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Effects of SomatoKine (Iplex)Recombinant Human Insulin-like Growth Factor-1/Recombinant Human Insulin-like Growth Factor-binding Protein-3 (rhIGF-I/rhIGFBP-3) in Myotonic Dystrophy Type 1 (DM1)

Primary Purpose

Myotonic Dystrophy

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
SomatoKine/IPLEX
Sponsored by
University of Rochester
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Myotonic Dystrophy

Eligibility Criteria

21 Years - 60 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria: A clinical diagnosis of DM-1 according to accepted clinical research criteria.23 The clinical research criteria require each of the following: (1) clinically evident myotonia; (2) muscle weakness in a characteristic distribution (distal predominant); and (3) similar findings in a first degree relative. Age 21 to 60 years (inclusive). Ability to walk 30 feet without assistance (cane and leg bracing is permitted). Weakness of sufficient severity to justify treatment and provide a reasonable opportunity to observe a therapeutic effect. At the eligibility evaluation, eligible patients must show both of the following: muscle strength in a distal muscle group (ankle dorsiflexors or deep flexors of the fingers) which is less than or equal to grade 4 (Medical Research Council grade). muscle strength in a proximal or mid-limb muscle group (flexors or extensors of the knee, elbow, shoulder, or hip) which is which is greater than or equal to 4- (Medical Research Council grade). For patients that are not within driving distance to Rochester, a local health care provider in their area must be able to complete their home visits. Competent, willing, and able to give informed consent. Able to self-administer study medication by subcutaneous injection or caregiver available to administer study medication. Exclusion Criteria: Congenital DM-1. Congenital disease constitutes ~10% of all cases of DM-1. Early in life, the weakness in individuals with congenital DM-1 derives from maldevelopment of skeletal muscle rather than muscle degeneration. Later in life, these individuals are also subject to the added effects of a wasting process similar to classical DM-1. However, it is difficult to determine which of these phenomena are mainly to blame for weakness in a particular patient. Furthermore, more than 75% of patients with congenital DM-1 have mental retardation. Prior treatment with glucocorticoids, anabolic steroids, testosterone, growth hormone, or IGF-I within 1 year of entry; or any investigational agent within 60 days of entry. Any history of malignancy except for surgically cured skin cancer or pilomatricoma (benign tumor of the hair follicle that is associated with DM-1). Women of childbearing potential who are not using effective birth control; women who are pregnant or lactating. Medical illness which would prevent assessment of muscle strength or function. This exclusion would include individuals with orthopedic, cardiac, or pulmonary disorders which preclude proper positioning on the myometry testing table, or restrict their ability to tolerate repeated maximum muscle contractions. Known allergy to tetracycline. Diaphragmatic weakness such that patients are unable to tolerate supine position, or swallowing impairment such that patients are unable to maintain nutrition without use of gastrostomy. Symptomatic liver or kidney disease, insulin requiring diabetes or type 2 diabetes requiring oral anti-diabetic agents. Untreated thyroid disease (hypo or hyperthyroidism) Major psychiatric illness (major depression, bipolar disorder, or schizophrenia) within twelve months of entry. History of non-compliance with other therapies. Drug or alcohol abuse within 12 months of enrollment. In men, evidence of a mass lesion on clinical examination by their primary care physician within twelve months prior to entry into the study (specifically prostate or testicular mass on clinical exam or other signs of mass lesion) or evidence of mass lesion on chest x-ray. In men 50 years of age or older, prostate specific antigen (PSA) elevation above normal. In women, evidence for mass lesion on clinical examination by their primary care physician or gynecologist (specifically breast & pelvic exam) within 12 months of entry into the study or evidence of mass lesion on chest x-ray. In women 40 years of age or older, evidence of mass lesion on mammogram. Women with Gail Scores > 1.7 will be excluded due to their increased risk of developing cancer. Atrial fibrillation/flutter; 2nd or 3rd degree heart block without pacemaker treatment Weight greater than 100 kilograms(kg). Body Mass Index greater than 30. History of bleeding diathesis or use of anticoagulant medications. Patients taking nonsteroidal anti-inflammatory agents will be asked to discontinue these medications 3 days prior to muscle biopsy.

