7% vs. 0.3% with placebo; all P < 0.01), total daily insulin dose (-3.4 to -14.9% more than placebo for acmopatide 4.1 and 6.6 mg), and mean systolic blood pressure (-3.1 to -8.4 mmHg vs. -3.3 mmHg with placebo). Adverse events were primarily gastrointestinal. No diabetic ketoacidosis (DKA) or severe hypoglycemia events occurred. CONCLUSIONS: In adults with T1D and overweight/obesity, acmopatide was associated with improved glycemic control and clinically meaningful weight loss without DKA or severe hypoglycemia events.