Rhythm Pharmaceuticals Announces MHLW Approval of IMCIVREE® (setmelanotide) for Patients with Acquired Hypothalamic Obesity (HO) in Japan
Rhea-AI Summary
Rhythm Pharmaceuticals (Nasdaq: RYTM) announced that Japan’s Ministry of Health, Labour and Welfare has granted marketing authorization for IMCIVREE (setmelanotide) to treat patients with acquired hypothalamic obesity (HO), the first approved therapy for this condition in Japan.
According to Rhythm, IMCIVREE, a melanocortin‑4 receptor agonist with MHLW orphan drug designation since March 2025, is expected to launch in Japan by the end of 2026, pending final pricing. Approval was supported by the global Phase 3 TRANSCEND trial in 142 acquired HO patients, which achieved a placebo‑adjusted −18.8% reduction in BMI. The study included a Japanese cohort of 12 patients. Rhythm estimates 5,000–8,000 people are living with acquired HO in Japan.
Positive
- MHLW approval in Japan for IMCIVREE in acquired hypothalamic obesity
- First approved therapy in Japan specifically for acquired hypothalamic obesity
- TRANSCEND Phase 3 trial met primary endpoint with −18.8% placebo‑adjusted BMI reduction
- 142 patients in pivotal TRANSCEND trial, including 12 from Japan
- Estimated 5,000–8,000 acquired HO patients in Japan represent a defined target population
- Japanese commercial launch targeted by end of 2026, pending pricing determination
Negative
- Serious risks include depression and suicidal ideation, requiring monitoring and potential discontinuation
- Acute adrenal insufficiency in acquired HO with secondary adrenal insufficiency reported in 5% of IMCIVREE‑treated patients
- In acquired HO with central diabetes insipidus, hyponatremia in 6% and hypernatremia in 5% of IMCIVREE‑treated patients
- Most common adverse reactions (≥20%) include skin hyperpigmentation, injection site reactions, nausea, headache, diarrhea, abdominal pain, vomiting, depression, spontaneous penile erection
- IMCIVREE has contraindication in prior serious hypersensitivity, including reported anaphylaxis
Key Figures
Previous Acquisition Reports
| Date | Event | Sentiment | 24h Move | Catalyst |
|---|---|---|---|---|
| Aug 11 | UK marketing authorization | Positive | -2.3% | MHRA expanded IMCIVREE authorization for acquired hypothalamic obesity |
| Jun 15 | ENDO data presentations | Positive | +0.0% | New MC4R agonist data covered acquired HO, BBS, and PWS |
| May 04 | Pediatric data | Positive | +4.6% | Longer-term pediatric setmelanotide outcomes showed sustained BMI reductions |
| May 01 | EU marketing authorization | Positive | +0.6% | European Commission authorized IMCIVREE for acquired hypothalamic obesity |
| Mar 26 | CHMP opinion | Positive | -3.2% | CHMP recommended expanding IMCIVREE for acquired hypothalamic obesity |
24h Move is the share-price change in the day after each event; other market factors may also have contributed.
Tag-specific authorization and data announcements produced mixed reactions, with three aligned and two divergent outcomes; the latest comparable reaction was -2.28%.
Key Terms
mhlw regulatory
mc4r agonist medical
orphan drug designation regulatory
hypothalamic obesity medical
hyperphagia medical
AI-generated analysis. How Rhea-AI works. Not financial advice.
-- Approximately 5,000 to 8,000 patients estimated to be living with acquired HO in Japan --
-- Commercial launch in Japan expected by end of 2026, pending final pricing determination --
BOSTON, Aug. 24, 2026 (GLOBE NEWSWIRE) -- Rhythm Pharmaceuticals, Inc. (Nasdaq: RYTM), a global commercial-stage biopharmaceutical company focused on transforming the lives of patients living with rare neuroendocrine diseases, today announced that Japan’s Ministry of Health, Labour and Welfare (MHLW) has granted marketing authorization to IMCIVREE® (setmelanotide) to treat patients living with acquired hypothalamic obesity (HO).
IMCIVREE, a melanocortin-4 receptor (MC4R) agonist which received orphan drug designation by the MHLW in March 2025, is the first therapy approved in Japan to treat acquired HO. Rhythm expects to launch IMCIVREE before the end of 2026, pending final pricing determination.
"Acquired hypothalamic obesity is a complex MC4R pathway disease that develops following injury to the hypothalamus, resulting in accelerated and sustained weight gain, hyperphagia, and significant impacts on quality of life,” said Yann Mazabraud, Executive Vice President and Head of International at Rhythm. “The approval of IMCIVREE provides healthcare professionals with an important new treatment option for eligible patients. We are grateful for the support of the Japanese patient and healthcare community, as well as government officials, and look forward to bringing IMCIVREE to patients living with acquired HO later this year.”
