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Ixekizumab Diabetes Intervention Trial (I-DIT) (I-DIT)

Primary Purpose

Type1 Diabetes Mellitus

Status
Recruiting
Phase
Phase 2
Locations
Sweden
Study Type
Interventional
Intervention
Ixekizumab
Placebo
Sponsored by
Vastra Gotaland Region
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type1 Diabetes Mellitus focused on measuring Type 1 diabetes, New-onset, MMTT, Ixekizumab

Eligibility Criteria

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

INCLUSION CRITERIA:

  • Signed informed consent and expected cooperation of the patients for the treatment and follow up must be obtained and documented according to ICH GCP, and national/local regulations before trial activities are begun.
  • Must be willing and capable of taking the study drugs and meet for tests and follow up as described.
  • Diagnosed Type 1 Diabetes (E10.9) within 100 days.
  • First injection of insulin maximum 100 days prior to screening
  • Aged 18-35 years old.
  • Presence of antibodies at clinical practice or at screening to at least one of the following antigens: insulin/IAA, GAD-65, IA-2 and ZnT8.
  • Remaining stimulated peak C-peptide ≥ 0.20 nmol/L
  • Male subjects agree to use a reliable method of birth control during the study
  • Female subjects:

Participants of childbearing age or childbearing potential who are sexually active who test negative for pregnancy must be counseled and agree to use either 1 highly effective method of contraception or 2 acceptable methods of contraception combined for the duration of the study and for at least 12 weeks following the last dose of study drug or remain abstinent during the study and for at least 12 weeks following the last dose of study drug.

If the highly effective contraceptive methods are contraindicated or strictly declined by patient, acceptable birth control methods may be considered. These may include combination of both of the following methods:

  • Male or female condom with spermicide
  • Cap, diaphragm, or sponge with spermicide

    1. Highly effective methods of contraception (use 1 form):

      1. combined oral contraceptive pill and mini-pill
      2. NuvaRing®
      3. implantable contraceptives
      4. injectable contraceptives (such as Depo-Provera®)
      5. intrauterine device (such as Mirena® and ParaGard®)
      6. contraceptive patch-ONLY women <198 pounds or 90 kg
      7. abstinence from sex
      8. vasectomy-for men in clinical studies
    2. Effective methods of contraception (use 2 forms combined)
  • male condom with spermicide
  • female condom with spermicide
  • diaphragm with spermicide
  • cervical sponge
  • cervical cap with spermicide

Females who are not of childbearing potential include those who have undergone or who have:

  • female sterilization
  • hysterectomy
  • menopause
  • Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome [also referred to as congenital absence of the uterus and vagina])

EXCLUSION CRITERIA:

  • Contraindications to Ixekizumab.
  • Treatment with any oral or injected glucose-lowering agents other than insulin.
  • A history of haemolytic anaemia or significantly abnormal haematology/coagulation results at screening.
  • Participation in other clinical trials with a new chemical entity within the previous 3 months.
  • Subjects with severe obesity (BMI>35 kg/m2)
  • Subjects with other autoimmune disease, e.g. Mb Crohn, Ulcerative colitis, Graves disease, psoriasis, psoriasis arthritis and axial spondylarthrosis, except celiac disease and hypothyroidism which do not need to be excluded for.
  • Active serious or chronic infections (ie: in case patient had a serious infection (eg pneumonia, cellulitis), has been hospitalized, has received intravenous antibiotics for an infection within 12 weeks prior to screening visit, had a serious bone or joint infection within 24 weeks before screening visit, has ever had an infection of an artificial joint
  • Known immunodeficiency or patient is immunocompromised to an extent that participation in the study would pose and unacceptable risk to the patient
  • Tuberculosis
  • History of HIV, hepatitis B or C
  • Active or recurrent fungal infection
  • Subjects with myocardial infarction, stroke, unstable angina or heart failure last 6 months
  • Current clinically significant cardiac arrhythmias as verified by ECG
  • Surgery (except minor surgery on skin lesions, e.g., nevus)
  • For female subjects: Positive pregnancy test, presently breast-feeding, or unwillingness to use effective contraceptive measures for the duration of the study and 3- months after discontinuation.
  • For male subjects: intent to procreate during the duration of the study or within 3 months after discontinuation or unwillingness of their partner to use effective contraceptive measures for the duration of the study and 4 months after discontinuation.
  • Any history of malignancy the last 5 years except for completely resected squamous or basal cell carcinoma of the skin.
  • Administration of live attenuated vaccine(s) (LAV) within 2 months of enrolment. Or intended use of LAV during the treatment period.
  • The investigator judges that the clinical diagnosis of T1D set is incorrect or uncertain (needs to be confirmed by discussion with experienced diabetologist if excluding due to this criterion)
  • Allergy against ingredients of the investigational products.
  • Known allergy or hypersensitivity to any biologic therapy (active substance or excipients) that would pose an unacceptable risk to the patient if participating in the study
  • Presence of serious disease or condition, which in the opinion of the investigator makes the patient non-eligible for the study.
  • Liver injury criteria: patients with active hepatobiliary diseases or at screening having alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 2.5 times the upper limit of normal (>2.5 x ULN)
  • Laboratory abnormalities at screening:

