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Effects of Sitagliptin in Relatives of T1D Patients (SITA-one)

Primary Purpose

Type 1 Diabetes

Status
Not yet recruiting
Phase
Phase 2
Locations
Italy
Study Type
Interventional
Intervention
Sitagliptin
Professional CGM
Sponsored by
University of Milan
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Type 1 Diabetes focused on measuring Sitagliptin

Eligibility Criteria

10 Years - 45 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Age of the subject between 10 and 45 years
  • Subject (or legal guardian in the case of a minor) is able to provide informed consent
  • If a first degree relative of the proband with T1D must be between 6 and 45 years old (brother, sister, parent, child)
  • If a relative of the proband with T1D is second degree, he must be between 6 and 20 years old (nephew, uncle, aunt, grandfather, grandmother, cousin)
  • Presence of at least two autoantibodies associated with diabetes
  • Impaired glucose tolerance on the OGTT test (fasting glucose greater than 110 mg/dl but less than 126 mg/dl or 2-hour glucose greater than or equal to 140 mg/dl but less than 200 mg/dl or 'OGTT at 30', 60 ', 90' greater than or equal to 200 mg/dl)
  • If the subject is a female with reproductive potential, she must have a negative pregnancy test at the enrollment visit and must agree not to seek pregnancy for at least one year from randomization
  • If the subject is male, he must agree not to seek pregnancies with any partner for at least one year from the randomization
  • The subject must agree to renounce other types of trials during this study
  • Weight at the time of recruitment of at least 26 kg
  • It must be favorable and clinically acceptable to postpone vaccinations with live and attenuated agents for at least one year after treatment

Exclusion Criteria:

  • Type 1 Diabetes Mellitus previously diagnosed or diagnosed during screening investigations
  • Serological evidence of current or past HIV, Hepatitis C, Hepatitis B
  • Changes in blood counts, INR or liver enzymes
  • Being pregnant or breastfeeding
  • Evidence of pancreatic changes in the laboratory
  • Having undergone a previous experimental treatment for Type 1 Diabetes Mellitus
  • Chronic Renal Failure stage IIIa onwards (eGFR <45 ml / min / 1.7 m2)
  • History of previous pancreatitis
  • Lymphopenia (<1000 lymphocytes / µL)
  • Neutropenia (<1500 PMN / µL)
  • Thrombocytopenia (<150,000 platelets / µL)
  • Anemia (Hgb <10 grams / deciliter [g / dL])
  • AST or ALT> 1.5 x ULN
  • Total bilirubin> 1.5 x upper limit of normal (ULN) with the exception of subjects diagnosed with Gilbert's syndrome who may be eligible provided they have no other cause leading to hyperbilirubinemia
  • INR> 0.1 above the upper limit of the norm at the laboratory of the participating center
  • Alterations of Amylase and Lipase due to the pancreas
  • Chronic active infection other than localized skin infections
  • A positive PPD test
  • Vaccination with a live virus within 8 weeks of randomization
  • Vaccination with a killed virus within 4 weeks of randomization
  • Laboratory or clinical evidence of acute EBV or CMV infection
  • Serological evidence of current or past HIV, hepatitis B or hepatitis C infection
  • Being currently pregnant or breastfeeding, or planning to become pregnant
  • Chronic use of steroids or other immunosuppressive agents
  • A history of asthma or atopic disease that requires chronic treatment
  • Untreated hypothyroidism or active Graves' disease at randomization
  • Current use of non-insulin drugs that affect glycemic control
  • Previous OKT®3 or other anti-CD3 treatment
  • Administration of a monoclonal antibody within the year prior to randomization
  • Participation in any type of clinical trial of therapeutic drugs or vaccines in the 12 weeks prior to randomization
  • Any conditions that, in the opinion of the investigator, could interfere with the conduct of the study or with the safety of the subject.

