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Diabetes Islet Preservation Immune Treatment (DIPIT)

Primary Purpose

Diabetes Mellitus, Type 1, Hypoglycemia, Autoimmune Diseases

Status
Not yet recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Anti-Thymocyte Globulin (ATG)
Interleukin 2
Exenatide
Adalimumab
ATG Placebo
IL-2 Placebo
Adalimumab Placebo
Exenatide Placebo
Sponsored by
Camillo Ricordi and Jay Skyler
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes Mellitus, Type 1

Eligibility Criteria

18 Years - 35 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients must meet all of the following criteria to be eligible to participate in this study:

    1. Subject must be able to understand and provide informed consent.
    2. Males and females, 18-35 years of age.
    3. New onset T1D for no longer than 120 days at the time of randomization.
    4. Affected by T1D, according to ADA standard criteria, and confirmed by positivity of at least one T1D-associated autoantibody, to GAD65, IA-2, ZnT8, or insulin autoantibodies (if patient has been treated with insulin for less than 2 weeks).
    5. Being on insulin therapy.
    6. Stimulated C-peptide peak level >0.2 nmol/L at the baseline 1 visit MMTT.
    7. Female subjects of childbearing potential must have a negative pregnancy test upon study entry.
    8. Female (and male) subjects with reproductive potential must agree to use two FDA approved methods of birth control for the entire duration of the study.
    9. Adequate venous access to support study required blood draws.

Exclusion Criteria:

  • Potential participants must not meet any of the following exclusion criteria:

    1. Inability or unwillingness of a participant to give written informed consent or comply with study protocol.
    2. BMI>30 Kg/m2.
    3. Contra-indications to ATG, GCSF, exenatide, etanercept and IL-2 (as per package insert, e.g., knowledge of hypersensitivity to drugs or its excipients).
    4. Uncompensated heart failure, fluid overload, myocardial infarction or liver disease or severe impairment of a vital organ within the last 6 weeks before enrollment.
    5. Any of the following laboratory findings: hemoglobin <10.0 g/dL; leukocytes <3,000/μL; neutrophils <1,500/μL; lymphocytes <800/μL; platelets <100,000/μL.
    6. Any sign or diagnosis of significant chronic active infection (e.g., hepatitis, tuberculosis, EBV, or CMV), or screening laboratory evidence consistent with a significant chronic active infection (such as positive for HIV, IGRA test for TB, or hepatitis B-C).
    7. Ongoing acute infections, e.g., acute respiratory tract urinary tract, or gastrointestinal tract infections.
    8. Ongoing or anticipated use of diabetes medications other than insulin.
    9. Current or ongoing use of non-insulin pharmaceuticals that affect glycemic control within prior 7 days of screening.
    10. Current or prior use of immunomodulators or systemic steroids in the last 2 months that could potentially affect diabetes or immunologic status.
    11. Recent recipient of any licensed or investigational live attenuated vaccine(s) within 6 weeks of randomization.
    12. Use of investigational drugs within 3 months of participation.
    13. Concomitant therapy with immunosuppressive drugs, immunomodulators, or cytotoxic agents, or previous therapy less than 3 months from randomization.
    14. History or diagnosis of malignancy. Any history of gastroparesis or other severe gastrointestinal disease, pancreatitis, thyroid nodules or malignancy with the exception of a history of localized basal cell carcinoma.
    15. Presence of an allograft.
    16. AST, ALT or Alkaline Phosphatase >2 times upper limit of normal or total bilirubin >1.5 times upper limit of normal.
    17. Current, diagnosed, mental illness or current, diagnosed or self-reported drug or alcohol abuse; or any situation that, in the opinion of the investigator, would interfere with the participant's ability to comply with study requirements.
    18. Pregnancy or ongoing breastfeeding for women; unwillingness or inability of both females and males of childbearing age to use a reliable and effective form of contraception, for the entire duration of the study.
    19. Past or current medical problems, or findings from physical examination, or laboratory testing, that are not listed above which, in the opinion of the investigator, may pose additional risks from participation in the study, may interfere with the participant's ability to comply with study requirements or that may impact the quality or interpretation of the data obtained.

Sites / Locations

  • Diabetes Research Institute, University of Miami Miller School of Medicine

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Arm A

Arm B

Arm Description

Participants in this group will receive Thymoglobulin, Aldesleukin, Adalimumab, and Exenatide over a period of 52 weeks. Anti-Thymocyte Globulin (ATG or Thymoglobulin®) will be administered at a dose of 2.5mg/kg (2 infusions, 0.5 and 2mg/kg) Days 1 and 2 Adalimumab (Humira®) will be administered at a dose of 50 mg every month, for 1 year Low-dose Interleukin 2 (Aldesleukin; IL-2 or Proleukin®) will be administered 1 million IU/dose; 5 consecutive days (days 10-14), & then every 2 weeks, for 52 weeks Exenatide (Bydureon®): 2 mg SC weekly up to 52 weeks.

Participants in this group will receive the placebos for Thymoglobulin, Aldesleukin, Adalimumab, Exenatide, and Neulasta over a period of 52 weeks.