    1. Neutrophil count < 1,500 cells/ μL (=1,5 *109 cells/ L)
    2. Platelet count < 100,000 cells/ μL (= 100 *109 cells/ L)
    3. Hemoglobin < 8.5 g/dL (= <85 g/L) (males) and <8g/dL (= <80 g/L) (women)

Sites / Locations

  • Södra Älvsborg HospitalRecruiting
  • Falu Lasarett
  • Sahlgrenska University Hospital, Östra HospitalRecruiting
  • Sahlgrenska University Hospital, Sahlgrenska
  • Kalmar Hospital
  • Blekinge Hospital
  • Kristianstad Hospital
  • Linköping University Hospital
  • Sunderby hospital
  • Lund University Hospital
  • Skåne University Hospital
  • Vrinnevi Hospital
  • Centrum för Diabetes,
  • Södersjukhuset Hospital
  • NU-Hospital GroupRecruiting
  • Uppsala Academic HospitalRecruiting
  • Växjö Hospital
  • Örebro University Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Ixekizumab

Placebo

Arm Description

Outcomes

Primary Outcome Measures

Residual insulin secretion
Change in residual insulin secretion measured by stimulated C-peptide two-hour area under the curve profile measured by Mixed Meal Tolerance Test (MMTT) between baseline and week 52.

Secondary Outcome Measures

Mean Insulin dosage per kilo bodyweight for 24 hours
Change in mean Insulin dosage per kilo bodyweight for 24 hours from baseline to week 52.
Time with glucose levels in range (3.9-10 mmol/L)
Change in time with glucose levels in range (3.9-10 mmol/l) measured by CGM/FGM from baseline to week 52.
Time in hypoglycaemia (<3.9 mmol/L)
Change in time in hypoglycaemia (<3.9 mmol/L) measured by CGM/FGM from baseline to week 52.
HbA1c
Difference in HbA1c from baseline to week 52.

Full Information

First Posted
September 24, 2020
Last Updated
December 5, 2022
Sponsor
Vastra Gotaland Region
Collaborators
Gothia Forum - Center for Clinical Trial, Statistiska Konsultgruppen
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1. Study Identification

Unique Protocol Identification Number
NCT04589325
Brief Title
Ixekizumab Diabetes Intervention Trial (I-DIT)
Acronym
I-DIT
Official Title
The Effect of Anti-IL17 in New-onset Type 1 Diabetes: a Randomized, Double-blind, Placebo-controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
May 2022
Overall Recruitment Status
Recruiting
Study Start Date
November 9, 2022 (Actual)
Primary Completion Date
February 2027 (Anticipated)
Study Completion Date
December 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Vastra Gotaland Region
Collaborators
Gothia Forum - Center for Clinical Trial, Statistiska Konsultgruppen

