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Afrezza® Dosing Optimization Study (DOS)

Primary Purpose

Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Afrezza Dose 1
Afrezza Dose 2
Sponsored by
Mannkind Corporation
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes Mellitus, Type 1 focused on measuring Afrezza, Dosing, Technosphere, Inhaled, Insulin, Diabetes

Eligibility Criteria

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

Subjects will be asked to provide a recent negative COVID-19 test (if available), confirm they have no symptoms of COVID-19, or provide evidence of COVID-19 vaccination.

Inclusion Criteria:

  1. Subjects ≥18 years of age at the time of signing the informed consent form
  2. Clinical diagnosis of T1DM or T2DM (per the Investigator) and on a stable basal-bolus insulin regimen

Exclusion Criteria:

  1. History of asthma, chronic obstructive pulmonary disease, or any other clinically important pulmonary disease (e.g., cystic fibrosis, bronchopulmonary dysplasia), use of any medications to treat such conditions within the last year, or significant congenital or acquired cardiopulmonary disease
  2. History of serious complications of diabetes (e.g., active proliferative retinopathy or symptomatic autonomic neuropathy)
  3. On dialysis
  4. Respiratory tract infection within 14 days before screening (subject may return 14 days after resolution of symptoms for rescreening)
  5. Treatment with any investigational drug in the past 30 days or an investigational device in the past 2 weeks
  6. Any disease other than diabetes or initiation of any new medication that, in the judgment of the Investigator, could have a direct impact on glycemic control during the study
  7. Use of antiadrenergic drugs (e.g., beta blockers and clonidine)
  8. Any concurrent illness (other than diabetes mellitus) not controlled by a stable therapeutic regimen
  9. History of a significant eating disorder (e.g., anorexia or bulimia nervosa)
  10. Current drug or alcohol abuse or a history of drug or alcohol abuse that, in the opinion of the Investigator or the Sponsor, would make the subject an unsuitable candidate for participation in the study
  11. History of smoking (includes cigarettes, cigars, pipes, vaping devices, and marijuana) in the 6 months before screening
  12. Female subject who is pregnant, breastfeeding, intends to become pregnant, or is of child-bearing potential and not using adequate contraceptive methods as required by local regulation or practice (may include sexual abstinence)
  13. An event of severe hypoglycemia, as judged by the Investigator, within the 90 days before screening
  14. An episode of diabetic ketoacidosis (DKA) requiring hospitalization within the 90 days before screening
  15. Exposure to Afrezza in the 30 days before screening

Sites / Locations

  • AMCR Institute
  • Diablo Clinical Research

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Afrezza

Arm Description

The test product is defined as Afrezza [insulin human] inhalation powder administered using the Afrezza inhaler. In addition, subjects will take their personal basal insulin while enrolled in the study.

Outcomes

Primary Outcome Measures

Post-prandial Glucose Excursion
Mean glucose change from baseline (or postprandial glucose excursion [PPGE]) based on self-monitored blood glucose (SMBG) at 15, 30, 45, 60, 90 and 120 minutes after the dose of Afrezza with baseline defined as SMBG at the time of the dose of Afrezza (t=0)

Secondary Outcome Measures

Number of Subjects With at Least 1 Event of Level 1 Hypoglycemia
Number of subjects with at least 1 event (also referred to as incidence) of Level 1 hypoglycemia (<70mg/dL) within the 120 minutes after Afrezza dosing as confirmed by SMBG.
Percent of Level 1 Hypoglycemia
Percent of total SMBG measurements <70 mg/dL (Level 1 hypoglycemia) within the 120 minutes after Afrezza dosing.
Number of Subjects With at Least 1 Event of Level 2 Hypoglycemia
Number of subjects with at least 1 event (also referred to as incidence) of Level 2 hypoglycemia (<54mg/dL) within the 120 minutes after Afrezza dosing as confirmed by SMBG.
Percent of Level 2 Hypoglycemia
Percent of total SMBG measurements <54 mg/dL (Level 2 hypoglycemia) within the 120 minutes after Afrezza dosing
Number of Subjects With At Least 1 Event of Severe Hypoglycemia
Number of subjects with at least 1 event (also referred to as incidence) of severe hypoglycemia, defined as events requiring assistance of another person to actively administer carbohydrate, glucagon, or other resuscitative actions within the 120 minutes after Afrezza dosing.
Change in Percent Predicted Forced Expiratory Volume in 1 Second (FEV1) Between Two Points, Baseline and 120 Minutes Post-Afrezza Dose
Change in percent predicted forced expiratory volume in 1 second (FEV1) between two points (value at 120 minutes post-Afrezza dose minus value at baseline). Standard deviation was not reported.