Sites / Locations

  • ASST FBF Sacco

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Treatment group

Control group

Arm Description

Sitagliptin

Placebo

Outcomes

Primary Outcome Measures

Rate of new diagnoses of Type 1 Diabetes Mellitus per year

Secondary Outcome Measures

Number of participants with adverse effects on Sitagliptin

Full Information

First Posted
January 20, 2022
Last Updated
May 9, 2023
Sponsor
University of Milan
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1. Study Identification

Unique Protocol Identification Number
NCT05219409
Brief Title
Effects of Sitagliptin in Relatives of T1D Patients
Acronym
SITA-one
Official Title
Effects of Sitagliptin in Relatives of Patients With Type 1 Diabetes Mellitus, at High Risk of Developing the Disease
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
July 2023 (Anticipated)
Primary Completion Date
December 2025 (Anticipated)
Study Completion Date
December 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Milan

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.
Yes

5. Study Description

Brief Summary
Type 1 Diabetes (T1D) is a chronic autoimmune disease, with a genetic background, resulting from the immune-mediated destruction of beta cells of the pancreas. It can lead to fatal short-term and long-term complications, especially if it is diagnosed late. Three stages of the disease can be identified: Stage 1 is defined by the presence of two or more anti-islet autoantibodies (GAD65, ICA, IA-2, ZnT8) with normoglycemia, Stage 2 shows progression to dysglycemia (impaired glucose tolerance) in the setting of two or more anti-islet autoantibodies, Stage 3 occurs when a patient meets ADA criteria for the diagnosis of diabetes. It's been demonstrated that Teplizumab (an Fc receptor nonbinding anti-CD3 monoclonal antibody) delays the transition from pre-symptomatic T1D (stage 2) to overt T1D (stage 3). Also Sitagliptin, a DPP4 inhibitor, has been proved effective in inhibiting inflammation in T1D both in vitro in T1D mice, and in vivo in Latent autoimmune diabetes in adults (LADA) patients. Furthermore, it has been confirmed that Sitagliptin reduces the prevalence of worse forms of acute GVHD after myeloablative allogeneic hematopoietic stem-cell transplantation. The study aims to investigate if Sitagliptin can have a delaying effect on progression to overt T1D, on the account of its anti-inflammatory properties. The cohort is made of screened relatives of T1D patients, who are classified as high-risk of developing T1D. Screening relatives of T1D patients for dysglycemia and anti-islet autoantibodies. Selecting the patients in Stage 2 Pre-symptomatic T1D (dysglycemia and at least two types of autoantibodies) and then beginning therapy with Sitagliptin, while monitoring their glucose metabolism with a Continuous Glucose Monitoring (CGM) system.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2, Phase 3
Interventional Study Model
Parallel Assignment
Model Description
A randomized controlled open label intervention study is proposed. Relatives of patients with type 1 diabetes in stage 2 will be included in the study and divided into two groups by randomization: sitagliptin add-on therapy vs placebo(group of control)
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
70 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment group
Arm Type
Active Comparator
Arm Description
Sitagliptin
Arm Title
Control group
Arm Type
Placebo Comparator
Arm Description
Placebo
Intervention Type
Drug
Intervention Name(s)
Sitagliptin
Intervention Description
The dose of sitagliptin will be established on the basis of the estimated glomerular filtrate: 100 mg in single daily administration (estimated glomerular filtration rate less than or equal to 45 mL / min / 1.73 m2) or 50 mg (estimated glomerular filtration rate 30-45 mL / min / 1.73 m2)
Intervention Type
Device
Intervention Name(s)
Professional CGM
Intervention Description
The sensor records the patient's glucose readings every 15 minutes for up to 14 days.
Primary Outcome Measure Information:
Title
Rate of new diagnoses of Type 1 Diabetes Mellitus per year
Time Frame
3 years
Secondary Outcome Measure Information:
Title
Number of participants with adverse effects on Sitagliptin
Time Frame
3 years
Other Pre-specified Outcome Measures:
Title
