Ixekizumab Diabetes Intervention Trial (I-DIT)

Type1 Diabetes Mellitus Clinical Trial

— I-DIT  

Official title:

The Effect of Anti-IL17 in New-onset Type 1 Diabetes: a Randomized, Double-blind, Placebo-controlled Trial

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04589325
• Other study ID #: IDIT001
• Status: Recruiting
• Phase: Phase 2
• Start date: November 9, 2022
• Est. completion date: December 2027

Study information

• Verified date: November 2023
• Source: Göteborg University
• Contact: Marcus Lind, MD, PhD
• Phone: +46(0)766-183142
• Email: marcus.lind[@]gu.se
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Although the clinical onset of type 1 diabetes (T1D) is acute, the progression of T1D occurs over many years often in a patchy manner with inflammation in certain lobes of the pancreas, leaving other lobes unaffected and long-lasting beta cells remain functional decades after diagnosis. Psoriasis share several aspects with T1D, e.g. the patchy inflammatory infiltrate consisting of tissue-resident memory (TRM) T cells, leaky blood vessels that facilitate leukocyte migration and the increased risk for systemic conditions. Moreover, interleukin (IL)-17 has shown to be increased in both persons with psoriasis and T1D. Activation of IL-17/IL-22 pathway is viewed to be both a hallmark of psoriasis and human T1D. Ixekizumab, an anti-IL17 biological agent, has shown marked therapeutic value in the treatment of subjects with psoriasis in several randomized trials and is currently an approved clinical therapy. Due to the many similarities in the current view of pathogenesis and manifestation of T1D and psoriasis it is possible that Ixekizumab can also influence the disease process of T1D.

Description:

In this double-blind, placebo-controlled prospective trial, patients with newly diagnosed T1D will be randomized to receive either Ixekizumab or placebo in addition to their conventional therapy. The primary aim is to examine the effect of Ixekizumab on endogenous insulin production when administered to persons with newly diagnosed T1D. The planned study duration is 52 weeks with an extension phase for 3 years and includes 127 patients at 19 centers in Sweden. During the extension phase the participants will be examined during a visit after 1 and 3 years after the end of the study regarding insulin production (C-peptide and proinsulin secretion during a Mixed Meal Tolerance Test), glycaemic control, T1D auto-antibodies and insulin doses.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 127
• Est. completion date: December 2027
• Est. primary completion date: February 2027
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 35 Years

Eligibility

INCLUSION CRITERIA:

• Signed informed consent and expected cooperation of the patients for the treatment and follow up must be obtained and documented according to ICH GCP, and national/local regulations before trial activities are begun.
• Must be willing and capable of taking the study drugs and meet for tests and follow up as described.
• Diagnosed Type 1 Diabetes (E10.9) within 100 days.
• First injection of insulin maximum 100 days prior to screening
• Aged 18-35 years old.
• Presence of antibodies at clinical practice or at screening to at least one of the following antigens: insulin/IAA, GAD-65, IA-2 and ZnT8.
• Remaining stimulated peak C-peptide = 0.20 nmol/L
• Male subjects agree to use a reliable method of birth control during the study
• Female subjects:

Participants of childbearing age or childbearing potential who are sexually active who test negative for pregnancy must be counseled and agree to use either 1 highly effective method of contraception or 2 acceptable methods of contraception combined for the duration of the study and for at least 12 weeks following the last dose of study drug or remain abstinent during the study and for at least 12 weeks following the last dose of study drug. If the highly effective contraceptive methods are contraindicated or strictly declined by patient, acceptable birth control methods may be considered. These may include combination

of both of the following methods:

• Male or female condom with spermicide
• Cap, diaphragm, or sponge with spermicide

1. Highly effective methods of contraception (use 1 form):

1. combined oral contraceptive pill and mini-pill

2. NuvaRing®

3. implantable contraceptives

4. injectable contraceptives (such as Depo-Provera®)

5. intrauterine device (such as Mirena® and ParaGard®)

6. contraceptive patch-ONLY women <198 pounds or 90 kg

7. abstinence from sex

8. vasectomy-for men in clinical studies

2. Effective methods of contraception (use 2 forms combined)

• male condom with spermicide
• female condom with spermicide
• diaphragm with spermicide
• cervical sponge
• cervical cap with spermicide

