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Study of Human Plasma-Derived Alpha1-Proteinase Inhibitor in Subjects With New-Onset Type 1 Diabetes Mellitus

Primary Purpose

Type 1 Diabetes Mellitus

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
180 mg/kg Alpha1-PI
90 mg/kg Alpha1-PI
Placebo
Sponsored by
Grifols Therapeutics LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 1 Diabetes Mellitus focused on measuring Type 1 Diabetes Mellitus, Alpha1-Proteinase Inhibitor, Beta Cell, Alpha1-Antitrypsin

Eligibility Criteria

6 Years - 35 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnosis of T1DM according to the ADA criteria.
  • Current use of injected insulin therapy and one positive result on testing for any of the following antibodies (If not currently on insulin therapy, must have positive result for at least two of the below antibodies):

    • Anti-islet-cell antibodies (islet cell antigen 512, insulinoma associated protein 2),
    • Anti-glutamic acid decarboxylase antibodies, or
    • Anti-insulin antibodies (unless received insulin therapy for > 7 days).
  • Body Mass Index (BMI) ≤ 28 kg/m2 for adults (≥ 20 years of age) OR ≤ 90th percentile in accordance with the Centers for Disease Control BMI assessment for children and teens (2 through 19 years old).

Exclusion Criteria:

  • History of or current diabetic retinopathy, neuropathy, or nephropathy.
  • Known thrombophilia or history of thrombosis.
  • Malignant disease (including malignant melanoma; however, other forms of skin cancer are allowed) within five years of randomization.
  • Active Hepatitis A virus, Hepatitis B virus, Hepatitis C virus, or Human Immunodeficiency Virus infection.
  • History of anaphylaxis or severe systemic response to any plasma-derived alpha1-PI preparation or other blood product(s).
  • Known selective or severe Immunoglobulin A deficiency.
  • Elevated liver enzymes (aspartate transaminase, alanine aminotransferase, and alkaline phosphatase) equal to or greater than 2.5 times the upper limit of normal.
  • Therapy with exenatide or any other agents that stimulate pancreatic β cell regeneration or insulin secretion, or any antidiabetic agents (oral or parenteral) other than insulin within one month prior to screening.
  • Use of omega-3 fatty acid supplements, including fish oil, within seven days prior to screening.
  • Current or planned therapy with inhaled insulin, if it becomes available.
  • Chronic use of systemic steroids, with the exception of inhaled steroids, above a stable dose equivalent to 5 mg/day prednisone (e.g., 10 mg every 2 days) within 4 weeks prior to randomization. It is recommended to maintain the same dose throughout the study. (Note: Subjects with autoimmune conditions (i.e., asthma) necessitating treatment with systemic short-term corticosteroids and administered a rapid taper are eligible per protocol with the caveat that the tapering is complete or decreased to the minimum requirement (i.e., 5 mg/day) at least 1 week prior to the Baseline visit (when randomization occurs) to ensure the subject is stable. For longer term steroid usage, please consult the Grifols Medical Monitor before considering the subject for study participation.)
  • Treatment with immunosuppressants or cytostatic agents within 6 months of randomization.

Sites / Locations

  • University of Arizona
  • Clinica Medica San Miguel
  • Diabetes Associates Medical Group
  • Rady Children's Hospital San Diego
  • Metabolic Institute of America
  • Ronald H Chochinov MD
  • Yale New Haven Hospital
  • Christiana Care Health Services
  • Solutions Through Advanced Research Inc.
  • CCM Clinical Research
  • Advanced Pharma CR LLC
  • Atlanta Diabetes Associates
  • Rocky Mountain Diabetes and Osteoporosis Center
  • Cook County Hospital
  • Methodist Research Institute
  • University of Iowa Hospitals and Clinics
  • University of Louisville
  • Barry J. Reiner MD, LLC.
  • UMass Memorial Medical Center
  • Wayne State University
  • Children's Hospitals and Clinics of Minnesota
  • Morristown Medical Center
  • University of New Mexico, Health Sciences Center
  • Women and Children's Hospital
  • WakeMed Children's Hospital
  • Endocrinology Associates Inc
  • Ohio State University
  • Pediatric Endocrinology, Genetics & Metabolism
  • Children's Hospital of Philadelphia
  • Children's Hospital of Pittsburgh
  • Rapid City Regional Hospital/Health Clinical Research
  • Research Institute of Dallas
  • University of Texas Southwestern Medical Center
  • Northeast Clinical Research of San Antonio LLC
  • University of Texas Health Science Center
  • Consano Clinical Research

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm Type

Experimental

Experimental

Placebo Comparator

Experimental

Experimental

Placebo Comparator

Arm Label

Alpha1-PI 180 mg/kg/wk, 26 weeks

90 mg/kg/wk Alpha1-PI, 26 weeks

Placebo, 26 weeks

180 mg/kg/wk Alpha1-PI, 13 weeks

90 mg/kg/wk Alpha1-PI, 13 weeks

Placebo, 13 weeks

Arm Description

180 mg/kg weekly infusions of Alpha1-PI for 26 weeks.

