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Multiple Ascending Dose (MAD) Study of IMT-002 in HLA-DQ8-positive Type 1 Diabetes

Primary Purpose

Type1 Diabetes

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
350mg BID (700mg total daily) IMT-002, D-methyldopa, active formulation in capsule or Placebo, microcrystalline cellulose in capsule
700mg BID (1400mg total daily) IMT-002, D-methyldopa, active formulation in capsule or Placebo, microcrystalline cellulose in capsule
1050mg QD (1050mg total daily) IMT-002, D-methyldopa, active formulation in capsule or Placebo, microcrystalline cellulose in capsule
1050mg BID (2100mg total daily) IMT-002, D-methyldopa, active formulation in capsule or Placebo, microcrystalline cellulose in capsule
Sponsored by
Immunomolecular Therapeutics, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type1 Diabetes focused on measuring diabetes, prescreening, autoimmunity, HLA

Eligibility Criteria

18 Years - 45 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Signed the ICF as described in Appendix 3 which includes compliance with the requirements and restrictions listed in the ICF and in this protocol.
  2. Man or woman, 18 to 45 years of age inclusive at the time of signing the ICF.
  3. Has received a diagnosis of T1D according to the criteria from the American Diabetes Association.
  4. Positive for at least one gene encoding for HLA-DQ8 (DQB*0302).
  5. If male, and of reproductive potential, willing to use medically acceptable birth control (Appendix 5), unless the female partner is postmenopausal or surgically sterile, until study completion and for at least 30 days after the last dose of study treatment and refrain from donating sperm during this period.
  6. If female: (a) surgically sterile or (b) postmenopausal or (c) if of reproductive potential, willing to use medically acceptable birth control (eg, female hormonal contraception, barrier methods or sterilization (Appendix 5) until study completion and for at least 30 days (one menstrual cycle).

Exclusion Criteria:

  1. Inability or unwillingness of a subject to give written informed consent or comply with the study protocol.
  2. No HLA-DQ8 gene (DQB*03:02).
  3. Any of the following hematologic abnormalities at the time of screening, confirmed by repeat tests:

    1. Leukopenia (<3,000 leukocytes/μL)
    2. Neutropenia (<1,500 neutrophils/μL)
    3. Thrombocytopenia (<125,000 platelets/μL)
    4. Hemoglobin less than 10 g/dl
  4. Evidence of liver dysfunction, with ALT > 2.5 times the upper limit of normal (ULN) or AST >3.0 times ULN persistent for 1 week or greater.
  5. Evidence of renal insufficiency as indicated by serum creatinine of >1.5 times ULN, confirmed by a repeat test.
  6. Clinically significant abnormal physical examination, vital signs, or 12-lead ECG at screening as deemed appropriate by the investigator.
  7. Has a history of or current clinically significant medical illness including, but not limited to, cardiac arrhythmias or other cardiac disease; significant pulmonary disease; neurologic or psychiatric disease; infection; or any other illness that the investigator considers should exclude the subject or that could interfere with the interpretation of the study results.
  8. Body mass index (BMI) > 32 kg/m2.
  9. Unstable blood sugar control defined as one or more episodes of severe hypoglycemia (defined as hypoglycemia that required the assistance of another person) within the last 30 days.
  10. Use of a treatment that is known to cause a significant, ongoing change in the course of T1D or immunologic status, within 4 weeks prior to participation; this includes high-dose inhaled, extensive topical or systemic glucocorticoids.
  11. History of any organ transplant, including islet cell transplant.
  12. Pregnant or anticipates pregnancy during the 2-week study period or within 30 days following the last dose of study drug.
  13. Use of investigational drugs within 90 days of participation.
  14. Currently taking methyldopa (Aldomet) at the time of randomization or taken within the past 3 months.
  15. Currently taking ferrous sulfate or ferrous gluconate, which are indicated for the treatment of anemia (hematological disease), or taken within the past 30 days.
  16. Unable to avoid medications that affect stomach pH, such as proton pump inhibitors or histamine H2 receptor blockers.
  17. Past or current medical problems or findings from physical examination or laboratory testing that are not listed above, which, in the opinion of the Investigator, may pose additional risks from participation in the study, may interfere with the subject's ability to comply with study requirements, or that may impact the quality or interpretation of the data obtained from the study.
  18. Has a history of the human immunodeficiency virus (HIV) antibody positive, or tests positive for HIV; has a history of hepatitis B surface antigen (HBsAg) or hepatitis C antibody (anti-HCV) positive, or another clinically active liver disease, or tests positive for HBsAg or anti-HCV at Screening.
  19. Has a known psychiatric or substance abuse disorder that would interfere with the subject's ability to cooperate with the requirements of the study.
  20. Has preplanned surgery or procedures that would interfere with the conduct of the study.
  21. Is an employee of the Investigator or study site, with direct involvement in the proposed study or other studies under the direction of that Investigator or study site, as well as family members of the employees or the Investigator.