Full Information

First Posted
April 16, 2021
Last Updated
September 14, 2023
Sponsor
Mannkind Corporation
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1. Study Identification

Unique Protocol Identification Number
NCT04849845
Brief Title
Afrezza® Dosing Optimization Study
Acronym
DOS
Official Title
DOS [Dosing Optimization Study]: Open-label, Single-arm, Proof-of-Concept Dosing Study of Afrezza® in Adult Subjects 18 Years and Older With Type 1 or Type 2 Diabetes Mellitus
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Completed
Study Start Date
April 9, 2021 (Actual)
Primary Completion Date
May 28, 2021 (Actual)
Study Completion Date
May 28, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Mannkind Corporation

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
MKC-TI-191 is a Phase 4, single-arm, multicenter, proof-of-concept clinical trial evaluating the efficacy and safety of Afrezza, administered according to the current Afrezza prescribing information (PI) compared to a titrated dose, in combination with a basal insulin in adult subjects (≥18 years of age) with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM). Eligible subjects will be on a stable regimen consisting of a basal bolus insulin therapy prior to screening. The study is composed of up to 4 clinic visits (screening, 2 treatment visits, and a follow-up visit). Two individual doses of Afrezza will be administered during a meal challenge at Visits 2 and 3. The duration of each subject's participation in the trial is expected to be approximately 2 weeks.
Detailed Description
Screening (Visit 1): Informed consent and California Experimental Subjects Bill of Rights will be signed and eligibility confirmed. Eligible subjects will be enrolled at Visit 1. Subjects will come into the clinic in a fasting state for a meal challenge and individual dose of Afrezza during Visits 2 and 3. At the beginning of each visit, before their dose of Afrezza, subjects will have FEV1 measurements taken in the clinic. Each meal challenge will consist of 1 to 2 bottles of nutritional shake to be fully consumed within 15 minutes. The nutritional shake will contain approximately 240 calories, 41 g carbohydrate, 10 g protein, and 4 g fat per bottle. Each Afrezza dose will be administered at the start of the meal challenge. Visit 2: The first dose of Afrezza will be based on the dose of subcutaneous (SC) rapid-acting analogue (RAA) insulin that the subject would normally take, converted according to the guidelines provided in the current Afrezza prescribing information. If subject's normal RAA dose is <4 units or 5 units, subject will be asked to consume enough nutritional shake, per their normal I:C ratio, to cover an RAA dose of 4 units or ≥6 units such that their Afrezza dose at Visit 3 is higher than the dose taken at Visit 2. After completing the standardized meal challenge, the Investigator will decide, based on the subject's glucose excursion at Visit 2, if the subject should proceed to Visit 3 where a second dose of Afrezza will be administered. Visit 3: The second dose of Afrezza will be based on the dose of SC RAA that the subject would normally take, converted by multiplying their RAA dose by 2 and rounding down to the nearest Afrezza cartridge size. Follow-up Visit (Visit 4): Subjects will return for safety assessments, including a final FEV1 measurement, 24 to 72 hours after their last dose of Afrezza.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2
Keywords
Afrezza, Dosing, Technosphere, Inhaled, Insulin, Diabetes

