Study of Growth Hormone Inhibition Using Pegvisomant in Severe Insulin Resistance
Primary Purpose
Insulin Receptor Mutation, Partial Lipodystrophy
Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Pegvisomant
Sponsored by
About this trial
This is an interventional treatment trial for Insulin Receptor Mutation focused on measuring Pegvisomant, Severe Insulin Resistance, Growth Hormone Inhibition, LIPOLYSIS
Eligibility Criteria
- INCLUSION CRITERIA
To be eligible to participate in this study, an individual must meet all the following criteria:
Either
- Known pathogenic variant in the insulin receptor gene, either dominant negative or recessive, OR
- Clinical diagnosis of partial lipodystrophy based on reduction in adipose tissue outside the normal range in selected adipose depots (including, at a minimum, the gluteofemoral depot) with preservation of adipose tissue in other depots.
- Male or female, aged 18-65 years.
- Completed linear growth and puberty.
EXCLUSION CRITERIA
An individual who meets any of the following criteria will be excluded from participation in this study:
- Use of niacin or other drugs that directly affect lipolysis within 8 weeks prior to enrollment.
- Patients taking anticoagulants (blood thinning medications).
- Use of non-steroidal anti-inflammatory medications (e.g., aspirin, ibuprofen) 2 weeks prior to the biopsy date (in patients who choose to undergo biopsy).
- Changes in medications for diabetes or dyslipidemia within 2 weeks prior to enrollment.
- In subjects with partial lipodystrophy only, use of insulin within 2 weeks prior to enrollment.
- Pregnancy or lactation.
- For females of reproductive potential: inability or unwillingness to use contraception during study participation and for an additional 1 month after the end of pegvisomant administration.
- For males of reproductive potential: inability or unwillingness to use condoms or other methods to ensure effective contraception with partner during the study and for an additional 1 month after the end of pegvisomant administration.
- Known allergic reactions pegvisomant or any of its components.
Clinically significant liver disease, evidenced by any of the following:
- ALT or AST >3 times the upper limit of normal at screening.
- Current known liver disease other than steatohepatitis (e.g., autoimmune or viral hepatitis).
- History of cirrhosis
- Triglycerides >1500 mg/dL (non-fasting) or >1000 mg/dL (fasting) at screening.
- Hemoglobin A1c >10% at screening.
- Any other medical condition or medication that, in the judgement of the investigator, will increase risk to the subject or impede the measurement of study outcomes.
- Inability of subject to understand or the unwillingness to sign a written informed consent document.
Sites / Locations
- National Institutes of Health Clinical CenterRecruiting
Arms of the Study
Arm 1
Arm Type
Other
Arm Label
1
Arm Description
open label pegvisomant
Outcomes
Primary Outcome Measures
Glycerol rate of appearance (Ra) normalized to fat mass, Palmitate Ra normalized to fat mass
Estimate the magnitude and variability of the effect of pegvisomant, 30 mg subcutaneously once daily for 1 month, on adipose tissue lipolysis rate in subjects with pathogenic variants in the insulin receptor and partial lipodystrophy.
Secondary Outcome Measures
Full Information
NCT ID
NCT05470504
First Posted
July 16, 2022
Last Updated
September 8, 2023
Sponsor
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
1. Study Identification
Unique Protocol Identification Number
NCT05470504
Brief Title
Study of Growth Hormone Inhibition Using Pegvisomant in Severe Insulin Resistance
Official Title
Phase II Study of Growth Hormone Inhibition Using Pegvisomant In Severe Insulin Resistance
Study Type
Interventional
2. Study Status
Record Verification Date
September 7, 2023
Overall Recruitment Status
Recruiting
Study Start Date
January 23, 2023 (Actual)
Primary Completion Date
January 30, 2025 (Anticipated)
Study Completion Date
January 30, 2025 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
5. Study Description
Brief Summary
Background:
Lipodystrophy (LD) syndromes are a group of rare disorders that affect how a person s body can store and use fat tissue. Many people with LDs become severely insulin resistant. Some people are insulin resistant because of a variant in the insulin receptor gene. Insulin resistance causes many health problems.
Objective:
To learn if blocking the effects of growth hormone in the body will help people with severe insulin resistance.
Eligibility:
Adults aged 18 to 65 years with either a known variant in the insulin receptor gene or with a diagnosis of partial LD.
Design:
Participants will have 2 hospital stays, about 1 month apart. Each stay will be 3 or 4 nights.
During each hospital stay, participants will have many tests. They will have a physical exam with blood tests. They will have all of their urine collected for a 24-hour period. They will have scans to measure their muscle, bone, and fat tissues. They will have tests to measure metabolism and insulin sensitivity. They may have an optional biopsy of fat tissue.
During the first hospital visit, participants will learn how to give themselves shots of a drug (pegvisomant) that blocks growth hormone. The drug is injected under the skin. Participants will continue to give themselves these shots once a day at home.