Sites / Locations

  • Prosciento, Inc.
  • Barbara Davis Center
  • Rainier Clinical Research Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Experimental

Arm Label

350 mg BID (700 mg total daily dose) of active drug or placebo

1050 mg QD (1050 mg total daily dose) of active drug or placebo

700 mg BID (1400 mg total daily dose) of active drug or placebo

1050 mg BID (2100 mg total daily dose) of active drug or placebo

Arm Description

Low dose, drug IMT-002

Moderate dose, drug IMT-002

Moderate to high dose, drug IMT-002

High dose, drug IMT-002

Outcomes

Primary Outcome Measures

Incidence of adverse events (AEs) and serious adverse events (SAEs)
Frequency tabulated as number of participants with adverse and serious adverse events (AEs)
Change from baseline in electrocardiogram (ECG)
Single 12-lead ECG will be measured in a supine position after 5 minutes rest and measure QRS, QT, and QTc intervals
Change in total daily insulin use
At each study visit, total daily insulin (ie, total insulin administered over the previous 24-hour period) will be entered in the Concomitant Medications CRF

Secondary Outcome Measures

Pharmacokinetic (PK) measurement in blood plasma, Cmax
Cmax, maximum plasma concentration during a dosing interval
Cytokine level from in vitro presentation of antigen by HLA-DQ8
Change from baseline of cytokine, interleukin-2, level produced in T-cell based in vitro assay of blood sample resulting from presentation of insulin or gluten peptide antigen by HLA-DQ8

Full Information

First Posted
October 20, 2020
Last Updated
August 24, 2021
Sponsor
Immunomolecular Therapeutics, Inc.
Collaborators
WCCT Global
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1. Study Identification

Unique Protocol Identification Number
NCT04625595
Brief Title
Multiple Ascending Dose (MAD) Study of IMT-002 in HLA-DQ8-positive Type 1 Diabetes
Official Title
A Phase 1b, Randomized, Single-blind, Placebo-controlled, Multiple Ascending Dose (MAD) Study to Assess the Steady-State Pharmacokinetics and DQ8 Blocking Efficacy of Orally Administered IMT-002 in Patients With Type 1 Diabetes and HLA-DQ8
Study Type
Interventional

2. Study Status

Record Verification Date
June 2021
Overall Recruitment Status
Completed
Study Start Date
November 9, 2020 (Actual)
Primary Completion Date
May 11, 2021 (Actual)
Study Completion Date
July 31, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Immunomolecular Therapeutics, Inc.
Collaborators
WCCT Global

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
This study is designed to characterize the safety, steady-state pharmacokinetics (PK) of IMT-002, and will serve as a dose range identification for the pharmacodynamic effect of blocking self-antigen presentation in adults with type 1 diabetes (T1D) having the human leukocyte antigen (HLA)-DQ8 gene.
Detailed Description
This is a randomized, single-blind, placebo-controlled study that will include 4 ascending dose cohorts: 350 mg twice daily (BID), 1050 mg once daily (QD), 700 mg BID, and 1050 mg BID. Subjects will undergo prescreening for genetic typing and then screening procedures up to 28 days prior to the first dose to determine eligibility. T1D adults between 18 and 45 years of age, inclusive, who are positive for at least one gene encoding for HLA-DQ8 (DQA1*0301, DQB1*0302) will be enrolled. Each cohort will include 6 subjects on active drug, and the study will include 6 subjects total on placebo. Each cohort will participate in a 2-week dosing period. Enrollment of the cohorts will be sequentially staggered such that initial safety data after the first four subjects assigned to active treatment complete one week of treatment in each cohort will be reviewed before the next ascending dose cohort is enrolled. The safety reviews will include cumulative safety data for all subjects to that point. Subjects will have 5 scheduled clinic visits: screening, first day of dosing, 1 week after dosing begins, 2 weeks after dosing begins (end of treatment), and 1 week following the final dose. Subjects will self-administer study drug on non-clinic treatment days. Safety assessments will be conducted at all study visits. Insulin use (dose and frequency) will be monitored. Pharmacokinetic (PK) assessments will be evaluated at every visit during the treatment period to characterize the following: single dose PK, trough PK and steady PK. Pharmacodynamic (PD) and immunological assessments will be evaluated before, during and after treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type1 Diabetes
Keywords
diabetes, prescreening, autoimmunity, HLA

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
30 (Actual)

