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G-Pen™ Compared to Lilly Glucagon for Hypoglycemia Rescue in Adults With Type 1 Diabetes

Primary Purpose

Insulin Hypoglycemia, Type 1 Diabetes Mellitus, Severe Hypoglycemia

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
G-Pen
Lilly Glucagon
Sponsored by
Xeris Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Insulin Hypoglycemia focused on measuring glucagon, hypoglycemia

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Males and females diagnosed with type 1 diabetes mellitus for at least 24 months.
  2. Current usage of daily insulin treatment that includes having an assigned "correction factor" for managing hyperglycemia.
  3. Age 18-75 years, inclusive.
  4. Random serum C-peptide concentration < 0.5 ng/mL.
  5. Willingness to follow all study procedures, including attending all clinic visits.
  6. Subject has provided informed consent as evidenced by a signed/dated informed consent form completed before any trial-related activities occur.

Exclusion Criteria:

  1. Pregnancy: For women of childbearing potential, there is a requirement for a negative urine pregnancy test and for agreement to use contraception throughout the study and for 7 days after the last dose of study glucagon. Acceptable contraception includes birth control pill / patch / vaginal ring, Depo-Provera, Norplant, an IUD, the double barrier method (the woman uses a diaphragm and spermicide and the man uses a condom), or abstinence.
  2. Breastfeeding: Nursing mothers will be allowed into the study. However, breast feeding during the during inpatient study visits and for 48 hours after each dose of study drug is not allowed.
  3. HbA1c >9.0% at Screening.
  4. BMI > 40 kg/m2.
  5. Renal insufficiency (serum creatinine greater than 3.0 mg/dL) or end-stage renal disease. requiring renal replacement therapy.
  6. Serum ALT or AST equal to or greater than 3 times the upper limit of normal.
  7. Hepatic synthetic insufficiency as defined as a serum albumin of less than 3.0 g/dL.
  8. Hematocrit of less than or equal to 30%.
  9. BP readings at Screening where SBP <90 or >150 mm Hg, and DBP <50 or >100 mm Hg.
  10. Clinically significant ECG abnormalities.
  11. Use of > 2.0 U/kg total insulin dose per day.
  12. Inadequate venous access.
  13. Congestive heart failure, NYHA class III or IV.
  14. History of myocardial infarction, unstable angina, or revascularization within the past 6 months.
  15. History of a cerebrovascular accident in past 6 months or with major neurological deficits.
  16. Active malignancy within 5 years from Screening, except basal cell or squamous cell skin cancers. History of breast cancer or malignant melanoma will be exclusionary.
  17. Major surgical operation within 30 days prior to Screening.
  18. Current seizure disorder (other than with suspect or documented hypoglycemia).
  19. Current bleeding disorder, treatment with warfarin, or platelet count below 50 x 10e9 per liter.
  20. History of pheochromocytoma or disorder with increased risk of pheochromocytoma (MEN 2, neurofibromatosis, or Von Hippel-Lindau disease).
  21. History of insulinoma.
  22. History of allergies to glucagon or glucagon-like products, or any history of significant hypersensitivity to glucagon or any related products or to any of the excipients (DMSO & trehalose) in the investigational formulation.
  23. History of glycogen storage disease.
  24. Subject tests positive for HIV, HCV or HBV infection (HBsAg+) at Screening.
  25. Active substance or alcohol abuse (more than 21 drinks/wk. for males or 14 drinks/wk. for females). Subjects reporting active marijuana use or testing positive for tetrahydrocannabinol (THC) via rapid urine test will be allowed to participate in the study at the discretion of the Investigator.
  26. Administration of glucagon within 28 days of Screening.
  27. Participation in other studies involving administration of an investigational drug or device within 30 days or 5 half-lives, whichever is longer, before Screening for the current study and during participation in the current study.
  28. Any reason the Investigator deems exclusionary.

Sites / Locations

  • ProSciento, Inc.
  • Diablo Clinical Research, Inc.
  • Atlanta Diabetes Associates
  • Rainier Clinical Research Center, Inc.
  • LMC ESD, Inc.
  • Altasciences Algorithme Pharma

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

Other

Arm Label

G-Pen followed by Lilly Glucagon

Lilly Glucagon followed by G-Pen

Arm Description

1 mg G-Pen at the first treatment visit followed by 1 mg Lilly Glucagon at the second treatment visit

1 mg Lilly Glucagon at the first treatment visit followed by 1 mg G-Pen at the second treatment visit

Outcomes

Primary Outcome Measures

Number of Subjects With a Positive Glucose Response
Increase in plasma glucose concentration from below 50.0 mg/dL to greater than 70.0 mg/dL within 30 minutes after receiving glucagon

