The primary purpose of this study is to determine if giving the combination therapy consisting of Thymoglobulin® (ATG) and Neulasta® (GCSF) to patients with established Type 1 Diabetes (T1D) is safe and secondarily, if the ATG and GCSF will preserve insulin production.
This is a randomized, placebo controlled, phase I/II trial. Potential subjects will be screened via a 4 hour mixed meal tolerance test to assess residual beta cell (C-peptide) function. If the C-peptide level at any time is ≥ 0.1 pmol/ml, and the subject meets the additional inclusion and exclusion criteria, they will be eligible for randomization and enrollment. The study will be randomized 2:1 such that 17 subjects will receive active therapy and 8 will receive placebo. Subjects must receive Thymoglobulin®/ Neulasta® or placebo within 8 weeks of randomization. Thymoglobulin® (2.5mg/kg)/placebo will be given as 0.5 mg/kg IV on day 1 and 2 mg/kg on day 2. Six doses of Neulasta® (6mg/dose)/placebo will be given as standard of care every 2 weeks, with the first dose given prior to discharge after the Thymoglobulin® infusion. Complete metabolic panel (CMP) and complete blood count (CBC) will be done at the screening visit, just prior to study drug initiation, daily during the Thymoglobulin® infusion admission, and at follow up visits. Following discharge, daily phone calls will be made to the subjects during the first 5 days of therapy and weekly thereafter. In addition, weekly phone calls for the month following completion of therapy will be used to document adverse reactions. Thereafter calls will be made every two weeks.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
25
Anti-Thymocyte Globin (ATG) will be given as 0.5/mg/kg on day 1 and 2mg/kg on day 2.
Saline infusions will be given on Day 1 and Day 2 followed by placebo injections given in identical volumes in identical syringes
6 doses of pegylated GCSF (6mg/dose) will be given subcutaneously every 2 weeks beginning after the ATG infusion.
University of California, San Francisco
San Francisco, California, United States
Barbara Davis Center for Childhood Diabetes
Aurora, Colorado, United States
University of Florida
Gainesville, Florida, United States
Change in Metabolic Function Baseline to 12 Months.
Area Under Curve (AUC) C-peptide production. Subjects underwent a 2 hour mixed meal tolerance test (MMTT) using a 6ml/kg load of boost to stimulate insulin production. Samples were collected at baseline, 10 minutes, 20 minutes, 30 minutes, 60 minutes, 90 minutes, and 120 minutes. AUC was then calculated. Subjects repeated the MMTT at baseline, 3, 6, 9, and 12 months following ATG/GCSF or placebo. The primary outcome for the study was the change over 12 months in AUC C-peptide (1 year - baseline) for those who received ATG/GCSF versus the change in AUC C-peptide (1 year - baseline) for those who received placebo
Time frame: Baseline and 12 months
Percent Change in Regulatory T Cells (Treg) Baseline to 12 Months
Change in regulatory T cells (Treg) baseline to 12 months
Time frame: Change in Baseline to 12 months
A1c
Change in A1c baseline to 12 months
Time frame: Change in baseline to 12 months
Change in Insulin Requirements, Baseline to 12 Months
Change in Insulin Requirements, baseline to 12 months
Time frame: Change from baseline to 12 months
Change in Glutamic Acid Decarboxylase Antibodies (GADA) From Baseline to 12 Months
Change in Glutamic Acid Decarboxylase Antibodies (GADA) over 12 months
Time frame: Change from baseline to 12 months
Change in Insulin Autoantibodies (IAA) From Baseline to 12 Months
Change in Insulin Autoantibodies (IAA) over 12 months
Time frame: Change from baseline to 12 months
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Change in Insulinoma Associated 2 Autoantibodies (IA-2A) From Baseline to 12 Months
Change in Insulinoma Associated 2 Autoantibodies (IA-2A)
Time frame: Change from baseline to 12 months
Change in Zinc Transporter 8 Autoantibodies (ZnT8A) From Baseline to 12 Months
Change in Zinc Transporter 8 Autoantibodies (ZnT8A) over 12 months
Time frame: Change from baseline to 12 months
Percentage of Neutrophils
Change in Neutrophil Count over 12 months
Time frame: Change from baseline to 12 months
Change in White Blood Count (WBC) From Baseline to 12 Months
Change in WBC over 12 months
Time frame: Change from baseline to 12 months