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Insulin and Abatacept in Recently-diagnosed Type 1 Diabetes (IAA)

Primary Purpose

Type 1 Diabetes, Diabetes Mellitus, Type 1

Status
Recruiting
Phase
Phase 2
Locations
Australia
Study Type
Interventional
Intervention
Abatacept (CTLA4-Ig) and nasal insulin (Humulin R®)
Abatacept (CTLA4-Ig) and nasal placebo (0.9% sodium chloride)
Sponsored by
Melbourne Health
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 1 Diabetes focused on measuring Abatacept, Nasal insulin, Beta-cell function, Glucose intolerance, Immune responses, Hypoglycemia

Eligibility Criteria

6 Years - 21 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Age between 6 and 21 years and weight at least 20kg at Visit 1 Diabetes mellitus diagnosed according to ADA criteria (53) within 100 days of Visit 2 Presence of at least one antibody against insulin (if <10 days since starting insulin therapy), GAD, IA2 or ZnT8 Random C-peptide >0.3nmol/l, measured by a NATA-accredited pathology laboratory within 2 weeks of Visit 2 Willing to use CGM for the duration of the study Demonstrated ability to record home glucose measurements and insulin doses, as judged by the study doctor Willing to forego other forms of experimental treatment during the study Fully vaccinated against Covid-19, as recommended by the Australian Technical Advisory Group on Immunisation Up to date with other vaccinations recommended by the Australian Technical Advisory Group on Immunisation Willing to postpone any live vaccine immunisations for 3 months after treatment Exclusion Criteria: Clinical or laboratory evidence of active infection other than localised skin infection, including viral hepatitis, EBV, CMV or tuberculosis Immunodeficiency or chronic use of immunosuppressive drugs other than topical or inhaled glucocorticoid Vaccination with live or dead virus within 4 weeks of Visit 2 History of malignancy Pregnant or lactating, or of child-bearing potential not using an effective method of contraception Any pathology of the nasal passages that would preclude safe application of the nasal spray Any condition that would interfere with study conduct or participant safety

Sites / Locations

  • The Children's Hospital at Westmead
  • Queensland Children's Hospital
  • Women's and Children's Hospital
  • The Royal Melbourne HospitalRecruiting
  • The Royal Children's Hospital
  • Perth Children's Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Abatacept and nasal insulin

Abatacept and nasal placebo

Arm Description

Abatacept (CTLA4-Ig; 50 mg for participant weight <25 kg, 87.5 mg for participant weight 25-50 kg, 125 mg for participant weight >50 kg) will be injected subcutaneously once per week and nasal insulin (Humulin R®, 100 Units/mL) will be inhaled for 10 consecutive days initially and twice per week thereafter, for 48-weeks.

Abatacept (CTLA4-Ig; 50 mg for participant weight <25 kg, 87.5 mg for participant weight 25-50 kg, 125 mg for participant weight >50 kg) will be injected subcutaneously once per week and nasal placebo (0.9% sodium chloride) will be inhaled for 10 consecutive days initially and twice per week thereafter, for 48-weeks.

Outcomes

Primary Outcome Measures

Beta-cell function at 48 weeks
Change in average C-peptide concentration during a 2-hour mixed meal challenge

Secondary Outcome Measures

Beta-cell function at 24, 72 and 96 weeks
Change in average C-peptide concentration during a 2-hour mixed meal challenge
Glucose regulation
Proportion of time in the range 3.9-10mmol/l, time below 3.9mmol/l and glucose %CV measured by continuous glucose monitoring (CGM)
Estimated C-peptide concentration
Average C-peptide concentration estimated from fasting glucose, C-peptide, HbA1c, body mass index, disease duration and insulin dose
Frequency of hypoglycemic events
Frequency of glucose readings <3.0mmol/l, determined by CGM and correcting for CGM wear time
Hemoglobin A1c levels
Change in HbA1c levels
Insulin use
Daily insulin dose at all visits
Weight, body mass index and sitting blood pressure
Change in weight, body mass index and blood pressure
Diabetes antibody levels
Insulin, GAD, IA2 and ZnT8 autoantibody concentrations
Quality of life assessment
Assessed by questionnaire
Adverse events
Frequency and severity of adverse events