Females who are not of childbearing potential include those who have undergone or who have:

• female sterilization
• hysterectomy
• menopause
• Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome [also referred to as congenital absence of the uterus and vagina])

EXCLUSION CRITERIA:

• Contraindications to Ixekizumab.
• Treatment with any oral or injected glucose-lowering agents other than insulin.
• A history of haemolytic anaemia or significantly abnormal haematology/coagulation results at screening.
• Participation in other clinical trials with a new chemical entity within the previous 3 months.
• Subjects with severe obesity (BMI>35 kg/m2)
• Subjects with other autoimmune disease, e.g. Mb Crohn, Ulcerative colitis, Graves disease, psoriasis, psoriasis arthritis and axial spondylarthrosis, except celiac disease and hypothyroidism which do not need to be excluded for.
• Active serious or chronic infections (ie: in case patient had a serious infection (eg pneumonia, cellulitis), has been hospitalized, has received intravenous antibiotics for an infection within 12 weeks prior to screening visit, had a serious bone or joint infection within 24 weeks before screening visit, has ever had an infection of an artificial joint
• Known immunodeficiency or patient is immunocompromised to an extent that participation in the study would pose and unacceptable risk to the patient
• Tuberculosis
• History of HIV, hepatitis B or C
• Active or recurrent fungal infection
• Subjects with myocardial infarction, stroke, unstable angina or heart failure last 6 months
• Current clinically significant cardiac arrhythmias as verified by ECG
• Planned surgery during the treatment period of the study (except minor surgery on skin lesions, e.g., nevus)
• For female subjects: Positive pregnancy test, presently breast-feeding, or unwillingness to use effective contraceptive measures for the duration of the study and 3- months after discontinuation.
• For male subjects: intent to procreate during the duration of the study or within 3 months after discontinuation or unwillingness of their partner to use effective contraceptive measures for the duration of the study and 4 months after discontinuation.
• Any history of malignancy the last 5 years except for completely resected squamous or basal cell carcinoma of the skin.
• Administration of live attenuated vaccine(s) (LAV) within 2 months of enrolment. Or intended use of LAV during the treatment period.
• The investigator judges that the clinical diagnosis of T1D set is incorrect or uncertain (needs to be confirmed by discussion with experienced diabetologist if excluding due to this criterion)
• Allergy against ingredients of the investigational products.
• Known allergy or hypersensitivity to any biologic therapy (active substance or excipients) that would pose an unacceptable risk to the patient if participating in the study
• Presence of serious disease or condition, which in the opinion of the investigator makes the patient non-eligible for the study.
• Liver injury criteria: patients with active hepatobiliary diseases or at screening having alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 2.5 times the upper limit of normal (>2.5 x ULN)
• Laboratory abnormalities at screening:

1. Neutrophil count < 1,500 cells/ µL (=1,5 *109 cells/ L)

2. Platelet count < 100,000 cells/ µL (= 100 *109 cells/ L)

3. Hemoglobin < 8.5 g/dL (= <85 g/L) (males) and <8g/dL (= <80 g/L) (women)

Related Conditions & MeSH terms

• Diabetes Mellitus
• Diabetes Mellitus, Type 1
• Type1 Diabetes Mellitus

Intervention

Drug:
• Ixekizumab
Ixekizumab will be available at a concentration of 80 mg solution for injection in pre-filled syringes. Ixekizumab will be administrated by the patient via subcutaneous (s.c.) injections for a total treatment period of 12 months. Two s.c. injections (160 mg) will be administrated at week 0, one dose (80 mg) at week 2, 4, 6, 8, 10 and 12 and continue with a maintenance dose (80 mg) every 4th week for a total treatment period of 12 months.
• Placebo
Placebo will be available at a concentration of 80 mg solution for injection in pre-filled syringes. Placebo will be administrated by the patient via subcutaneous (s.c.) injections for a total treatment period of 12 months. Two s.c. injections (160 mg) will be administrated at week 0, one dose (80 mg) at week 2, 4, 6, 8, 10 and 12 and continue with a maintenance dose (80 mg) every 4th week for a total treatment period of 12 months.

