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A Study to Assess the Safety and Tolerability of Different Doses of AG019 Administered Alone or in Combination With Teplizumab in Participants With Recent-onset Diagnosed Type 1 Diabetes (T1D)

Primary Purpose

Diabetes type1

Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
AG019 - Low Dose
Teplizumab
Placebo-AG019
Placebo-Teplizumab
AG019 - High Dose
AG019 - High Dose
Sponsored by
Precigen Actobio T1D, LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes type1

Eligibility Criteria

12 Years - 40 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or non-pregnant, non-lactating females, 18 - 40 years of age (both inclusive) or 12-17 years of age (both inclusive)
  • Diagnosis of diabetes according to the American Diabetes Association (ADA) recommended criteria
  • Evidence of auto-antibodies to at least 1 β-cell autoantigen
  • Stimulated C-peptide measured during 4h Mixed Meal tolerance Test (MMTT) > 0.2 nmol/L
  • The first administration of AG019 should occur no later than 150 days post diagnosis of diabetes
  • Body weight ≥ 33kg
  • Written informed consent obtained and documented (participant, parent, guardian as applicable)

Exclusion Criteria:

  • Previous history of serious cytokine release syndrome to teplizumab or other humanized anti-CD3 monoclonal antibodies with no or minimal capacity to bind Fc receptors. (Participants enrolled in the second phase of the trial in either Combination Cohort 1 or Combination Cohort 2, only)
  • Use of immunosuppressive or immunomodulatory therapies, including systemic steroids within 1 month prior to randomization
  • Participation in another investigational drug trial within 12 weeks prior to the first study drug intake and during participation in this study
  • History of recurrent infections, other autoimmune diseases, cardiac disease, malignancy, or any other (chronic) medical condition which, in the investigator's opinion, could compromise participant safety
  • Documented history of human immunodeficiency virus (HIV), Hepatitis Virus Type C (HCV), Hepatitis Virus Type B (HBV) infection
  • Evidence of active infection with Epstein-Barr Virus (EBV) or cytomegalovirus (CMV)
  • Evidence of active or latent tuberculosis (TB)
  • Administration of anti-CD3 antibody in past year
  • Current therapy with any other anti-diabetic agents other than insulin (MDI, CSII or analogue). Current or planned therapy with experimental (i.e., unapproved) insulin. Patients on therapy for type 2 diabetes (e.g. metformin) should stop their therapy in order to be eligible for study participation.
  • Use of medications known to influence glucose tolerance
  • Daily use of non-steroidal anti-inflammatory agents
  • Compromised GI mucosal integrity or motility, not attributable to T1D (i.e., recent diarrhea, gluten sensitive enteropathy, inflammatory bowel disease, irritable bowel syndrome), or current use of medications known to influence GI motility
  • Positive result of SARS-Cov2 PCR test at screening or within 3 days before randomization

Sites / Locations

  • University of Alabama, Birmingham
  • University of California, San Francisco
  • Coastal Metabolic Research Centre
  • University of Colorado
  • Yale Center for Clinical Investigation
  • University of Miami
  • University of South Florida
  • Barry J Reiner, MD, LLC
  • University of Minnesota Health
  • University of Missouri-Kansas City School of Medicine
  • Sanford Children's Specialty Clinic
  • University Diabetes and Endocrine Consultants
  • Texas Diabetes & Endocrinology, P.A.
  • Research Institute of Dallas
  • Benaroya Research Institute
  • UZ Brussel
  • UZ Antwerpen
  • UZ Leuven

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

AG019 Cohort 1 - Low Dose/Adults

AG019 Cohort 2 - High Dose/Adults

AG019 Cohort 3 - Low Dose/Adolescents

AG019 Cohort 4 - High Dose/Adolescents

Combination Cohort 1 - Adults

Combination Cohort 2 - Adolescents

Arm Description

Outcomes

Primary Outcome Measures

Incidence of Treatment-emergent Adverse Events (TEAE)
Treatment-emergent adverse events assessed by the investigator, review of lab reports and information provided by the participant during site visits and/or participant diary with AG019 alone or with teplizumab

