Novel Procedure May Help Improve Metabolic Disease

Andrew D. Bowser

November 11, 2019

BOSTON — An ablative procedure intended to promote regrowth of duodenal mucosa was safe and had disease-modifying metabolic effects in a randomized study including patients with type 2 diabetes, according to investigators.

A single duodenal mucosal resurfacing (DMR) procedure improved glycemic, hepatic, and body weight measures at 24 weeks in the multicenter study, investigators will report at the annual meeting of the American Association for the Study of Liver Diseases.

The novel and minimally invasive endoscopic procedure treats the duodenum, which is increasingly recognized as a key metabolic signaling center, according to the study authors, including senior author Arun Sanyal, MD, professor in the gastroenterology division of the department of internal medicine at Virginia Commonwealth University School of Medicine in Richmond.

"Duodenal mucosal hyperplasia is a potential therapeutic target for insulin-resistance–related metabolic diseases," Dr. Sanyal and coauthors said in a late-breaking abstract for the study published in the AASLD meeting proceedings.

In a previous international open-label, prospective, multicenter study, published in July in the journal Gut, DMR was feasible and safe, producing durable glycemic improvement in patients with type 2 diabetes with suboptimal control on oral glucose-lowering mediation, according to investigators.

The present study, conducted at nine sites in the European Union and two in Brazil, is the first sham-controlled, double-blind, and prospective study of the modality in patients with suboptimally controlled type 2 diabetes, according to Dr. Sanyal and coauthors.

A total of 39 patients in the study underwent DMR, while 36 underwent a sham procedure, according to the published abstract. The mean HbA1c for those patients was 8.3, BMI was 31.1 kg/m2, and most (77%) were male.

Median change in HbA1c from baseline to 24 weeks, one of two primary endpoints in the study, was –0.6% for DMR, and –0.3% for the sham procedure (P less than 0.05), according to the study abstract.

Likewise, the primary efficacy endpoint of change in a nonalcoholic steatohepatitis (NASH) biomarker favored the DMR arm. The median change in liver magnetic resonance imaging-proton density fat fraction (MRI-PDFF) from baseline to 12 weeks was –5.4% for DMR and –2.4% for the sham procedure (P less than 0.05), according to the reported data.

Hypoglycemia rates were similar in the DMR and sham arms, and over 24 weeks of study, there were no unanticipated adverse effects attributable to the device, and no serious adverse events, Dr. Sanyal and colleagues reported.

Dr. Sanyal reported disclosures related to Fractyl Laboratories, Sanyal Bio, Exhalenz, Akarna, Genfit, Durect, Indalo, Tiziana, Novartis, Merck, Galectin, Janssen, Merck, and more.

SOURCE: Bergman JJGHM, et al. Presented at The Liver Meeting 2019, Boston, Presentation LO2.

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