4. Oversight

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

5. Study Description

Brief Summary
Although the clinical onset of type 1 diabetes (T1D) is acute, the progression of T1D occurs over many years often in a patchy manner with inflammation in certain lobes of the pancreas, leaving other lobes unaffected and long-lasting beta cells remain functional decades after diagnosis. Psoriasis share several aspects with T1D, e.g. the patchy inflammatory infiltrate consisting of tissue-resident memory (TRM) T cells, leaky blood vessels that facilitate leukocyte migration and the increased risk for systemic conditions. Moreover, interleukin (IL)-17 has shown to be increased in both persons with psoriasis and T1D. Activation of IL-17/IL-22 pathway is viewed to be both a hallmark of psoriasis and human T1D. Ixekizumab, an anti-IL17 biological agent, has shown marked therapeutic value in the treatment of subjects with psoriasis in several randomized trials and is currently an approved clinical therapy. Due to the many similarities in the current view of pathogenesis and manifestation of T1D and psoriasis it is possible that Ixekizumab can also influence the disease process of T1D.
Detailed Description
In this double-blind, placebo-controlled prospective trial, patients with newly diagnosed T1D will be randomized to receive either Ixekizumab or placebo in addition to their conventional therapy. The primary aim is to examine the effect of Ixekizumab on endogenous insulin production when administered to persons with newly diagnosed T1D. The planned study duration is 52 weeks with an extension phase for 3 years and includes 127 patients at 19 centers in Sweden. During the extension phase the participants will be examined during a visit after 1 and 3 years after the end of the study regarding insulin production (C-peptide and proinsulin secretion during a Mixed Meal Tolerance Test), glycaemic control, T1D auto-antibodies and insulin doses.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type1 Diabetes Mellitus
Keywords
Type 1 diabetes, New-onset, MMTT, Ixekizumab