Secondary Outcome Measures

AG019 in Systemic Circulation
The presence of live L. lactis bacteria in blood will be assessed by plating
L. Lactis-secreted hPINS or hIL-10 in Systemic Circulation
The presence of L. lactis-secreted hPINS or hIL-10 in the blood will be assessed by ELISA (enzyme-linked immunosorbent assay)
AG019 in Feces
The presence of L. lactis (live or dead) in feces will be assessed by Q-PCR (quantitative real-time polymerase chain reaction)
C-peptide Area Under the Concentration-time Curve (AUC) Calculated From a 2 Hour Mixed Meal Tolerance Test (MMTT) at 12 Months
MMTT-stimulated 2-hour C-peptide AUC was defined as the mean area under the C-peptide level time curve over the 2-hour period divided by the duration after a mixed-meal tolerance test.

Full Information

First Posted
November 8, 2018
Last Updated
January 31, 2023
Sponsor
Precigen Actobio T1D, LLC
Collaborators
Intrexon Actobiotics NV, d/b/a Precigen Actobio
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1. Study Identification

Unique Protocol Identification Number
NCT03751007
Brief Title
A Study to Assess the Safety and Tolerability of Different Doses of AG019 Administered Alone or in Combination With Teplizumab in Participants With Recent-onset Diagnosed Type 1 Diabetes (T1D)
Official Title
A Prospective, Multi-center, Phase 1b/2a Study to Assess the Safety and Tolerability of Different Doses of AG019 Administered Alone or in Association With Teplizumab in Patients With Clinical Recent-onset Type 1 Diabetes Mellitus (T1D)
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Completed
Study Start Date
October 24, 2018 (Actual)
Primary Completion Date
October 13, 2021 (Actual)
Study Completion Date
October 13, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Precigen Actobio T1D, LLC
Collaborators
Intrexon Actobiotics NV, d/b/a Precigen Actobio

4. Oversight

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

5. Study Description

Brief Summary
The purpose of this study is to assess the safety and tolerability of different doses of AG019 administered alone or in combination with teplizumab in participants with recent-onset type 1 diabetes (T1D).
Detailed Description
This Phase 1b/2a, multi-center study will be conducted in participants with clinical recent-onset type 1 diabetes (T1D). The primary objective of this study is to assess the safety and tolerability of different doses of AG019 alone as well as AG019 in combination with teplizumab. The secondary objectives of this study are: to obtain pharmacodynamic (PD) data of AG019 alone as well as AG019 in combination with teplizumab; and to determine the potential presence of AG019 in systemic circulation (safety - systemic exposure) and the presence of L. lactis bacteria in fecal excretion (local exposure): Pharmacokinetic (PK) profile. This study consists of 2 phases: Phase 1b: this open-label part of the study will investigate the safety and tolerability of 2 different doses of AG019 in 2 age groups (18-40 years of age and 12-17 years of age). Phase 2a: this randomized, double-blind part of the study will investigate the safety and tolerability of AG019, in combination with teplizumab, in 2 age groups (18-40 years of age and 12-17 years of age).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes type1

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
The phase 1b part of the study will enroll 4 sequential AG019 cohorts of up to 6 participants, in ascending dose cohorts and descending age cohorts. All participants in these cohorts will be treated with AG019 in an open label fashion. The phase 2a part of the study will evaluate 2 cohorts of participants administered AG019 and teplizumab. The first 2 participants will be treated with active treatment in an open label fashion. Participants 3-12 will be randomized (4:1) to receive active treatment or placebo in a double-blind fashion.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
For the randomized participants in the combination cohorts, blinding will be accomplished by arranging for AG019 and placebo components as well as teplizumab and placebo components to have identical packaging.
Allocation
Randomized
Enrollment
45 (Actual)