Full Information

First Posted
February 15, 2023
Last Updated
February 15, 2023
Sponsor
Melbourne Health
Collaborators
National Health and Medical Research Council, Australia, Juvenile Diabetes Research Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT05742243
Brief Title
Insulin and Abatacept in Recently-diagnosed Type 1 Diabetes
Acronym
IAA
Official Title
Abatacept Combined With Nasal Insulin to Preserve Beta-cell Function in Recently-diagnosed Type 1 Diabetes
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 13, 2023 (Actual)
Primary Completion Date
February 13, 2026 (Anticipated)
Study Completion Date
February 13, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Melbourne Health
Collaborators
National Health and Medical Research Council, Australia, Juvenile Diabetes Research Foundation

4. Oversight

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

5. Study Description

Brief Summary
The goal of this clinical trial is to test whether the combination of two safe immune therapies called abatacept and nasal insulin can preserve pancreas function in recently-diagnosed type 1 diabetes. When type 1 diabetes is first diagnosed, the pancreas is still able to make small amounts of insulin, which helps control glucose levels. Preserving pancreas function can make glucose control easier and reduce the need to use injected insulin. Participants will be asked to inject abatacept under their skin once per week and inhale nasal insulin or nasal placebo using a spray for 10 consecutive days initially and twice per week thereafter. The treatment period is for 48 weeks, with another 48-week follow-up period.
Detailed Description
Type 1 diabetes is caused by an immune attack on insulin-producing beta cells of the pancreas that impairs their ability to make insulin to control blood glucose levels. When diabetes is diagnosed, the pancreas is usually still able to make some insulin, but not enough to meet the body's needs. Over time, continued immune attack further decreases insulin production until after one to two years it is very low or undetectable. When type 1 diabetes is diagnosed, treatments that stop the immune attack may preserve residual beta-cell function. This decreases the requirement for injected insulin and improves glucose control. However, so far, immune therapies have not been shown to prevent ongoing loss of beta-cell function. In this clinical trial, two safe immune therapies called abatacept and nasal insulin will be used together to test if the combination can better preserve the function of beta cells to make insulin after diagnosis. If this occurs, it will be relatively simple to develop this treatment for routine use in recently-diagnosed people and to test whether it prevents high-risk individuals progressing to need insulin injections. This trial will also provide research samples to improve our understanding of how type 1 diabetes develops and how abatacept and nasal insulin might affect this process. The new knowledge created from studying these samples will improve our ability to use abatacept and nasal insulin to preserve pancreas function in type 1 diabetes.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes, Diabetes Mellitus, Type 1
Keywords
Abatacept, Nasal insulin, Beta-cell function, Glucose intolerance, Immune responses, Hypoglycemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
62 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Abatacept and nasal insulin
Arm Type
Active Comparator
Arm Description
Abatacept (CTLA4-Ig; 50 mg for participant weight <25 kg, 87.5 mg for participant weight 25-50 kg, 125 mg for participant weight >50 kg) will be injected subcutaneously once per week and nasal insulin (Humulin R®, 100 Units/mL) will be inhaled for 10 consecutive days initially and twice per week thereafter, for 48-weeks.
Arm Title
Abatacept and nasal placebo
Arm Type
Placebo Comparator
Arm Description
Abatacept (CTLA4-Ig; 50 mg for participant weight <25 kg, 87.5 mg for participant weight 25-50 kg, 125 mg for participant weight >50 kg) will be injected subcutaneously once per week and nasal placebo (0.9% sodium chloride) will be inhaled for 10 consecutive days initially and twice per week thereafter, for 48-weeks.
Intervention Type
Drug
Intervention Name(s)
Abatacept (CTLA4-Ig) and nasal insulin (Humulin R®)
Other Intervention Name(s)
Abatacept and nasal insulin
Intervention Description
Abatacept injected subcutaneously once per week and nasal insulin inhaled for 10 consecutive days initially and twice per week thereafter
Intervention Type
Drug
Intervention Name(s)
Abatacept (CTLA4-Ig) and nasal placebo (0.9% sodium chloride)
Other Intervention Name(s)
Abatacept and nasal placebo
Intervention Description
Abatacept injected subcutaneously once per week and nasal placebo inhaled for 10 consecutive days initially and twice per week thereafter
Primary Outcome Measure Information:
Title
Beta-cell function at 48 weeks
Description
Change in average C-peptide concentration during a 2-hour mixed meal challenge
Time Frame
0 weeks - 48 weeks
Secondary Outcome Measure Information:
