Multiple Dose Study to Evaluate the Efficacy, Safety and Pharmacodynamics of REMD-477 in Subjects With Type 1 Diabetes Mellitus
Primary Purpose
Type1 Diabetes Mellitus
Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
REMD-477
Placebo Comparator
Sponsored by
About this trial
This is an interventional treatment trial for Type1 Diabetes Mellitus
Eligibility Criteria
Inclusion Criteria:
- Men and women between the ages of 18 and 65 years old, inclusive, at the time of screening;
- Females of non-child bearing potential must be ≥1 year post-menopausal (confirmed by a serum follicle-stimulating hormone (FSH) levels ≥ 40 IU/mL) or documented as being surgically sterile. Females of child bearing potential must agree to use two methods of contraception;
- Male subjects must be willing to use clinically acceptable method of contraception during the entire study;
- Body mass index between 18.5 and 32 kg/m2, inclusive, at screening;
- Diagnosed with Type 1 diabetes, based on clinical history or as defined by the current American Diabetes Association (ADA) criteria;
- HbA1c > 7% and < 10 % at screening;
- Fasting C-peptide < 0.7 ng/mL;
- Treatment with a stable insulin regimen for at least 8 weeks before screening with multiple daily insulin (MDI) injections or continue subcutaneous insulin infusion (CSII)
- Willing to use continuous CGM system (e.g. DexCom) throughout the study;
- Alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) ≤ 1.5x upper limit of normal (ULN) at screening;
- Able to provide written informed consent approved by an Institutional Review Board (IRB).
Exclusion Criteria:
- History or evidence of clinically-significant disorder or condition that, in the opinion of the Investigator, would pose a risk to subject safety or interfere with the study evaluation, procedures, or completion;
- Significant organ system dysfunction (e.g., clinically significant pulmonary or cardiovascular disease, anemia [Hemoglobin < 10.0 g/dL], known hemoglobinopathies, and renal dysfunction [eGFR < 60 ml/min]);
- Any severe symptomatic hypoglycemic event associated with a seizure or requiring help from other people or medical facility in the past 6 months;
- Myocardial infarction, unstable angina, revascularization procedure, or cerebrovascular accident ≤12 weeks before screening;
- History of New York Heart Association Functional Classification III-IV cardiac disease;
- Current or recent (within 1 month of screening) use of diabetes medications other than insulin - subjects on an SGLT2 inhibitor should be discontinue the SGLT2 inhibitor during the Screening Period, at least 2 weeks prior to the start of the Lead-in Period;
- Use of steroids and/or other prescribed or over-the-counter medications that are known to affect the outcome measures in this study or known to influence glucose metabolism;
- Smokes > 10 cigarettes/day, and/or is unwilling to abstain from smoking during admission periods;
- Known sensitivity to mammalian-derived drug preparations, recombinant protein-based drugs or to humanized or human antibodies;
- History of illicit drug use or alcohol abuse within the last 6 months or a positive drug urine test result at screening;
- History of pancreatitis, pancreatic neuroendocrine tumors or multiple endocrine neoplasia (MEN) or family history of MEN;
- History of pheochromocytoma, or family history of familial pheochromocytoma;
- Known or suspected susceptibility to infectious disease (e.g. taking immunosuppressive agents or has a documented inherited or acquired immunodeficiency);
- Known history of positive for human immunodeficiency virus (HIV) antibodies, hepatitis B surface antigen (HbsAg), or hepatitis C antibodies (HepC Ab);
- Participation in an investigational drug or device trial within 30 days of screening or within 5 times the half-life of the investigational agent in the other clinical study, if known, whichever period is longer;
- Blood donor or blood loss > 500 mL within 30 days of Day 1;
- Women who are pregnant or lactating/breastfeeding;
- Unable or unwilling to follow the study protocol or who are non-compliant with screening appointments or study visits;
- Any other condition(s) that might reduce the chance of obtaining study data, or that might cause safety concerns, or that might compromise the ability to give truly informed consent
Other inclusion and exclusion criteria may apply.