After the first hospital visit, participants will talk on the phone with members of the study team once each week. After 2 weeks they will have blood drawn for tests.
Participants will stop the shots after the second hospital visit.
Detailed Description
STUDY DESCRIPTION
The role of growth hormone (GH) in mediating pathological consequences of inadequate lipid storage will be studied in rare patient populations with high lipolysis and severe metabolic syndrome. Specifically, patients with partial lipodystrophy and pathogenic variants in the insulin receptor gene (INSR) will be studied before and after 1 month of administration of pegvisomant (a GH receptor blocker).
OBJECTIVES
Primary Objective:
Establish proof of concept that GH blockade reduces adipose tissue lipolysis in humans with severe insulin resistance.
Secondary Objectives:
Determine the effects of pegvisomant on lipolytic products and IGF-1.
ENDPOINTS
Primary Endpoint:
Adipose tissue lipolysis measured by glycerol and palmitate rates of appearance using stable isotope tracers.
Secondary Endpoints:
Free fatty acids (FFA), glycerol, IGF-1.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Insulin Receptor Mutation, Partial Lipodystrophy
Keywords
Pegvisomant, Severe Insulin Resistance, Growth Hormone Inhibition, LIPOLYSIS
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
25 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
1
Arm Type
Other
Arm Description
open label pegvisomant
Intervention Type
Drug
Intervention Name(s)
Pegvisomant
Intervention Description
30 mg subcutaneously every day for 4 weeks.
Primary Outcome Measure Information:
Title
Glycerol rate of appearance (Ra) normalized to fat mass, Palmitate Ra normalized to fat mass
Description
Estimate the magnitude and variability of the effect of pegvisomant, 30 mg subcutaneously once daily for 1 month, on adipose tissue lipolysis rate in subjects with pathogenic variants in the insulin receptor and partial lipodystrophy.
Time Frame
1 month
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA:
To be eligible to participate in this study, an individual must meet all the following criteria:
Either
Known pathogenic variant in the insulin receptor gene, either dominant negative or recessive, OR
Clinical diagnosis of partial lipodystrophy based on reduction in adipose tissue outside the normal range in selected adipose depots (including, at a minimum, the gluteofemoral depot) with preservation of adipose tissue in other depots.
Male or female, aged 18-65 years.
Completed linear growth and puberty.
EXCLUSION CRITERIA:
An individual who meets any of the following criteria will be excluded from participation in this study:
Use of niacin or other drugs that directly affect lipolysis within 8 weeks prior to enrollment.
Patients taking anticoagulants (blood thinning medications).
Use of non-steroidal anti-inflammatory medications (e.g., aspirin, ibuprofen) 2 weeks prior to the biopsy date (in patients who choose to undergo biopsy).
Changes in medications for diabetes or dyslipidemia within 2 weeks prior to enrollment.
Pregnancy or lactation.
For females of reproductive potential: inability or unwillingness to use contraception during study participation and for an additional 1 month after the end of pegvisomant administration.
For males of reproductive potential: inability or unwillingness to use condoms or other methods to ensure effective contraception with partner during the study and for an additional 1 month after the end of pegvisomant administration.
Known allergic reactions pegvisomant or any of its components.
Clinically significant liver disease, evidenced by any of the following:
ALT or AST >3 times the upper limit of normal at screening.
Current known liver disease other than steatohepatitis (e.g., autoimmune or viral hepatitis).
History of cirrhosis
Triglycerides >1500 mg/dL (non-fasting) or >1000 mg/dL (fasting) at screening.
In subjects with partial lipodystrophy only, Hemoglobin A1c >10% at screening.
Any other medical condition or medication that, in the judgement of the investigator, will increase risk to the subject or impede the measurement of study outcomes.
Inability of subject to understand or the unwillingness to sign a written informed consent document.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Megan S Startzell, R.N.
Phone
(301) 402-6371
Email
megan.startzell@nih.gov
First Name & Middle Initial & Last Name or Official Title & Degree
Rebecca J Brown, M.D.
Phone
(301) 594-0609
Email
brownrebecca@mail.nih.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rebecca J Brown, M.D.
Organizational Affiliation
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
For more information at the NIH Clinical Center contact Office of Patient Recruitment (OPR)
Phone
800-411-1222
Ext
TTY dial 711
Email
ccopr@nih.gov
12. IPD Sharing Statement
Plan to Share IPD
No
IPD Sharing Plan Description
.Result of the study will be disseminated to participants upon publication.
Links:
URL
https://clinicalstudies.info.nih.gov/cgi/detail.cgi?A_000756-DK.html
Description
NIH Clinical Center Detailed Web Page
Learn more about this trial
Study of Growth Hormone Inhibition Using Pegvisomant in Severe Insulin Resistance
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