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Effects of Metreleptin in Type 1 Diabetes Mellitus

Primary Purpose

Type 1 Diabetes

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Leptin
Sponsored by
University of Texas Southwestern Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 1 Diabetes focused on measuring Type 1 Diabetes Mellitus

Eligibility Criteria

18 Years - 50 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

All of the following criteria are to be fulfilled for inclusion of an individual in the study. An eligible individual:

  1. Is male or female and is 18 to 50 years of age
  2. Has been diagnosed with T1DM for at least 1 year. Diagnosis of T1DM will be based on clinical criteria including: insulin-dependence within 6 months of the onset, history of prior episode of ketoacidosis, previous documentation of positive serum islet cell autoantibodies or low or undetectable serum C-peptide levels.
  3. Has an HbA1c 7.0 to 10.0 %, inclusive
  4. Currently on insulin pump or on a combination of basal (long-acting insulin preparation) and pre-prandial (short-acting insulin preparation) insulin therapy
  5. Is male, or if female of childbearing potential, is non-lactating, and has a negative pregnancy test (human chorionic gonadotropin, beta subunit [βhCG]) result at screening (Visit 1) and Visit 2 regardless of menopausal status (If female and of childbearing potential [including peri menopausal women who have had a menstrual period within one year], must practice and be willing to continue to practice appropriate birth control [defined as a method which results in a low failure rate, i.e., less than 1% per year, when used consistently and correctly, such as implants, injectables, oral contraceptives, some intrauterine contraceptive devices, sexual abstinence, tubal ligation, or a vasectomized partner] during the entire duration of the study.)
  6. Has a BMI < 27 kg/m2
  7. Has clinical laboratory test values (clinical chemistry, hematology, and urinalysis) judged to be not clinically significant by the investigator at screening (Visit 1)
  8. Has a physical examination and electrocardiogram (ECG) with no clinically significant abnormalities as judged by the investigator

Exclusion Criteria:

  1. Has a fasting serum triglyceride concentration >400 mg/dL at screening
  2. Has hypoglycemia unawareness (Loss of consciousness due to hypoglycemia without preceding symptoms or recent history of blood glucose <50 mg/dl without symptoms)
  3. Currently abuses drugs or alcohol, or has a history of abuse that in the investigator's opinion could cause the individual to be noncompliant with study procedures, or has a positive urine screen for drugs of abuse at screening (Visit 1)
  4. Has chronic renal insufficiency with serum creatinine > 2 mg/dL
  5. Has a history of weight loss (>3%) in the last 3 months
  6. Is currently enrolled or plans to enroll in a diet, weight loss, or exercise program
  7. Has a sitting blood pressure >160/95 mmHg (either systolic or diastolic) at screening (Visit 1)
  8. Has a clinically significant history or presence of any of the following conditions:

    • Active cardio- or cerebrovascular disease
    • Active pulmonary disease
    • Hepatic disease defined as follows:

      • At screening (Visit 1), alanine transaminase (ALT), aspartate transaminase (AST), or alkaline phosphatase > three times the upper limit of normal (elevated Liver Function Test values suggestive of obesity related non-alcoholic fatty liver disease may not be exclusionary)
    • The presence of any other co morbid disorders that, in the opinion of the investigator, would interfere with the subject's compliance of study procedures
    • Clinically significant malignancies within 5 years of screening (Visit 1)
    • Chronic infections (e.g., HIV [human immunodeficiency virus] or tuberculosis)
  9. Has received any investigational drug within 30 days or within a period corresponding to five half-lives of that drug, whichever is greater, before screening (Visit 1)
  10. Has had major surgery or a blood transfusion within 2 months before screening (Visit 1) or has a hematocrit < 30%
  11. Has a known hypersensitivity to any of the components of the study treatment (e.g. has a known hypersensitivity to E. Coli derived proteins
  12. Is an immediate family member (spouse, parent, child, or sibling; biological or legally adopted) of personnel directly affiliated with the study at the investigative site, or is personally directly affiliated with the study at the investigative site
  13. Is employed by Amylin Pharmaceuticals, Inc., (i.e., an employee, temporary contract worker, or designee responsible for the conduct of the study)
  14. Has previously received treatment with recombinant leptin (metreleptin or Fc leptin)

Sites / Locations

  • UT Southwestern Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

active open label Leptin

Arm Description

Active open label Leptin for type 1 Diabetes

Outcomes

Primary Outcome Measures

HbA1c
Change in Hba1c after 12 weeks on Leptin Therapy compared to Baseline value

Secondary Outcome Measures

Weight
Change in Body Weight after 12 weeks on Leptin Therapy compared to Baseline value
Insulin Dose
Change in Insulin dose after 12 weeks on Leptin Therapy compared to Baseline value
Change in HbA1c From Baseline to Week 20 on Leptin Therapy
Change in Hba1c after 20 weeks on Leptin Therapy compared to Baseline value. With ongoing metreleptin therapy, the concomitant basal insulin dose was actively reduced by 50% after week 12.