Sites / Locations
- AMCR Institute
- Marin Endocrine Care & Research
- Altman Clinical and Translational Research Institute
- Diablo Clinical Research
- University of Colorado, Denver/Barbara Davis Center for Diabetes
- Atlanta Diabetes Assoicates
- Washington University School of Medicine
- Texas Diabetes & Endocrinology
- Dallas Diabetes Research Center
- Clinical Trials of Texas
- Rainer Clinical Research Center
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Experimental
Experimental
Placebo Comparator
Arm Label
35 mg REMD-477
70 mg REMD-477
Matching placebo
Arm Description
Administered as a repeated subcutaneous (SC) doses in subjects with Type 1 Diabetes
Administered as a repeated SC doses in subjects with Type 1 Diabetes
Administered as a repeated SC doses in subjects with Type 1 Diabetes
Outcomes
Primary Outcome Measures
Change in Average Daily Total Insulin Use
Change from Baseline in average daily total insulin use at Week 12
Secondary Outcome Measures
Change From Baseline Difference in AUC Glucose Concentrations Following Mixed Meal Tolerance Test (MMTT) - Part A Only
Difference from baseline at Week 13 in AUC glucose concentration following the Mixed Meal Tolerance Test (MMTT) after repeated doses of REMD-477.
Continuous Glucose Monitoring (CGM) - Change in Average Daily 24-hour Glucose Concentration at Week 12
Change from baseline at Week 12 in average daily 24-h blood glucose as assessed by CGM after repeated doses of REMD-477.
Seven-Point Glucose Profile - Change in Average 24-h Glucose Concentrations
Change from baseline at Week 12 in the average daily 24-h blood glucose concentration as assessed by seven-point glucose profile after repeated doses of REMD-477. The 7-point blood glucose profiles includes measuring glucose via finger stick, at the following times of the day: before each meal, 2 hours after each meal, and at bedtime. The 7-point glucose profiles were obtained for 3 consecutive days before (Day 1) and for 3 consecutive days during week 12.
Summary of the Product of Average Daily 24-h Glucose Ratio and Daily Insulin Use Ratio (Day 78 [Week 12]/Baseline)
The product of the ratio of average glucose (Week 12/Baseline) and ratio of average insulin use (Week 12/Baseline).
Change in Hemoglobin A1c From Baseline at Week 13
Change in Hemoglobin A1c from baseline at Week 13, after repeated doses of REMD-477.
Percentage of Subjects With HbA1c Reduction of ≥ 0.4% at Week 13
Proportion (percentage) of subjects who achieve HbA1c reduction of ≥ 0.4%, after repeated doses of REMD-477
Change in C-peptide Adjusted AUC Following Mixed Meal Tolerance Test (MMTT)
Change from baseline at Week 13 in the C-peptide adjusted AUC following MMTT after repeated doses of REMD-477.
Change in Baseline Difference in Glucagon Adjusted AUC Following Mixed Meal Tolerance Test (MMTT) - Part A Only
Change from baseline at Week 13 in glucagon adjusted AUC after MMTT challenge, after repeated doses of REMD-477.
Proportion of Subjects With Positive Anti-REMD-477 Antibodies
Proportion of subjects positive for anti-REMD-477 antibody formation.
Summary of REMD-477 Plasma Concentrations
REMD-477 serum-concentration after repeated doses of REMD-477.
Change in Hemoglobin A1c at Week 13 in Subjects With Baseline HbA1c ≥7.5%
Change in Hemoglobin A1c from baseline at Week 13, after repeated doses of REMD-477.
Proportion of Subjects With Targeted Hemoglobin A1C (HbA1c) of ≤ 7.0% at Week 13
Proportion (percentage) of subjects who achieve target HbA1c reduction of ≤ 7.0% at Week 13, after repeated doses of REMD-477
Continuous Glucose Monitoring (CGM) - Change in Percent Time Spent in Target Blood Glucose Range (70-180 mg/dL) at Week 12
Change from baseline at Week 12 in percent time spent in target blood glucose range (70-180 mg/dL) after repeated doses of REMD-477.
Continuous Glucose Monitoring (CGM) - Change in Percent Time Spent in Hyperglycemia (Blood Glucose Range >180 mg/dL) at Week 12
Change from baseline at Week 12 in percent time spent in Hyperglycemia (Blood Glucose Range >180 mg/dL) after repeated doses of REMD-477.
Continuous Glucose Monitoring (CGM) - Change in Percent Time Spent in Hypoglycemia (Blood Glucose Range <70 mg/dL) at Week 12
Change from baseline at Week 12 in percent time spent in Hypoglycemia (Blood Glucose Range <70 mg/dL) after repeated doses of REMD-477.
