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A Study to Evaluate the Effect of ORMD-0801 in Patients With Type 2 Diabetes Mellitus

Primary Purpose

Diabetes Mellitus, Type 2

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
ORMD-0801
Placebo
Sponsored by
Oramed, Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes Mellitus, Type 2

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male and female subjects aged, 18 - 70 years.
  • Established diagnosis of T2DM for at least 6 months prior to Screening, with HbA1c ≥ 7.5%. and ≤ 11%.
  • Stable dose of metformin (at least 1500 mg or maximal tolerated dose) for a period of at least 3 months prior to Screening.
  • Taking metformin only or metformin in addition to no more than two of the following: DPP-4, SGLT-2, or TZD.
  • Body mass index (BMI) of up to 35 kg/m2 at Screening and stable weight, with no more than 5 kg gain or loss in the 3 months prior to Screening.
  • Renal function - eGFR > 30 ml/min/1.73 m2.
  • Females of childbearing potential must have a negative serum pregnancy test result at Screening.

Exclusion Criteria:

  • Subjects with insulin-dependent diabetes:

    1. Has a history of type 1 diabetes mellitus or a history of ketoacidosis, or subject is assessed by the investigator as possibly having type 1 diabetes mellitus confirmed by a C-peptide < 0.7 ng/mL (0.23 nmol/L).
    2. Has a history of other specific types of diabetes (e.g., genetic syndromes, secondary pancreatic diabetes, diabetes due to endocrinopathies, drug- or chemical-induced, and post-organ transplant).
  • Treatment with glucosidase inhibitor, insulin secretagogues (other than sulfonylureas), glucagon-like peptide 1 (GLP-1) agonists within 3 months prior to Visit 1.
  • History of any basal, pre-mix or prandial insulin (greater than 7 days) within 6 months prior to Screening.
  • History of > 2 episodes of severe hypoglycemia within 6 months prior to Screening.
  • History of hypoglycemic unawareness (episodes of severe hypoglycemia with seizure or requiring third party intervention or documented low blood glucose without associated autonomic symptoms).
  • Subjects with the following secondary complications of diabetes:

    1. Active proliferative retinopathy as confirmed by a dilated ophthalmoscopy/retinal photography examination performed (by a qualified person as per the country legislation) within 6 months prior to Screening.
    2. Renal dysfunction: estimated creatinine clearance < 30 ml/min.
    3. History of proliferative retinopathy or severe form of neuropathy or cardiac autonomic neuropathy (CAN).
    4. Uncontrolled or untreated severe hypertension defined as systolic blood pressure above or equal to 180 mmHg and/or diastolic blood pressure above or equal to 120 mmHg.
    5. Presence of unstable angina or myocardial infarction within 6 months prior to Screening, Grade 3 or 4 congestive heart failure (CHF) according to the New York Heart Association (NYHA) criteria, valvular heart disease, cardiac arrhythmia requiring treatment, pulmonary hypertension, cardiac surgery, history/occurrence of coronary angioplasty and/or stroke or transient ischemic attack (TIA) within 6 months prior to Screening.
  • Subjects with psychiatric disorders which, per investigator judgment, may have impact on the safety of the subject or interfere with subject's participation or compliance in the study.
  • Subjects who needed (in the last 12 months) or may require systemic (oral, intravenous, intramuscular) glucocorticoid therapy for more than 2 weeks during the study period.
  • Laboratory abnormalities at Screening including:

    1. C-peptide < 0.7 ng/mL (0.23 nmol/L).
    2. Abnormal serum thyrotropin (TSH) levels below the lower limit of normal or > 1.5X the upper limit of normal.
    3. Elevated liver enzymes (alanine transaminase (ALT), alanine aminotransferase (AST), alkaline phosphatase) > 2X the upper limit of normal.
    4. Very high triglyceride levels (> 600 mg/dL); a single repeat test is allowable.
    5. Any relevant abnormality that would interfere with the efficacy or the safety assessments during study treatment administration.
  • Positive history of active liver disease (other than non-alcoholic hepatic steatosis), including chronic hepatitis B or C, primary biliary cirrhosis, or active symptomatic gallbladder disease.
  • Positive history of HIV.
  • Use of the following medications:

