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Baricitinib in New-onset Type 1 Diabetes (BANDIT)

Primary Purpose

Type 1 Diabetes

Status
Active
Phase
Phase 2
Locations
Australia
Study Type
Interventional
Intervention
Baricitinib
Placebo
Sponsored by
St Vincent's Institute of Medical Research
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 1 Diabetes focused on measuring newly diagnosed

Eligibility Criteria

10 Years - 30 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or female aged between 10 and 30 years (inclusive) at screening;
  2. Diagnosis of T1D according to ADA criteria within 100 days prior to starting study drug;
  3. Islet autoantibody positivity (one or more of: GADA, IA-2A, IAA (assessed within one week of commencing insulin therapy), ZnT8A);
  4. Stimulated (peak or 90 min) C-peptide >0.2 nM during a 2-hour MMTT at the screening visit; or random C-peptide result >0.3 nM during the screening period.
  5. Participants of childbearing age who are sexually active must agree to use of effective birth control until the end of the study;
  6. Be able to read, understand and give written informed consent;
  7. Be willing to comply with intensive diabetes management.

Exclusion Criteria:

  1. Use of immunosuppressive or immunomodulatory therapies other than inhaled or topical glucocorticoids;
  2. Current or past history of deep vein thrombosis or pulmonary embolism;
  3. Impaired renal function defined by estimated glomerular filtration rate (according to the CKD-EPI) of < 60 mL/min/1.73 m2;
  4. LDL cholesterol >4mmol/l;
  5. Elevated liver function tests at screening:

    1. Aspartate aminotransferase 2x ULN
    2. Alanine aminotransferase 2 x ULN;
  6. Clinically significant abnormal laboratory parameters at screening including but not limited to:

    1. Hemoglobin < 8 g/L;
    2. White blood cells <2500 cells/µl;
    3. Lymphocyte count <750 cells/µl;
    4. Platelets <50,000 cells/µl;
    5. Neutrophils <1200cells/µL;
  7. Known hypersensitivity to baricitinib;
  8. Known malignancy with the exception of successfully treated non- metastatic basal cell and squamous cell carcinoma;
  9. Pregnancy, a desire for pregnancy, breast feeding, or a desire to father a child during the study;
  10. Patients with current or recent (within 12 weeks of screening) clinically significant comorbidity, including clinically serious viral, bacterial, fungal, or parasitic infection. Viral infections include HBV, HCV, EBV, HIV, recent herpes zoster and TB;
  11. Treatment with any investigational product within 30 days or 5 half - lives (whichever is longer) prior to baseline visit, or concurrent participation in a clinical trial with an investigational product or device;
  12. Experienced any of the following within 12 weeks of screening: myocardial infarction, unstable ischemic heart disease, stroke, or New York Heart Association Stage IV heart failure;
  13. Any serious medical condition within the previous 4 weeks which places the participant at an unacceptable risk if he or she were to participate in the study or confounds the ability to interpret data from the study, including, but not limited to, symptomatic cardiovascular, renal, respiratory, hepatic, gastrointestinal, endocrine, haematological and neurological conditions or psychiatric illness/social situations that would limit compliance with study requirements;
  14. Have had any major surgery within 8 weeks prior to screening or will require major surgery during the study that, in the opinion of the investigator would pose an unacceptable risk to the participant;
  15. History of chronic alcohol abuse or IV drug abuse or other illicit drug abuse within 2 years prior to screening.

Sites / Locations

  • Women's and Children's Hospital Adelaide
  • St Vincent's Hospital Melbourne
  • Royal Melbourne Hospital
  • Royal Children's Hospital Melbourne

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Baricitinib

Placebo

Arm Description

Baricitinib is an oral JAK1/JAK2-selective inhibitor. Dosage: The dose of baricitinib is 1 x 4mg tablet once daily Duration of administration: 48 weeks Mode of administration: Orally, with or without food

One placebo tablet once daily for a duration of 48 weeks. Placebo tablets contain lactose monohydrate, microcrystalline cellulose, croscarmellose sodium and magnesium stearate.

Outcomes

Primary Outcome Measures

The primary endpoint of the study is the change from baseline of plasma C-peptide area under the curve (AUC) over 2 hours following a mixed meal.

Secondary Outcome Measures

Change from baseline in plasma C-peptide AUC over 2 hours following a mixed meal.
Change from baseline in mean daily insulin use over 7 consecutive days.
Change from baseline in glycosylated haemoglobin (HbA1c) levels.
Number of participants with responder status. Responder status is defined as glycosylated haemoglobin (HbA1c) less than or equal to 6.5 percent and mean daily insulin use less than 0.5 international units per kilogram per day (IU/kg/day).
Change in estimated C-peptide (CPEST) from baseline. CPEST is calculated based on six variable routine measures: disease duration, BMI, insulin dose, HbA1c, fasting plasma C-peptide and fasting plasma glucose.
Continuous glucose monitoring (CGM).
The composite outcome assessing both the frequency, and when relevant, the severity of all adverse events.