Continuous Glucose Monitoring (CGM) - Change in Percent Time Spent in Hypoglycemia (Blood Glucose Range <55 mg/dL) at Week 12
Change from baseline at Week 12 in percent time spent in Hypoglycemia (Blood Glucose Range <55 mg/dL) after repeated doses of REMD-477.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT03117998
Brief Title
Multiple Dose Study to Evaluate the Efficacy, Safety and Pharmacodynamics of REMD-477 in Subjects With Type 1 Diabetes Mellitus
Official Title
A Randomized, Placebo-controlled, Double-blind Study to Evaluate the Efficacy, Safety, and Pharmacodynamics of Multiple Doses of REMD-477 in Subjects With Type 1 Diabetes Mellitus
Study Type
Interventional
2. Study Status
Record Verification Date
May 2023
Overall Recruitment Status
Completed
Study Start Date
September 19, 2017 (Actual)
Primary Completion Date
March 5, 2021 (Actual)
Study Completion Date
March 5, 2021 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
REMD Biotherapeutics, Inc.
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
5. Study Description
Brief Summary
This is a randomized, placebo-controlled, double-blind study to evaluate the efficacy, safety, and pharmacodynamics (PD) of multiple doses of REMD-477 in subjects who have Type 1 diabetes and are currently receiving insulin treatment. This study will determine whether REMD-477 can decrease daily insulin requirements and improve glycemic control after 12 weeks of treatment in subjects diagnosed with Type 1 diabetes with fasting C-peptide < 0.7 ng/mL at Screening.
The study will be conducted at multiple sites in the United States. Approximately 150 subjects with type 1 diabetes on stable doses of insulin will be randomized in a 1:1:1 fashion into one of three treatment groups.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type1 Diabetes Mellitus
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
154 (Actual)
8. Arms, Groups, and Interventions
Arm Title
35 mg REMD-477
Arm Type
Experimental
Arm Description
Administered as a repeated subcutaneous (SC) doses in subjects with Type 1 Diabetes
Arm Title
70 mg REMD-477
Arm Type
Experimental
Arm Description
Administered as a repeated SC doses in subjects with Type 1 Diabetes
Arm Title
Matching placebo
Arm Type
Placebo Comparator
Arm Description
Administered as a repeated SC doses in subjects with Type 1 Diabetes
Intervention Type
Biological
Intervention Name(s)
REMD-477
Intervention Description
Administered as repeated SC doses in subjects with Type 1 Diabetes
Intervention Type
Biological
Intervention Name(s)
Placebo Comparator
Intervention Description
Administered as a repeated SC doses in subjects with Type 1 Diabetes
Primary Outcome Measure Information:
Title
Change in Average Daily Total Insulin Use
Description
Change from Baseline in average daily total insulin use at Week 12
Time Frame
Baseline and 12 weeks
Secondary Outcome Measure Information:
Title
Change From Baseline Difference in AUC Glucose Concentrations Following Mixed Meal Tolerance Test (MMTT) - Part A Only
Description
Difference from baseline at Week 13 in AUC glucose concentration following the Mixed Meal Tolerance Test (MMTT) after repeated doses of REMD-477.
Time Frame
Baseline and 13 weeks; AUC glucose timepoints: 10 minutes prior and just before (time ) initiating the mixed-meal ingestion and at 30, 60 and 120 minutes after the mixed meal ingestion.
Title
Continuous Glucose Monitoring (CGM) - Change in Average Daily 24-hour Glucose Concentration at Week 12
Description
Change from baseline at Week 12 in average daily 24-h blood glucose as assessed by CGM after repeated doses of REMD-477.
Time Frame
Baseline and 12 weeks
Title
Seven-Point Glucose Profile - Change in Average 24-h Glucose Concentrations
Description
Change from baseline at Week 12 in the average daily 24-h blood glucose concentration as assessed by seven-point glucose profile after repeated doses of REMD-477. The 7-point blood glucose profiles includes measuring glucose via finger stick, at the following times of the day: before each meal, 2 hours after each meal, and at bedtime. The 7-point glucose profiles were obtained for 3 consecutive days before (Day 1) and for 3 consecutive days during week 12.
Time Frame
Baseline and 12 weeks
Title
Summary of the Product of Average Daily 24-h Glucose Ratio and Daily Insulin Use Ratio (Day 78 [Week 12]/Baseline)
Description
The product of the ratio of average glucose (Week 12/Baseline) and ratio of average insulin use (Week 12/Baseline).