The approval is supported by the positive pivotal Phase 3 TRANSCEND trial of setmelanotide in 142 patients with acquired HO. This data set includes 12 patients from a Japanese cohort and 10 supplemental patients who were enrolled in addition to the primary 120-patient pivotal cohort. The global study met its primary endpoint, with a statistically significant -
Rhythm estimates there are 5,000 to 8,000 people living with acquired HO in Japan. Acquired HO is a rare disease characterized by accelerated and sustained weight gain caused by an injury to the hypothalamus. Hypothalamic injury may lead to decreased alpha-melanocyte-stimulating hormone (α-MSH) production and impairment of MC4R pathway signaling. The MC4R pathway is responsible for regulating energy balance and body weight. Acquired HO most frequently follows the growth or treatment of craniopharyngioma, astrocytoma, or other hypothalamic-pituitary tumors. Additional causes of injury may include traumatic brain injury, stroke, infection, or inflammation. Due to impairment of the MC4R pathway, patients experience accelerated and sustained weight gain, often accompanied by hyperphagia and/or decreased energy expenditure. Acquired hypothalamic obesity can occur as early as six months following hypothalamic injury.
About Rhythm Pharmaceuticals
Rhythm is a commercial-stage biopharmaceutical company committed to transforming the lives of patients and their families living with rare neuroendocrine diseases. Rhythm’s lead asset, IMCIVREE® (setmelanotide), an MC4R agonist designed to treat hyperphagia and severe obesity, is approved by the U.S. Food and Drug Administration (FDA) to reduce excess body weight and maintain weight reduction long term in adult and pediatric patients aged 4 years and older with acquired hypothalamic obesity, adult and pediatric patients 2 years of age and older with syndromic or monogenic obesity due to Bardet-Biedl syndrome (BBS) or genetically confirmed pro-opiomelanocortin (POMC), including proprotein convertase subtilisin/kexin type 1 (PCSK1), deficiency or leptin receptor (LEPR) deficiency. Both the European Commission (EC) and the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) have authorized setmelanotide for the treatment of obesity and control of hunger in patients 4 years of age and above with acquired hypothalamic obesity due to hypothalamic injury or impairment; and for the treatment of obesity and the control of hunger associated with genetically confirmed BBS or genetically confirmed loss-of-function biallelic POMC, including PCSK1, deficiency or biallelic LEPR deficiency in adults and children 2 years of age and above. Additionally, Rhythm is advancing a broad clinical development program for setmelanotide in other rare diseases, as well as investigational MC4R agonists bivamelagon and RM-718, and a preclinical suite of small molecules for the treatment of congenital hyperinsulinism. Rhythm’s headquarters is in Boston, MA.
Setmelanotide Indication
In the United States, setmelanotide is indicated to reduce excess body weight and maintain weight reduction long term in adults and pediatric patients aged 4 years and older with acquired hypothalamic obesity, in adult and pediatric patients aged 2 years and older with syndromic or monogenic obesity due to Bardet-Biedl syndrome (BBS) or Pro-opiomelanocortin (POMC), proprotein convertase subtilisin/kexin type 1 (PCSK1), or leptin receptor (LEPR) deficiency confirmed by genetic testing demonstrating variants in POMC, PCSK1, or LEPR genes that are interpreted as pathogenic, likely pathogenic, or of uncertain significance (VUS).
In the European Union and the United Kingdom, setmelanotide is indicated for the treatment of obesity and the control of hunger associated with genetically confirmed BBS or loss-of-function biallelic POMC, including PCSK1, deficiency or biallelic LEPR deficiency in adults and children 2 years of age and above, and for the treatment of obesity and control of hunger in adults and children 4 years of age and above with acquired hypothalamic obesity due to hypothalamic injury or impairment. In the European Union and the United Kingdom, setmelanotide should be prescribed and supervised by a physician experienced in the diagnosis and management of rare forms of obesity with genetic or hypothalamic origin.
Limitations of Use
Setmelanotide is not indicated for the treatment of patients with the following conditions as setmelanotide would not be expected to be effective:
- Obesity due to suspected POMC, PCSK1, or LEPR deficiency with POMC, PCSK1, or LEPR variants classified as benign or likely benign
- Other types of obesity not related to acquired HO, BBS, or POMC, PCSK1 or LEPR deficiency, including obesity associated with other genetic syndromes and general (polygenic) obesity.