Full Information

First Posted
February 22, 2021
Last Updated
June 28, 2023
Sponsor
St Vincent's Institute of Medical Research
Collaborators
Juvenile Diabetes Research Foundation, Juvenile Diabetes Research Foundation Australia
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1. Study Identification

Unique Protocol Identification Number
NCT04774224
Brief Title
Baricitinib in New-onset Type 1 Diabetes
Acronym
BANDIT
Official Title
A Phase 2, Randomised, Placebo Controlled Study Investigating the Efficacy of Baricitinib in New Onset Type 1 Diabetes Mellitus
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
October 30, 2020 (Actual)
Primary Completion Date
January 30, 2023 (Actual)
Study Completion Date
March 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
St Vincent's Institute of Medical Research
Collaborators
Juvenile Diabetes Research Foundation, Juvenile Diabetes Research Foundation Australia

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
Type 1 diabetes (T1D) results from the killing of insulin-producing pancreatic beta cells by cells of the immune system. The study aims to slow the progressive, immune-mediated loss of insulin-producing beta cells that occurs after clinical presentation. The investigators have identified a pathway that is important for immune cells to kill beta cells, and a drug that will block this pathway and prevent beta cell death. This drug, baricitinib, is already in clinical use for rheumatoid arthritis, and is currently in clinical trials for other diseases, including childhood autoimmune diseases. It is hypothesized that baricitinib treatment for 48 weeks will preserve beta cell function in children and young adults with recently-diagnosed T1D. The trial aims to recruit 83 participants aged 10-30 years who have been recently diagnosed with T1D. Two thirds of the participants will be randomly assigned to receive baricitinib, one third will receive placebo. The trial will test if baricitinib can slow the progressive loss of insulin-producing beta cells in these patients. The primary objective is to determine if baricitinib can reduce the loss of meal-stimulated plasma C-peptide, a measure of beta-cell function. Maintaining endogenous insulin in recent-onset T1D improves glucose control and may lead to long-term improvements in glucose and lower rates of serious diabetes complications and death.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes
Keywords
newly diagnosed