To study the effects of Sitagliptin on metabolic markers (C-peptide, OGTT, Insulin) over time up to the diagnosis of diabetes
Time Frame
3 years
Title
To study the prevalence of T1D, T1D-related Auto-antibodies and Dysglycemia in relatives of T1D patients
Time Frame
3 years
Title
Monitor Stage 2 patients with a CGM system (continuous blood glucose detection)
Time Frame
3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
10 Years
Maximum Age & Unit of Time
45 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age of the subject between 10 and 45 years Subject (or legal guardian in the case of a minor) is able to provide informed consent If a first degree relative of the proband with T1D must be between 6 and 45 years old (brother, sister, parent, child) If a relative of the proband with T1D is second degree, he must be between 6 and 20 years old (nephew, uncle, aunt, grandfather, grandmother, cousin) Presence of at least two autoantibodies associated with diabetes Impaired glucose tolerance on the OGTT test (fasting glucose greater than 110 mg/dl but less than 126 mg/dl or 2-hour glucose greater than or equal to 140 mg/dl but less than 200 mg/dl or 'OGTT at 30', 60 ', 90' greater than or equal to 200 mg/dl) If the subject is a female with reproductive potential, she must have a negative pregnancy test at the enrollment visit and must agree not to seek pregnancy for at least one year from randomization If the subject is male, he must agree not to seek pregnancies with any partner for at least one year from the randomization The subject must agree to renounce other types of trials during this study Weight at the time of recruitment of at least 26 kg It must be favorable and clinically acceptable to postpone vaccinations with live and attenuated agents for at least one year after treatment Exclusion Criteria: Type 1 Diabetes Mellitus previously diagnosed or diagnosed during screening investigations Serological evidence of current or past HIV, Hepatitis C, Hepatitis B Changes in blood counts, INR or liver enzymes Being pregnant or breastfeeding Evidence of pancreatic changes in the laboratory Having undergone a previous experimental treatment for Type 1 Diabetes Mellitus Chronic Renal Failure stage IIIa onwards (eGFR <45 ml / min / 1.7 m2) History of previous pancreatitis Lymphopenia (<1000 lymphocytes / µL) Neutropenia (<1500 PMN / µL) Thrombocytopenia (<150,000 platelets / µL) Anemia (Hgb <10 grams / deciliter [g / dL]) AST or ALT> 1.5 x ULN Total bilirubin> 1.5 x upper limit of normal (ULN) with the exception of subjects diagnosed with Gilbert's syndrome who may be eligible provided they have no other cause leading to hyperbilirubinemia INR> 0.1 above the upper limit of the norm at the laboratory of the participating center Alterations of Amylase and Lipase due to the pancreas Chronic active infection other than localized skin infections A positive PPD test Vaccination with a live virus within 8 weeks of randomization Vaccination with a killed virus within 4 weeks of randomization Laboratory or clinical evidence of acute EBV or CMV infection Serological evidence of current or past HIV, hepatitis B or hepatitis C infection Being currently pregnant or breastfeeding, or planning to become pregnant Chronic use of steroids or other immunosuppressive agents A history of asthma or atopic disease that requires chronic treatment Untreated hypothyroidism or active Graves' disease at randomization Current use of non-insulin drugs that affect glycemic control Previous OKT®3 or other anti-CD3 treatment Administration of a monoclonal antibody within the year prior to randomization Participation in any type of clinical trial of therapeutic drugs or vaccines in the 12 weeks prior to randomization Any conditions that, in the opinion of the investigator, could interfere with the conduct of the study or with the safety of the subject.
Facility Information:
Facility Name
ASST FBF Sacco
City
Milan
ZIP/Postal Code
20157
Country
Italy

12. IPD Sharing Statement

Plan to Share IPD
No
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Links:
URL
https://www.niddk.nih.gov/about-niddk/strategic-plans-reports/diabetes-in-america-2nd-edition
Description
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Effects of Sitagliptin in Relatives of T1D Patients

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