Time Frame
Baseline and week 12
Title
Change in Hemoglobin A1c From Baseline at Week 13
Description
Change in Hemoglobin A1c from baseline at Week 13, after repeated doses of REMD-477.
Time Frame
Baseline and 13 weeks
Title
Percentage of Subjects With HbA1c Reduction of ≥ 0.4% at Week 13
Description
Proportion (percentage) of subjects who achieve HbA1c reduction of ≥ 0.4%, after repeated doses of REMD-477
Time Frame
Baseline and 13 weeks
Title
Change in C-peptide Adjusted AUC Following Mixed Meal Tolerance Test (MMTT)
Description
Change from baseline at Week 13 in the C-peptide adjusted AUC following MMTT after repeated doses of REMD-477.
Time Frame
Baseline and 13 weeks; AUC C-peptide timepoints: 10 minutes prior and just before (time 0) initiating the mixed-meal ingestion and at 30, 60 and 120 minutes after the mixed meal ingestion.
Title
Change in Baseline Difference in Glucagon Adjusted AUC Following Mixed Meal Tolerance Test (MMTT) - Part A Only
Description
Change from baseline at Week 13 in glucagon adjusted AUC after MMTT challenge, after repeated doses of REMD-477.
Time Frame
Baseline and 13 weeks; AUC glucagon timepoints: 10 minutes prior and just before (time ) initiating the mixed-meal ingestion and at 30, 60 and 120 minutes after the mixed meal ingestion.
Title
Proportion of Subjects With Positive Anti-REMD-477 Antibodies
Description
Proportion of subjects positive for anti-REMD-477 antibody formation.
Time Frame
Day 1 (pre-dose), Day 85 (Week 13) and Day 162 (Week 24)
Title
Summary of REMD-477 Plasma Concentrations
Description
REMD-477 serum-concentration after repeated doses of REMD-477.
Time Frame
Baseline (Day 1 pre-dose) and Weeks 2, 5, 9, 13 and 16.
Title
Change in Hemoglobin A1c at Week 13 in Subjects With Baseline HbA1c ≥7.5%
Description
Change in Hemoglobin A1c from baseline at Week 13, after repeated doses of REMD-477.
Time Frame
Baseline and 13 weeks
Title
Proportion of Subjects With Targeted Hemoglobin A1C (HbA1c) of ≤ 7.0% at Week 13
Description
Proportion (percentage) of subjects who achieve target HbA1c reduction of ≤ 7.0% at Week 13, after repeated doses of REMD-477
Time Frame
Baseline and 13 weeks
Title
Continuous Glucose Monitoring (CGM) - Change in Percent Time Spent in Target Blood Glucose Range (70-180 mg/dL) at Week 12
Description
Change from baseline at Week 12 in percent time spent in target blood glucose range (70-180 mg/dL) after repeated doses of REMD-477.
Time Frame
Baseline and 12 weeks
Title
Continuous Glucose Monitoring (CGM) - Change in Percent Time Spent in Hyperglycemia (Blood Glucose Range >180 mg/dL) at Week 12
Description
Change from baseline at Week 12 in percent time spent in Hyperglycemia (Blood Glucose Range >180 mg/dL) after repeated doses of REMD-477.
Time Frame
Baseline and 12 weeks
Title
Continuous Glucose Monitoring (CGM) - Change in Percent Time Spent in Hypoglycemia (Blood Glucose Range <70 mg/dL) at Week 12
Description
Change from baseline at Week 12 in percent time spent in Hypoglycemia (Blood Glucose Range <70 mg/dL) after repeated doses of REMD-477.
Time Frame
Baseline and 12 weeks
Title
Continuous Glucose Monitoring (CGM) - Change in Percent Time Spent in Hypoglycemia (Blood Glucose Range <55 mg/dL) at Week 12
Description
Change from baseline at Week 12 in percent time spent in Hypoglycemia (Blood Glucose Range <55 mg/dL) after repeated doses of REMD-477.
