Dose-Finding Study Evaluating Effect on Body Composition of Enobosarm in Patients Taking a GLP-1 for Chronic Weight Mgmt

Prior treatment

• Treatment with any investigational product within \< 5 half-lives for each individual investigational product OR within 30 days prior to randomization
• Major surgery within 30 days prior to randomization
• Planned major surgery during course of the study
• Testosterone, methyltestosterone, oxandrolone (Oxandrin®), oxymetholone, danazol, fluoxymesterone (Halotestin®), testosterone-like agents (such as dehydroepiandrosterone, androstenedione, and other androgenic compounds, including herbals), myostatin inhibitors, apelin receptor agonists, or antiandrogens (flutamide, bicalutamide, abiraterone, enzalutamide, apalutamide, or darolutamide).
  • Previous therapy with testosterone and testosterone-like agents is acceptable with a 30-day washout (if previous testosterone therapy was long term depot within the past 6 months, the site should contact the Medical Monitor) or any other androgenic agent.
• Major depressive disorder diagnosed within 2 years prior to screening (NOTE: a diagnosis of major depressive disorder ≥2 years prior to screening that is stably managed \[with or without pharmacological intervention\] without additional exclusionary history are not excluded from the study), history of other severe psychiatric disorder, including schizophrenia and bipolar disorder, any lifetime history of suicide attempt, or with suicidal ideation or behavior within 1 month prior to screening.
• Prior bariatric surgery or weight loss devices unless removed for ≥1 year prior to screening for this study.
• Patients that are currently taking a GLP-1 receptor agonists or have taken a GLP-1 receptor agonists within one year prior to screening for this study. Patients may not resume treatment with GLP-1 receptor agonists until after the 30-day follow-up visit.
• Patients with prior tendon rupture or those taking concomitant medications that increase the risk of tendon rupture (e.g., fluroquinoline antibiotics, bempedoic acid, or corticosteroids).

Other illness

• Any of the following conditions are cause for exclusion from the study:
• Known hypersensitivity or allergy to enobosarm or a GLP-1 receptor agonist
• Pre-existing liver disease (hepatitis B, uncontrolled hepatitis A, hepatitis C, autoimmune hepatitis, liver cancer, alcohol-associated cirrhosis, alcohol-associated hepatitis, alcohol-associated fatty liver)
• History of acute pancreatitis within one year of screening or history of chronic pancreatitis
• Severe gastrointestinal disease, including gastroparesis
• Monogenic or syndrome obesity, and endocrine causes of obesity (such as untreated hypothyroidism or Cushing's syndrome), and obesity caused by medications that cause weight gain
• Any condition that is exclusionary for use of semaglutide (generally WEGOVY) in the patient. See the WEGOVY Prescribing Information. The following contraindications are listed in the WEGOVY prescribing information:
  • Personal or family history of medullary thyroid carcinoma or in patients with Multiple Endocrine Neoplasia syndrome type 2
  • Known hypersensitivity to semaglutide or any of the excipients in WEGOVY
• Subjects with active or untreated malignancy within 5 years of screening (NOTE:
  • treated non-melanoma skin cancers are allowable).
• Male subjects with a lifetime history of malignant prostate disease, such as prostate cancer.

Lab values

• Creatinine clearance \< 30 milliliter per minute (mL/min) as measured using the Cockcroft Gault formula (patients with mild and moderate renal failure are not excluded from participation in this study)
• Baseline ALT or AST \>3x upper limit of normal
• Baseline total bilirubin levels \> upper limit of normal
• Diagnosis of diabetes requiring current use of any antidiabetic drug or HbA1c ≥ 6.5% Note: Metabolic syndrome is not an exclusion, even if managed with an anti-diabetic drug such as metformin or an SGLT2 inhibitor. A diagnosis of prediabetes or impaired glucose tolerance managed with antidiabetic medication or non-pharmacologic approaches (e.g., diet and exercise) is not an exclusion as long as other study criteria are met and the patient has not progressed to a diagnosis of diabetes.
• Creatine kinase \>ULN

Other

• An abnormal ECG result which, based on the investigator's clinical judgment, would place the subject at increased medical risk
• Concurrently participating in any other interventional or treatment clinical trial.
• Patient Health Questionnaire score \>15 or any suicidal ideation of type 4 or type 5 on the Columbia-Suicide Severity Rating Scale
• Male subjects with a PSA ≥4 ng/mL

• Subjects accepted for this study must:
• Provide informed consent from the subject or the subject's legally authorized representative
• Be able to communicate effectively with the study personnel
• Aged ≥60 years
• For Female Subjects
  • Menopausal status
  • Be postmenopausal as defined by either:
  • one year or more of amenorrhea
  • surgical menopause with bilateral oophorectomy
  • For Male Subjects
  • Subject must agree to use acceptable methods of contraception:
  • If the study subject's partner could become pregnant, use acceptable methods of contraception from the time of the first administration of study medication until 30 days following administration of the last dose of study medication. Acceptable methods of contraception are as follows: surgical sterilization (vasectomy with documentation of azoospermia) and a barrier method {condom used with spermicidal foam/gel/film/cream/suppository}, the female partner uses oral contraceptives (combination estrogen/progesterone pills), injectable progesterone or subdermal implants and a barrier method (condom used with spermicidal foam/gel/film/cream/suppository)
  • If female partner of a study subject has undergone documented tubal ligation (female sterilization), a barrier method (condom used with spermicidal foam/gel/film/cream/suppository) should also be used
  • If female partner of a study subject has undergone documented placement of an intrauterine device (IUD) or intrauterine system (IUS), a barrier method (condom with spermicidal foam/gel/film/cream/suppository) should also be used
  • Female partner is menopausal as defined above
• Documented evidence of obesity (BMI ≥30 or ≥27 with the presence of at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia)
• Medically indicated for use of GLP-1 receptor agonist for weight management.
• Consents to be treated with GLP-1 receptor agonist for 84 days under this protocol.
• Subject is willing to comply with the requirements of the protocol through the end of the study
• The patient is able to swallow oral medications
• The patient is able to complete the physical function (stair climb) assessment
• Maximum weight at screening of 300lbs as per DEXA requirements
• Complete a valid OSA assessment