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Trial · Interventional

Active, not recruitingPhase 3Results postedRegistry data

A Trial of Setmelanotide in Acquired Hypothalamic Obesity

NCTNCT05774756 (opens ClinicalTrials.gov in a new tab)Other idRM-493-040
Open at ClinicalTrials.govAsk about this trial

Overview

Status
Active, not recruiting
Phase
Phase 3
Enrollment
143 participants (actual)
Sponsor
Rhythm Pharmaceuticals, Inc. · Industry
Design
Randomized · Triple masking
Countries
6 countries

United States, Canada, Germany, Japan, Netherlands, United Kingdom

Start
26 Apr 2023
Primary completion
18 Mar 2025
Completion
16 Apr 2027 (estimated)
First posted
20 Mar 2023
Last update posted
10 Aug 2026
Conditions
Hypothalamic Obesity

Timeline

1 trial · 1 ongoing · 1 with posted results

  • Completed
  • Ongoing
  • Not yet recruiting
  • Stopped
  • Estimated dates (est.)
  • Results posted
202320242025202620272028
  1. Ph 3

    A Trial of Setmelanotide in Acquired Hypothalamic Obesity

    NCT05774756

    26 Apr 2023 to est. 16 Apr 2027

Registry summary

Text and fields below are the sponsor's entries at ClinicalTrials.gov, shown as posted.

The goal of this trial is to learn how well Setmelanotide works to improve weight reduction, hunger, and quality of life in patients 4 years of age and older with acquired Hypothalamic Obesity (HO). To determine how well setmelanotide works and how safe it is, patients with HO will take a daily injection of either setmelanotide or placebo and complete trial assessments for 52 weeks on a therapeutic regimen. A separate sub-study in patients with congenital HO is detailed under NCT06760546.

Interventions

  • SetmelanotideDrug
  • PlaceboDrug

Arms2

  • Experimental

    Setemelanotide

    Randomized 2:1 (Setmelanotide: Placebo)

  • Placebo comparator

    Placebo

    Randomized 2:1 (Setmelanotide: Placebo)

Primary outcomes1

Outcomes the sponsor listed as primary.

  1. Pivotal Cohort: Mean Percent Change From Baseline in Body Mass Index (BMI) After 52 Weeks on a Therapeutic Regimen

    Time frame · Baseline, after approximately 52 Weeks on a Therapeutic Regimen (up to approximately 60 weeks)

    Registry description

    BMI was calculated as weight (kg)/height (m\^2). Least square (LS) mean and standard error (SE) were calculated using analysis of covariance (ANCOVA) model.

Secondary outcomes(16)

  1. Pivotal Cohort: Percentage of Participants With ≥5% Reduction From Baseline in BMI (≥18 Years of Age) or ≥0.2-point Reduction From Baseline in BMI Z-score (<18 Years of Age)

    Time frame · After approximately 52 Weeks on a Therapeutic Regimen (baseline up to approximately 60 weeks)

    Registry description

    BMI was calculated as weight (kg)/height (m\^2). BMI Z-Score calculated for participants \<18 years old only is a measure of relative weight adjusted for child's age, sex and height at the time of data collection. The Z-Scores were calculated using the World Health Organization's WHO 2007 BMI SAS Macro Package. A Z-score of 0 is equal to the mean of a reference population (i.e., healthy, age and sex-matched individuals). A decrease in BMI Z-score (\< 0) indicates a reduction in BMI from Baseline whereas an increase in BMI-Z score (\> 0) indicated an increase in BMI from Baseline. Baseline was defined as the most recent measurement prior to the first administration of study drug. Results below represent the percentage of estimated participants with either ≥5% BMI reduction or ≥0.2 point reduction in BMI Z-score by age in each treatment arm as calculated through the MIANALYZE SAS procedure.

  2. Pivotal Cohort: Percentage of Participants With ≥5% Reduction From Baseline in BMI

    Time frame · After approximately 52 Weeks on a Therapeutic Regimen (baseline up to approximately 60 weeks)

    Registry description

    BMI was calculated as weight (kg)/height (m\^2). Results below represent the percentage of estimated participants with ≥5% BMI reduction in each treatment arm as calculated through the MIANALYZE SAS procedure.

