Phase 2 Multi-Regional Clinical Trial Protocol (GLP-1 Receptor Agonist) — Singapore, Brazil, United States
📌 Protocol ID: GLP1‑P2‑MR‑001 · v1.0 / March 4, 2026
Sponsor: [Sponsor Legal Name] · IP: [GLP-1 RA name] (SC once-weekly or oral once-daily) · Indication: Chronic weight management / T2DM · Regions: United States (FDA), Brazil (ANVISA + CEP/CONEP), Singapore (HSA + IRB)
1. Synopsis
Study Title: A Phase 2, Randomized, Double-Blind, Placebo-Controlled, Dose-Ranging Study to Evaluate the Efficacy, Safety, and Tolerability of [IP] in Adults With [Obesity/Overweight OR T2DM], Conducted in the United States, Brazil, and Singapore.
DesignPhase 2, multicenter, multi-regional, randomised, double-blind, placebo-controlled, parallel-group, dose-ranging
ArmsPlacebo + lifestyle counseling; Low dose; Mid dose; High dose (all + lifestyle counseling)
Randomisation1:1:1:1 — stratified by country/region, baseline BMI/HbA1c category, and sex
Treatment Duration24 weeks double-blind treatment + 4–8 weeks safety follow-up
Total Duration~32–36 weeks per participant including screening
Sample Size~240 participants total (60/arm) — placeholder; align to dose-response precision
Primary Objectives
- Obesity/Overweight path: Percent change in body weight from baseline to Week 24 vs placebo
- T2DM path: Change in HbA1c from baseline to Week 24 vs placebo
2. Background & Regulatory Anchoring
This protocol is designed to align with three concurrent regulatory frameworks:
- FDA obesity/overweight development recommendations (draft, Jan 2025) (fda.gov)
- Brazil ANVISA RDC 9/2015 — procedures and requirements for clinical trials including DDCM submission (bvsms.saude.gov.br)
- Singapore HSA clinical trial submission routes under the Health Products Act (CTA/CTN) (hsa.gov.sg)
- IND content expectations: 21 CFR §312.23 requires detailed protocols for Phase 2 and 3 submissions (law.cornell.edu)
3. Study Population
Option A — Obesity/Overweight
- BMI ≥30 kg/m², or BMI ≥27 kg/m² with ≥1 weight-related comorbidity
- Excluding T2DM if pursuing non-diabetes obesity label path
Option B — T2DM
- Adults with T2DM, HbA1c 7.0–10.5% on stable background therapy
- BMI threshold optional per programme
Key Exclusion Criteria
- Prior exposure to GLP-1 RA (or within washout)
- History of pancreatitis (acute/chronic)
- Personal/family history of MTC or MEN2
- Severe GI disease affecting absorption (especially oral)
- eGFR <30/45 mL/min/1.73m² (programme-dependent)
- Weight-loss drugs or bariatric surgery within defined window
4. Treatments
Form/Route: SC weekly injection or oral daily. Standard GLP-1 titration to reduce GI intolerance — start low for 4 weeks → uptitrate every 4 weeks. Dose reductions allowed per tolerability algorithm.
Placebo: Matched placebo (appearance, device/tablet, titration schedule).
Background SoC: Standardised lifestyle counseling across all arms with identical frequency/content. T2DM path: stable metformin allowed; rescue algorithm defined if persistent hyperglycaemia (FPG >270 mg/dL or HbA1c >10.5%).
5. Efficacy Endpoints
Primary (Obesity)% change in body weight from baseline to Week 24
Primary (T2DM)Change in HbA1c from baseline to Week 24
Key Secondary≥5% and ≥10% weight loss at Week 24; waist circumference; cardiometabolic biomarkers; FPG; proportion achieving HbA1c target
ExploratoryBody composition (DXA subset); digital appetite/satiety instruments; sparse PK/PD
6. Safety Assessments
- TEAEs collected from first dose through end of follow-up (MedDRA coding)
- AESIs: GI (nausea/vomiting/diarrhoea); pancreatitis signals (abdominal pain + lipase/amylase); gallbladder events; hypoglycaemia; renal AKI risk (dehydration); diabetic retinopathy (T2DM); thyroid-related events
- Chemistry/haematology/urinalysis at baseline; Weeks 4/8/12/16/24; follow-up
- HbA1c (T2DM path): baseline; Week 12; Week 24
- Lipase/amylase: baseline and symptom-triggered
7. Visit Schedule (Summary)
ScreeningUp to 28 daysConsent · Medical history · Labs · Eligibility confirmation
RandomisationWeek 0Baseline weight (×2) · Waist · Dosing training · Lifestyle counseling
TreatmentWk 2,4,8,12,16,20,24Weight · Vitals · AE review · IP dispense/return · Labs at prespecified visits · Dose escalation
Follow-upWk 28–32Safety visit/phone · AEs/SAEs · Targeted labs if needed
8. Statistical Considerations
- Primary analysis: MMRM with treatment, visit, treatment-by-visit interaction, baseline value, stratification factors
- Multiplicity: Hierarchical testing or adjusted procedure across doses/secondary endpoints
- Missing data: Estimand strategy prespecified per ICH E9(R1); sensitivity analyses (jump-to-reference, delta adjustments)
- Dose-response: MCP-Mod, Emax model, or contrast-based approach (predefine in SAP)
9. Ethics & Regional Submissions
🇺🇸
United States — FDA + IRB
Conduct under IND per 21 CFR §312.23. Informed consent per 21 CFR §50.20: "no investigator may involve a human being as a subject unless the investigator has obtained the legally effective informed consent."
fda.gov
🇧🇷
Brazil — ANVISA + CEP/CONEP
ANVISA RDC 9/2015 defines procedures for DDCM submission. Ethics via Plataforma Brasil — "base nacional e unificada de registros de pesquisas envolvendo seres humanos."
bvsms.saude.gov.br
🇸🇬
Singapore — HSA + IRB
Regulated under the Health Products Act via Clinical Trial Authorisation (CTA) or Clinical Trial Notification (CTN) routes as applicable.
hsa.gov.sg
10. Safety Reporting (Global)
Per FDA IND safety reporting requirements: unexpected serious suspected adverse reactions must be reported "as soon as possible but no later than within 15 calendar days"; unexpected fatal/life-threatening SUSARs within 7 calendar days. (fda.gov)
- Immediate site notification to sponsor of SAEs ≤24 hours from awareness
- Clear SUSAR handling workflow across all three regions (submission portals, formats, translations)
- DMC charter as separate controlled document; independent DMC reviews unblinded safety data periodically
1. FDA. Obesity and Overweight: Developing Drugs for Weight Reduction (Draft Guidance, Jan 2025).
fda.gov
3. Health Sciences Authority (HSA), Singapore. Regulatory overview of clinical trials.
hsa.gov.sg
4. FDA. IND Application Reporting: Safety Reports.
fda.gov
5. Ministério da Saúde (Brasil). Plataforma Brasil.
gov.br