Secondary Outcome Measures

Time for Positive Glucose Response
Time from administration of glucagon for plasma glucose to rise from below 50.0 mg/dL to above 70.0 mg/dL
Number of Subjects With a Positive Response for the Combination Endpoint: Positive Glucose Response/Positive Glucose Increase
A positive response for this endpoint is a return of plasma glucose to > 70 mg/dL or an increase in plasma glucose by ≥20 mg/dL within 30 minutes after receiving glucagon
Number of Subjects With a Positive Glucose Increase
Increase in plasma glucose by ≥ 20.0 mg/dL within 30 minutes after receiving glucagon
Time for Positive Glucose Increase
Time from administration of glucagon for plasma glucose to increase by ≥20 mg/dL from baseline
Number of Subjects With a Positive Response for the Combination Endpoint: Positive Glucose Response/Relief of Neuroglycopenic Symptoms
A positive response for this endpoint is a return of plasma glucose to > 70 mg/dL or clearance of all neuroglycopenic symptoms of hypoglycemia within 30 minutes after receiving glucagon. Four symptoms were assessed: dizziness, blurred vision, difficulty in thinking and faintness.
Number of Subjects With Relief of Neuroglycopenic Symptoms
Clearance of all neuroglycopenic symptoms of hypoglycemia within 30 minutes after receiving glucagon. Four symptoms were assessed: dizziness, blurred vision, difficulty in thinking and faintness.
Time to Resolution of Autonomic Symptoms
Time from administration of glucagon to complete resolution of 4 autonomic symptoms of hypoglycemia. Symptoms included: sweating, tremor, palpitations and feeling of nervousness.
Time to Resolution of Neuroglycopenic Symptoms
Time from administration of glucagon to complete resolution of 4 neuroglycopenic symptoms of hypoglycemia. Four symptoms were assessed: dizziness, blurred vision, difficulty in thinking and faintness.
Time to Resolution of the Feeling of Hypoglycemia
Time from administration of glucagon to resolution of the overall sensation of hypoglycemia. Subjects were asked to answer yes/no to the question, "Do you feel hypoglycemic?" The time point as which the subject first answered "no" was considered the time of resolution.
Glucose AUC
Area under the curve for plasma glucose.
Glucose Cmax
Maximum concentration of plasma glucose.
Glucose Tmax
Time to maximum concentration of plasma glucose. Blood samples for assessment of blood glucose concentration were collected every 5 minutes post-dose to 90 minutes, and then at 120, 150 and 180 minutes post dose.
Glucagon Preparation and Administration Time
Time required to prepare and inject glucagon as measured between a "decision to dose" and completion of the injection

Full Information

First Posted
February 13, 2018
Last Updated
February 13, 2020
Sponsor
Xeris Pharmaceuticals
Collaborators
SGS S.A., Integrated Medical Development
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1. Study Identification

Unique Protocol Identification Number
NCT03439072
Brief Title
G-Pen™ Compared to Lilly Glucagon for Hypoglycemia Rescue in Adults With Type 1 Diabetes
Official Title
G-Pen™ (Glucagon Injection) Compared to Lilly Glucagon (Glucagon for Injection [RDNA Origin]) for Induced Hypoglycemia Rescue in Adults With T1D: a Phase 3 B Multi-Centered, Randomized, Controlled, Single Blind, 2-Way Crossover Study to Evaluate Efficacy and Safety
Study Type
Interventional

2. Study Status

Record Verification Date
February 2020
Overall Recruitment Status
Completed
Study Start Date
January 23, 2018 (Actual)
Primary Completion Date
April 18, 2018 (Actual)
Study Completion Date
May 3, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Xeris Pharmaceuticals
Collaborators
SGS S.A., Integrated Medical Development

4. Oversight

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

5. Study Description

Brief Summary
This is a non-inferiority, multi-center, randomized, controlled, single-blind, two-way crossover efficacy and safety study in subjects with Type 1 diabetes mellitus. The study involves two daytime clinical research center (CRC) visits with random assignment to receive G-Pen™ glucagon 1 mg during one period and Lilly Glucagon 1 mg during the other. Each daytime visit is preceded by an overnight stay in the CRC. In the morning of the inpatient study visit, the subject is brought into a state of hypoglycemia through IV administration of regular insulin diluted in normal saline. After a hypoglycemic state with plasma glucose < 50 mg/dL is verified, the subject is administered a dose of G-Pen or Lilly Glucagon via subcutaneous injection. Plasma glucose levels are monitored for up to 180 minutes post-dosing, with a value of >70.0 mg/dL within 30 minutes of glucagon administration indicating a positive response. After 3 hours, the subject is given a meal and discharged when medically stable. After a wash-out period of 7 to 28 days, subjects return to the CRC, and the procedure are repeated with each subject crossed over to the other treatment. A follow-up visit as a safety check is conducted 2-7 days following administration of the final dose of study drug.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Insulin Hypoglycemia, Type 1 Diabetes Mellitus, Severe Hypoglycemia
Keywords
glucagon, hypoglycemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Crossover Assignment
Masking
Participant
Allocation
Randomized
Enrollment
81 (Actual)

