The study is a prospective, randomized, double-blind, placebo-controlled, multi-center trial in subjects with new onset T1D.
The study will include 210 male or female subjects aged 12 to 35 years diagnosed with T1D, as defined by the American Diabetes Association (ADA) criteria and meeting enrollment criteria as follows. Initial enrollment will be restricted to subjects aged 18 and older until an analysis of data from subjects with 3 months' exposure to drug confirms safety. Upon completion of this assessment, enrollment will be open without further restrictions for subjects aged 12-35.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
TOL-3021 1 mg is a bacterial plasmid expression vector containing the coding sequences for the human proinsulin (hINS) gene.
TOL-3021 Placebo
University of Miami Diabetes Research Institute
Miami, Florida, United States
Treatment effect on log-transformed MMTT C-peptide area under the curve (AUC)
The primary outcome is the treatment effect on log-transformed MMTT C-peptide area under the curve (AUC)
Time frame: 52 weeks
Rate of clinically important hypoglycemia
glucometer, a single blood glucose level
Time frame: 52 weeks
Rate of clinically important hypoglycemia
CGM, ≥15 consecutive minutes with glucose \<54 mg/dL
Time frame: 52 weeks
Daily Insulin requirements
Total daily insulin requirements in units per kilogram (kg) body weight
Time frame: 52 weeks
Clinical Responder
A clinical responder analysis will be undertaken as a secondary endpoint to further characterize the treatment effect on a clinical level. A positive responder outcome will be defined as no change or increase in C-peptide AUC from baseline vs. Week 52
Time frame: 52 weeks
Exogenous insulin-free
Proportion of subjects in each treatment arm who are exogenous insulin-free for at least 3 months with HbA1c levels less than 6.5%
Time frame: at Week 52
Persistent Reduction
Proportion of subjects in each treatment arm who achieve a persistent reduction for at least 3 months in insulin dose to \<0.5 units/kg
Time frame: at Week 52
GCM Measurement
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Time in range 70-80 mg/dL
Time frame: at Week 52
GCM Measurement
Time \>180 mg/dL
Time frame: at Week 52
GCM Measurement
Time \>250 mg/dL
Time frame: at Week 52
GCM Measurement
Mean Glucose Coefficient of Variation
Time frame: at Week 52
GCM Measurement
Low Blood Glucose Index (LBGI)
Time frame: at Week 52
GCM Measurement
Glucose below 70 mg/dL Area Over the Curve (AOC70)
Time frame: at Week 52
Other measures of hypoglycemia
Severe hypoglycemia (SH) events (impaired or loss of consciousness requiring assistance of another)
Time frame: at Week 52
Other measures of hypoglycemia
Documented symptomatic hypoglycemia (an event during which typical symptoms of hypoglycemia are accompanied by a measured plasma glucose concentration \<70 mg/dl (3.9 mmol/L))
Time frame: at Week 52
Other measures of hypoglycemia
Total time \<70 mg/dL by CGM
Time frame: at Week 52
Other measures of hypoglycemia
Nocturnal hypoglycemia, severe or documented symptomatic episodes (as defined above) occurring after the subject has retired for the primary sleeping period
Time frame: at Week 52
Immunologic
Quantum dot (Q-dot) responses within the qualifying subpopulation to confirm induction of specific autoantigen tolerance
Time frame: at Week 52
Immunologic
Comparison of quantum dot responses within the qualifying subpopulation to clinical outcomes to confirm correlation with specific autoantigen tolerance
Time frame: at Week 52
Immunologic
Determine the effect of treatment on and predictive value of regulatory/protective humoral immune response to proinsulin/insulin
Time frame: at Week 52
Immunologic
Determine the effect of treatment on and predictive value of serum insulin autoantibody affinity for subjects
Time frame: at Week 52
Immunologic
Determine the effect of treatment on and predictive value of insulin autoantibody isotypes (IgA and IgM) and IgG subclasses
Time frame: at Week 52
Immunologic
Determine the effect of treatment on and predictive value of serum insulin, glutamic acid decarboxylase, IA-2, and ZnT8 antibodies by highly sensitive ECL assay
Time frame: at Week 52
Immunologic
Determine the effect of treatment on and predictive value of competition assays of serum insulin and proinsulin IgM and IgG antibodies
Time frame: at Week 52