Time Frame
Baseline and 12 weeks
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:
Men and women between the ages of 18 and 65 years old, inclusive, at the time of screening;
Females of non-child bearing potential must be ≥1 year post-menopausal (confirmed by a serum follicle-stimulating hormone (FSH) levels ≥ 40 IU/mL) or documented as being surgically sterile. Females of child bearing potential must agree to use two methods of contraception;
Male subjects must be willing to use clinically acceptable method of contraception during the entire study;
Body mass index between 18.5 and 32 kg/m2, inclusive, at screening;
Diagnosed with Type 1 diabetes, based on clinical history or as defined by the current American Diabetes Association (ADA) criteria;
HbA1c > 7% and < 10 % at screening;
Fasting C-peptide < 0.7 ng/mL;
Treatment with a stable insulin regimen for at least 8 weeks before screening with multiple daily insulin (MDI) injections or continue subcutaneous insulin infusion (CSII)
Willing to use continuous CGM system (e.g. DexCom) throughout the study;
Alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) ≤ 1.5x upper limit of normal (ULN) at screening;
Able to provide written informed consent approved by an Institutional Review Board (IRB).
Exclusion Criteria:
History or evidence of clinically-significant disorder or condition that, in the opinion of the Investigator, would pose a risk to subject safety or interfere with the study evaluation, procedures, or completion;
Significant organ system dysfunction (e.g., clinically significant pulmonary or cardiovascular disease, anemia [Hemoglobin < 10.0 g/dL], known hemoglobinopathies, and renal dysfunction [eGFR < 60 ml/min]);
Any severe symptomatic hypoglycemic event associated with a seizure or requiring help from other people or medical facility in the past 6 months;
Myocardial infarction, unstable angina, revascularization procedure, or cerebrovascular accident ≤12 weeks before screening;
History of New York Heart Association Functional Classification III-IV cardiac disease;
Current or recent (within 1 month of screening) use of diabetes medications other than insulin - subjects on an SGLT2 inhibitor should be discontinue the SGLT2 inhibitor during the Screening Period, at least 2 weeks prior to the start of the Lead-in Period;
Use of steroids and/or other prescribed or over-the-counter medications that are known to affect the outcome measures in this study or known to influence glucose metabolism;
Smokes > 10 cigarettes/day, and/or is unwilling to abstain from smoking during admission periods;
Known sensitivity to mammalian-derived drug preparations, recombinant protein-based drugs or to humanized or human antibodies;
History of illicit drug use or alcohol abuse within the last 6 months or a positive drug urine test result at screening;
History of pancreatitis, pancreatic neuroendocrine tumors or multiple endocrine neoplasia (MEN) or family history of MEN;
History of pheochromocytoma, or family history of familial pheochromocytoma;
Known or suspected susceptibility to infectious disease (e.g. taking immunosuppressive agents or has a documented inherited or acquired immunodeficiency);
Known history of positive for human immunodeficiency virus (HIV) antibodies, hepatitis B surface antigen (HbsAg), or hepatitis C antibodies (HepC Ab);
Participation in an investigational drug or device trial within 30 days of screening or within 5 times the half-life of the investigational agent in the other clinical study, if known, whichever period is longer;
Blood donor or blood loss > 500 mL within 30 days of Day 1;
Women who are pregnant or lactating/breastfeeding;
Unable or unwilling to follow the study protocol or who are non-compliant with screening appointments or study visits;
Any other condition(s) that might reduce the chance of obtaining study data, or that might cause safety concerns, or that might compromise the ability to give truly informed consent
Other inclusion and exclusion criteria may apply.
Facility Information:
Facility Name
AMCR Institute
City
Escondido
State/Province
California
ZIP/Postal Code
92025
Country
United States
Facility Name
Marin Endocrine Care & Research
City
Greenbrae
State/Province
California
ZIP/Postal Code
94904
Country
United States
Facility Name
Altman Clinical and Translational Research Institute
City
San Diego
State/Province
California
ZIP/Postal Code
92037
Country
United States
Facility Name
Diablo Clinical Research
City
Walnut Creek
State/Province
California
ZIP/Postal Code
94598
Country
United States
Facility Name
University of Colorado, Denver/Barbara Davis Center for Diabetes
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
Atlanta Diabetes Assoicates
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30318
Country
United States
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
Texas Diabetes & Endocrinology
City
Austin
State/Province
Texas
ZIP/Postal Code
78749
Country
United States
Facility Name
Dallas Diabetes Research Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75230
Country
United States
Facility Name
Clinical Trials of Texas
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78229
Country
United States
Facility Name
Rainer Clinical Research Center
City
Renton
State/Province
Washington
ZIP/Postal Code
98057
Country
United States
12. IPD Sharing Statement
Learn more about this trial
Multiple Dose Study to Evaluate the Efficacy, Safety and Pharmacodynamics of REMD-477 in Subjects With Type 1 Diabetes Mellitus
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