8. Arms, Groups, and Interventions

Arm Title
350 mg BID (700 mg total daily dose) of active drug or placebo
Arm Type
Experimental
Arm Description
Low dose, drug IMT-002
Arm Title
1050 mg QD (1050 mg total daily dose) of active drug or placebo
Arm Type
Experimental
Arm Description
Moderate dose, drug IMT-002
Arm Title
700 mg BID (1400 mg total daily dose) of active drug or placebo
Arm Type
Experimental
Arm Description
Moderate to high dose, drug IMT-002
Arm Title
1050 mg BID (2100 mg total daily dose) of active drug or placebo
Arm Type
Experimental
Arm Description
High dose, drug IMT-002
Intervention Type
Drug
Intervention Name(s)
350mg BID (700mg total daily) IMT-002, D-methyldopa, active formulation in capsule or Placebo, microcrystalline cellulose in capsule
Other Intervention Name(s)
350mg BID
Intervention Description
Oral drug or placebo self-administered by subject as a capsule by mouth once-daily or twice-daily
Intervention Type
Drug
Intervention Name(s)
700mg BID (1400mg total daily) IMT-002, D-methyldopa, active formulation in capsule or Placebo, microcrystalline cellulose in capsule
Other Intervention Name(s)
700mg BID
Intervention Description
Oral drug or placebo self-administered by subject as a capsule by mouth once-daily or twice-daily
Intervention Type
Drug
Intervention Name(s)
1050mg QD (1050mg total daily) IMT-002, D-methyldopa, active formulation in capsule or Placebo, microcrystalline cellulose in capsule
Other Intervention Name(s)
1050mg QD
Intervention Description
Oral drug or placebo self-administered by subject as a capsule by mouth once-daily or twice-daily
Intervention Type
Drug
Intervention Name(s)
1050mg BID (2100mg total daily) IMT-002, D-methyldopa, active formulation in capsule or Placebo, microcrystalline cellulose in capsule
Other Intervention Name(s)
1050mg BID
Intervention Description
Oral drug or placebo self-administered by subject as a capsule by mouth once-daily or twice-daily
Primary Outcome Measure Information:
Title
Incidence of adverse events (AEs) and serious adverse events (SAEs)
Description
Frequency tabulated as number of participants with adverse and serious adverse events (AEs)
Time Frame
Treatment and follow-up period, Day 21
Title
Change from baseline in electrocardiogram (ECG)
Description
Single 12-lead ECG will be measured in a supine position after 5 minutes rest and measure QRS, QT, and QTc intervals
Time Frame
Day 1, Day 7, Day 14 and Day 21
Title
Change in total daily insulin use
Description
At each study visit, total daily insulin (ie, total insulin administered over the previous 24-hour period) will be entered in the Concomitant Medications CRF
Time Frame
Day 1, Day 7, Day 14 and Day 21
Secondary Outcome Measure Information:
Title
Pharmacokinetic (PK) measurement in blood plasma, Cmax
Description
Cmax, maximum plasma concentration during a dosing interval
Time Frame
Day 1, Day 7, Day 14
Title
Cytokine level from in vitro presentation of antigen by HLA-DQ8
Description
Change from baseline of cytokine, interleukin-2, level produced in T-cell based in vitro assay of blood sample resulting from presentation of insulin or gluten peptide antigen by HLA-DQ8
Time Frame
Day 1, Day 7, Day 14 and Day 21