Outcomes

Primary Outcome Measures

Simulated C-peptide AUC
Endogenous insulin secretion as measured as stimulated C-peptide section Area Under the Curve (AUC) during a 4 hour mixed meal tolerance test (MMTT)
Proportion of regulatory T cells
As measured from blood samples

Secondary Outcome Measures

Hemoglobin A1c (HbA1c) levels
Measure of glycemic control as evaluated by HbA1c levels from blood samples
Insulin dose
Measure of glycemic control as evaluated by insulin dose
Mean daily plasma glucose levels
Measure of glycemic control as evaluated by the mean daily plasma glucose levels from blood samples
Incidence of immune response adverse events
Incidence of immune response adverse events as assessed by treating physician

Full Information

First Posted
October 23, 2015
Last Updated
July 24, 2023
Sponsor
Camillo Ricordi and Jay Skyler
Collaborators
Diabetes Research Institute Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT02586831
Brief Title
Diabetes Islet Preservation Immune Treatment
Acronym
DIPIT
Official Title
A Pilot, Safety and Feasibility Trial of Anti-Thymocyte Globulin (ATG), Low Dose Interleukin-2 (IL-2), Adalimumab and Exenatide in the Treatment of New-Onset Type 1 Diabetes
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
December 1, 2023 (Anticipated)
Primary Completion Date
December 1, 2026 (Anticipated)
Study Completion Date
December 1, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Camillo Ricordi and Jay Skyler
Collaborators
Diabetes Research Institute Foundation