    1. History of any basal, pre-mix or prandial insulin (greater than 7 days) within 6 months prior to Screening.
    2. Administration of thyroid preparations or thyroxine (except in subjects on stable replacement therapy) within 6 weeks prior to Screening.
    3. Administration of systemic long-acting corticosteroids within two months or prolonged use (more than one week) of other systemic corticosteroids or inhaled corticosteroids (if daily dosage is > 1,000 μg equivalent beclomethasone) within 30 days prior to Screening. Intra-articular and/or topical corticosteroids are not considered systemic.
    4. Use of medications known to modify glucose metabolism or to decrease the ability to recover from hypoglycemia such as oral, parenteral, and inhaled steroids (as discussed above), and immunosuppressive or immunomodulating agents.
  • Known allergy to soy.
  • Subject is on a weight loss program and is not in the maintenance phase, or subject has started weight loss medication (e.g., orlistat or liraglutide), within 8 weeks prior to Screening.
  • Subject has had bariatric surgery.
  • Subject is pregnant or breast-feeding.
  • Subject is a user of recreational or illicit drugs or has had a recent history (within 1 year of Screening) of drug or alcohol abuse or dependence. (Note: Alcohol abuse includes heavy alcohol intake as defined by > 3 drinks per day or > 14 drinks per week, or binge drinking) at Screening. Occasional intermittent use of cannabinoid products will be allowed provided that no cannabinoid products have been used during the 1 week prior to each visit.
  • Subject is smoking more than 10 cigarettes per day.
  • One or more contraindications to metformin as per local label.
  • History of gastrointestinal disorders (e.g. hypochlorhydria) with the potential to interfere with drug absorption.
  • At the Principal Investigator's discretion, any condition or other factor that is deemed unsuitable for subject enrollment into the study.

Sites / Locations

  • Orange County Research Center (OCRC) 14351 Myford Rd., Suite B, Tustin, CA 92780

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Active Comparator

Arm Label

Placebo

ORMD-0801

Arm Description

Subjects will be administered a single capsule of placebo( fish oil); placebo will be dispensed and subjects will dose twice a day, once in the morning prior to breakfast and once at night prior to bedtime.

Subjects will be administered a single 8mg capsule of ORMD-0801; study medication will be dispensed and subjects will dose twice a day, once in the morning prior to breakfast and once at night prior to bedtime.

Outcomes

Primary Outcome Measures

Difference in Area Under the Curve (AUC(0-16)) of endogenous glucose production between placebo and ORMD-0801
The difference in endogenous glucose production between active and placebo as measured by the glucose with tracer attached using AUC(0-16) as the primary parameter.

Secondary Outcome Measures

Mean changes in HbA1c
Mean Changes of HbA1c measured in percent
Mean changes plasma glucose levels
Mean changes in plasma glucose levels measured in mg/dL
Mean changes in ketones from baseline to Day 29 of the treatment period.
Mean changes in ketones measured in percent

Full Information

First Posted
September 21, 2020
Last Updated
September 13, 2022
Sponsor
Oramed, Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT04564846
Brief Title
A Study to Evaluate the Effect of ORMD-0801 in Patients With Type 2 Diabetes Mellitus
Official Title
A Randomized, Double Blind, Phase 2b Study to Evaluate the Effect of ORMD-0801 Compared to Placebo on Endogenous Glucose Production in Patients With Type 2 Diabetes Mellitus
Study Type
Interventional

2. Study Status

Record Verification Date
September 2022
Overall Recruitment Status
Completed
Study Start Date
November 23, 2020 (Actual)
Primary Completion Date
June 7, 2022 (Actual)
Study Completion Date
June 7, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Oramed, Ltd.

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 study is designed to explore the efficacy of ORMD-0801 compared to placebo on endogenous glucose production in subjects with type 2 diabetes (T2DM). Subjects will undergo an initial Screening Visit (Visit 0) to establish their eligibility to participate in the study. At Visit 1 (2 weeks after the Screening Visit), qualifying subjects will be randomized to either ORMD-0801 (8 mg) or matching placebo, study medication will be dispensed and subjects will dose, twice a day, once in the morning prior to breakfast and once at night prior to bedtime
Detailed Description
This study is designed to explore the efficacy of ORMD-0801 compared to placebo on endogenous glucose production in subjects with type 2 diabetes (T2DM). Subjects will undergo an initial Screening Visit (Visit 0) to establish their eligibility to participate in the study. At Visit 1 (2 weeks after the Screening Visit), qualifying subjects will be randomized to either ORMD-0801 (8 mg) or matching placebo, study medication will be dispensed and subjects will dose, twice a day, once in the morning prior to breakfast and once at night prior to bedtime. Doses will occur at 45 minutes (± 15 minutes) before breakfast and no later than 10 AM each morning, and at 8 PM (± 120 minutes) each night, and no sooner than 1 hour after dinner. Subjects will return to the clinic, 2 weeks later, for Visit 2. At this visit, subject compliance will be assessed, medication will be dispensed, a blood sample will be collected to measure HbA1c and subjects will be questioned for any adverse events. Subjects will be scheduled to return to the clinic in 2 weeks for morning admission (8 AM ± 120 minutes) to the PK unit (Visit 3). Subjects will be provided with standardized meals and the morning dose in-clinic. A light standardized dinner meal will be provided at 6 PM ± 30 minutes. At approximately 8 PM (± 60 minutes, and no sooner than 1 hour after dinner), subjects will be dosed with their study medication and will be started on a 16-hour infusion of [6,6-2H2]-glucose tracer.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 2

