Chinese Multiple Dose Escalation (MDE) High Dose Study

This is a randomized, double-blinded, placebo-controlled study designed to evaluate the safety, tolerability, PK and efficacy of ascending doses of cotadutide in overweight or obese subjects with T2DM. This study will enroll subjects aged 18 to 74 years with a body mass index (BMI) ≥ 25 and ≤ 35 kg/m2. Subjects will have a diagnosis of T2DM and inadequate blood glucose control as defined by a HbA1c of 7% to 8.5%, and will be on metformin monotherapy in the three months prior to screening. Total 16 Chinese subjects will be randomized to cotadutide or placebo in a 3:1 ratio (cotadutide [n=12] and placebo [n=4]) at multicentre in China mainland. Those subjects who receive cotadutide once daily SC will be titrated to a maximum of 600 μg once daily SC, beginning at 50 μg once daily SC. The study has about 2 weeks screening period, a run-in period of 10 days and an up to 7-week up-titration treatment period followed by a 3-week treatment extension period at the dose of 600 μg and followed by a 28-day follow-up period.

Inclusion criteria

• Subjects aged 18 to 74 years
• Provision of signed and dated written informed consent prior to any study specific procedures
• BMI between 25 and 35 kg/m2
• HbA1c range of 7% to 8.5%
• Willing and able to self-inject investigational product
• Diagnosed with T2DM with glucose control managed with metformin monotherapy where no significant dose change has occurred in the three months prior to screening.
• Women of child-bearing potential who are sexually active with a male partner must be using at least one highly effective method of contraception. And must have a negative serum or urine pregnancy test within 72 hours prior to the start of IP, and must not be breastfeeding.

Exclusion criteria

• Any subject who has received another IP as part of a clinical study or a GLP-1 analogue containing preparation within the last 30 days or 5 half-lives of the drug (whichever is longer) at the time of screening
• Concurrent participation in another randomization study of any kind; repeat randomization is prohibited
• Any subject who has received any of the following medications within the specified timeframe prior to the start of the study

• Herbal preparations for control of body weight or appetite
• Drugs licensed for control of body weight or appetite
• Opiates, domperidone, metoclopramide, or other drugs known to alter gastric emptying
• Antimicrobials within the quinolone (eg, ciprofloxacin), macrolide (eg, clarithromycin) or azole class (eg, ketoconazole)
• Any change in antihypertensive medication
• Aspirin (acetylsalicylic acid) at a dose greater than 150 mg once daily
• Paracetamol (acetaminophen) or paracetamol-containing preparations at a total daily dose of greater than 3000 mg
• Ascorbic acid (vitamin C) supplements at a total daily dose of greater than 1000 mg
• Symptoms of acutely decompensated blood glucose control, recent severe hypoglycemia, a history of T1DM orDKA
• Acute pancreatitis at screening or history of acute pancreatitis or chronic pancreatitis or serum triglyceride levels > 11 mmol/L at screening
• Significant inflammatory bowel disease, gastroparesis or other severe disease or surgery affecting the upper GI tract, which may affect gastric emptying or could affect the interpretation of safety and tolerability data
• Significant hepatic disease (except for NASH or NAFLD without portal hypertension or cirrhosis) and/or subjects with any of the following results at screening:

• AST ≥ 3 × ULN
• ALT ≥ 3 × ULN
• TBL ≥ 2 × ULN
• Impaired renal function defined as eGFR< 30 mL/minute/1.73m2 at screening
• Poorly controlled hypertension defined as:

• SBP > 160 mmHg
• DBP or ≥ 90 mmHg - After 10 minutes of supine rest and confirmed by repeated measurement at screening. Subjects who fail BP screening criteria may be considered for 24-hour ABPM at the discretion of the investigator. Subjects who maintain a mean 24-hour BP < 160/100 mmHg with a preserved nocturnal dip of > 15% will be considered eligible.
• Any clinically important abnormalities in rhythm, conduction, or morphology of the resting 12-lead ECG or any abnormalities that may interfere with the interpretation of serial ECG changes, including QTc interval changes at screening, as judged by the investigator, and prolonged QTcF > 450 ms, or family history of long QT-segment at screening
• PR (PQ) interval prolongation, intermittent second (Wenckebach block while asleep is not exclusive), or third-degree AV block, or AV dissociation
• Persistent or intermittent complete bundle branch block.
• Unstable angina pectoris, myocardial infarction, transient ischemic attack, or stroke within 3 months prior to screening, or subjects who have undergone percutaneous coronary intervention or a coronary artery bypass graft within the past 6 months or who are due to undergo these procedures at the time of screening
• Severe congestive heart failure (NYHA Class III or IV)
• Basal calcitonin level ≥ 50 ng/L at screening or history/family history of medullary thyroid carcinoma or MEN2
• History of neoplastic disease within 5 years prior to screening, except for adequately treated basal cell, squamous cell skin cancer, or in situ cervical cancer
• Any positive results for serum hepatitis B surface antigen, hepatitis C antibody, and HIV antibody
• History of substance dependence, alcohol abuse, or excessive alcohol intake within 3 years prior to screening and/or a positive screen for drugs of abuse or alcohol at screening or on admission to the study unit.
• Symptoms of depression or any other psychiatric disorder requiring treatment with medication (eg, anti-depressants, anti-psychotics) at screening. However, subjects who use benzodiazepines for chronic anxiety or sleep disorders may be permitted to enter the study.
• History of severe allergy/hypersensitivity, including to any component of the investigational product formulation or other biological agent, or ongoing clinically important allergy/hypersensitivity as judged by the investigator
• Blood/plasma donation within 1 month of screening
• Involvement of any AstraZeneca, the contract research organization, or the virtual study site employee or their close relatives
• For women only- currently pregnant (confirmed with positive pregnancy test) or breastfeeding