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FDA Grants Breakthrough Device Designation for System Maintaining Weight Loss After GLP-1

The system is an outpatient procedure that resurfaces the mucosal lining, making it easier for the body to maintain healthy metabolism and blood glucose levels.

The FDA has granted breakthrough device designation to Revita System (Fractyl Health Inc) for the maintenance of weight loss after discontinuation of glucagon-like peptide-1 (GLP-1) medications. The breakthrough device designation grants priority review by the FDA after completion of the REMAIN-1 study, with the potential for early or accelerated decision on reimbursement by the Centers for Medicare & Medicaid Services.1

FDA Breakthrough Device Designation | Image Credit: Iryna - stock.adobe.com

Image Credit: Iryna - stock.adobe.com

“Patients who discontinue GLP-1 drugs need a reliable off-ramp that will allow them to maintain weight loss without having to continue taking these medicines. Breakthrough device designation from the FDA validates Revita’s potential for these patients. We believe durable weight maintenance is the single largest unmet need in obesity today, and we believe Revita is one of the only investigational products that is being evaluated in a pivotal study to test its potential to provide sustained weight maintenance,” Harith Rajagopalan, MD, PhD, co-founder and CEO of Fractyl, said in a new release.1

The system is an outpatient procedure that resurfaces the mucosal lining of the duodenum, the first part of the small intestine after the stomach. The duodenum breaks down food into absorbable nutrients, so by targeting the lining, the system makes it easier for the body to maintain healthy metabolism and blood glucose levels.1

The REMAIN-1 trial is a randomized, double-blind study of the system compared with sham in individuals who have lost at least 15% of total body weight on tirzepatide (Zepound, Mounjaro; Eli Lilly). It is being designed as a pivotal study to support the registration filing for Revita and is set to begin in the second half of 2024.2

Key Takeaways

  1. The FDA granted breakthrough device designation for the Revita System to help patients maintain weight loss after stopping GLP-1 medications for obesity.
  2. This outpatient procedure targets the lining of the small intestine to potentially improve metabolism and blood sugar control, promoting weight loss maintenance.
  3. The REMAIN-1 trial will compare the Revita System to a sham procedure in people who lost weight on GLP-1 drugs. This study aims to support future regulatory approval.

At the same time as announcing the REMAIN-1 trial, the company also announced the REVEAL-1 study, which is an open-label cohort that will follow a similar population for open-label data updates as the study progresses.2

In 2022, the company announced results of the REVITA-1 and REVITA-2 studies, which established the improvements after 2 years with the device in patients with type 2 diabetes (T2D) and established the efficacy and safety of the device in the same population, respectively.3,4

In the REVITA-1 trial, investigators reported that the mean hemoglobin A1c levels were reduced from 8.5% to 7.5% at 6 months, with the reduction sustained through 24 months. In REVITA-2, investigators established the efficacy for those with T2D with or without non-alcoholic liver disease.3,4

“We look forward to reporting data from our open-label study in weight maintenance in the fourth quarter of this year and anticipate a mid-point randomized analysis of the REMAIN-1 pivotal study in Q2 2025. We believe these data will provide further proof that Revita stands alone in the crowded obesity landscape and has the potential to change the treatment paradigm for the majority of patients who want a sustainable solution for their obesity,” Rajagopalan said.1

References
1. Fractyl Health receives FDA breakthrough device designation for Revita in weight maintenance for people with obesity who discontinue GLP-1 based drugs. News release. Fractyl Health. July 30, 2024. Accessed July 31, 2024. https://ir.fractyl.com/news-releases/news-release-details/fractyl-health-receives-fda-breakthrough-device-designation
2. Fractyl Health received FDA IDE approval for the Revita Remain-1 pivotal study of weight maintenance in obesity after discontinuation of GLP-1 based drugs. News release. April 1, 2024. Accessed July 31, 2024. https://ir.fractyl.com/news-releases/news-release-details/fractyl-health-receives-fda-ide-approval-revitar-remain-1
3. van Baar ACG, Devière J, Hopkins D, et al. Durable metabolic improvements 2 years after duodenal mucosal resurfacing (DMR) in patients with type 2 diabetes (REVITA-1 Study). Diabetes Res Clin Pract. 2022;184:109194. doi:10.1016/j.diabres.2022.109194
4. Mingrone G, van Baar AC, Devière J, et al. Safety and efficacy of hydrothermal duodenal mucosal resurfacing in patients with type 2 diabetes: the randomised, double-blind, sham-controlled, multicentre REVITA-2 feasibility trial. Gut. 2022;71(2):254-264. doi:10.1136/gutjnl-2020-323608
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