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
45 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Signed the ICF as described in Appendix 3 which includes compliance with the requirements and restrictions listed in the ICF and in this protocol. Man or woman, 18 to 45 years of age inclusive at the time of signing the ICF. Has received a diagnosis of T1D according to the criteria from the American Diabetes Association. Positive for at least one gene encoding for HLA-DQ8 (DQB*0302). If male, and of reproductive potential, willing to use medically acceptable birth control (Appendix 5), unless the female partner is postmenopausal or surgically sterile, until study completion and for at least 30 days after the last dose of study treatment and refrain from donating sperm during this period. If female: (a) surgically sterile or (b) postmenopausal or (c) if of reproductive potential, willing to use medically acceptable birth control (eg, female hormonal contraception, barrier methods or sterilization (Appendix 5) until study completion and for at least 30 days (one menstrual cycle). Exclusion Criteria: Inability or unwillingness of a subject to give written informed consent or comply with the study protocol. No HLA-DQ8 gene (DQB*03:02). Any of the following hematologic abnormalities at the time of screening, confirmed by repeat tests: Leukopenia (<3,000 leukocytes/μL) Neutropenia (<1,500 neutrophils/μL) Thrombocytopenia (<125,000 platelets/μL) Hemoglobin less than 10 g/dl Evidence of liver dysfunction, with ALT > 2.5 times the upper limit of normal (ULN) or AST >3.0 times ULN persistent for 1 week or greater. Evidence of renal insufficiency as indicated by serum creatinine of >1.5 times ULN, confirmed by a repeat test. Clinically significant abnormal physical examination, vital signs, or 12-lead ECG at screening as deemed appropriate by the investigator. Has a history of or current clinically significant medical illness including, but not limited to, cardiac arrhythmias or other cardiac disease; significant pulmonary disease; neurologic or psychiatric disease; infection; or any other illness that the investigator considers should exclude the subject or that could interfere with the interpretation of the study results. Body mass index (BMI) > 32 kg/m2. Unstable blood sugar control defined as one or more episodes of severe hypoglycemia (defined as hypoglycemia that required the assistance of another person) within the last 30 days. Use of a treatment that is known to cause a significant, ongoing change in the course of T1D or immunologic status, within 4 weeks prior to participation; this includes high-dose inhaled, extensive topical or systemic glucocorticoids. History of any organ transplant, including islet cell transplant. Pregnant or anticipates pregnancy during the 2-week study period or within 30 days following the last dose of study drug. Use of investigational drugs within 90 days of participation. Currently taking methyldopa (Aldomet) at the time of randomization or taken within the past 3 months. Currently taking ferrous sulfate or ferrous gluconate, which are indicated for the treatment of anemia (hematological disease), or taken within the past 30 days. Unable to avoid medications that affect stomach pH, such as proton pump inhibitors or histamine H2 receptor blockers. Past or current medical problems or findings from physical examination or laboratory testing that are not listed above, which, in the opinion of the Investigator, may pose additional risks from participation in the study, may interfere with the subject's ability to comply with study requirements, or that may impact the quality or interpretation of the data obtained from the study. Has a history of the human immunodeficiency virus (HIV) antibody positive, or tests positive for HIV; has a history of hepatitis B surface antigen (HBsAg) or hepatitis C antibody (anti-HCV) positive, or another clinically active liver disease, or tests positive for HBsAg or anti-HCV at Screening. Has a known psychiatric or substance abuse disorder that would interfere with the subject's ability to cooperate with the requirements of the study. Has preplanned surgery or procedures that would interfere with the conduct of the study. Is an employee of the Investigator or study site, with direct involvement in the proposed study or other studies under the direction of that Investigator or study site, as well as family members of the employees or the Investigator.
Facility Information:
Facility Name
Prosciento, Inc.
City
Chula Vista
State/Province
California
ZIP/Postal Code
91911
Country
United States
Facility Name
Barbara Davis Center
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
Rainier Clinical Research Center
City
Renton
State/Province
Washington
ZIP/Postal Code
98057
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
29438107
Citation
Ostrov DA, Alkanani A, McDaniel KA, Case S, Baschal EE, Pyle L, Ellis S, Pollinger B, Seidl KJ, Shah VN, Garg SK, Atkinson MA, Gottlieb PA, Michels AW. Methyldopa blocks MHC class II binding to disease-specific antigens in autoimmune diabetes. J Clin Invest. 2018 May 1;128(5):1888-1902. doi: 10.1172/JCI97739. Epub 2018 Apr 3.
Results Reference
background
PubMed Identifier
30694829
Citation
Ostrov DA, Gottlieb PA, Michels AW. Rationally designed small molecules to prevent type 1 diabetes. Curr Opin Endocrinol Diabetes Obes. 2019 Apr;26(2):90-95. doi: 10.1097/MED.0000000000000470.
Results Reference
background
PubMed Identifier
4646774
Citation
Au WY, Dring LG, Grahame-Smith DG, Isaac P, Williams RT. The metabolism of 14 C-labelled -methyldopa in normal and hypertensive human subjects. Biochem J. 1972 Aug;129(1):1-10. doi: 10.1042/bj1290001.
Results Reference
background
PubMed Identifier
13898638
Citation
GILLESPIE L Jr, OATES JA, CROUT JR, SJOERDSMA A. Clinical and chemical studies with alpha-methyl-dopa in patients with hypertension. Circulation. 1962 Feb;25:281-91. doi: 10.1161/01.cir.25.2.281. No abstract available.
Results Reference
background
PubMed Identifier
14068757
Citation
SJOERDSMA A, VENDSALU A, ENGELMAN K. STUDIES ON THE METABOLISM AND MECHANISM OF ACTION OF METHYLDOPA. Circulation. 1963 Oct;28:492-502. doi: 10.1161/01.cir.28.4.492. No abstract available.
Results Reference
background

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Multiple Ascending Dose (MAD) Study of IMT-002 in HLA-DQ8-positive Type 1 Diabetes

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