Title
Beta-cell function at 24, 72 and 96 weeks
Description
Change in average C-peptide concentration during a 2-hour mixed meal challenge
Time Frame
0, 24, 72 and 96 weeks
Title
Glucose regulation
Description
Proportion of time in the range 3.9-10mmol/l, time below 3.9mmol/l and glucose %CV measured by continuous glucose monitoring (CGM)
Time Frame
0, 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 60, 72 and 96 weeks
Title
Estimated C-peptide concentration
Description
Average C-peptide concentration estimated from fasting glucose, C-peptide, HbA1c, body mass index, disease duration and insulin dose
Time Frame
-2, 24, 48, 72 and 96 weeks
Title
Frequency of hypoglycemic events
Description
Frequency of glucose readings <3.0mmol/l, determined by CGM and correcting for CGM wear time
Time Frame
0, 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, 60, 72 and 96 weeks
Title
Hemoglobin A1c levels
Description
Change in HbA1c levels
Time Frame
0, 12, 24, 36, 48, 60, 72 and 96 weeks
Title
Insulin use
Description
Daily insulin dose at all visits
Time Frame
Every 4 weeks for 96 weeks
Title
Weight, body mass index and sitting blood pressure
Description
Change in weight, body mass index and blood pressure
Time Frame
0, 12, 24, 48, 60, 72 and 96 weeks
Title
Diabetes antibody levels
Description
Insulin, GAD, IA2 and ZnT8 autoantibody concentrations
Time Frame
-2, 0, 4, 12, 24, 48, 60, 72 and 96 weeks
Title
Quality of life assessment
Description
Assessed by questionnaire
Time Frame
-2, 0, 24, 48, 72 and 96 weeks
Title
Adverse events
Description
Frequency and severity of adverse events
Time Frame
All visits for 96 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Years
Maximum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age between 6 and 21 years and weight at least 20kg at Visit 1 Diabetes mellitus diagnosed according to ADA criteria (53) within 100 days of Visit 2 Presence of at least one antibody against insulin (if <10 days since starting insulin therapy), GAD, IA2 or ZnT8 Random C-peptide >0.3nmol/l, measured by a NATA-accredited pathology laboratory within 2 weeks of Visit 2 Willing to use CGM for the duration of the study Demonstrated ability to record home glucose measurements and insulin doses, as judged by the study doctor Willing to forego other forms of experimental treatment during the study Fully vaccinated against Covid-19, as recommended by the Australian Technical Advisory Group on Immunisation Up to date with other vaccinations recommended by the Australian Technical Advisory Group on Immunisation Willing to postpone any live vaccine immunisations for 3 months after treatment Exclusion Criteria: Clinical or laboratory evidence of active infection other than localised skin infection, including viral hepatitis, EBV, CMV or tuberculosis Immunodeficiency or chronic use of immunosuppressive drugs other than topical or inhaled glucocorticoid Vaccination with live or dead virus within 4 weeks of Visit 2 History of malignancy Pregnant or lactating, or of child-bearing potential not using an effective method of contraception Any pathology of the nasal passages that would preclude safe application of the nasal spray Any condition that would interfere with study conduct or participant safety
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Kate Murphy
Phone
+61393427344
Email
kate.murphy3@mh.org.au
First Name & Middle Initial & Last Name or Official Title & Degree
Candice Hall
Email
candice.hall@mh.org.au
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
John Wentworth
Organizational Affiliation
Melbourne Health
Official's Role
Principal Investigator
Facility Information:
Facility Name
The Children's Hospital at Westmead
City
Westmead
State/Province
New South Wales
ZIP/Postal Code
2145
Country
Australia
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kate Murphy
Facility Name
Queensland Children's Hospital
City
South Brisbane
State/Province
Queensland
ZIP/Postal Code
4101
Country
Australia
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kate Murphy
Facility Name
Women's and Children's Hospital
City
North Adelaide
State/Province
South Australia
ZIP/Postal Code
5006
Country
Australia
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kate Murphy
Facility Name
The Royal Melbourne Hospital
City
Parkville
State/Province
Victoria
ZIP/Postal Code
3050
Country
Australia
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kate Murphy
Facility Name
The Royal Children's Hospital
City
Parkville
State/Province
Victoria
ZIP/Postal Code
3052
Country
Australia
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kate Murphy
Facility Name
Perth Children's Hospital
City
Nedlands
State/Province
Western Australia
ZIP/Postal Code
6009
Country
Australia
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kate Murphy

12. IPD Sharing Statement

Plan to Share IPD
No
Links:
URL
https://atic.svi.edu.au/clinical-trials/
Description
Link to clinical trial

Learn more about this trial

Insulin and Abatacept in Recently-diagnosed Type 1 Diabetes

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