Relamorelin Reduces Vomiting Frequency and Severity and Accelerates Gastric Emptying in Adults With Diabetic Gastroparesis

Background & Aims Gastroparesis is an important complication of diabetes. We investigated the effects of relamorelin, a pentapeptide-selective agonist of the ghrelin receptor that speeds gastric emptying in patients with diabetes, in patients with diabetic gastroparesis. Methods We performed a double-blind trial of 204 patients (78% Caucasian; 67% female; mean age, 55 y; 88% with type 2 diabetes) with diabetic gastroparesis with moderate to severe symptoms and delayed gastric emptying at 27 clinical centers, from June 2012 until August 2013. Patients were assigned randomly (1:1:1) to groups given placebo or subcutaneous relamorelin 10 μg once or twice daily. The primary end point was the half-time of gastric emptying. Secondary end points included nausea, abdominal pain, bloating, early satiety, as well as the composite score of these 4 subjective symptoms and vomiting frequency and severity. Results Twice-daily relamorelin significantly accelerated gastric emptying ( P < .03) and reduced vomiting frequency (by ∼60%) and severity vs placebo ( P ≤ .033). Compared with placebo, relamorelin did not improve other gastrointestinal symptoms, such as abdominal pain and satiety. In 119 patients (58.3%) with baseline vomiting, twice-daily relamorelin significantly reduced the half-time of gastric emptying and vomiting, as well as nausea, abdominal pain, bloating, and early satiety compared with placebo (composite score, P = .043). No overall safety concerns were identified. Conclusions In a clinical trial of patients with diabetic gastroparesis patients, relamorelin (10 μg twice daily) significantly accelerated gastric and significantly reduced vomiting, compared with placebo. Among patients with baseline vomiting, relamorelin had prokinetic effects and significantly reduced vomiting and other symptoms of diabetic gastroparesis compared with placebo. ClincialTrials.gov number: NCT01571297.