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Single Dose Clamp Study to Evaluate Concentration-time Profile and Metabolic Activity of 3 Dose Levels of Afrezza and 3 Dose Levels of Insulin Lispro in Patients With Type 1 Diabetes Mellitus

Primary Purpose

Type 1 Diabetes Mellitus

Status
Completed
Phase
Phase 1
Locations
Germany
Study Type
Interventional
Intervention
SAR439065
Insulin lispro
Sponsored by
Mannkind Corporation
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Type 1 Diabetes Mellitus

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion criteria :

  • Male or female patients, between 18 and 65 years of age, inclusive, with diabetes mellitus type 1 for more than one year, as defined by the American Diabetes Association.
  • Total insulin dose of <1.0 U/kg/day.
  • Body weight between 50.0 and 95 kg, inclusive, body mass index between 18.5 and 29 kg/m², inclusive.
  • Fasting serum C-peptide <0.3 nmol/L.
  • Glycohemoglobin (HbA1c) ≤75 mmol/mol (≤9%).
  • Stable insulin regimen for at least 2 months prior to study (with respect to safety of the patient and scientific integrity of the study).
  • Certified as otherwise healthy for type 1 diabetes mellitus patient by assessment of medical history and physical examination (cardiovascular system, chest and lungs, thyroid, abdomen, nervous system, skin and mucosae, and musculoskeletal system), unless the Investigator considers any abnormality to be clinically irrelevant and not interfering with the conduct of the study (with respect to safety of the subject and scientific integrity of the study).
  • Having given written informed consent prior to undertaking any study-related procedure.
  • Non-smoking at least for the last 6 months before screening (to be confirmed by urine cotinine <500 µg/L).
  • Pulmonary function test at screening: forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) >70% of the individual prediction according to the equation of the Third National Health and Nutrition Examination Survey (NHANES III).

Exclusion criteria:

  • Severe hypoglycemia resulting in coma/seizures or requiring assistance of another person, and/or hospitalization for diabetic ketoacidosis in the last 6 months before screening visit.
  • Frequent severe headaches and/or migraine, recurrent nausea and/or vomiting (more than twice a month).
  • Presence or history of drug hypersensitivity, or allergic disease diagnosed and treated by a physician.
  • History or presence of drug or alcohol abuse (alcohol consumption more than 40 g per day).
  • If female, pregnancy (defined as positive beta-human chorionic gonadotropin [β-hCG] blood test), breastfeeding at screening and before any treatment periods (defined as positive β-hCG urine test).
  • Any medication (including St John's Wort) within 14 days before inclusion or within 5 times the elimination half-life or PD half-life of the medication, with the exception of insulins, thyroid hormones, lipid-lowering, and antihypertensive drugs and if female with the exception of hormonal contraception or menopausal hormone replacement therapy; any vaccination within 28 days before inclusion.
  • Presence or history of any acute or chronic obstructive bronchopulmonary disease including chronic obstructive pulmonary disease, asthma, and cancer.
  • Upper respiratory tract infection within 8 weeks before screening.
  • Known hypersensitivity to insulin lispro or Afrezza Technosphere insulin and excipients.
  • Inability, in the opinion of the Principal Investigator or a designee, to adequately inhale Afrezza powder.
  • Any history or presence of deep leg vein thrombosis or a frequent appearance of deep leg vein thrombosis in first-degree relatives (parents, siblings, or children).
  • The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.

Sites / Locations

  • Investigational Site Number 276001

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

SAR439065 + insulin lispro

Arm Description

1 of 6 sequences with single administration of 3 dose levels of SAR439065 (Afrezza Technosphere insulin) and 3 dose levels of insulin lispro with a washout duration between dosing days (7 to 28 days)

Outcomes

Primary Outcome Measures

Assessment of PD parameter: Area under the glucose infusion rate curve within 24 hours after administration of the investigational medicinal product or until administration of rescue insulin (GIR-AUC0-end)