  3. Pivotal Cohort: Change From Baseline in Weekly Average Daily Most Hunger Score in Participants ≥12 Years of Age

    Time frame · Baseline, after approximately 52 Weeks on a Therapeutic Regimen (up to approximately 60 weeks)

    Registry description

    Change from baseline in hunger scores for participants ≥12 years of age with acquired hypothalamic obesity was evaluated. Hunger score ranged from 0= "not hungry at all" to 10= "hungriest possible" on an 11-point numeric rating scale. On Daily Hunger Questionnaire, each of the 2 items (average hunger and most hunger) was scored separately and averaged on weekly basis. LSM and SE were calculated using ANCOVA model.

  4. Pivotal Cohort: Percentage of Participants (≥12 Years of Age) With a ≥2-point Reduction From Baseline in the Weekly Average Daily Most Hunger Score

    Time frame · After approximately 52 Weeks on a Therapeutic Regimen (baseline up to approximately 60 weeks)

    Registry description

    Hunger score ranged from 0= "not hungry at all" to 10= "hungriest possible" on an 11-point numeric rating scale. On Daily Hunger Questionnaire, each of the 2 items (average hunger and most hunger) was scored separately and averaged on weekly basis. Results below represent the percentage of estimated participants ≥12 years of age with ≥2-point reduction in each treatment arm as calculated through the MIANALYZE SAS procedure.

  5. Pivotal Cohort: Mean Change From Baseline in the Weekly Average of the Symptoms of Hyperphagia Composite Score in Participants ≥12 Years of Age

    Time frame · Baseline, after approximately 52 Weeks on a Therapeutic Regimen (up to approximately 60 weeks)

    Registry description

    Participants ≥12 years of age who were able to self-report were administered the Symptoms of Hyperphagia: Patient (Version 1.0). The questionnaire consisted of 4 items related to the frequency of a participant's hunger symptoms on a scale (Never, 1 or 2 times, 3 or more times) over the past 24 hours. The scores on this scale range from 0 to 2 with higher scores indicating more hyperphagia. Daily composite score was derived as the sum of daily answered questions divided by the number of answered questions per day. The weekly average of the daily composite scores equals to the sum of daily composite scores divided by the number of days with a composite score within the 7 identified days prior to the visit. LSM and SE were calculated using ANCOVA model.

  6. Pivotal Cohort: Percentage of Participants With a ≥10% Reduction From Baseline in BMI

    Time frame · After approximately 52 Weeks on a Therapeutic Regimen (baseline up to approximately 60 weeks)

    Registry description

    BMI was calculated as weight (kg)/height (m\^2). Results below represent the percentage of estimated participants with ≥10% BMI reduction in each treatment arm as calculated through the MIANALYZE SAS procedure.

  7. Pivotal Cohort: Percentage of Participants With a ≥10% Reduction From Baseline in Body Weight

    Time frame · After approximately 52 Weeks on a Therapeutic Regimen (baseline up to approximately 60 weeks)

    Registry description

    Body weight was captured for analysis in kilograms. Results below represent the percentage of estimated participants with ≥10% reduction in body weight in each treatment arm as calculated through the MIANALYZE SAS procedure.

  8. Pivotal Cohort: Mean Percent Change From Baseline in Body Weight in Participants ≥18 Years

    Time frame · Baseline, after approximately 52 Weeks on a Therapeutic Regimen (up to approximately 60 weeks)

    Registry description

    Body weight was captured for analysis in kilograms. LSM and SE were calculated using ANCOVA model.

  9. Pivotal Cohort: Mean Change From Baseline in BMI Z-Score in Participants <18 Years of Age

    Time frame · Baseline, after approximately 52 Weeks on a Therapeutic Regimen (up to approximately 60 weeks)

    Registry description

    BMI was calculated as weight (kg)/height (m\^2). BMI Z-Score calculated for participants \<18 years old only is a measure of relative weight adjusted for child's age, sex and height at the time of data collection. The Z-Scores were calculated using the World Health Organization's WHO 2007 BMI SAS Macro Package. A Z-score of 0 is equal to the mean of a reference population (i.e., healthy, age and sex-matched individuals). A decrease in BMI Z-score (\< 0) indicates a reduction in BMI from Baseline whereas an increase in BMI-Z score (\> 0) indicates an increase in BMI from Baseline. Baseline was defined as the most recent measurement prior to the first administration of study drug. LSM and SE were calculated using ANCOVA model.