8. Arms, Groups, and Interventions

Arm Title
AG019 Cohort 1 - Low Dose/Adults
Arm Type
Experimental
Arm Title
AG019 Cohort 2 - High Dose/Adults
Arm Type
Experimental
Arm Title
AG019 Cohort 3 - Low Dose/Adolescents
Arm Type
Experimental
Arm Title
AG019 Cohort 4 - High Dose/Adolescents
Arm Type
Experimental
Arm Title
Combination Cohort 1 - Adults
Arm Type
Experimental
Arm Title
Combination Cohort 2 - Adolescents
Arm Type
Experimental
Intervention Type
Biological
Intervention Name(s)
AG019 - Low Dose
Intervention Description
Solid, orally administered capsule - 2 capsules per day for 1 day (single dose) or 8 weeks (repeat dose)
Intervention Type
Drug
Intervention Name(s)
Teplizumab
Intervention Description
Daily IV infusions of Teplizumab during the first 12 days of AG019 treatment. Total cumulative dose is approximately 17mg (dose calculation based on body surface area).
Intervention Type
Drug
Intervention Name(s)
Placebo-AG019
Intervention Description
Formulated identically to AG019 with the active ingredient removed.
Intervention Type
Drug
Intervention Name(s)
Placebo-Teplizumab
Intervention Description
Formulated identically to teplizumab with the active ingredient removed.
Intervention Type
Biological
Intervention Name(s)
AG019 - High Dose
Intervention Description
Solid, orally administered capsule - 6 capsules per day for 1 day (single dose) or 8 weeks
Intervention Type
Biological
Intervention Name(s)
AG019 - High Dose
Intervention Description
Solid, orally administered capsule - 6 capsules per day for 8 weeks.
Primary Outcome Measure Information:
Title
Incidence of Treatment-emergent Adverse Events (TEAE)
Description
Treatment-emergent adverse events assessed by the investigator, review of lab reports and information provided by the participant during site visits and/or participant diary with AG019 alone or with teplizumab
Time Frame
up to 6 months
Secondary Outcome Measure Information:
Title
AG019 in Systemic Circulation
Description
The presence of live L. lactis bacteria in blood will be assessed by plating
Time Frame
Up to 3 months after initiation of the treatment
Title
L. Lactis-secreted hPINS or hIL-10 in Systemic Circulation
Description
The presence of L. lactis-secreted hPINS or hIL-10 in the blood will be assessed by ELISA (enzyme-linked immunosorbent assay)
Time Frame
Up to 3 months after initiation of the treatment
Title
AG019 in Feces
Description
The presence of L. lactis (live or dead) in feces will be assessed by Q-PCR (quantitative real-time polymerase chain reaction)
Time Frame
Up to 8 days after completion of the treatment
Title
C-peptide Area Under the Concentration-time Curve (AUC) Calculated From a 2 Hour Mixed Meal Tolerance Test (MMTT) at 12 Months
Description
MMTT-stimulated 2-hour C-peptide AUC was defined as the mean area under the C-peptide level time curve over the 2-hour period divided by the duration after a mixed-meal tolerance test.
Time Frame
up to 12 months
Other Pre-specified Outcome Measures:
Title
Incidence of Treatment Emergent Adverse Events up to 12 Months
Description
Incidence of all reported TEAE up to the 12-month follow-up visit. The TEAE are counted once within each patient on the preferred term level.
Time Frame
Up to 12 months from screening