Secondary Outcome Measures

Assessment of PD parameters: Maximum smoothed glucose infusion rate (GIRmax)
Assessment of PD parameters: Time to GIRmax (GIR-Tmax)
Duration of blood glucose control (time to elevation of smoothed blood glucose profile above different prespecified clamp levels)
Assessment of PK parameters: Area under the baseline-corrected serum insulin concentration-time curve over 24 hours or until administration of rescue insulin (INS-AUClast)
Assessment of PK parameters: Baseline-corrected maximum serum concentration (INS-Cmax)
Assessment of PK parameters: Time to INS-Cmax (INS-Tmax)
Assessment of PK parameters: Area under the concentration-time curve (INS-AUClast)
Number of patients with adverse events

Full Information

First Posted
June 10, 2015
Last Updated
April 12, 2017
Sponsor
Mannkind Corporation
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1. Study Identification

Unique Protocol Identification Number
NCT02470637
Brief Title
Single Dose Clamp Study to Evaluate Concentration-time Profile and Metabolic Activity of 3 Dose Levels of Afrezza and 3 Dose Levels of Insulin Lispro in Patients With Type 1 Diabetes Mellitus
Official Title
A Randomized, Controlled, 6-treatment, 6-sequence, 6-period Cross-over Dose Response Study of 3 Single Doses of Afrezza Inhaled Technosphere Insulin and of 3 Single Doses of SC Insulin Lispro in Patients With Diabetes Mellitus Type 1 Using the Euglycemic Clamp Technique
Study Type
Interventional

2. Study Status

Record Verification Date
April 2017
Overall Recruitment Status
Completed
Study Start Date
June 2015 (undefined)
Primary Completion Date
September 2015 (Actual)
Study Completion Date
September 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Mannkind Corporation

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Primary Objective: To assess the dose-response pattern of the glucose consumption (GIR-AUC0-end) of 3 different single doses of Afrezza inhaled Technosphere insulin and of 3 single doses of subcutaneous (SC) insulin lispro in a euglycemic clamp setting. Secondary Objectives: To assess the dose proportionality of insulin exposure (INS-AUClast) of 3 different single doses of Afrezza inhaled Technosphere insulin and of 3 single doses of SC insulin lispro in a euglycemic clamp setting. To assess the pharmacodynamic (PD) characteristics of 3 different single doses of Afrezza inhaled Technosphere insulin and of 3 single doses of SC insulin lispro in a euglycemic clamp setting. To assess the pharmacokinetic (PK) characteristics of 3 different single doses of Afrezza inhaled Technosphere insulin and of 3 single doses of SC insulin lispro in a euglycemic clamp setting. To assess the safety and tolerability of 3 different single doses of Afrezza inhaled Technosphere insulin.
Detailed Description
The total study duration for one patient is approximately 6.7 to 22.7 weeks (minimum to maximum duration, excluding screening). The duration of the study includes a screening period of 3 to 28 days (D -28 to D -3), 6 treatment periods of 1 or 2 days each (1 overnight stay), a washout period of 7 to 28 days (preferentially 7 days between consecutive dosing), and an end-of-study visit of 7 to 14 days after the last study drug administration.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 1
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
30 (Actual)