  10. Pivotal Cohort: Mean Change From Baseline in Percent of BMI 95th Percentile in Participants <18 Years of Age

    Time frame · Baseline, after approximately 52 Weeks on a Therapeutic Regimen (up to approximately 60 weeks)

    Registry description

    BMI was calculated using participant's weight and height assessments, using the following formula: BMI = kg/m\^2. BMI percentile scores are measures of relative weight adjusted for child's age and gender. The percent of the BMI 95th percentile score expresses the participant's BMI as a percentage of the Centers for Disease Control (CDC) 95th percentile reference population. Baseline was defined as the most recent measurement prior to the first administration of study drug. LSM and SE were calculated using ANCOVA model.

  11. Pivotal Cohort: Percentage of Participants <18 Years of Age With ≥0.2-Point Reduction From Baseline in BMI Z-Score

    Time frame · After approximately 52 Weeks on a Therapeutic Regimen (baseline up to approximately 60 weeks)

    Registry description

    BMI was calculated as weight (kg)/height (m\^2). BMI Z-Score calculated for participants \<18 years old only is a measure of relative weight adjusted for child's age, sex and height at the time of data collection. The Z-Scores were calculated using the World Health Organization's WHO 2007 BMI SAS Macro Package. A Z-score of 0 is equal to the mean of a reference population (i.e., healthy, age and sex-matched individuals). A decrease in BMI Z-score (\< 0) indicates a reduction in BMI from Baseline whereas an increase in BMI-Z score (\> 0) indicates an increase in BMI from Baseline. Baseline was defined as the most recent measurement prior to the first administration of study drug. Results below represent the percentage of estimated participants with ≥0.2 point reduction in BMI Z-score in each treatment arm and the difference between the treatment arms as calculated through the MIANALYZE SAS procedure.

  12. Pivotal Cohort: Percentage of Participants With BMI <30 kg/m^2 (Aged ≥18 Years) or <95th Percentile (Aged <18 Years) From Baseline

    Time frame · After approximately 52 Weeks on a Therapeutic Regimen (baseline up to approximately 60 weeks)

    Registry description

    BMI was calculated using participant's weight and height assessments, using the following formula: BMI = kg/m\^2. BMI Percentile scores are measures of relative weight adjusted for child's age and gender. The percent of the BMI 95th percentile score expresses the participant's BMI as a percentage of the CDC 95th percentile reference population. Baseline was defined as the most recent measurement prior to the first administration of study drug. Results below represent the percentage of estimated participants with either BMI \<30 kg/m\^2 (aged ≥18 years) or \<95th percentile (aged \<18 years) in each treatment arm and the difference between the treatment arms as calculated through the MIANALYZE SAS procedure.

  13. Pivotal Cohort: Mean Change From Baseline in Physical Functioning Score and Total Score on the Impact of Weight on Quality of Life-Lite (IWQOL)

    Time frame · Baseline, after approximately 52 Weeks on a Therapeutic Regimen (up to approximately 60 weeks)

    Registry description

    The IWQOL-Lite-Clinical Trials (administered to participants ≥18 years of age) is a validated 20-item self-report measure of obesity-specific quality of life questionnaire. It assessed 2 primary domains of obesity-related health-related quality of life (HRQoL): physical (7 items) and psychosocial (13 items). Each item was rated on a scale from 0 (worst) to 100 (best), with higher scores indicating better levels of functioning. It provided composite scores for each domain, as well as a total score, all ranging from 0 (worst) to 100 (best). Higher scores reflect better levels of functioning and quality of life. LSM and SE were calculated using ANCOVA model.