8. Arms, Groups, and Interventions

Arm Title
G-Pen followed by Lilly Glucagon
Arm Type
Other
Arm Description
1 mg G-Pen at the first treatment visit followed by 1 mg Lilly Glucagon at the second treatment visit
Arm Title
Lilly Glucagon followed by G-Pen
Arm Type
Other
Arm Description
1 mg Lilly Glucagon at the first treatment visit followed by 1 mg G-Pen at the second treatment visit
Intervention Type
Drug
Intervention Name(s)
G-Pen
Other Intervention Name(s)
glucagon
Intervention Description
1 mg subcutaneous injection of G-Pen (glucagon injection) administered via auto-injector
Intervention Type
Drug
Intervention Name(s)
Lilly Glucagon
Other Intervention Name(s)
GEK
Intervention Description
1 mg subcutaneous injection of Lilly Glucagon (glucagon injection [RNDA Origin])
Primary Outcome Measure Information:
Title
Number of Subjects With a Positive Glucose Response
Description
Increase in plasma glucose concentration from below 50.0 mg/dL to greater than 70.0 mg/dL within 30 minutes after receiving glucagon
Time Frame
0 to 30 minutes post dose
Secondary Outcome Measure Information:
Title
Time for Positive Glucose Response
Description
Time from administration of glucagon for plasma glucose to rise from below 50.0 mg/dL to above 70.0 mg/dL
Time Frame
0 to 180 minutes post dose
Title
Number of Subjects With a Positive Response for the Combination Endpoint: Positive Glucose Response/Positive Glucose Increase
Description
A positive response for this endpoint is a return of plasma glucose to > 70 mg/dL or an increase in plasma glucose by ≥20 mg/dL within 30 minutes after receiving glucagon
Time Frame
0 to 30 minutes post dose
Title
Number of Subjects With a Positive Glucose Increase
Description
Increase in plasma glucose by ≥ 20.0 mg/dL within 30 minutes after receiving glucagon
Time Frame
0 to 30 minutes post dose
Title
Time for Positive Glucose Increase
Description
Time from administration of glucagon for plasma glucose to increase by ≥20 mg/dL from baseline
Time Frame
0 to 180 minutes post dose
Title
Number of Subjects With a Positive Response for the Combination Endpoint: Positive Glucose Response/Relief of Neuroglycopenic Symptoms
Description
A positive response for this endpoint is a return of plasma glucose to > 70 mg/dL or clearance of all neuroglycopenic symptoms of hypoglycemia within 30 minutes after receiving glucagon. Four symptoms were assessed: dizziness, blurred vision, difficulty in thinking and faintness.
Time Frame
0 to 30 minutes post dose
Title
Number of Subjects With Relief of Neuroglycopenic Symptoms
Description
Clearance of all neuroglycopenic symptoms of hypoglycemia within 30 minutes after receiving glucagon. Four symptoms were assessed: dizziness, blurred vision, difficulty in thinking and faintness.
Time Frame
0 to 30 minutes post dose
Title
Time to Resolution of Autonomic Symptoms
Description
Time from administration of glucagon to complete resolution of 4 autonomic symptoms of hypoglycemia. Symptoms included: sweating, tremor, palpitations and feeling of nervousness.
Time Frame
0 to 180 minutes post dose
Title
Time to Resolution of Neuroglycopenic Symptoms
Description
Time from administration of glucagon to complete resolution of 4 neuroglycopenic symptoms of hypoglycemia. Four symptoms were assessed: dizziness, blurred vision, difficulty in thinking and faintness.
Time Frame
0 to 180 minutes post dose
Title
Time to Resolution of the Feeling of Hypoglycemia
Description
Time from administration of glucagon to resolution of the overall sensation of hypoglycemia. Subjects were asked to answer yes/no to the question, "Do you feel hypoglycemic?" The time point as which the subject first answered "no" was considered the time of resolution.
Time Frame
0 to 180 minutes post dose
Title
Glucose AUC
Description
Area under the curve for plasma glucose.
Time Frame
0 to 180 minutes post dose - Blood samples for assessment of blood glucose concentration were collected every 5 minutes post-dose to 90 minutes, and then at 120, 150 and 180 minutes post dose.
Title
Glucose Cmax
Description
Maximum concentration of plasma glucose.
Time Frame
0 to 180 minutes post dose - Blood samples for assessment of blood glucose concentration were collected every 5 minutes post-dose to 90 minutes, and then at 120, 150 and 180 minutes post dose.
Title
Glucose Tmax
Description
Time to maximum concentration of plasma glucose. Blood samples for assessment of blood glucose concentration were collected every 5 minutes post-dose to 90 minutes, and then at 120, 150 and 180 minutes post dose.
Time Frame
0 to 180 minutes post dose
Title
Glucagon Preparation and Administration Time
Description
Time required to prepare and inject glucagon as measured between a "decision to dose" and completion of the injection
Time Frame
0 to 5 minutes pre-dose