90 mg/kg weekly infusions of Alpha1-PI for 26 weeks.

Weekly infusions of placebo for 26 weeks.

180 mg/kg weekly infusions of Alpha1-PI for 13 weeks.

90 mg/kg weekly infusions of Alpha1-PI for 13 weeks

Weekly infusions of placebo for 13 weeks.

Outcomes

Primary Outcome Measures

Change From Baseline in Mixed Meal Tolerance Test (MMTMT) Stimulated C-peptide 2 Hour Area Under the Concentration-time Curve (AUC)
C-peptide concentration during MMTT with high protein energy drink. "Dose" for time frame refers to intake of high protein energy drink.

Secondary Outcome Measures

Change From Baseline for MMTT Stimulated C-peptide 2h AUC
Change From Baseline for HbA1c Levels
Number of Subjects With Overall Severe Hypoglycemic Episodes
Severe hypoglycemia defined according the ADA Workgroup on Hypoglycemia definition, as follows: An event requiring assistance of another person to actively administer carbohydrate, glucagons, or other resuscitative actions.
Change From Baseline for Mean Daily Insulin Dose Requirements
Change From Baseline for Mean Daily Glucose Levels Prior to Meals and Bedtime
For each visit, the mean daily glucose levels were calculated over the previous 3-7 days prior to the study visit from blood glucose levels recorded daily prior to meals and bedtime.

Full Information

First Posted
March 11, 2014
Last Updated
August 6, 2018
Sponsor
Grifols Therapeutics LLC
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1. Study Identification

Unique Protocol Identification Number
NCT02093221
Brief Title
Study of Human Plasma-Derived Alpha1-Proteinase Inhibitor in Subjects With New-Onset Type 1 Diabetes Mellitus
Official Title
A Multicenter, Randomized, Partial-Blinded, Placebo-Controlled Study to Evaluate the Safety and Efficacy of a Human Plasma-Derived Alpha1-Proteinase Inhibitor in Subjects With New-Onset Type 1 Diabetes Mellitus
Study Type
Interventional

2. Study Status

Record Verification Date
August 2018
Overall Recruitment Status
Terminated
Why Stopped
Wk 52 primary endpoint results would be unaffected by follow-up data so trial was discontinued prior to wk 104. No safety data was collected after wk 52.
Study Start Date
March 2014 (undefined)
Primary Completion Date
January 2017 (Actual)
Study Completion Date
June 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Grifols Therapeutics LLC