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
To assess whether there is a difference in endogenous insulin secretion, measured as stimulated C-peptide secretion (area under the curve during a 4-hour mixed meal tolerance test), at the 1 year visit, for study subjects receiving combinational therapy versus those receiving placebo. The study will also examine the effect of the proposed treatments on immunological outcomes, specifically proportion of regulatory T cells at the 1 year visit.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
45 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Arm A
Arm Type
Experimental
Arm Description
Participants in this group will receive Thymoglobulin, Aldesleukin, Adalimumab, and Exenatide over a period of 52 weeks. Anti-Thymocyte Globulin (ATG or Thymoglobulin®) will be administered at a dose of 2.5mg/kg (2 infusions, 0.5 and 2mg/kg) Days 1 and 2 Adalimumab (Humira®) will be administered at a dose of 50 mg every month, for 1 year Low-dose Interleukin 2 (Aldesleukin; IL-2 or Proleukin®) will be administered 1 million IU/dose; 5 consecutive days (days 10-14), & then every 2 weeks, for 52 weeks Exenatide (Bydureon®): 2 mg SC weekly up to 52 weeks.
Arm Title
Arm B
Arm Type
Placebo Comparator
Arm Description
Participants in this group will receive the placebos for Thymoglobulin, Aldesleukin, Adalimumab, Exenatide, and Neulasta over a period of 52 weeks.
Intervention Type
Drug
Intervention Name(s)
Anti-Thymocyte Globulin (ATG)
Other Intervention Name(s)
Thymoglobulin
Intervention Description
2.5 mg/kg administered as two divided infusions of 0.5 mg/kg and 2 mg/kg on Days 1 and 2.
Intervention Type
Drug
Intervention Name(s)
Interleukin 2
Other Intervention Name(s)
Aldesleukin; IL-2 or Proleukin®
Intervention Description
1 million IU per dose administered subcutaneously for 5 consecutive days on Days 10-14, and then every two weeks.
Intervention Type
Drug
Intervention Name(s)
Exenatide
Other Intervention Name(s)
Bydureon®
Intervention Description
2 mg administered subcutaneously weekly for up to 52 weeks.
Intervention Type
Drug
Intervention Name(s)
Adalimumab
Other Intervention Name(s)
HUMIRA®
Intervention Description
50 mg administered subcutaneously once a month for 1 year.
Intervention Type
Other
Intervention Name(s)
ATG Placebo
Intervention Description
ATG placebo mimicking Thymoglobulin administered intravenously.
Intervention Type
Other
Intervention Name(s)
IL-2 Placebo
Intervention Description
IL-2 placebo mimicking Aldesleukin administered subcutaneously.
Intervention Type
Other
Intervention Name(s)
Adalimumab Placebo
Intervention Description
Placebo mimicking Adalimumab administered subcutaneously.
Intervention Type
Other
Intervention Name(s)
Exenatide Placebo
Intervention Description
Placebo mimicking Exenatide administered subcutaneously.
Primary Outcome Measure Information:
Title
Simulated C-peptide AUC
Description
Endogenous insulin secretion as measured as stimulated C-peptide section Area Under the Curve (AUC) during a 4 hour mixed meal tolerance test (MMTT)
Time Frame
1 Year Visit
Title
Proportion of regulatory T cells
Description
As measured from blood samples
Time Frame
1 Year Visit
Secondary Outcome Measure Information:
Title
Hemoglobin A1c (HbA1c) levels
Description
Measure of glycemic control as evaluated by HbA1c levels from blood samples
Time Frame
Up to 18 months
Title
Insulin dose
Description
Measure of glycemic control as evaluated by insulin dose
Time Frame
Up to 18 months
Title
Mean daily plasma glucose levels
Description
Measure of glycemic control as evaluated by the mean daily plasma glucose levels from blood samples
Time Frame
Up to 18 months
Title
Incidence of immune response adverse events
Description
Incidence of immune response adverse events as assessed by treating physician
Time Frame
Up to 18 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
35 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must meet all of the following criteria to be eligible to participate in this study: Subject must be able to understand and provide informed consent. Males and females, 18-35 years of age. New onset T1D for no longer than 120 days at the time of randomization. Affected by T1D, according to ADA standard criteria, and confirmed by positivity of at least one T1D-associated autoantibody, to GAD65, IA-2, ZnT8, or insulin autoantibodies (if patient has been treated with insulin for less than 2 weeks). Being on insulin therapy. Stimulated C-peptide peak level >0.2 nmol/L at the baseline 1 visit MMTT. Female subjects of childbearing potential must have a negative pregnancy test upon study entry. Female (and male) subjects with reproductive potential must agree to use two FDA approved methods of birth control for the entire duration of the study. Adequate venous access to support study required blood draws. Exclusion Criteria: Potential participants must not meet any of the following exclusion criteria: Inability or unwillingness of a participant to give written informed consent or comply with study protocol. BMI>30 Kg/m2. Contra-indications to ATG, GCSF, exenatide, etanercept and IL-2 (as per package insert, e.g., knowledge of hypersensitivity to drugs or its excipients). Uncompensated heart failure, fluid overload, myocardial infarction or liver disease or severe impairment of a vital organ within the last 6 weeks before enrollment. Any of the following laboratory findings: hemoglobin <10.0 g/dL; leukocytes <3,000/μL; neutrophils <1,500/μL; lymphocytes <800/μL; platelets <100,000/μL. Any sign or diagnosis of significant chronic active infection (e.g., hepatitis, tuberculosis, EBV, or CMV), or screening laboratory evidence consistent with a significant chronic active infection (such as positive for HIV, IGRA test for TB, or hepatitis B-C). Ongoing acute infections, e.g., acute respiratory tract urinary tract, or gastrointestinal tract infections. Ongoing or anticipated use of diabetes medications other than insulin. Current or ongoing use of non-insulin pharmaceuticals that affect glycemic control within prior 7 days of screening. Current or prior use of immunomodulators or systemic steroids in the last 2 months that could potentially affect diabetes or immunologic status. Recent recipient of any licensed or investigational live attenuated vaccine(s) within 6 weeks of randomization. Use of investigational drugs within 3 months of participation. Concomitant therapy with immunosuppressive drugs, immunomodulators, or cytotoxic agents, or previous therapy less than 3 months from randomization. History or diagnosis of malignancy. Any history of gastroparesis or other severe gastrointestinal disease, pancreatitis, thyroid nodules or malignancy with the exception of a history of localized basal cell carcinoma. Presence of an allograft. AST, ALT or Alkaline Phosphatase >2 times upper limit of normal or total bilirubin >1.5 times upper limit of normal. Current, diagnosed, mental illness or current, diagnosed or self-reported drug or alcohol abuse; or any situation that, in the opinion of the investigator, would interfere with the participant's ability to comply with study requirements. Pregnancy or ongoing breastfeeding for women; unwillingness or inability of both females and males of childbearing age to use a reliable and effective form of contraception, for the entire duration of the study. Past or current medical problems, or findings from physical examination, or laboratory testing, that are not listed above which, in the opinion of the investigator, may pose additional risks from participation in the study, may interfere with the participant's ability to comply with study requirements or that may impact the quality or interpretation of the data obtained.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Rodolfo Alejandro, M.D.
Phone
(305) 243-5324
Email
ralejand@med.miami.edu
First Name & Middle Initial & Last Name or Official Title & Degree
David A Baidal, M.D.
Phone
(305) 243-7740
Email
dbaidal@med.miami.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rodolfo Alejandro, M.D.
Organizational Affiliation
Diabetes Research Institute, University of Miami
Official's Role
Principal Investigator
Facility Information:
Facility Name
Diabetes Research Institute, University of Miami Miller School of Medicine
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Rodolfo Alejandro, M.D.
Phone
305-243-5324
Email
ralejand@med.miami.edu
First Name & Middle Initial & Last Name & Degree
David A Baidal, M.D.
Phone
(305) 243-7740
Email
dbaidal@med.miami.edu
First Name & Middle Initial & Last Name & Degree
Rodolfo Alejandro, M.D.
First Name & Middle Initial & Last Name & Degree
David A Baidal, M.D.

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
25998292
Citation
Skyler JS. Prevention and reversal of type 1 diabetes--past challenges and future opportunities. Diabetes Care. 2015 Jun;38(6):997-1007. doi: 10.2337/dc15-0349.
Results Reference
background
PubMed Identifier
21193733
Citation
Skyler JS, Ricordi C. Stopping type 1 diabetes: attempts to prevent or cure type 1 diabetes in man. Diabetes. 2011 Jan;60(1):1-8. doi: 10.2337/db10-1114. No abstract available.
Results Reference
background

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Diabetes Islet Preservation Immune Treatment

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