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
127 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Ixekizumab
Arm Type
Experimental
Arm Title
Placebo
Arm Type
Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
Ixekizumab
Other Intervention Name(s)
Taltz
Intervention Description
Ixekizumab will be available at a concentration of 80 mg solution for injection in pre-filled syringes. Ixekizumab will be administrated by the patient via subcutaneous (s.c.) injections for a total treatment period of 12 months. Two s.c. injections (160 mg) will be administrated at week 0, one dose (80 mg) at week 2, 4, 6, 8, 10 and 12 and continue with a maintenance dose (80 mg) every 4th week for a total treatment period of 12 months.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo will be available at a concentration of 80 mg solution for injection in pre-filled syringes. Placebo will be administrated by the patient via subcutaneous (s.c.) injections for a total treatment period of 12 months. Two s.c. injections (160 mg) will be administrated at week 0, one dose (80 mg) at week 2, 4, 6, 8, 10 and 12 and continue with a maintenance dose (80 mg) every 4th week for a total treatment period of 12 months.
Primary Outcome Measure Information:
Title
Residual insulin secretion
Description
Change in residual insulin secretion measured by stimulated C-peptide two-hour area under the curve profile measured by Mixed Meal Tolerance Test (MMTT) between baseline and week 52.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Mean Insulin dosage per kilo bodyweight for 24 hours
Description
Change in mean Insulin dosage per kilo bodyweight for 24 hours from baseline to week 52.
Time Frame
12 months
Title
Time with glucose levels in range (3.9-10 mmol/L)
Description
Change in time with glucose levels in range (3.9-10 mmol/l) measured by CGM/FGM from baseline to week 52.
Time Frame
12 months
Title
Time in hypoglycaemia (<3.9 mmol/L)
Description
Change in time in hypoglycaemia (<3.9 mmol/L) measured by CGM/FGM from baseline to week 52.
Time Frame
12 months
Title
HbA1c
Description
Difference in HbA1c from baseline to week 52.
Time Frame
12 months
Other Pre-specified Outcome Measures:
Title
Time in hypoglycaemia (<3.0 mmol/L)
Description
Change in time in hypoglycaemia (<3.0 mmol/L) measured by CGM/FGM from baseline to week 52.
Time Frame
12 months
Title
Proinsulin/c-peptide ratio in serum as a measure of beta cell stress
Description
Change in proinsulin/c-peptide ratio in serum as a measure of beta cell stress from baseline to week 52.
Time Frame
12 months
Title
Time in target (3.9-8 mmol/L)
Description
Change in time in target (3.9-8 mmol/L) measured by CGM/FGM from baseline to week 52.
Time Frame
12 months
Title
Time in hyperglycaemia >10 mmol/L and ≥ 14 mmol/L
Description
Change in time in hyperglycaemia >10 mmol/L and ≥ 14 mmol/L measured by CGM/FGM from baseline to week 52.
Time Frame
12 months
Title
Glycaemic variability (mean amplitude of glycemic excursions (MAGE))
Description
Change in glycaemic variability measured by mean amplitude of glycemic excursions (MAGE) by CGM/FGM from baseline to week 52.
Time Frame
12 months
Title
Glycaemic variability (coefficient of variation (CV))
Description
Change in glycaemic variability measured by coefficient of variation (CV) by CGM/FGM from baseline to week 52.
Time Frame
12 months
Title
Glycaemic variability (standard deviation (SD))
Description
Change in glycaemic variability measured by standard deviation (SD) by CGM/FGM from baseline to week 52.
Time Frame
12 months
Title
Proportion of patients with peak residual insulin secretion
Description
Change in proportion of patients with peak residual insulin secretion measured by MMTT: stimulated C-peptide >0.4 pmol/mL from baseline to week 52
Time Frame
12 months
Title
Change in World Health Organization-5 (WHO-5) scores from baseline and week 52.
Description
Score 0 to 100; higher value indicates better well-being
Time Frame
12 months
Title
Change in Diabetes Treatment Satisfaction Questionnaire (DTSQ) scores from baseline and week 52.
Description
Score 0 to 36; higher value indicates better satisfaction and change in satisfaction (score -18 to 18; higher value indicates better change in satisfaction).
Time Frame
12 months
Title
Change in Hypoglycaemia Fear Survey (Swe-HFS) scores from baseline and week 52.
Description
Score 0 to 4; higher value indicates greater fear.
Time Frame
12 months
Title
Change in Problem Areas in Diabetes Scale (PAID) scores from baseline and week 52.
Description
Score 0 to 100; higher value indicates greater problems.
Time Frame
12 months
Title
Change in International Physical Activity Questionnaire (IPAQ) scores from baseline and week 52.
Description
Total Physical Activity Scores are calculated by Metabolic Energy Turnover (MET)-minutes/week score.
Time Frame
12 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: Signed informed consent and expected cooperation of the patients for the treatment and follow up must be obtained and documented according to ICH GCP, and national/local regulations before trial activities are begun. Must be willing and capable of taking the study drugs and meet for tests and follow up as described. Diagnosed Type 1 Diabetes (E10.9) within 100 days. First injection of insulin maximum 100 days prior to screening Aged 18-35 years old. Presence of antibodies at clinical practice or at screening to at least one of the following antigens: insulin/IAA, GAD-65, IA-2 and ZnT8. Remaining stimulated peak C-peptide ≥ 0.20 nmol/L Male subjects agree to use a reliable method of birth control during the study Female subjects: Participants of childbearing age or childbearing potential who are sexually active who test negative for pregnancy must be counseled and agree to use either 1 highly effective method of contraception or 2 acceptable methods of contraception combined for the duration of the study and for at least 12 weeks following the last dose of study drug or remain abstinent during the study and for at least 12 weeks following the last dose of study drug. If the highly effective contraceptive methods are contraindicated or strictly declined by patient, acceptable birth control methods may be considered. These may include combination of both of the following methods: Male or female condom with spermicide Cap, diaphragm, or