Sites / Locations

  • University of Rochester Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Cohort 1- Two Escalating Doses of Iplex

Cohort 2 - Three Escalating Doses of Iplex

Arm Description

0.5 and 1.0 mg/kg/day

0.5, 1.0, and 2.0 mg/kg/day

Outcomes

Primary Outcome Measures

The Number of Study Participants Who Safely Tolerated Somatokine
Safety and tolerability was measured via interval laboratory studies,electrocardiograms, echocardiograms, ultrasounds of the abdomen and pelvis, dual energy x-ray absorptiometry (DEXA) studies, chest and neck x-rays, and serial physical examinations. The participants had six inpatient evaluations at the University of Rochester General Clinical Research Center (Weeks 0, 8, 16, 24, 28, and 40) and nine outpatient evaluations. Patients also completed side effects diaries to record any adverse events in the interval time between inpatient and outpatient evaluations.

Secondary Outcome Measures

Full Information

First Posted
October 3, 2005
Last Updated
June 20, 2012
Sponsor
University of Rochester
Collaborators
National Institute of Neurological Disorders and Stroke (NINDS), Imsmed Incorporated
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1. Study Identification

Unique Protocol Identification Number
NCT00233519
Brief Title
Effects of SomatoKine (Iplex)Recombinant Human Insulin-like Growth Factor-1/Recombinant Human Insulin-like Growth Factor-binding Protein-3 (rhIGF-I/rhIGFBP-3) in Myotonic Dystrophy Type 1 (DM1)
Official Title
Effects of SomatoKine (Iplex) (rhIGF-I/rhIGFBP-3) in Myotonic Dystrophy Type 1 (DM1)
Study Type
Interventional

2. Study Status

Record Verification Date
June 2012
Overall Recruitment Status
Completed
Study Start Date
November 2005 (undefined)
Primary Completion Date
May 2008 (Actual)
Study Completion Date
May 2008 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Rochester
Collaborators
National Institute of Neurological Disorders and Stroke (NINDS), Imsmed Incorporated