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Years
Maximum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or non-pregnant, non-lactating females, 18 - 40 years of age (both inclusive) or 12-17 years of age (both inclusive) Diagnosis of diabetes according to the American Diabetes Association (ADA) recommended criteria Evidence of auto-antibodies to at least 1 β-cell autoantigen Stimulated C-peptide measured during 4h Mixed Meal tolerance Test (MMTT) > 0.2 nmol/L The first administration of AG019 should occur no later than 150 days post diagnosis of diabetes Body weight ≥ 33kg Written informed consent obtained and documented (participant, parent, guardian as applicable) Exclusion Criteria: Previous history of serious cytokine release syndrome to teplizumab or other humanized anti-CD3 monoclonal antibodies with no or minimal capacity to bind Fc receptors. (Participants enrolled in the second phase of the trial in either Combination Cohort 1 or Combination Cohort 2, only) Use of immunosuppressive or immunomodulatory therapies, including systemic steroids within 1 month prior to randomization Participation in another investigational drug trial within 12 weeks prior to the first study drug intake and during participation in this study History of recurrent infections, other autoimmune diseases, cardiac disease, malignancy, or any other (chronic) medical condition which, in the investigator's opinion, could compromise participant safety Documented history of human immunodeficiency virus (HIV), Hepatitis Virus Type C (HCV), Hepatitis Virus Type B (HBV) infection Evidence of active infection with Epstein-Barr Virus (EBV) or cytomegalovirus (CMV) Evidence of active or latent tuberculosis (TB) Administration of anti-CD3 antibody in past year Current therapy with any other anti-diabetic agents other than insulin (MDI, CSII or analogue). Current or planned therapy with experimental (i.e., unapproved) insulin. Patients on therapy for type 2 diabetes (e.g. metformin) should stop their therapy in order to be eligible for study participation. Use of medications known to influence glucose tolerance Daily use of non-steroidal anti-inflammatory agents Compromised GI mucosal integrity or motility, not attributable to T1D (i.e., recent diarrhea, gluten sensitive enteropathy, inflammatory bowel disease, irritable bowel syndrome), or current use of medications known to influence GI motility Positive result of SARS-Cov2 PCR test at screening or within 3 days before randomization
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Chantal Mathieu, MD
Organizational Affiliation
University Hospital of Leuven, Clinical and Experimental Endocrinology
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Kevan Herold, MD
Organizational Affiliation
Yale Center for Clinical Investigation; Yale University
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Alabama, Birmingham
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35294
Country
United States
Facility Name
University of California, San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94158
Country
United States
Facility Name
Coastal Metabolic Research Centre
City
Ventura
State/Province
California
ZIP/Postal Code
93003
Country
United States
Facility Name
University of Colorado
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
Yale Center for Clinical Investigation
City
New Haven
State/Province
Connecticut
ZIP/Postal Code
06519
Country
United States
Facility Name
University of Miami
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
University of South Florida
City
Tampa
State/Province
Florida
ZIP/Postal Code
33612
Country
United States
Facility Name
Barry J Reiner, MD, LLC
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21229
Country
United States
Facility Name
University of Minnesota Health
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55454
Country
United States
Facility Name
University of Missouri-Kansas City School of Medicine
City
Kansas City
State/Province
Missouri
ZIP/Postal Code
64108
Country
United States
Facility Name
Sanford Children's Specialty Clinic
City
Sioux Falls
State/Province
South Dakota
ZIP/Postal Code
57117
Country
United States
Facility Name
University Diabetes and Endocrine Consultants
City
Chattanooga
State/Province
Tennessee
ZIP/Postal Code
37411
Country
United States
Facility Name
Texas Diabetes & Endocrinology, P.A.
City
Austin
State/Province
Texas
ZIP/Postal Code
78749
Country
United States
Facility Name
Research Institute of Dallas
City
Dallas
State/Province
Texas
ZIP/Postal Code
75231
Country
United States
Facility Name
Benaroya Research Institute
City
Seattle
State/Province
Washington
ZIP/Postal Code
98101
Country
United States
Facility Name
UZ Brussel
City
Brussels
ZIP/Postal Code
1090
Country
Belgium
Facility Name
UZ Antwerpen
City
Edegem
ZIP/Postal Code
2650
Country
Belgium
Facility Name
UZ Leuven
City
Leuven
ZIP/Postal Code
3000
Country
Belgium

12. IPD Sharing Statement

Learn more about this trial

A Study to Assess the Safety and Tolerability of Different Doses of AG019 Administered Alone or in Combination With Teplizumab in Participants With Recent-onset Diagnosed Type 1 Diabetes (T1D)

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