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Pasireotide s.c. in Patients With Post-Bariatric Hypoglycaemia (PASIPHY)

Primary Purpose

Post-Bariatric Hypoglycemia

Status
Not yet recruiting
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Pasireotide Diaspartate
Sponsored by
RECORDATI GROUP
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Post-Bariatric Hypoglycemia

Eligibility Criteria

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

Inclusion Criteria: Male or- non-pregnant female patients ≥ 18 years of age Patients able to provide and have provided signed written informed consent prior to study participation. Patients capable of self-injecting subcutaneously. Specific training to self-inject the study drug will be provided. Post-bariatric surgery more than 6 months prior to screening Patient with a documented diagnosis of PBH defined as having: postprandial neuroglycopenia occurring >1 hour after meals no hypoglycaemia in fasting conditions documented history of Whipple's triad documented history of hypoglycaemia based on glucose value <50mg/dL or 2.8 mmol/L on a sporadic or scheduled blood analysis - OR - glucose value <60 mg/dL or 3.3 mmol/L at 90, 120, 150 or 180 min during an OGTT (oral glucose tolerance test) - OR- glucose value <54 mg/dL at 60, 90, 120 or 180 min during a 3-hour MMTT (mixed meal tolerance test) Patients must have at least one glucose level < 54 mg/dL at 30, 90, 120, 150 or 180 min during the 3-hour MMTT at screening Historical evidence of previous level 3 hypoglycaemia events at any time Patients who have failed diet recommended by the treating physician for the PBH Karnofsky Performance Status ≥ 60 (i.e., requires occasional assistance, but is able to care for most of their personal needs) Patients who received other therapies for PBH (such as acarbose, gama guar, pectin, diazoxide) must have stopped all treatments and allow a wash out period of at least 2 weeks prior to entering the run-in period. Patients who have been treated with GLP-1 antagonists in the past must have a wash-out period of at least 4 weeks before the start of the run-in period Patients who have been treated with SGLT2 inhibitors (glifozins) in the past must have a wash-out period of at least 4 weeks before the start of the run-in period Patients who have been treated with somatostatin receptor analogues in the past, must have an appropriate interval between the last administration of somatostatin receptor analogues treatment and the start of the run-in period as follows: Octreotide s.c. for ≥ 72 hours Octreotide LAR for ≥ 56 days (8 weeks) Lanreotide Autogel for ≥ 98 days (14 weeks) Lanreotide SR ≥ 28 days (4 weeks) Exclusion Criteria (main ones): Bariatric patients who have lap band. Patients with a current diagnosis of uncontrolled Diabetes Mellitus. However, diabetic patients in remission, as defined below, are eligible: With an HbA1c at screening <6.5% Not taking any medications for hyperglycaemia for at least 3 months prior to screening. Their qualifying Level 3 hypoglycaemia events (see above) must have occurred at least 1 month after the discontinuation of the glucose lowering agent(s). Patients previously treated with pasireotide at any time Patients who have a known hypersensitivity to somatostatin receptor analogues. Patients currently using medications that may interfere with glucose metabolism within 5 half-lives of drug. Patients with history of or current insulinoma Patients who have any severe and/or uncontrolled medical condition or other conditions that could affect their participation in the study (defined in the core text of the protocol) Patients with symptomatic cholelithiasis and/ or acute or chronic pancreatitis. Patients with abnormal coagulation (PT and PTT elevated by 30% above normal limits). Patients on continuous anticoagulation therapy. Patients who were on anticoagulant therapy must complete a washout period of at least 10 days and have confirmed normal coagulation parameters before study inclusion (patients receiving aspirin once a day are allowed to be enrolled). Patients who are hypothyroid and not on adequate replacement therapy. Patients who have undergone major surgery/surgical therapy for any cause within 1 month. Patients should have recovered from the surgery and be in good clinical condition before entering the study. Bradycardia and QT-related exclusion criteria (in the core text of the protocol) Participation in any clinical investigation within 4 weeks prior to dosing or longer if required by local regulation. (Use of an investigational drug within 1 month prior to dosing). Significant acute illness within the two weeks prior to dosing/randomization. Female patients who are pregnant, intending to become pregnant or breastfeed during the study or lactating, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive hCG laboratory test. Women of childbearing potential (WOCBP) who are unwilling of using highly effective contraception methods (definition in core protocol) Potentially unreliable or vulnerable patients (e.g., person kept in detention) and those judged by the investigator to be unsuitable for the study.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm 4