  14. Pivotal Cohort: Mean Change From Baseline in Total Score on the Impact of Weight on Quality of Life-Kids (IWQOL-Kids)

    Time frame · Baseline, after approximately 52 Weeks on a Therapeutic Regimen (up to approximately 60 weeks)

    Registry description

    The IWQOL-Kids (administered to participants between the ages of 11 and \<18 years) is a validated 27-item self-report measure of weight-related quality of life for youth. It provided a total score inclusive of 4 domains: physical comfort, body esteem, social life, and family relations. Results below represent the total score, which is rated on a scale from 0 (worst) to 100 (best), with higher scores indicating better levels of functioning. LSM and SE were calculated using ANCOVA model.

  15. Pivotal Cohort: Mean Change From Baseline in Waist Circumference

    Time frame · Baseline, after approximately 52 Weeks on a Therapeutic Regimen (up to approximately 60 weeks)

    Registry description

    Waist circumference was captured for analysis in centimeters. LSM and SE were calculated using ANCOVA model.

  16. Pivotal Cohort: Change From Baseline in Systolic and Diastolic Blood Pressure

    Time frame · Baseline, after approximately 52 Weeks on a Therapeutic Regimen (up to approximately 60 weeks)

    Registry description

    Blood pressure was calculated in millimeters of mercury.

Posted results

Values are shown as posted at ClinicalTrials.gov, with their units. PepBank has not converted, pooled or compared them.

Primary outcome results

Primary outcomeLeast squares mean· Baseline, after approximately 52 Weeks on a Therapeutic Regimen (up to approximately 60 weeks)

Pivotal Cohort: Mean Percent Change From Baseline in Body Mass Index (BMI) After 52 Weeks on a Therapeutic Regimen

GroupValue (Percent change)Spread
Setmelanotide-16.511.401
Placebo3.321.984
Secondary and other outcome results(7)
Secondary outcomeNumber· After approximately 52 Weeks on a Therapeutic Regimen (baseline up to approximately 60 weeks)

Pivotal Cohort: Percentage of Participants With ≥5% Reduction From Baseline in BMI (≥18 Years of Age) or ≥0.2-point Reduction From Baseline in BMI Z-score (<18 Years of Age)

GroupValue (Calculated estimate: % of participants)
Setmelanotide82.73
Placebo20.90
Secondary outcomeNumber· After approximately 52 Weeks on a Therapeutic Regimen (baseline up to approximately 60 weeks)

Pivotal Cohort: Percentage of Participants With ≥5% Reduction From Baseline in BMI

GroupValue (Calculated estimate: % of participants)
Setmelanotide79.53
Placebo10.41
Secondary outcomeLeast squares mean· Baseline, after approximately 52 Weeks on a Therapeutic Regimen (up to approximately 60 weeks)

Pivotal Cohort: Change From Baseline in Weekly Average Daily Most Hunger Score in Participants ≥12 Years of Age

GroupValue (Score on a scale)Spread
Setmelanotide-2.730.279
Placebo-1.450.399
Secondary outcomeNumber· After approximately 52 Weeks on a Therapeutic Regimen (baseline up to approximately 60 weeks)

Pivotal Cohort: Percentage of Participants (≥12 Years of Age) With a ≥2-point Reduction From Baseline in the Weekly Average Daily Most Hunger Score

GroupValue (Calculated estimate: % of participants)
Setmelanotide61.04
Placebo45.04
Secondary outcomeLeast squares mean· Baseline, after approximately 52 Weeks on a Therapeutic Regimen (up to approximately 60 weeks)

Pivotal Cohort: Mean Change From Baseline in the Weekly Average of the Symptoms of Hyperphagia Composite Score in Participants ≥12 Years of Age

GroupValue (Score on a scale)Spread
Setmelanotide-0.300.029
Placebo-0.140.042
Secondary outcomeNumber· After approximately 52 Weeks on a Therapeutic Regimen (baseline up to approximately 60 weeks)

Pivotal Cohort: Percentage of Participants With a ≥10% Reduction From Baseline in BMI

GroupValue (Calculated estimate: % of participants)
Setmelanotide63.02
Placebo5.18
Secondary outcomeNumber· After approximately 52 Weeks on a Therapeutic Regimen (baseline up to approximately 60 weeks)