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Males and females diagnosed with type 1 diabetes mellitus for at least 24 months. Current usage of daily insulin treatment that includes having an assigned "correction factor" for managing hyperglycemia. Age 18-75 years, inclusive. Random serum C-peptide concentration < 0.5 ng/mL. Willingness to follow all study procedures, including attending all clinic visits. Subject has provided informed consent as evidenced by a signed/dated informed consent form completed before any trial-related activities occur. Exclusion Criteria: Pregnancy: For women of childbearing potential, there is a requirement for a negative urine pregnancy test and for agreement to use contraception throughout the study and for 7 days after the last dose of study glucagon. Acceptable contraception includes birth control pill / patch / vaginal ring, Depo-Provera, Norplant, an IUD, the double barrier method (the woman uses a diaphragm and spermicide and the man uses a condom), or abstinence. Breastfeeding: Nursing mothers will be allowed into the study. However, breast feeding during the during inpatient study visits and for 48 hours after each dose of study drug is not allowed. HbA1c >9.0% at Screening. BMI > 40 kg/m2. Renal insufficiency (serum creatinine greater than 3.0 mg/dL) or end-stage renal disease. requiring renal replacement therapy. Serum ALT or AST equal to or greater than 3 times the upper limit of normal. Hepatic synthetic insufficiency as defined as a serum albumin of less than 3.0 g/dL. Hematocrit of less than or equal to 30%. BP readings at Screening where SBP <90 or >150 mm Hg, and DBP <50 or >100 mm Hg. Clinically significant ECG abnormalities. Use of > 2.0 U/kg total insulin dose per day. Inadequate venous access. Congestive heart failure, NYHA class III or IV. History of myocardial infarction, unstable angina, or revascularization within the past 6 months. History of a cerebrovascular accident in past 6 months or with major neurological deficits. Active malignancy within 5 years from Screening, except basal cell or squamous cell skin cancers. History of breast cancer or malignant melanoma will be exclusionary. Major surgical operation within 30 days prior to Screening. Current seizure disorder (other than with suspect or documented hypoglycemia). Current bleeding disorder, treatment with warfarin, or platelet count below 50 x 10e9 per liter. History of pheochromocytoma or disorder with increased risk of pheochromocytoma (MEN 2, neurofibromatosis, or Von Hippel-Lindau disease). History of insulinoma. History of allergies to glucagon or glucagon-like products, or any history of significant hypersensitivity to glucagon or any related products or to any of the excipients (DMSO & trehalose) in the investigational formulation. History of glycogen storage disease. Subject tests positive for HIV, HCV or HBV infection (HBsAg+) at Screening. Active substance or alcohol abuse (more than 21 drinks/wk. for males or 14 drinks/wk. for females). Subjects reporting active marijuana use or testing positive for tetrahydrocannabinol (THC) via rapid urine test will be allowed to participate in the study at the discretion of the Investigator. Administration of glucagon within 28 days of Screening. Participation in other studies involving administration of an investigational drug or device within 30 days or 5 half-lives, whichever is longer, before Screening for the current study and during participation in the current study. Any reason the Investigator deems exclusionary.
Facility Information:
Facility Name
ProSciento, Inc.
City
Chula Vista
State/Province
California
ZIP/Postal Code
91911
Country
United States
Facility Name
Diablo Clinical Research, Inc.
City
Walnut Creek
State/Province
California
ZIP/Postal Code
94598
Country
United States
Facility Name
Atlanta Diabetes Associates
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30318
Country
United States
Facility Name
Rainier Clinical Research Center, Inc.
City
Renton
State/Province
Washington
ZIP/Postal Code
98057
Country
United States
Facility Name
LMC ESD, Inc.
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M4G 3E8
Country
Canada
Facility Name
Altasciences Algorithme Pharma
City
Montréal
State/Province
Quebec
ZIP/Postal Code
H3P 3P1
Country
Canada

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
34620618
Citation
Christiansen MP, Cummins M, Prestrelski S, Close NC, Nguyen A, Junaidi K. Comparison of a ready-to-use liquid glucagon injection administered by autoinjector to glucagon emergency kit for the symptomatic relief of severe hypoglycemia: two randomized crossover non-inferiority studies. BMJ Open Diabetes Res Care. 2021 Oct;9(1):e002137. doi: 10.1136/bmjdrc-2021-002137.
Results Reference
derived

Learn more about this trial

G-Pen™ Compared to Lilly Glucagon for Hypoglycemia Rescue in Adults With Type 1 Diabetes

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