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a multicenter, randomized, partial-blinded, five-arm, placebo-controlled study of human plasma-derived alpha1-proteinase inhibitor (alpha1-PI) in children (ages 6-11 years old) and teens/adults (ages 12-35 years old) with new onset Type 1 Diabetes Mellitus (T1DM). Currently enrolling ages 12-35 only. Once 25 patients are randomized and data is reviewed enrollment will be opened to the child cohort. The purpose of this study is to evaluate the safety and efficacy of four dosing regimens of human plasma-derived alpha1-PI in T1DM.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes Mellitus
Keywords
Type 1 Diabetes Mellitus, Alpha1-Proteinase Inhibitor, Beta Cell, Alpha1-Antitrypsin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
76 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Alpha1-PI 180 mg/kg/wk, 26 weeks
Arm Type
Experimental
Arm Description
180 mg/kg weekly infusions of Alpha1-PI for 26 weeks.
Arm Title
90 mg/kg/wk Alpha1-PI, 26 weeks
Arm Type
Experimental
Arm Description
90 mg/kg weekly infusions of Alpha1-PI for 26 weeks.
Arm Title
Placebo, 26 weeks
Arm Type
Placebo Comparator
Arm Description
Weekly infusions of placebo for 26 weeks.
Arm Title
180 mg/kg/wk Alpha1-PI, 13 weeks
Arm Type
Experimental
Arm Description
180 mg/kg weekly infusions of Alpha1-PI for 13 weeks.
Arm Title
90 mg/kg/wk Alpha1-PI, 13 weeks
Arm Type
Experimental
Arm Description
90 mg/kg weekly infusions of Alpha1-PI for 13 weeks
Arm Title
Placebo, 13 weeks
Arm Type
Placebo Comparator
Arm Description
Weekly infusions of placebo for 13 weeks.
Intervention Type
Biological
Intervention Name(s)
180 mg/kg Alpha1-PI
Other Intervention Name(s)
Alpha1-antitrypsin, Prolastin-C, Alpha1-Proteinase Inhibitor (human), Modified Process, Alpha-1 MP
Intervention Type
Biological
Intervention Name(s)
90 mg/kg Alpha1-PI
Other Intervention Name(s)
Alpha1-antitrypsin, Prolastin-C, Alpha1-Proteinase Inhibitor (human), Modified Process, Alpha-1 MP
Intervention Type
Biological
Intervention Name(s)
Placebo
Primary Outcome Measure Information:
Title
Change From Baseline in Mixed Meal Tolerance Test (MMTMT) Stimulated C-peptide 2 Hour Area Under the Concentration-time Curve (AUC)
Description
C-peptide concentration during MMTT with high protein energy drink. "Dose" for time frame refers to intake of high protein energy drink.
Time Frame
Baseline, Week 52 (pre-high protein drink and 15, 30, 60, 90, 120 minutes post-drink)
Secondary Outcome Measure Information:
Title
Change From Baseline for MMTT Stimulated C-peptide 2h AUC
Time Frame
Baseline, Weeks 14, 27, 39, 69, 87, and 104 (pre-high protein drink and 15, 30, 60, 90, 120 minutes post-drink)
Title
Change From Baseline for HbA1c Levels
Time Frame
Baseline, Weeks 14, 27, 39, 52, 69, 87, and 104
Title
Number of Subjects With Overall Severe Hypoglycemic Episodes
Description
Severe hypoglycemia defined according the ADA Workgroup on Hypoglycemia definition, as follows: An event requiring assistance of another person to actively administer carbohydrate, glucagons, or other resuscitative actions.
Time Frame
104 weeks
Title
Change From Baseline for Mean Daily Insulin Dose Requirements
Time Frame
Baseline, Weeks 2, 4, 14, 27, 39, 52, 69, 87, and 104
Title
Change From Baseline for Mean Daily Glucose Levels Prior to Meals and Bedtime
Description
For each visit, the mean daily glucose levels were calculated over the previous 3-7 days prior to the study visit from blood glucose levels recorded daily prior to meals and bedtime.
Time Frame
Baseline, Weeks 2, 4, 14, 27, 39, 52, 69, 87, and 104