Pivotal Cohort: Percentage of Participants With a ≥10% Reduction From Baseline in Body Weight

GroupValue (Calculated estimate: % of participants)
Setmelanotide55.60
Placebo0.05

Adverse events, as posted

Adverse events as posted: participants affected out of participants at risk, by group
GroupDeathsSerious eventsOther events
SetmelanotideParticipants received setmelanotide solution QD as a SC injection for approximately 52 weeks on a therapeutic regimen (up to approximately 60 weeks).2 / 9526 / 9494 / 94
PlaceboParticipants received placebo matched to setmelanotide solution QD as a SC injection for approximately 52 weeks on a therapeutic regimen (up to approximately 60 weeks).0 / 483 / 4846 / 48

Each cell reads participants affected / participants at risk, as the registry posted them.

Registry data comes from ClinicalTrials.gov. Study results come from studies, not from the registry. How PepBank works

Studies3

Studies that cite this trial.

Studies with results

2 studies on this page

Indexing hint: Randomized controlled trial · 2026

8 results

Setmelanotide for the Treatment of Acquired Hypothalamic Obesity.

Miller et al. 2026The New England journal of medicinecited by 7

PMID 42418774DOI 10.1056/nejmoa2512275PUB-42418774

Full text at the publisher8 results
Publisher pageSee results (8)

Indexing hint: Clinical trial · 2026

1 result

Quality of life improvements with setmelanotide treatment in acquired hypothalamic obesity: TRANSCEND trial interview results from US participants.

Roth et al. 2026Frontiers in behavioral neuroscience

PMID 42528856PMC13415934DOI 10.3389/fnbeh.2026.1830070PUB-42528856

CC BY1 result
Download PDFSee results (1)

PubMed tag: none · 2026

Measuring Hunger Severity in Rare MC4R Pathway Diseases: Development and Psychometric Evaluation of the Most Hunger Item.

Clément et al. 2026Advances in therapy

PMID 42821228DOI 10.1007/s12325-026-03741-xPUB-42821228

Full text at the publisher
Publisher page

Eligibility

Who could join, as posted.

Sex
All
Age
from 4 Years
Healthy volunteers
Not accepted
Inclusion and exclusion criteria, as posted
Key Inclusion Criteria: 1. Documented evidence of acquired hypothalamic obesity (HO) 2. Age 4 years and older 3. Weight gain associated with the hypothalamic injury and a BMI of ≥30 kg/m2 for patients ≥18 years of age or BMI ≥95th percentile for age and sex for patients 4 to \<18 years of age 4. Agree to use a highly effective form of contraception throughout the study and for 90 days after the study Key Exclusion Criteria: 1. Diagnosis of Prader-Willi syndrome (PWS) or Rapid-onset obesity with hypoventilation, hypothalamic, autonomic dysregulation, neuroendocrine tumor syndrome (ROHHADNET) 2. Weight loss \>2% in the previous 3 months for patients aged ≥18 years or \>2% reduction in BMI for patients aged 4 to \<18 years 3. Bariatric surgery or procedure within last 2 years 4. Diagnosis of severe psychiatric disorders; any suicidal ideation, attempt or behavior 5. Current, clinically significant pulmonary, cardiac, metabolic, or oncologic disease 6. Significant dermatologic findings relating to melanoma or pre-melanoma skin lesions (excluding non-invasive basal or squamous cell lesion) 7. History or close family history of skin cancer or melanoma 8. Participation in any clinical trial with an investigational drug/device within 3 months prior to the first trial dose 9. Previously enrolled in a clinical trial involving setmelanotide or any previous exposure to setmelanotide 10. Inability to comply with once daily (QD) injection regimen 11. If female, pregnant and/or breastfeeding 12. Patients with obesity attributable to other genetic or syndromic conditions (eg, PPL \[POMC, PCSK1, LEPR, collectively\], BBS) prior to the hypothalamic injury. 13. If receiving hormone replacement therapy, dose has remained stable for at least 2 months before Screening Other protocol defined Inclusion/Exclusion criteria may apply.

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