8. Arms, Groups, and Interventions

Arm Title
SAR439065 + insulin lispro
Arm Type
Experimental
Arm Description
1 of 6 sequences with single administration of 3 dose levels of SAR439065 (Afrezza Technosphere insulin) and 3 dose levels of insulin lispro with a washout duration between dosing days (7 to 28 days)
Intervention Type
Drug
Intervention Name(s)
SAR439065
Other Intervention Name(s)
Afrezza Technosphere insulin
Intervention Description
Pharmaceutical form:dry powder insulin Route of administration: inhalation
Intervention Type
Drug
Intervention Name(s)
Insulin lispro
Other Intervention Name(s)
Humalog
Intervention Description
Pharmaceutical form:solution for injection Route of administration: subcutaneous
Primary Outcome Measure Information:
Title
Assessment of PD parameter: Area under the glucose infusion rate curve within 24 hours after administration of the investigational medicinal product or until administration of rescue insulin (GIR-AUC0-end)
Time Frame
24 hours
Secondary Outcome Measure Information:
Title
Assessment of PD parameters: Maximum smoothed glucose infusion rate (GIRmax)
Time Frame
24 hours
Title
Assessment of PD parameters: Time to GIRmax (GIR-Tmax)
Time Frame
24 hours
Title
Duration of blood glucose control (time to elevation of smoothed blood glucose profile above different prespecified clamp levels)
Time Frame
24 hours
Title
Assessment of PK parameters: Area under the baseline-corrected serum insulin concentration-time curve over 24 hours or until administration of rescue insulin (INS-AUClast)
Time Frame
24 hours
Title
Assessment of PK parameters: Baseline-corrected maximum serum concentration (INS-Cmax)
Time Frame
24 hours
Title
Assessment of PK parameters: Time to INS-Cmax (INS-Tmax)
Time Frame
24 hours
Title
Assessment of PK parameters: Area under the concentration-time curve (INS-AUClast)
Time Frame
24 hours
Title
Number of patients with adverse events
Time Frame
Up to 2 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria : Male or female patients, between 18 and 65 years of age, inclusive, with diabetes mellitus type 1 for more than one year, as defined by the American Diabetes Association. Total insulin dose of <1.0 U/kg/day. Body weight between 50.0 and 95 kg, inclusive, body mass index between 18.5 and 29 kg/m², inclusive. Fasting serum C-peptide <0.3 nmol/L. Glycohemoglobin (HbA1c) ≤75 mmol/mol (≤9%). Stable insulin regimen for at least 2 months prior to study (with respect to safety of the patient and scientific integrity of the study). Certified as otherwise healthy for type 1 diabetes mellitus patient by assessment of medical history and physical examination (cardiovascular system, chest and lungs, thyroid, abdomen, nervous system, skin and mucosae, and musculoskeletal system), unless the Investigator considers any abnormality to be clinically irrelevant and not interfering with the conduct of the study (with respect to safety of the subject and scientific integrity of the study). Having given written informed consent prior to undertaking any study-related procedure. Non-smoking at least for the last 6 months before screening (to be confirmed by urine cotinine <500 µg/L). Pulmonary function test at screening: forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) >70% of the individual prediction according to the equation of the Third National Health and Nutrition Examination Survey (NHANES III). Exclusion criteria: Severe hypoglycemia resulting in coma/seizures or requiring assistance of another person, and/or hospitalization for diabetic ketoacidosis in the last 6 months before screening visit. Frequent severe headaches and/or migraine, recurrent nausea and/or vomiting (more than twice a month). Presence or history of drug hypersensitivity, or allergic disease diagnosed and treated by a physician. History or presence of drug or alcohol abuse (alcohol consumption more than 40 g per day). If female, pregnancy (defined as positive beta-human chorionic gonadotropin [β-hCG] blood test), breastfeeding at screening and before any treatment periods (defined as positive β-hCG urine test). Any medication (including St John's Wort) within 14 days before inclusion or within 5 times the elimination half-life or PD half-life of the medication, with the exception of insulins, thyroid hormones, lipid-lowering, and antihypertensive drugs and if female with the exception of hormonal contraception or menopausal hormone replacement therapy; any vaccination within 28 days before inclusion. Presence or history of any acute or chronic obstructive bronchopulmonary disease including chronic obstructive pulmonary disease, asthma, and cancer. Upper respiratory tract infection within 8 weeks before screening. Known hypersensitivity to insulin lispro or Afrezza Technosphere insulin and excipients. Inability, in the opinion of the Principal Investigator or a designee, to adequately inhale Afrezza powder. Any history or presence of deep leg vein thrombosis or a frequent appearance of deep leg vein thrombosis in first-degree relatives (parents, siblings, or children). The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Clinical Sciences & Operations
Organizational Affiliation
Sanofi
Official's Role
Study Director
Facility Information:
Facility Name
Investigational Site Number 276001
City
Neuss
ZIP/Postal Code
41460
Country
Germany

12. IPD Sharing Statement

Citations:
PubMed Identifier
34773608
Citation
Grant M, Heise T, Baughman R. Comparison of Pharmacokinetics and Pharmacodynamics of Inhaled Technosphere Insulin and Subcutaneous Insulin Lispro in the Treatment of Type 1 Diabetes Mellitus. Clin Pharmacokinet. 2022 Mar;61(3):413-422. doi: 10.1007/s40262-021-01084-0. Epub 2021 Nov 13.
Results Reference
derived

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Single Dose Clamp Study to Evaluate Concentration-time Profile and Metabolic Activity of 3 Dose Levels of Afrezza and 3 Dose Levels of Insulin Lispro in Patients With Type 1 Diabetes Mellitus

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