Important Safety Information
CONTRAINDICATIONS
Prior serious hypersensitivity to setmelanotide or any of the excipients in IMCIVREE. Serious hypersensitivity reactions (e.g., anaphylaxis) have been reported.
WARNINGS AND PRECAUTIONS
Disturbance in Sexual Arousal: Spontaneous penile erections and increased frequency of penile erections in males have occurred. Inform patients that these events may occur and instruct patients who have an erection lasting longer than 4 hours to seek emergency medical attention.
Depression and Suicidal Ideation: Depression and suicidal ideation have occurred. Monitor patients for new onset or worsening depression or suicidal thoughts or behaviors. Consider discontinuing IMCIVREE if patients experience suicidal thoughts or behaviors, or clinically significant or persistent depression symptoms occur.
Hypersensitivity Reactions: Serious hypersensitivity reactions (e.g., anaphylaxis) have been reported. If suspected, advise patients to promptly seek medical attention and discontinue IMCIVREE.
Skin Hyperpigmentation, Darkening of Pre-existing Nevi, and Development of New Melanocytic Nevi: Generalized or focal increases in skin pigmentation occurred in the majority of IMCIVREE-treated patients. IMCIVREE may also cause development of new melanocytic nevi or darkening of pre-existing nevi. Perform a full body skin examination prior to initiation and periodically during treatment to monitor pre-existing and new pigmented lesions.
Acute Adrenal Insufficiency with Acquired HO: Patients with acquired HO and secondary adrenal insufficiency reported serious adverse reactions related to acute adrenal insufficiency in
Sodium Imbalance in Patients with Acquired HO and Central Diabetes Insipidus: Patients with acquired HO and concomitant central diabetes insipidus (DI)/arginine vasopressin (AVP) deficiency reported hyponatremia in
ADVERSE REACTIONS
Most common adverse reactions (incidence ≥
USE IN SPECIFIC POPULATIONS
Treatment with IMCIVREE is not recommended when breastfeeding. Discontinue IMCIVREE when pregnancy is recognized unless the benefits of therapy outweigh the potential risks to the fetus.
To report SUSPECTED ADVERSE REACTIONS, contact Rhythm Pharmaceuticals at +1 (833) 789-6337 or FDA at 1-800-FDA-1088 or http://www.fda.gov/medwatch. See section 4.8 of the Summary of Product Characteristics for information on reporting suspected adverse reactions in Europe.
Please see the full Prescribing Information for additional Important Safety Information.
Forward-looking Statements
This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. All statements contained in this press release that do not relate to matters of historical fact should be considered forward-looking statements, including, without limitation, statements regarding the safety, efficacy, potential benefits of, and clinical design or progress of any of our products or product candidates at any dosage or in any indication, including, setmelanotide, bivamelagon, and RM-718; the use of setmelanotide in patients with acquired HO and the success of our commercial launch; our expectations surrounding potential regulatory submissions, progress, or approvals and timing thereof for any of our product candidates, including launch in Japan and the timing thereof; the commercial growth of IMCIVREE; the estimated market size and addressable population for our drug products, including setmelanotide for the treatment of acquired HO; and the timing of any of the foregoing. Statements using words such as “expect”, “anticipate”, “believe”, “may”, “will” and similar terms are also forward-looking statements. Such statements are subject to numerous risks and uncertainties, including, but not limited to, our ability to enroll patients in clinical trials, the design and outcome of clinical trials, the impact of competition, the ability to achieve or obtain necessary regulatory approvals, risks associated with data analysis and reporting, unfavorable pricing regulations, third-party reimbursement practices or healthcare reform initiatives, risks associated with the laws and regulations governing our international operations and the costs of any related compliance programs, our ability to successfully commercialize setmelanotide, our liquidity and expenses, our ability to retain our key employees and consultants, and to attract, retain and motivate qualified personnel, and general economic conditions, and the other important factors, including those discussed under the caption “Risk Factors” in Rhythm’s Quarterly Report on Form 10-Q for the three months ended June 30, 2026, and our other filings with the Securities and Exchange Commission. Except as required by law, we undertake no obligations to make any revisions to the forward-looking statements contained in this release or to update them to reflect events or circumstances occurring after the date of this release, whether as a result of new information, future developments or otherwise.
Corporate Contacts:
David Connolly
Head of Investor Relations and Corporate Communications
Rhythm Pharmaceuticals, Inc.
857-264-4280
dconnolly@rhythmtx.com
Kate Walsh
Director, Corporate Communications
Rhythm Pharmaceuticals, Inc.
(857) 264-4280
kwalsh@rhythmtx.com