    Arm Type

    Experimental

    Experimental

    Experimental

    Placebo Comparator

    Arm Label

    Pasireotide s.c. 50 mcg

    Pasireotide 100 mcg

    Pasireotide 200 mcg

    Placebo

    Arm Description

    Pasireotide 50 mcg s.c. tid

    Pasireotide 100 mcg s.c. tid

    Pasireotide 200 mcg s.c. tid

    Placebo s.c. tid

    Outcomes

    Primary Outcome Measures

    Level 2 hypoglycaemic events (plasma glucose <54 mg/dL) during a 3-hour MMTT (mixed meal tolerance test)
    The response rate defined as the proportion of patients with no level 2 hypoglycaemic events (plasma glucose <54 mg/dL) at 90, 120, 150 and 180 min during a 3-hour MMTT after 12 weeks of treatment with pasireotide s.c. 50 µg, or 100 µg or 200 µg tid vs placebo tid respectively

    Secondary Outcome Measures

    Full Information

    First Posted
    June 23, 2023
    Last Updated
    July 7, 2023
    Sponsor
    RECORDATI GROUP
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05928390
    Brief Title
    Pasireotide s.c. in Patients With Post-Bariatric Hypoglycaemia
    Acronym
    PASIPHY
    Official Title
    A Double-blind Randomized Placebo-controlled Dose-finding Phase II Study to Assess the Efficacy and Safety of Pasireotide s.c. in Patients With Post-Bariatric Hypoglycaemia
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    October 2023 (Anticipated)
    Primary Completion Date
    April 2025 (Anticipated)
    Study Completion Date
    April 2026 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    RECORDATI GROUP

    4. Oversight

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

    5. Study Description

    Brief Summary
    The Total duration of trial participation for each participant with post-bariatric hypoglycemia will be a maximum of 59 weeks, with the following duration of trial periods 19 weeks for the Core Phase. It is composed of: a Screening period: a maximum of 3 weeks a Run-in period (no treatment): 4 weeks a Blinded Treatment Phase: 12 weeks 36 weeks Extension Phase = an open-label Treatment period 4 weeks for the safety follow-up period (without any treatment).
    Detailed Description
    Subjects with post-bariatric hypoglycemia will be screened for participation in this trial. Eligible patients will complete the rest of the Core phase by entering a run-in period of 4 weeks without any treatment. At the end of the run-in period, participants will be randomized to receive in a blinded manner either pasireotide 50 µg or pasireotide 100 µg or pasireotide 200 µg or Placebo subcutaneously three times a day (prior to each meal). Participants will blindly self-administer their treatment for a total of 12 weeks when the primary endpoint will be assessed. All participants completing the core phase will be offered to enter the extension phase. Participants will openly self-administer pasireotide 50 µg or pasireotide 100 µg or pasireotide 200 µg subcutaneously three times a day for a total of 36 weeks of treatment. There will be no more placebo during this extension phase of treatment. Dose changes/adjustments will be possible only during the extension phase and the decision to change the dose of pasireotide will be left to the investigator's judgment. All participants will come for a safety visit after discontinuation or completion of treatment.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Post-Bariatric Hypoglycemia

    7. Study Design

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

    8. Arms, Groups, and Interventions

    Arm Title
    Pasireotide s.c. 50 mcg
    Arm Type
    Experimental
    Arm Description
    Pasireotide 50 mcg s.c. tid
    Arm Title
    Pasireotide 100 mcg
    Arm Type
    Experimental
    Arm Description
    Pasireotide 100 mcg s.c. tid
    Arm Title
    Pasireotide 200 mcg
    Arm Type
    Experimental
    Arm Description
    Pasireotide 200 mcg s.c. tid
    Arm Title
    Placebo
    Arm Type
    Placebo Comparator
    Arm Description
    Placebo s.c. tid
    Intervention Type
    Drug
    Intervention Name(s)
    Pasireotide Diaspartate
    Other Intervention Name(s)
    Pasireotide
    Intervention Description
    Injectable ampoules
    Primary Outcome Measure Information:
    Title
    Level 2 hypoglycaemic events (plasma glucose <54 mg/dL) during a 3-hour MMTT (mixed meal tolerance test)
    Description
    The response rate defined as the proportion of patients with no level 2 hypoglycaemic events (plasma glucose <54 mg/dL) at 90, 120, 150 and 180 min during a 3-hour MMTT after 12 weeks of treatment with pasireotide s.c. 50 µg, or 100 µg or 200 µg tid vs placebo tid respectively
    Time Frame
    12 weeks