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
The subject will receive either placebo or ORMD-0801
Masking
ParticipantCare ProviderInvestigator
Masking Description
Participant, Care Provider, and Investigator will be masked to the intervention (ORMD-0801 or placebo)
Allocation
Randomized
Enrollment
50 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Subjects will be administered a single capsule of placebo( fish oil); placebo will be dispensed and subjects will dose twice a day, once in the morning prior to breakfast and once at night prior to bedtime.
Arm Title
ORMD-0801
Arm Type
Active Comparator
Arm Description
Subjects will be administered a single 8mg capsule of ORMD-0801; study medication will be dispensed and subjects will dose twice a day, once in the morning prior to breakfast and once at night prior to bedtime.
Intervention Type
Drug
Intervention Name(s)
ORMD-0801
Other Intervention Name(s)
Oral Insulin
Intervention Description
8 mg capsules of ORMD-0801 (Oral Insulin)
Intervention Type
Other
Intervention Name(s)
Placebo
Other Intervention Name(s)
Fish Oil
Intervention Description
Placebo capsule (Fish Oil)
Primary Outcome Measure Information:
Title
Difference in Area Under the Curve (AUC(0-16)) of endogenous glucose production between placebo and ORMD-0801
Description
The difference in endogenous glucose production between active and placebo as measured by the glucose with tracer attached using AUC(0-16) as the primary parameter.
Time Frame
Day 29 (1 day)
Secondary Outcome Measure Information:
Title
Mean changes in HbA1c
Description
Mean Changes of HbA1c measured in percent
Time Frame
baseline to Day 29 of the treatment period.
Title
Mean changes plasma glucose levels
Description
Mean changes in plasma glucose levels measured in mg/dL
Time Frame
baseline to Day 29 of the treatment period.
Title
Mean changes in ketones from baseline to Day 29 of the treatment period.
Description
Mean changes in ketones measured in percent
Time Frame
baseline to Day 29 of the treatment period.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male and female subjects aged, 18 - 70 years. Established diagnosis of T2DM for at least 6 months prior to Screening, with HbA1c ≥ 7.5%. and ≤ 11%. Stable dose of metformin (at least 1500 mg or maximal tolerated dose) for a period of at least 3 months prior to Screening. Taking metformin only or metformin in addition to no more than two of the following: DPP-4, SGLT-2, or TZD. Body mass index (BMI) of up to 35 kg/m2 at Screening and stable weight, with no more than 5 kg gain or loss in the 3 months prior to Screening. Renal function - eGFR > 30 ml/min/1.73 m2. Females of childbearing potential must have a negative serum pregnancy test result at Screening. Exclusion Criteria: Subjects with insulin-dependent diabetes: Has a history of type 1 diabetes mellitus or a history of ketoacidosis, or subject is assessed by the investigator as possibly having type 1 diabetes mellitus confirmed by a C-peptide < 0.7 ng/mL (0.23 nmol/L). Has a history of other specific types of diabetes (e.g., genetic syndromes, secondary pancreatic diabetes, diabetes due to endocrinopathies, drug- or chemical-induced, and post-organ transplant). Treatment with glucosidase inhibitor, insulin secretagogues (other than sulfonylureas), glucagon-like peptide 1 (GLP-1) agonists within 3 months prior to Visit 1. History of any basal, pre-mix or prandial insulin (greater than 7 days) within 6 months prior to Screening. History of > 2 episodes of severe hypoglycemia within 6 months prior to Screening. History of hypoglycemic unawareness (episodes of severe hypoglycemia with seizure or requiring third party intervention or documented low blood glucose without associated autonomic symptoms). Subjects with the following secondary complications of diabetes: Active proliferative retinopathy as confirmed by a dilated ophthalmoscopy/retinal photography examination performed (by a qualified person as per the country legislation) within 6 months prior to Screening. Renal dysfunction: estimated creatinine clearance < 30 ml/min. History of proliferative retinopathy or severe form of neuropathy or cardiac autonomic neuropathy (CAN). Uncontrolled or untreated severe hypertension defined as systolic blood pressure above or equal to 180 mmHg and/or diastolic blood pressure above or equal to 120 mmHg. Presence of unstable angina or myocardial infarction within 6 months prior to Screening, Grade 3 or 4 congestive heart failure (CHF) according to the New York Heart Association (NYHA) criteria, valvular