Full Information

First Posted
December 29, 2010
Last Updated
July 17, 2019
Sponsor
University of Texas Southwestern Medical Center
Collaborators
Juvenile Diabetes Research Foundation, Amylin Pharmaceuticals, LLC.
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1. Study Identification

Unique Protocol Identification Number
NCT01268644
Brief Title
Effects of Metreleptin in Type 1 Diabetes Mellitus
Official Title
Open Label Single Center Pilot Study to Study Teh Effects of Metreleptin Administration in Patients With Type 1 Diabetes Mellitus ( T1DM ).
Study Type
Interventional

2. Study Status

Record Verification Date
July 2019
Overall Recruitment Status
Terminated
Why Stopped
Sponsor request
Study Start Date
September 2010 (undefined)
Primary Completion Date
January 2013 (Actual)
Study Completion Date
August 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Texas Southwestern Medical Center
Collaborators
Juvenile Diabetes Research Foundation, Amylin Pharmaceuticals, LLC.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will add leptin therapy to the current insulin therapy of Type 1 Diabetics with the aim of lowering the total insulin requirements and suppressing the steep fluctuations typically associated with Type 1 Diabetes.
Detailed Description
The adipocyte hormone, leptin, has been shown to restore the health and glucoregulation of near-death, insulin deficient diabetic rodents. This makes leptin the only hormone, since the discovery of insulin in 1922, with this capability. Leptin normalizes the hyperglucagonemia of diabetes and reduces lipogenesis and cholesterologenenesis. Treatment of diabetic rodents with a combination of leptin and insulin, leads to a stable pattern of glucose control with reduced insulin requirements, as opposed to the high glucose variability that characterizes the treatment of type 1 diabetes with supraphysiologic doses of insulin alone. As such, we will initiate a pilot clinical trial to test combination leptin and insulin therapy in type 1 diabetes. Fifteen leptin sensitive patients (body mass index <27 kg/m²) with uncontrolled diabetes (HbA1c 7.0 to 10.0 %) will be treated with slightly supraphysiologic doses of recombinant human leptin (Amylin Pharmaceuticals). Subjects will be compared to themselves before and after treatment with leptin. Endpoint variables include HbA1c, change in daily insulin dose, mean and standard deviation of blood glucose from inpatient glucose monitoring and glucose meter download. We will also assess effects of leptin therapy on energy intake as assessed by 3-day food record and body weight and fat by DEXA. Intramyocellular and intrahepatic lipid concentration by 1H-MRS will be assessed before and after 3 months of metreleptin therapy. A satiety analysis will be employed. In addition, plasma hormones and inflammatory biomarkers will be assayed during the course of this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes
Keywords
Type 1 Diabetes Mellitus

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
8 (Actual)