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Years
Maximum Age & Unit of Time
35 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of T1DM according to the ADA criteria. Current use of injected insulin therapy and one positive result on testing for any of the following antibodies (If not currently on insulin therapy, must have positive result for at least two of the below antibodies): Anti-islet-cell antibodies (islet cell antigen 512, insulinoma associated protein 2), Anti-glutamic acid decarboxylase antibodies, or Anti-insulin antibodies (unless received insulin therapy for > 7 days). Body Mass Index (BMI) ≤ 28 kg/m2 for adults (≥ 20 years of age) OR ≤ 90th percentile in accordance with the Centers for Disease Control BMI assessment for children and teens (2 through 19 years old). Exclusion Criteria: History of or current diabetic retinopathy, neuropathy, or nephropathy. Known thrombophilia or history of thrombosis. Malignant disease (including malignant melanoma; however, other forms of skin cancer are allowed) within five years of randomization. Active Hepatitis A virus, Hepatitis B virus, Hepatitis C virus, or Human Immunodeficiency Virus infection. History of anaphylaxis or severe systemic response to any plasma-derived alpha1-PI preparation or other blood product(s). Known selective or severe Immunoglobulin A deficiency. Elevated liver enzymes (aspartate transaminase, alanine aminotransferase, and alkaline phosphatase) equal to or greater than 2.5 times the upper limit of normal. Therapy with exenatide or any other agents that stimulate pancreatic β cell regeneration or insulin secretion, or any antidiabetic agents (oral or parenteral) other than insulin within one month prior to screening. Use of omega-3 fatty acid supplements, including fish oil, within seven days prior to screening. Current or planned therapy with inhaled insulin, if it becomes available. Chronic use of systemic steroids, with the exception of inhaled steroids, above a stable dose equivalent to 5 mg/day prednisone (e.g., 10 mg every 2 days) within 4 weeks prior to randomization. It is recommended to maintain the same dose throughout the study. (Note: Subjects with autoimmune conditions (i.e., asthma) necessitating treatment with systemic short-term corticosteroids and administered a rapid taper are eligible per protocol with the caveat that the tapering is complete or decreased to the minimum requirement (i.e., 5 mg/day) at least 1 week prior to the Baseline visit (when randomization occurs) to ensure the subject is stable. For longer term steroid usage, please consult the Grifols Medical Monitor before considering the subject for study participation.) Treatment with immunosuppressants or cytostatic agents within 6 months of randomization.
Facility Information:
Facility Name
University of Arizona
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85724
Country
United States
Facility Name
Clinica Medica San Miguel
City
Los Angeles
State/Province
California
ZIP/Postal Code
90015
Country
United States
Facility Name
Diabetes Associates Medical Group
City
Orange
State/Province
California
ZIP/Postal Code
92868
Country
United States
Facility Name
Rady Children's Hospital San Diego
City
San Diego
State/Province
California
ZIP/Postal Code
92123
Country
United States
Facility Name
Metabolic Institute of America
City
Tarzana
State/Province
California
ZIP/Postal Code
91356
Country
United States
Facility Name
Ronald H Chochinov MD
City
Ventura
State/Province
California
ZIP/Postal Code
93003
Country
United States
Facility Name
Yale New Haven Hospital
City
New Haven
State/Province
Connecticut
ZIP/Postal Code
06511
Country
United States
Facility Name
Christiana Care Health Services
City
Newark
State/Province
Delaware
ZIP/Postal Code
19713
Country
United States
Facility Name
Solutions Through Advanced Research Inc.
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32258
Country
United States
Facility Name
CCM Clinical Research
City
Miami
State/Province
Florida
ZIP/Postal Code
33133
Country
United States
Facility Name
Advanced Pharma CR LLC
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
Atlanta Diabetes Associates
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30309
Country
United States
Facility Name
Rocky Mountain Diabetes and Osteoporosis Center
City
Idaho Falls
State/Province
Idaho
ZIP/Postal Code
83404
Country
United States
Facility Name
Cook County Hospital
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
Facility Name
Methodist Research Institute
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States
Facility Name
University of Iowa Hospitals and Clinics
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
Facility Name
University of Louisville
City
Louisville
State/Province
Kentucky
ZIP/Postal Code
40202
Country
United States
Facility Name
Barry J. Reiner MD, LLC.
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21229
Country
United States
Facility Name
UMass Memorial Medical Center
City
Worcester
State/Province
Massachusetts
ZIP/Postal Code
01655
Country
United States
Facility Name
Wayne State University
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201
Country
United States
Facility Name
Children's Hospitals and Clinics of Minnesota
City
Saint Paul
State/Province
Minnesota
ZIP/Postal Code
55102
Country
United States
Facility Name
Morristown Medical Center
City
Morristown
State/Province
New Jersey
ZIP/Postal Code
07962
Country
United States
Facility Name
University of New Mexico, Health Sciences Center
City
Albuquerque
State/Province
New Mexico
ZIP/Postal Code
87131-0001
Country
United States
Facility Name
Women and Children's Hospital
City
Buffalo
State/Province
New York
ZIP/Postal Code
14222
Country
United States
Facility Name
WakeMed Children's Hospital
City
Raleigh
State/Province
North Carolina
ZIP/Postal Code
27610
Country
United States
Facility Name
Endocrinology Associates Inc
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43201
Country
United States
Facility Name
Ohio State University
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States
Facility Name
Pediatric Endocrinology, Genetics & Metabolism
City
Oklahoma City
State/Province
Oklahoma
ZIP/Postal Code
73112
Country
United States
Facility Name
Children's Hospital of Philadelphia
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19106
Country
United States
Facility Name
Children's Hospital of Pittsburgh
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15224
Country
United States
Facility Name
Rapid City Regional Hospital/Health Clinical Research
City
Rapid City
State/Province
South Dakota
ZIP/Postal Code
57701
Country
United States
Facility Name
Research Institute of Dallas
City
Dallas
State/Province
Texas
ZIP/Postal Code
75231
Country
United States
Facility Name
University of Texas Southwestern Medical Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75390
Country
United States
Facility Name
Northeast Clinical Research of San Antonio LLC
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78154
Country
United States
Facility Name
University of Texas Health Science Center
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78229
Country
United States
Facility Name
Consano Clinical Research
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78232
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
33244872
Citation
Lagarde WH, Courtney KL, Reiner B, Steinmann K, Tsalikian E, Willi SM. Human plasma-derived alpha1 -proteinase inhibitor in patients with new-onset type 1 diabetes mellitus: A randomized, placebo-controlled proof-of-concept study. Pediatr Diabetes. 2021 Mar;22(2):192-201. doi: 10.1111/pedi.13162. Epub 2020 Dec 13.
Results Reference
derived

Learn more about this trial

Study of Human Plasma-Derived Alpha1-Proteinase Inhibitor in Subjects With New-Onset Type 1 Diabetes Mellitus

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