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Randomised placebo controlled trial
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Prior to study initiation, an independent researcher is responsible for generating the randomization schedule. The randomization schedule including treatment group assignment (active or placebo) will be provided to the pharmacists at each one of the study sites. The study pharmacists will conceal the group assignment from study participants, investigators and study staff including the statistician.
Allocation
Randomized
Enrollment
91 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Baricitinib
Arm Type
Active Comparator
Arm Description
Baricitinib is an oral JAK1/JAK2-selective inhibitor. Dosage: The dose of baricitinib is 1 x 4mg tablet once daily Duration of administration: 48 weeks Mode of administration: Orally, with or without food
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
One placebo tablet once daily for a duration of 48 weeks. Placebo tablets contain lactose monohydrate, microcrystalline cellulose, croscarmellose sodium and magnesium stearate.
Intervention Type
Drug
Intervention Name(s)
Baricitinib
Intervention Description
Participants will take one tablet of study drug per day for 48 weeks, and will be followed up for 48 weeks after study drug treatment has finished. Two-thirds of participants will receive Baricitinib.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Participants will take one tablet of study drug per day for 48 weeks, and will be followed up for 48 weeks after study drug treatment has finished. One-third of participants will receive Placebo.
Primary Outcome Measure Information:
Title
The primary endpoint of the study is the change from baseline of plasma C-peptide area under the curve (AUC) over 2 hours following a mixed meal.
Time Frame
Measured at 48 weeks post commencement of intervention.
Secondary Outcome Measure Information:
Title
Change from baseline in plasma C-peptide AUC over 2 hours following a mixed meal.
Time Frame
Measured at weeks 12, 24, 72 and 96 post commencement of intervention.
Title
Change from baseline in mean daily insulin use over 7 consecutive days.
Time Frame
Measured during the 2 weeks prior to the assessment at weeks 12, 24, 48, 72 and 96 post commencement of intervention.
Title
Change from baseline in glycosylated haemoglobin (HbA1c) levels.
Time Frame
Measured at weeks 12, 24, 48, 72 and 96 post commencement of intervention.
Title
Number of participants with responder status. Responder status is defined as glycosylated haemoglobin (HbA1c) less than or equal to 6.5 percent and mean daily insulin use less than 0.5 international units per kilogram per day (IU/kg/day).
Time Frame
Measured at weeks 12, 24, 48, 72 and 96 post commencement of intervention.
Title
Change in estimated C-peptide (CPEST) from baseline. CPEST is calculated based on six variable routine measures: disease duration, BMI, insulin dose, HbA1c, fasting plasma C-peptide and fasting plasma glucose.
Time Frame
Measured at weeks 12, 24, 48, 72 and 96 post commencement of intervention.
Title
Continuous glucose monitoring (CGM).
Time Frame
Measured at baseline, 12, 24, 48 and 96 weeks post commencement of intervention.
Title
The composite outcome assessing both the frequency, and when relevant, the severity of all adverse events.
Time Frame
Adverse events will be monitored throughout the entire study duration at weeks 0, 2, 4, 8, 12, 16, 20, 24, 36, 48, 72 and 96.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
10 Years
Maximum Age & Unit of Time
30 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female aged between 10 and 30 years (inclusive) at screening; Diagnosis of T1D according to ADA criteria within 100 days prior to starting study drug; Islet autoantibody positivity (one or more of: GADA, IA-2A, IAA (assessed within one week of commencing insulin therapy), ZnT8A); Stimulated (peak or 90 min) C-peptide >0.2 nM during a 2-hour MMTT at the screening visit; or random C-peptide result >0.3 nM during the screening period. Participants of childbearing age who are sexually active must agree to use of effective birth control until the end of the study; Be able to read, understand and give written informed consent; Be willing to comply with intensive diabetes management. Exclusion Criteria: Use of immunosuppressive or immunomodulatory therapies other than inhaled or topical glucocorticoids; Current or past history of deep vein thrombosis or pulmonary embolism; Impaired renal function defined by estimated glomerular filtration rate (according to the CKD-EPI) of < 60 mL/min/1.73 m2; LDL cholesterol >4mmol/l; Elevated liver function tests at screening: Aspartate aminotransferase 2x ULN Alanine aminotransferase 2 x ULN; Clinically significant abnormal laboratory parameters at screening including but not limited to: Hemoglobin < 8 g/L; White blood cells <2500 cells/µl; Lymphocyte count <750 cells/µl; Platelets <50,000 cells/µl; Neutrophils <1200cells/µL; Known hypersensitivity to baricitinib; Known malignancy with the exception of successfully treated non- metastatic basal cell and squamous cell carcinoma; Pregnancy, a desire for pregnancy, breast feeding, or a desire to father a child during the study; Patients with current or recent (within 12 weeks of screening) clinically significant comorbidity, including clinically serious viral, bacterial, fungal, or parasitic infection. Viral infections include HBV, HCV, EBV, HIV, recent herpes zoster and TB; Treatment with any investigational product within 30 days or 5 half - lives (whichever is longer) prior to baseline visit, or concurrent participation in a clinical trial with an investigational product or device; Experienced any of the following within 12 weeks of screening: myocardial infarction, unstable ischemic heart disease, stroke, or New York Heart Association Stage IV heart failure; Any serious medical condition within the previous 4 weeks which places the participant at an unacceptable risk if he or she were to participate in the study or confounds the ability to interpret data from the study, including, but not limited to, symptomatic cardiovascular, renal, respiratory, hepatic, gastrointestinal, endocrine, haematological and neurological conditions or psychiatric illness/social situations that would limit compliance with study requirements; Have had any major surgery within 8 weeks prior to screening or will require major surgery during the study that, in the opinion of the investigator would pose an unacceptable risk to the participant; History of chronic alcohol abuse or IV drug abuse or other illicit drug abuse within 2 years prior to screening.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Tom Kay, Prof
Organizational Affiliation
SVI
Official's Role
Principal Investigator
Facility Information:
Facility Name
Women's and Children's Hospital Adelaide
City
North Adelaide
State/Province
South Australia
ZIP/Postal Code
5006
Country
Australia
Facility Name
St Vincent's Hospital Melbourne
City
Fitzroy
State/Province
Victoria
ZIP/Postal Code
3065
Country
Australia
Facility Name
Royal Melbourne Hospital
City
Parkville
State/Province
Victoria
ZIP/Postal Code
3050
Country
Australia
Facility Name
Royal Children's Hospital Melbourne
City
Parkville
State/Province
Victoria
ZIP/Postal Code
3052
Country
Australia

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
All of the individual participant data collected during the trial, after de-identification.
IPD Sharing Time Frame
Immediately following publication, and for at least 15 years after the end of the study.
IPD Sharing Access Criteria
The data will be made available on a case-by-case basis at the discretion of primary sponsor and only to researchers who have obtained ethical approval to access it. Access is subject to approvals by the Principal Investigator, Prof Thomas Kay. Enquiries should be directed to tkay@svi.edu.au.
Citations:
PubMed Identifier
35606820
Citation
Waibel M, Thomas HE, Wentworth JM, Couper JJ, MacIsaac RJ, Cameron FJ, So M, Krishnamurthy B, Doyle MC, Kay TW. Investigating the efficacy of baricitinib in new onset type 1 diabetes mellitus (BANDIT)-study protocol for a phase 2, randomized, placebo controlled trial. Trials. 2022 May 23;23(1):433. doi: 10.1186/s13063-022-06356-z.
Results Reference
derived
Links:
URL
https://www.svi.edu.au/research/collaborative-programs/type-1-diabetes-clinical-trial/
Description
Trial website

Learn more about this trial

Baricitinib in New-onset Type 1 Diabetes

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