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The aim of this study is to investigate the safety and feasibility of daily subcutaneous injections of recombinant IGF1 complexed with IGF binding protein 3 (SomatoKine-INSMED) as a treatment for muscle wasting and weakness in myotonic dystrophy type 1.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Myotonic Dystrophy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
17 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cohort 1- Two Escalating Doses of Iplex
Arm Type
Experimental
Arm Description
0.5 and 1.0 mg/kg/day
Arm Title
Cohort 2 - Three Escalating Doses of Iplex
Arm Type
Active Comparator
Arm Description
0.5, 1.0, and 2.0 mg/kg/day
Intervention Type
Drug
Intervention Name(s)
SomatoKine/IPLEX
Intervention Description
Cohort 1: self-administered subcuteanous injections of 0.5 mg/kg/day of iPlex for 8 weeks, followed by 1.0 mg/kg/day of iPlex for 16 weeks. Cohort 2: consecutive 8 week treatments of 0.5, 1.0, and 2.0 mg/kg/day of iPlex for a total of 24 weeks by self-administered subcuteanous injection.
Primary Outcome Measure Information:
Title
The Number of Study Participants Who Safely Tolerated Somatokine
Description
Safety and tolerability was measured via interval laboratory studies,electrocardiograms, echocardiograms, ultrasounds of the abdomen and pelvis, dual energy x-ray absorptiometry (DEXA) studies, chest and neck x-rays, and serial physical examinations. The participants had six inpatient evaluations at the University of Rochester General Clinical Research Center (Weeks 0, 8, 16, 24, 28, and 40) and nine outpatient evaluations. Patients also completed side effects diaries to record any adverse events in the interval time between inpatient and outpatient evaluations.
Time Frame
24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: A clinical diagnosis of DM-1 according to accepted clinical research criteria.23 The clinical research criteria require each of the following: (1) clinically evident myotonia; (2) muscle weakness in a characteristic distribution (distal predominant); and (3) similar findings in a first degree relative. Age 21 to 60 years (inclusive). Ability to walk 30 feet without assistance (cane and leg bracing is permitted). Weakness of sufficient severity to justify treatment and provide a reasonable opportunity to observe a therapeutic effect. At the eligibility evaluation, eligible patients must show both of the following: muscle strength in a distal muscle group (ankle dorsiflexors or deep flexors of the fingers) which is less than or equal to grade 4 (Medical Research Council grade). muscle strength in a proximal or mid-limb muscle group (flexors or extensors of the knee, elbow, shoulder, or hip) which is which is greater than or equal to 4- (Medical Research Council grade). For patients that are not within driving distance to Rochester, a local health care provider in their area must be able to complete their home visits. Competent, willing, and able to give informed consent. Able to self-administer study medication by subcutaneous injection or caregiver available to administer study medication. Exclusion Criteria: Congenital DM-1. Congenital disease constitutes ~10% of all cases of DM-1. Early in life, the weakness in individuals with congenital DM-1 derives from maldevelopment of skeletal muscle rather than muscle degeneration. Later in life, these individuals are also subject to the added effects of a wasting process similar to classical DM-1. However, it is difficult to determine which of these phenomena are mainly to blame for weakness in a particular patient. Furthermore, more than 75% of patients with congenital DM-1 have mental retardation. Prior treatment with glucocorticoids, anabolic steroids, testosterone, growth hormone, or IGF-I within 1 year of entry; or any investigational agent within 60 days of entry. Any history of malignancy except for surgically cured skin cancer or pilomatricoma (benign tumor of the hair follicle that is associated with DM-1). Women of childbearing potential who are not using effective birth control; women who are pregnant or lactating. Medical illness which would prevent assessment of muscle strength or function. This exclusion would include individuals with orthopedic, cardiac, or pulmonary disorders which preclude proper positioning on the myometry testing table, or restrict their ability to tolerate repeated maximum muscle contractions. Known allergy to tetracycline. Diaphragmatic weakness such that patients are unable to tolerate supine position, or swallowing impairment such that patients are unable to maintain nutrition without use of gastrostomy. Symptomatic liver or kidney disease, insulin requiring diabetes or type 2 diabetes requiring oral anti-diabetic agents. Untreated thyroid disease (hypo or hyperthyroidism) Major psychiatric illness (major depression, bipolar disorder, or schizophrenia) within twelve months of entry. History of non-compliance with other therapies. Drug or alcohol abuse within 12 months of enrollment. In men, evidence of a mass lesion on clinical examination by their primary care physician within twelve months prior to entry into the study (specifically prostate or testicular mass on clinical exam or other signs of mass lesion) or evidence of mass lesion on chest x-ray. In men 50 years of age or older, prostate specific antigen (PSA) elevation above normal. In women, evidence for mass lesion on clinical examination by their primary care physician or gynecologist (specifically breast & pelvic exam) within 12 months of entry into the study or evidence of mass lesion on chest x-ray. In women 40 years of age or older, evidence of mass lesion on mammogram. Women with Gail Scores > 1.7 will be excluded due to their increased risk of developing cancer. Atrial fibrillation/flutter; 2nd or 3rd degree heart block without pacemaker treatment Weight greater than 100 kilograms(kg). Body Mass Index greater than 30. History of bleeding diathesis or use of anticoagulant medications. Patients taking nonsteroidal anti-inflammatory agents will be asked to discontinue these medications 3 days prior to muscle biopsy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Richard T. Moxley, III, M.D.
Organizational Affiliation
University of Rochester
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Rochester Medical Center
City
Rochester
State/Province
New York
ZIP/Postal Code
14642
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20837825
Citation
Heatwole CR, Eichinger KJ, Friedman DI, Hilbert JE, Jackson CE, Logigian EL, Martens WB, McDermott MP, Pandya SK, Quinn C, Smirnow AM, Thornton CA, Moxley RT 3rd. Open-label trial of recombinant human insulin-like growth factor 1/recombinant human insulin-like growth factor binding protein 3 in myotonic dystrophy type 1. Arch Neurol. 2011 Jan;68(1):37-44. doi: 10.1001/archneurol.2010.227. Epub 2010 Sep 13.
Results Reference
derived
Links:
URL
http://www.dystrophyregistry.org
Description
Webpage for the National Registry of Myotonic Dystrophy and Facioscapulohumeral Dystrophy patients and their family members.

Learn more about this trial

Effects of SomatoKine (Iplex)Recombinant Human Insulin-like Growth Factor-1/Recombinant Human Insulin-like Growth Factor-binding Protein-3 (rhIGF-I/rhIGFBP-3) in Myotonic Dystrophy Type 1 (DM1)

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