Locations

Country	Name	City	State
Sweden	Södra Älvsborg Hospital	Borås
Sweden	Falu Lasarett	Falun
Sweden	Sahlgrenska University Hospital, Sahlgrenska	Göteborg
Sweden	Sahlgrenska University Hospital, Östra Hospital	Gothenburg
Sweden	Karlstad lasarett	Karlstad
Sweden	Kristianstad Hospital	Kristianstad
Sweden	Linköping University Hospital	Linköping
Sweden	Lund University Hospital	Lund
Sweden	Skåne University Hospital	Malmö
Sweden	Vrinnevi Hospital	Norrköping
Sweden	Örebro University Hospital	Örebro
Sweden	Centrum för Diabetes,	Stockholm
Sweden	Södersjukhuset Hospital	Stockholm
Sweden	NU-Hospital Group	Uddevalla
Sweden	Uppsala Academic Hospital	Uppsala

Sponsors (3)

Lead Sponsor	Collaborator
Göteborg University	Gothia Forum - Center for Clinical Trial, Statistiska Konsultgruppen

Country where clinical trial is conducted

Sweden, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Time in hypoglycaemia (<3.0 mmol/L)	Change in time in hypoglycaemia (<3.0 mmol/L) measured by CGM/FGM from baseline to week 52.	12 months
Other	Proinsulin/c-peptide ratio in serum as a measure of beta cell stress	Change in proinsulin/c-peptide ratio in serum as a measure of beta cell stress from baseline to week 52.	12 months
Other	Time in target (3.9-8 mmol/L)	Change in time in target (3.9-8 mmol/L) measured by CGM/FGM from baseline to week 52.	12 months
Other	Time in hyperglycaemia >10 mmol/L and = 14 mmol/L	Change in time in hyperglycaemia >10 mmol/L and = 14 mmol/L measured by CGM/FGM from baseline to week 52.	12 months
Other	Glycaemic variability (mean amplitude of glycemic excursions (MAGE))	Change in glycaemic variability measured by mean amplitude of glycemic excursions (MAGE) by CGM/FGM from baseline to week 52.	12 months
Other	Glycaemic variability (coefficient of variation (CV))	Change in glycaemic variability measured by coefficient of variation (CV) by CGM/FGM from baseline to week 52.	12 months
Other	Glycaemic variability (standard deviation (SD))	Change in glycaemic variability measured by standard deviation (SD) by CGM/FGM from baseline to week 52.	12 months
Other	Proportion of patients with peak residual insulin secretion	Change in proportion of patients with peak residual insulin secretion measured by MMTT: stimulated C-peptide >0.4 pmol/mL from baseline to week 52	12 months
Other	Change in World Health Organization-5 (WHO-5) scores from baseline and week 52.	Score 0 to 100; higher value indicates better well-being	12 months
Other	Change in Diabetes Treatment Satisfaction Questionnaire (DTSQ) scores from baseline and week 52.	Score 0 to 36; higher value indicates better satisfaction and change in satisfaction (score -18 to 18; higher value indicates better change in satisfaction).	12 months
Other	Change in Hypoglycaemia Fear Survey (Swe-HFS) scores from baseline and week 52.	Score 0 to 4; higher value indicates greater fear.	12 months
Other	Change in Problem Areas in Diabetes Scale (PAID) scores from baseline and week 52.	Score 0 to 100; higher value indicates greater problems.	12 months
Other	Change in International Physical Activity Questionnaire (IPAQ) scores from baseline and week 52.	Total Physical Activity Scores are calculated by Metabolic Energy Turnover (MET)-minutes/week score.	12 months
Primary	Residual insulin secretion	Change in residual insulin secretion measured by stimulated C-peptide two-hour area under the curve profile measured by Mixed Meal Tolerance Test (MMTT) between baseline and week 52.	12 months
Secondary	Mean Insulin dosage per kilo bodyweight for 24 hours	Change in mean Insulin dosage per kilo bodyweight for 24 hours from baseline to week 52.	12 months
Secondary	Time with glucose levels in range (3.9-10 mmol/L)	Change in time with glucose levels in range (3.9-10 mmol/l) measured by CGM/FGM from baseline to week 52.	12 months
Secondary	Time in hypoglycaemia (<3.9 mmol/L)	Change in time in hypoglycaemia (<3.9 mmol/L) measured by CGM/FGM from baseline to week 52.	12 months
Secondary	HbA1c	Difference in HbA1c from baseline to week 52.	12 months