A Phase 2/3, Randomized, Double-Blind, Multicenter, Multinational, 4-Arm, Controlled, Dose-Ranging Study to Evaluate Efficacy and Safety of Teplizumab (MGA031), a Humanized, FcR Non-Binding, Anti-CD3 Monoclonal Antibody, in Children and Adults with Recent-Onset Type 1 Diabetes Mellitus

Phase 2

Completed

• Conditions: diabetes; 10003816

• Registration Number: NL-OMON33995
• Lead Sponsor: MacroGenics Inc.

Brief Summary

Not available

Detailed Description

Not available

Study Timeline

• Last Update Posted: 13 May 2024

Recruitment & Eligibility

• Status: Completed
• Sex: Not specified
• Target Recruitment: 20

Inclusion Criteria

1. Written informed consent obtained from the subject (assent will be obtained for subjects under age 18, according to country-specific requests) including consent for the use of research-related health information.
2. Enrollment (Segment #1) or randomization (Segment #2) on Study Day 0 within 12 weeks of first visit to any physician for symptoms or signs of diabetes.
3. Diagnosis of type 1 diabetes mellitus, according to the American Diabetes Association and must have adiagnosis of type 1 diabetes mellitus.
4. Requirement for injected insulin therapy currently or in recent past.
5. Have a detectable fasting or stimulated C-peptide level (above the lower limit of detection of the assay).
6. One positive result on testing for any of the following antibodies:
a. islet-cell autoantibodies (ICA512/IA-2),
b. glutamic acid decarboxylase autoantibodies, or
c. insulin autoantibodies (if present during first 2 weeks, but not beyond 2 weeks, of
insulin treatment)
7. Male or female.
8. Subject must be in one of the following age groups:
· Age 18-35 years (initiation of enrollment in Segment #2 requires approval by DMC
and, if required, other authorities according to all applicable regulations); or
· Age 12-17 years pending approval by DMC and, if required, other authorities
according to all applicable regulations; or
· Age 8-11 years pending approval by DMC and, if required, other authorities according to all applicable regulations.
9. Body weight >= 36 kg.
10. Body surface area (BSA) <=2.4 m2 (Interactive Voice Response System [IVRS] will be used to calculate BSA using Mosteller formula) (see Appendix B).
11. Sexually active females, unless surgically sterile, must use 2 forms of contraception (including oral, transdermal, injectable, or implanted contraceptives, IUD, female condom, diaphragm with spermicide, cervical cap, abstinence, use of a condom by the sexual partner or sterile sexual partner) for 30 days before the first dose of study drug and must agree to continue using such precautions through the end of the study (Study Day 728). Cessation of birth control after this point should be discussed with a responsible physician. Male subjects with parners of child-bearing potential should use barrier contraception in addition to having their partners use another method of contraception.
*Abstinence is only an acceptable form of contraception if it is the subject's preexisting normal status.
12. Willing to forego other forms of experimental treatment during the study, particularly immunomodulatory agents and agents that stimulate pancreatic beta cell regeneration or insulin secretion.

Exclusion Criteria

1. Prior administration of a monoclonal antibody*within the 1 year before enrollment or randomization at Study Day 0* that could potentially prevent or confound a therapeutic response to teplizumab.
2. Participation in any type of therapeutic drug or vaccine clinical trial within the last 12 weeks before enrollment or randomization at Study Day 0.
3. Any medical condition that, in the opinion of the investigator, would interfere with safe completion of the trial.
4. Pregnant females or lactating females who intend to provide their own breast milk to the baby during the study
5. Prior murine OKT®3 treatment at any time before enrollment or randomization.
6. Current or planned therapy with Exenatide or any other agents that stimulate pancreatic beta cell regeneration or insulin secretion, or any oral antibiabetic agents
7. Current or planned therapy with inhaled insulin, if it becomes available
8. Uncompensated heart failure, fluid overload, myocardial infarction or evidence of ischemic heart disease or other serious cardiac disease within the 12 weeks before enrollment or randomization.
9. History of epilepsy, cancer, cystic fibrosis, sickle cell anemia, neuropathy, peripheral vascular disease or cerebrovascular disease.
10. Newly diagnosed hypothyroidism (not currently being treated but which, in the opinion of the investigator, should be treated) or active Graves* disease. Subjects with preexisting hypothyroidism may join the study if their medication is stable with no expected change in dosage or status of disease.
11. Eczema, asthma or severe atopic disease requiring treatment, including tpoical or inhales coricosteroids, within the 12 weeks before enrollment or randomization.
12. Evidence of active infection, such as fever >= 38.0oC (100.5oF).
13. Known or suspected infection with human immunodeficiency virus (HIV).
14. Evidence of active hepatitis B (HBV) or hepatitis C virus (HCV), such as positive hepatitis B surface antigen (HBsAg) or anti-hepatitis C antibody.
15. Total bilirubin >1.5 x upper limit of normal (ULN).
16. AST or ALT >1.5 x ULN.
17. Evidence of active or latent tuberculosis, which may include a positive purified protein derivative (PPD) skin test result (>=10 mm induration); a chest X-ray consistent with tuberculosis; or household contact with a person with active tuberculosis, unless appropriate isoniazid (INH) prophylaxis for tuberculosis was previously given
18. Vaccination with a live virus within the 8 weeks before enrollment or randomization or planned live virus vaccination continuing through Week 52 of the study. Vaccination with an antigen or killed organism must not be given within 8 weeks before or planned within 8 weeks after each dosing cycle. (For additional information on vaccines see section 3.3.5.2).
19. Any infectious mononucleosis-like illness within the 6 months before enrollment or randomization.
20. Serologic and clinical evidence of acute infection with Epstein-Barr virus (EBV), including a positive EBV IgM. (Viral load does not have to be positive).
21. Serologic evidence of acute infection with cytomegalovirus (CMV), defined as a positive CMV IgG and a positive viral load.
22. Lymphopenia (<1000 lymphocytes/µL).
23. Neutropenia (<1000 PMN/µL on 2 consecutive evaluations performed on different days).
24. Thrombocytopenia (<150,000 platelets/µL).
25. Anemia (Hgb <10 g/dL).

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
<p>Primary Efficacy Endpoint<br /><br>This study has two primary endpoints. The first primary endpoint is a<br /><br>composite endpoint. It is the proportion of subjects, who at 52 weeks after<br /><br>randomization, have both a total daily insulin dose of less than 0.5 U/kg/day<br /><br>and HbA1c level of less than 6.5%. The second primary endpoint is the mean<br /><br>HbA1c level at 52 weeks after randomization.<br /><br><br /><br>The two primary endpoints will be assessed in a hierarchical manner with the<br /><br>composite being assessed first. The mean HbA1c will only be assessed if a<br /><br>statistically significant difference is obtained with the composite endpoint.<br /><br><br /><br><br /><br>Safety Endpoints<br /><br>Evaluations of safety will be based on adverse event (AE) and serious adverse<br /><br>event (SAE) rates,<br /><br>as well as other safety parameters. AEs will be described by system organ class<br /><br>and MedDRA<br /><br>term, severity, and relationship to teplizumab.</p><br>