8. Arms, Groups, and Interventions

Arm Title
active open label Leptin
Arm Type
Experimental
Arm Description
Active open label Leptin for type 1 Diabetes
Intervention Type
Drug
Intervention Name(s)
Leptin
Other Intervention Name(s)
Metreleptin
Intervention Description
weight based sub-cutaneous injection twice daily of Leptin
Primary Outcome Measure Information:
Title
HbA1c
Description
Change in Hba1c after 12 weeks on Leptin Therapy compared to Baseline value
Time Frame
Baseline and 12 weeks
Secondary Outcome Measure Information:
Title
Weight
Description
Change in Body Weight after 12 weeks on Leptin Therapy compared to Baseline value
Time Frame
Baseline to 12 weeks
Title
Insulin Dose
Description
Change in Insulin dose after 12 weeks on Leptin Therapy compared to Baseline value
Time Frame
Baseline to 12 weeks
Title
Change in HbA1c From Baseline to Week 20 on Leptin Therapy
Description
Change in Hba1c after 20 weeks on Leptin Therapy compared to Baseline value. With ongoing metreleptin therapy, the concomitant basal insulin dose was actively reduced by 50% after week 12.
Time Frame
Baseline to Week 20 (On leptin)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: All of the following criteria are to be fulfilled for inclusion of an individual in the study. An eligible individual: Is male or female and is 18 to 50 years of age Has been diagnosed with T1DM for at least 1 year. Diagnosis of T1DM will be based on clinical criteria including: insulin-dependence within 6 months of the onset, history of prior episode of ketoacidosis, previous documentation of positive serum islet cell autoantibodies or low or undetectable serum C-peptide levels. Has an HbA1c 7.0 to 10.0 %, inclusive Currently on insulin pump or on a combination of basal (long-acting insulin preparation) and pre-prandial (short-acting insulin preparation) insulin therapy Is male, or if female of childbearing potential, is non-lactating, and has a negative pregnancy test (human chorionic gonadotropin, beta subunit [βhCG]) result at screening (Visit 1) and Visit 2 regardless of menopausal status (If female and of childbearing potential [including peri menopausal women who have had a menstrual period within one year], must practice and be willing to continue to practice appropriate birth control [defined as a method which results in a low failure rate, i.e., less than 1% per year, when used consistently and correctly, such as implants, injectables, oral contraceptives, some intrauterine contraceptive devices, sexual abstinence, tubal ligation, or a vasectomized partner] during the entire duration of the study.) Has a BMI < 27 kg/m2 Has clinical laboratory test values (clinical chemistry, hematology, and urinalysis) judged to be not clinically significant by the investigator at screening (Visit 1) Has a physical examination and electrocardiogram (ECG) with no clinically significant abnormalities as judged by the investigator Exclusion Criteria: Has a fasting serum triglyceride concentration >400 mg/dL at screening Has hypoglycemia unawareness (Loss of consciousness due to hypoglycemia without preceding symptoms or recent history of blood glucose <50 mg/dl without symptoms) Currently abuses drugs or alcohol, or has a history of abuse that in the investigator's opinion could cause the individual to be noncompliant with study procedures, or has a positive urine screen for drugs of abuse at screening (Visit 1) Has chronic renal insufficiency with serum creatinine > 2 mg/dL Has a history of weight loss (>3%) in the last 3 months Is currently enrolled or plans to enroll in a diet, weight loss, or exercise program Has a sitting blood pressure >160/95 mmHg (either systolic or diastolic) at screening (Visit 1) Has a clinically significant history or presence of any of the following conditions: Active cardio- or cerebrovascular disease Active pulmonary disease Hepatic disease defined as follows: At screening (Visit 1), alanine transaminase (ALT), aspartate transaminase (AST), or alkaline phosphatase > three times the upper limit of normal (elevated Liver Function Test values suggestive of obesity related non-alcoholic fatty liver disease may not be exclusionary) The presence of any other co morbid disorders that, in the opinion of the investigator, would interfere with the subject's compliance of study procedures Clinically significant malignancies within 5 years of screening (Visit 1) Chronic infections (e.g., HIV [human immunodeficiency virus] or tuberculosis) Has received any investigational drug within 30 days or within a period corresponding to five half-lives of that drug, whichever is greater, before screening (Visit 1) Has had major surgery or a blood transfusion within 2 months before screening (Visit 1) or has a hematocrit < 30% Has a known hypersensitivity to any of the components of the study treatment (e.g. has a known hypersensitivity to E. Coli derived proteins Is an immediate family member (spouse, parent, child, or sibling; biological or legally adopted) of personnel directly affiliated with the study at the investigative site, or is personally directly affiliated with the study at the investigative site Is employed by Amylin Pharmaceuticals, Inc., (i.e., an employee, temporary contract worker, or designee responsible for the conduct of the study) Has previously received treatment with recombinant leptin (metreleptin or Fc leptin)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Abhimanyu Garg, M.D.
Organizational Affiliation
UT Southwestern Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
UT Southwestern Medical Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75390
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
28223297
Citation
Vasandani C, Clark GO, Adams-Huet B, Quittner C, Garg A. Efficacy and Safety of Metreleptin Therapy in Patients With Type 1 Diabetes: A Pilot Study. Diabetes Care. 2017 May;40(5):694-697. doi: 10.2337/dc16-1553. Epub 2017 Feb 21.
Results Reference
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Effects of Metreleptin in Type 1 Diabetes Mellitus

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