Glucagon‐like peptide ‐1/glucagon receptor agonism associates with reduced metabolic adaptation and higher fat oxidation: A randomized trial
Open accessAbstract
Objective: This study tested the hypothesis that treatment with the glucagon‐like peptide‐1/glucagon receptor agonist SAR425899 would lead to a smaller decrease in sleeping metabolic rate (SMR; kilocalories/day) than expected from the loss of lean and fat mass (metabolic adaptation). Methods: This Phase 1b, double‐blind, randomized, placebo‐controlled study was conducted at two centers in inpatient metabolic wards. Thirty‐five healthy males and females with overweight and obesity (age = 36.5 ± 7.1 years) were randomized to a calorie‐reduced diet (−1000 kcal/d) and escalating doses (0.06‐0.2 mg/d) of SAR425899 (n = 17) or placebo ( n = 18) for 19 days. SMR was measured by whole‐room calorimetry. Results: Both groups lost weight (−3.68 ± 1.37 kg placebo; −4.83 ± 1.44 kg SAR425899). Those treated with SAR425899 lost more weight, fat mass, and fat free mass ( p < 0.05) owing to a greater achieved energy deficit than planned. The SAR425899 group had a smaller reduction in body composition‐adjusted SMR ( p = 0.002) as compared with placebo, but not 24‐hour energy expenditure. Fat oxidation and ketogenesis increased in both groups, with significantly greater increases with SAR425899 ( p < 0.05). Conclusions: SAR425899 led to reduced selective metabolic adaptation and increased lipid oxidation, which are believed to be beneficial for weight loss and weight‐loss maintenance.
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A clinical study of the dual GLP-1-glucagon receptor agonist SAR435899 (bamadutide) supports that pharmacological attenuation of metabolic adaptation is a biological possibility in humans.
“Although hampered by lack of weight matching in the control group, a clinical study of the dual GLP-1–glucagon receptor agonist SAR435899 (bamadutide) supports that pharmacological attenuation of metabolic adaptation is indeed a biological possibility in humans16.”
From CagriSema drives weight loss in rats by reducing energy intake and preserving energy expenditure (2025) · cites this paper as [16]
The Results (page unavailable) report that treatment blunted metabolic adaptation during sleep compared with placebo, supporting the claim's biological point in humans. The Abstract Results also report greater weight loss in the treatment group, consistent with the citing sentence's caveat. However, the paper identifies the agonist as SAR425899, not SAR435899; the provided passages do not identify it as bamadutide. (LLM, conf=0.87)
Experimental — accuracy not yet measuredA GLP-1R/GIPR co-agonist still reduces inflammation in mice lacking Glp1r only in the brain.
“treatment of brain-specific Glp1r-deficient mice with a GLP-1R/GIPR co-agonist retains anti-inflammatory action”
From Transforming obesity: The advancement of multi-receptor drugs (2024) · cites this paper as [118]
The Introduction discusses dual GLP-1R/glucagon-receptor agonists, and the Conclusion reports metabolic effects of SAR425899. Searches for brain-specific Glp1r-deficient mice, GLP-1R/GIPR co-agonism, and anti-inflammatory effects found no passage addressing the claimed mouse experiment. No page numbers were available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredGIPR activity outside the CNS, in fat tissue and immune cells, may produce beneficial systemic effects.
“suggesting that peripheral GIPR activity in adipose tissue and immune cells, i.e. macrophages, can elicit positive systemic effects118.”
From Transforming obesity: The advancement of multi-receptor drugs (2024) · cites this paper as [118]
The Introduction and Discussion address dual GLP-1R/GCGR agonism and its metabolic effects, not GIPR activity. Searches for GIPR, peripheral adipose tissue, and macrophages found no passage addressing the claimed effects; the cited paper’s findings therefore do not verify this attribution. The available passages have no page numbers. (LLM, conf=0.76)
Experimental — accuracy not yet measuredGLP-1R activation reduces inflammation only through its actions in the brain.
“the anti-inflammatory effects of GLP-1R activation are mediated exclusively through the central actions of GLP-1R118.”
From Transforming obesity: The advancement of multi-receptor drugs (2024) · cites this paper as [118]
The Introduction discusses GLP-1R effects on food intake and metabolism, while the Discussion and Conclusion address metabolic adaptation and fat oxidation. Searches for anti-inflammatory effects and central or brain-mediated GLP-1R action found no passage addressing whether inflammation is reduced, let alone whether that effect occurs exclusively through the brain. No page numbers are available in our copy. (LLM, conf=0.77)
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“In recent years, two glucagon receptor/GLP-1 receptor co-agonists underwent phase II clinical trials in human experiments, namely, SAR425899 and cotadutide [98,99].”
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- Authors
- Corbin, K. D., Carnero, E. A., Allerton, T. D., Tillner, J., Bock, C. P., Luyet, P., Göbel, B., Hall, K. D., Parsons, S. A., Ravussin, E., & Smith, S. R.
- Affiliations
- AdventHealth Orlando (US)
- AdventHealth Translational Research Institute Orlando Florida USA
- Pennington Biomedical Research Center (US)
- Sanofi (Germany) (DE)
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- Pennington Biomedical Research Center Baton Rouge Louisiana USA
- Corresponding author
- Smith, Steven R.
- ORCID
- Venue
- Obesity
- Publisher
- Wiley
- Published
- 2023-01-25
- Volume
- 31
- Issue
- 2
- Pages
- 350-362
- ISSN
- 1930-7381 (ISSN-L)
- 1930-739X
- PMC
- PMC9881753
- OpenAlex
- W4317930838
- Cited by
- 32
- References
- 45
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 10 · 2023: 2
- FWCI
- 4.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Obesity (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Civil War Book Review (submittedVersion)
- Funders
- Sanofi
- Topics
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- GLP-1 receptor agonists, glucagon receptor agonist, metabolic adaptation, sleeping metabolic rate, fat oxidation, ketogenesis, weight loss, calorie-restricted diet, energy expenditure, fat loss
- MeSH terms
- Adult, Energy Metabolism, Female, Humans, Male, Obesity, Oxidation-Reduction, Weight Loss, Receptors, Glucagon, Overweight, Glucagon-Like Peptide 1
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