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Afrezza
Arm Type
Experimental
Arm Description
The test product is defined as Afrezza [insulin human] inhalation powder administered using the Afrezza inhaler. In addition, subjects will take their personal basal insulin while enrolled in the study.
Intervention Type
Combination Product
Intervention Name(s)
Afrezza Dose 1
Intervention Description
The first dose of Afrezza will be based on the dose of subcutaneous rapid-acting analogue (RAA) insulin that the subject would normally take for the standardized meal, converted according to the guidelines provided in the current Afrezza U.S. prescribing information.
Intervention Type
Combination Product
Intervention Name(s)
Afrezza Dose 2
Intervention Description
The second dose of Afrezza will be based on the dose of subcutaneous rapid-acting analogue that the subject would normally take for the standardized meal, converted by multiplying their RAA dose by 2 and rounding down to the nearest Afrezza cartridge size.
Primary Outcome Measure Information:
Title
Post-prandial Glucose Excursion
Description
Mean glucose change from baseline (or postprandial glucose excursion [PPGE]) based on self-monitored blood glucose (SMBG) at 15, 30, 45, 60, 90 and 120 minutes after the dose of Afrezza with baseline defined as SMBG at the time of the dose of Afrezza (t=0)
Time Frame
120 minutes post-dose
Secondary Outcome Measure Information:
Title
Number of Subjects With at Least 1 Event of Level 1 Hypoglycemia
Description
Number of subjects with at least 1 event (also referred to as incidence) of Level 1 hypoglycemia (<70mg/dL) within the 120 minutes after Afrezza dosing as confirmed by SMBG.
Time Frame
120 minutes
Title
Percent of Level 1 Hypoglycemia
Description
Percent of total SMBG measurements <70 mg/dL (Level 1 hypoglycemia) within the 120 minutes after Afrezza dosing.
Time Frame
120 minutes
Title
Number of Subjects With at Least 1 Event of Level 2 Hypoglycemia
Description
Number of subjects with at least 1 event (also referred to as incidence) of Level 2 hypoglycemia (<54mg/dL) within the 120 minutes after Afrezza dosing as confirmed by SMBG.
Time Frame
120 minutes
Title
Percent of Level 2 Hypoglycemia
Description
Percent of total SMBG measurements <54 mg/dL (Level 2 hypoglycemia) within the 120 minutes after Afrezza dosing
Time Frame
120 minutes
Title
Number of Subjects With At Least 1 Event of Severe Hypoglycemia
Description
Number of subjects with at least 1 event (also referred to as incidence) of severe hypoglycemia, defined as events requiring assistance of another person to actively administer carbohydrate, glucagon, or other resuscitative actions within the 120 minutes after Afrezza dosing.
Time Frame
120 minutes
Title
Change in Percent Predicted Forced Expiratory Volume in 1 Second (FEV1) Between Two Points, Baseline and 120 Minutes Post-Afrezza Dose
Description
Change in percent predicted forced expiratory volume in 1 second (FEV1) between two points (value at 120 minutes post-Afrezza dose minus value at baseline). Standard deviation was not reported.
Time Frame
120 minutes post-dose

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Subjects will be asked to provide a recent negative COVID-19 test (if available), confirm they have no symptoms of COVID-19, or provide evidence of COVID-19 vaccination. Inclusion Criteria: Subjects ≥18 years of age at the time of signing the informed consent form Clinical diagnosis of T1DM or T2DM (per the Investigator) and on a stable basal-bolus insulin regimen Exclusion Criteria: History of asthma, chronic obstructive pulmonary disease, or any other clinically important pulmonary disease (e.g., cystic fibrosis, bronchopulmonary dysplasia), use of any medications to treat such conditions within the last year, or significant congenital or acquired cardiopulmonary disease History of serious complications of diabetes (e.g., active proliferative retinopathy or symptomatic autonomic neuropathy) On dialysis Respiratory tract infection within 14 days before screening (subject may return 14 days after resolution of symptoms for rescreening) Treatment with any investigational drug in the past 30 days or an investigational device in the past 2 weeks Any disease other than diabetes or initiation of any new medication that, in the judgment of the Investigator, could have a direct impact on glycemic control during the study Use of antiadrenergic drugs (e.g., beta blockers and clonidine) Any concurrent illness (other than diabetes mellitus) not controlled by a stable therapeutic regimen History of a significant eating disorder (e.g., anorexia or bulimia nervosa) Current drug or alcohol abuse or a history of drug or alcohol abuse that, in the opinion of the Investigator or the Sponsor, would make the subject an unsuitable candidate for participation in the study History of smoking (includes cigarettes, cigars, pipes, vaping devices, and marijuana) in the 6 months before screening Female subject who is pregnant, breastfeeding, intends to become pregnant, or is of child-bearing potential and not using adequate contraceptive methods as required by local regulation or practice (may include sexual abstinence) An event of severe hypoglycemia, as judged by the Investigator, within the 90 days before screening An episode of diabetic ketoacidosis (DKA) requiring hospitalization within the 90 days before screening Exposure to Afrezza in the 30 days before screening
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kevin Kaiserman, MD
Organizational Affiliation
Mannkind Corporation
Official's Role
Study Director
Facility Information:
Facility Name
AMCR Institute
City
Escondido
State/Province
California
ZIP/Postal Code
92025
Country
United States
Facility Name
Diablo Clinical Research
City
Walnut Creek
State/Province
California
ZIP/Postal Code
94598
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Afrezza® Dosing Optimization Study

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