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Male or- non-pregnant female patients ≥ 18 years of age Patients able to provide and have provided signed written informed consent prior to study participation. Patients capable of self-injecting subcutaneously. Specific training to self-inject the study drug will be provided. Post-bariatric surgery more than 6 months prior to screening Patient with a documented diagnosis of PBH defined as having: postprandial neuroglycopenia occurring >1 hour after meals no hypoglycaemia in fasting conditions documented history of Whipple's triad documented history of hypoglycaemia based on glucose value <50mg/dL or 2.8 mmol/L on a sporadic or scheduled blood analysis - OR - glucose value <60 mg/dL or 3.3 mmol/L at 90, 120, 150 or 180 min during an OGTT (oral glucose tolerance test) - OR- glucose value <54 mg/dL at 60, 90, 120 or 180 min during a 3-hour MMTT (mixed meal tolerance test) Patients must have at least one glucose level < 54 mg/dL at 30, 90, 120, 150 or 180 min during the 3-hour MMTT at screening Historical evidence of previous level 3 hypoglycaemia events at any time Patients who have failed diet recommended by the treating physician for the PBH Karnofsky Performance Status ≥ 60 (i.e., requires occasional assistance, but is able to care for most of their personal needs) Patients who received other therapies for PBH (such as acarbose, gama guar, pectin, diazoxide) must have stopped all treatments and allow a wash out period of at least 2 weeks prior to entering the run-in period. Patients who have been treated with GLP-1 antagonists in the past must have a wash-out period of at least 4 weeks before the start of the run-in period Patients who have been treated with SGLT2 inhibitors (glifozins) in the past must have a wash-out period of at least 4 weeks before the start of the run-in period Patients who have been treated with somatostatin receptor analogues in the past, must have an appropriate interval between the last administration of somatostatin receptor analogues treatment and the start of the run-in period as follows: Octreotide s.c. for ≥ 72 hours Octreotide LAR for ≥ 56 days (8 weeks) Lanreotide Autogel for ≥ 98 days (14 weeks) Lanreotide SR ≥ 28 days (4 weeks) Exclusion Criteria (main ones): Bariatric patients who have lap band. Patients with a current diagnosis of uncontrolled Diabetes Mellitus. However, diabetic patients in remission, as defined below, are eligible: With an HbA1c at screening <6.5% Not taking any medications for hyperglycaemia for at least 3 months prior to screening. Their qualifying Level 3 hypoglycaemia events (see above) must have occurred at least 1 month after the discontinuation of the glucose lowering agent(s). Patients previously treated with pasireotide at any time Patients who have a known hypersensitivity to somatostatin receptor analogues. Patients currently using medications that may interfere with glucose metabolism within 5 half-lives of drug. Patients with history of or current insulinoma Patients who have any severe and/or uncontrolled medical condition or other conditions that could affect their participation in the study (defined in the core text of the protocol) Patients with symptomatic cholelithiasis and/ or acute or chronic pancreatitis. Patients with abnormal coagulation (PT and PTT elevated by 30% above normal limits). Patients on continuous anticoagulation therapy. Patients who were on anticoagulant therapy must complete a washout period of at least 10 days and have confirmed normal coagulation parameters before study inclusion (patients receiving aspirin once a day are allowed to be enrolled). Patients who are hypothyroid and not on adequate replacement therapy. Patients who have undergone major surgery/surgical therapy for any cause within 1 month. Patients should have recovered from the surgery and be in good clinical condition before entering the study. Bradycardia and QT-related exclusion criteria (in the core text of the protocol) Participation in any clinical investigation within 4 weeks prior to dosing or longer if required by local regulation. (Use of an investigational drug within 1 month prior to dosing). Significant acute illness within the two weeks prior to dosing/randomization. Female patients who are pregnant, intending to become pregnant or breastfeed during the study or lactating, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive hCG laboratory test. Women of childbearing potential (WOCBP) who are unwilling of using highly effective contraception methods (definition in core protocol) Potentially unreliable or vulnerable patients (e.g., person kept in detention) and those judged by the investigator to be unsuitable for the study.

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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