Effects of MetAP2 inhibition on hyperphagia and body weight in Prader–Willi syndrome: A randomized, double-blind, placebo-controlled trial

Shawn E. McCandless, Jack A. Yanovski, Jennifer Miller, Cary Fu, Lynne M. Bird, Parisa Salehi, Christine L. Chan, Diane Stafford, M. Jennifer Abuzzahab, David Viskochil, Sarah E. Barlow, Moris Angulo, Susan E. Myers, Barbara Y. Whitman, Dennis Styne, Elizabeth Roof, Elisabeth M. Dykens, Ann O. Scheimann, Jaret Malloy, Dongliang ZhuangKristin Taylor, Thomas E. Hughes, Dennis D. Kim, Merlin G. Butler

Research output: Contribution to journalArticlepeer-review

61 Scopus citations


Aims: There are no treatments for the extreme hyperphagia and obesity in Prader–Willi syndrome (PWS). The bestPWS clinical trial assessed the efficacy, safety and tolerability of the methionine aminopeptidase 2 (MetAP2) inhibitor, beloranib. Materials and Methods: Participants with PWS (12-65 years old) were randomly assigned (1:1:1) to biweekly placebo, 1.8 mg beloranib or 2.4 mg beloranib injection for 26 weeks at 15 US sites. Co-primary endpoints were the changes in hyperphagia [measured by Hyperphagia Questionnaire for Clinical Trials (HQ-CT); possible score 0-36] and weight by intention-to-treat. ClinicalTrials.gov registration: NCT02179151. Results: One-hundred and seven participants were included in the intention-to-treat analysis: placebo (n = 34); 1.8 mg beloranib (n = 36); or 2.4 mg beloranib (n = 37). Improvement (reduction) in HQ-CT total score was greater in the 1.8 mg (mean difference −6.3, 95% CI −9.6 to −3.0; P =.0003) and 2.4 mg beloranib groups (−7.0, 95% CI −10.5 to −3.6; P =.0001) vs placebo. Compared with placebo, weight change was greater with 1.8 mg (mean difference − 8.2%, 95% CI −10.8 to −5.6; P <.0001) and 2.4 mg beloranib (−9.5%, 95% CI −12.1 to −6.8; P <.0001). Injection site bruising was the most frequent adverse event with beloranib. Dosing was stopped early due to an imbalance in venous thrombotic events in beloranib-treated participants (2 fatal events of pulmonary embolism and 2 events of deep vein thrombosis) compared with placebo. Conclusions: MetAP2 inhibition with beloranib produced statistically significant and clinically meaningful improvements in hyperphagia-related behaviours and weight loss in participants with PWS. Although investigation of beloranib has ceased, inhibition of MetAP2 is a novel mechanism for treating hyperphagia and obesity.

Original languageEnglish (US)
Pages (from-to)1751-1761
Number of pages11
JournalDiabetes, Obesity and Metabolism
Issue number12
StatePublished - Dec 2017


  • antiobesity drug
  • appetite control
  • clinical trial
  • phase III study
  • randomized trial

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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