heart disease, cardiac arrhythmia requiring treatment, pulmonary hypertension, cardiac surgery, history/occurrence of coronary angioplasty and/or stroke or transient ischemic attack (TIA) within 6 months prior to Screening. Subjects with psychiatric disorders which, per investigator judgment, may have impact on the safety of the subject or interfere with subject's participation or compliance in the study. Subjects who needed (in the last 12 months) or may require systemic (oral, intravenous, intramuscular) glucocorticoid therapy for more than 2 weeks during the study period. Laboratory abnormalities at Screening including: C-peptide < 0.7 ng/mL (0.23 nmol/L). Abnormal serum thyrotropin (TSH) levels below the lower limit of normal or > 1.5X the upper limit of normal. Elevated liver enzymes (alanine transaminase (ALT), alanine aminotransferase (AST), alkaline phosphatase) > 2X the upper limit of normal. Very high triglyceride levels (> 600 mg/dL); a single repeat test is allowable. Any relevant abnormality that would interfere with the efficacy or the safety assessments during study treatment administration. Positive history of active liver disease (other than non-alcoholic hepatic steatosis), including chronic hepatitis B or C, primary biliary cirrhosis, or active symptomatic gallbladder disease. Positive history of HIV. Use of the following medications: History of any basal, pre-mix or prandial insulin (greater than 7 days) within 6 months prior to Screening. Administration of thyroid preparations or thyroxine (except in subjects on stable replacement therapy) within 6 weeks prior to Screening. Administration of systemic long-acting corticosteroids within two months or prolonged use (more than one week) of other systemic corticosteroids or inhaled corticosteroids (if daily dosage is > 1,000 μg equivalent beclomethasone) within 30 days prior to Screening. Intra-articular and/or topical corticosteroids are not considered systemic. Use of medications known to modify glucose metabolism or to decrease the ability to recover from hypoglycemia such as oral, parenteral, and inhaled steroids (as discussed above), and immunosuppressive or immunomodulating agents. Known allergy to soy. Subject is on a weight loss program and is not in the maintenance phase, or subject has started weight loss medication (e.g., orlistat or liraglutide), within 8 weeks prior to Screening. Subject has had bariatric surgery. Subject is pregnant or breast-feeding. Subject is a user of recreational or illicit drugs or has had a recent history (within 1 year of Screening) of drug or alcohol abuse or dependence. (Note: Alcohol abuse includes heavy alcohol intake as defined by > 3 drinks per day or > 14 drinks per week, or binge drinking) at Screening. Occasional intermittent use of cannabinoid products will be allowed provided that no cannabinoid products have been used during the 1 week prior to each visit. Subject is smoking more than 10 cigarettes per day. One or more contraindications to metformin as per local label. History of gastrointestinal disorders (e.g. hypochlorhydria) with the potential to interfere with drug absorption. At the Principal Investigator's discretion, any condition or other factor that is deemed unsuitable for subject enrollment into the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joel M Neutel, M. D.
Organizational Affiliation
Orange County Research Center (OCRC)
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Ele Ferrannini, M. D.
Organizational Affiliation
CNR Institute of Clinical Physiology
Official's Role
Principal Investigator
Facility Information:
Facility Name
Orange County Research Center (OCRC) 14351 Myford Rd., Suite B, Tustin, CA 92780
City
Tustin
State/Province
California
ZIP/Postal Code
92780
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
10923639
Citation
Gastaldelli A, Baldi S, Pettiti M, Toschi E, Camastra S, Natali A, Landau BR, Ferrannini E. Influence of obesity and type 2 diabetes on gluconeogenesis and glucose output in humans: a quantitative study. Diabetes. 2000 Aug;49(8):1367-73. doi: 10.2337/diabetes.49.8.1367.
Results Reference
background
PubMed Identifier
21281836
Citation
Ferrannini E, Gastaldelli A, Iozzo P. Pathophysiology of prediabetes. Med Clin North Am. 2011 Mar;95(2):327-39, vii-viii. doi: 10.1016/j.mcna.2010.11.005.
Results Reference
background

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A Study to Evaluate the Effect of ORMD-0801 in Patients With Type 2 Diabetes Mellitus

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