sponge with spermicide Highly effective methods of contraception (use 1 form): combined oral contraceptive pill and mini-pill NuvaRing® implantable contraceptives injectable contraceptives (such as Depo-Provera®) intrauterine device (such as Mirena® and ParaGard®) contraceptive patch-ONLY women <198 pounds or 90 kg abstinence from sex vasectomy-for men in clinical studies Effective methods of contraception (use 2 forms combined) male condom with spermicide female condom with spermicide diaphragm with spermicide cervical sponge cervical cap with spermicide Females who are not of childbearing potential include those who have undergone or who have: female sterilization hysterectomy menopause Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome [also referred to as congenital absence of the uterus and vagina]) EXCLUSION CRITERIA: Contraindications to Ixekizumab. Treatment with any oral or injected glucose-lowering agents other than insulin. A history of haemolytic anaemia or significantly abnormal haematology/coagulation results at screening. Participation in other clinical trials with a new chemical entity within the previous 3 months. Subjects with severe obesity (BMI>35 kg/m2) Subjects with other autoimmune disease, e.g. Mb Crohn, Ulcerative colitis, Graves disease, psoriasis, psoriasis arthritis and axial spondylarthrosis, except celiac disease and hypothyroidism which do not need to be excluded for. Active serious or chronic infections (ie: in case patient had a serious infection (eg pneumonia, cellulitis), has been hospitalized, has received intravenous antibiotics for an infection within 12 weeks prior to screening visit, had a serious bone or joint infection within 24 weeks before screening visit, has ever had an infection of an artificial joint Known immunodeficiency or patient is immunocompromised to an extent that participation in the study would pose and unacceptable risk to the patient Tuberculosis History of HIV, hepatitis B or C Active or recurrent fungal infection Subjects with myocardial infarction, stroke, unstable angina or heart failure last 6 months Current clinically significant cardiac arrhythmias as verified by ECG Planned surgery during the treatment period of the study (except minor surgery on skin lesions, e.g., nevus) For female subjects: Positive pregnancy test, presently breast-feeding, or unwillingness to use effective contraceptive measures for the duration of the study and 3- months after discontinuation. For male subjects: intent to procreate during the duration of the study or within 3 months after discontinuation or unwillingness of their partner to use effective contraceptive measures for the duration of the study and 4 months after discontinuation. Any history of malignancy the last 5 years except for completely resected squamous or basal cell carcinoma of the skin. Administration of live attenuated vaccine(s) (LAV) within 2 months of enrolment. Or intended use of LAV during the treatment period. The investigator judges that the clinical diagnosis of T1D set is incorrect or uncertain (needs to be confirmed by discussion with experienced diabetologist if excluding due to this criterion) Allergy against ingredients of the investigational products. Known allergy or hypersensitivity to any biologic therapy (active substance or excipients) that would pose an unacceptable risk to the patient if participating in the study Presence of serious disease or condition, which in the opinion of the investigator makes the patient non-eligible for the study. Liver injury criteria: patients with active hepatobiliary diseases or at screening having alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 2.5 times the upper limit of normal (>2.5 x ULN) Laboratory abnormalities at screening: Neutrophil count < 1,500 cells/ μL (=1,5 *109 cells/ L) Platelet count < 100,000 cells/ μL (= 100 *109 cells/ L) Hemoglobin < 8.5 g/dL (= <85 g/L) (males) and <8g/dL (= <80 g/L) (women)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Marcus Lind, MD, PhD
Phone
+46(0)766-183142
Email
marcus.lind@gu.se
First Name & Middle Initial & Last Name or Official Title & Degree
Shilan Seyed Ahmadi, MD
Email
shilan.seyed.ahmadi@vgregion.se
Facility Information:
Facility Name
Södra Älvsborg Hospital
City
Borås
Country
Sweden
Individual Site Status
Recruiting
Facility Name
Falu Lasarett
City
Falun
Country
Sweden
Individual Site Status
Not yet recruiting
Facility Name
Sahlgrenska University Hospital, Östra Hospital
City
Gothenburg
Country
Sweden
Individual Site Status
Recruiting
Facility Name
Sahlgrenska University Hospital, Sahlgrenska
City
Göteborg
Country
Sweden
Individual Site Status
Not yet recruiting
Facility Name
Kalmar Hospital
City
Kalmar
Country
Sweden
Individual Site Status
Not yet recruiting
Facility Name
Blekinge Hospital
City
Karlskrona
Country
Sweden
Individual Site Status
Not yet recruiting
Facility Name
Kristianstad Hospital
City
Kristianstad
Country
Sweden
Individual Site Status
Not yet recruiting
Facility Name
Linköping University Hospital
City
Linköping
Country
Sweden
Individual Site Status
Not yet recruiting
Facility Name
Sunderby hospital
City
Luleå
Country
Sweden
Individual Site Status
Not yet recruiting
Facility Name
Lund University Hospital
City
Lund
Country
Sweden
Individual Site Status
Not yet recruiting
Facility Name
Skåne University Hospital
City
Malmö
Country
Sweden
Individual Site Status
Not yet recruiting
Facility Name
Vrinnevi Hospital
City
Norrköping
Country
Sweden
Individual Site Status
Not yet recruiting
Facility Name
Centrum för Diabetes,
City
Stockholm
Country
Sweden
Individual Site Status
Not yet recruiting
Facility Name
Södersjukhuset Hospital
City
Stockholm
Country
Sweden
Individual Site Status
Not yet recruiting
Facility Name
NU-Hospital Group
City
Uddevalla
Country
Sweden
Individual Site Status
Recruiting
Facility Name
Uppsala Academic Hospital
City
Uppsala
Country
Sweden
Individual Site Status
Recruiting
Facility Name
Växjö Hospital
City
Växjö
Country
Sweden
Individual Site Status
Not yet recruiting
Facility Name
Örebro University Hospital
City
Örebro
Country
Sweden
Individual Site Status
Not yet recruiting

12. IPD Sharing Statement

Plan to Share IPD
No

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Ixekizumab Diabetes Intervention Trial (I-DIT)

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