The study is a prospective, randomized, 52-week double-blind, placebo-controlled, multicenter trial in subjects with T1D followed by a 2-year safety follow-up.
The SUNRISE study is a prospective, multi-center, double-blind, randomized, placebo-controlled trial in subjects aged 12.0 to \<41.0 years diagnosed with T1D, as defined by American Diabetes Association (ADA) criteria, and within 5 years of diagnosis. Time of diagnosis is defined as the first day of insulin administration. Subjects will be stratified by duration (zero up to 1 year and 1 year up to five years) to ensure balance of disease duration across treatment and placebo groups in each strata. For analytical purposes, all subjects12-\<41 will be considered cohort A, subjects aged 12-\<18 will considered cohort B and subjects aged 18-\<41 will be considered cohort C. For subjects aged 12-\<18 (Cohort B), dosing will be staggered with an initial 6 subjects aged 14-\<18 being enrolled with the last subject a having a minimum of 2 injections with at least 1 week follow-up after the 2nd injection. Safety data from this cohort will be evaluated before opening the study to subjects 12 and older. Subjects should be randomized no sooner than 6 weeks after diagnosis, unless glycemic range is adequately controlled as confirmed by time in glycemic range (70-180 mg/dL) \>55% by CGM recording over 3 or more consecutive or non-consecutive days. Screening assessments will include a physical examination, a fundoscopic photograph, chemistry and hematology safety labs, urinalysis, 24-hour urine protein and creatinine, HbA1c, presence of T1D antibodies, and a 4-hour MMTT. Approximately 99 qualified subjects who meet all selection criteria will be randomized in a 2:1 ratio to treatment with TOL-3021 or placebo and treated for 52 weeks. Study drug treatments will be administered via an IM injection into a large muscle every week for 52 weeks. Continuous glucose monitoring (CGM) will be initiated within 5 days prior to the screening MMTT visit and continued through Week 52. Subjects will agree to diabetes management during the study with the goal of maintaining HbA1c levels of approximately 7.0% without frequent episodes of hypoglycemia.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
78
TOL-3021 1 mg is a bacterial plasmid expression vector containing the coding sequences for the human proinsulin (hINS) gene.
TOL-3021 Placebo
Altman Clinical and Translational Research Institute UCSD
San Diego, California, United States
Treatment effect on log-transformed MMTT C-peptide area under the curve (AUC)
The primary outcome is the TOL-3021 treatment effect as determined by a repeated measures analysis of change from baseline in the log-transformed MMTT C-peptide AUC at 12, 16, and 24 weeks
Time frame: 12. 16, 24 weeks
Treatment effect on rates of clinically important hypoglycemia
Rates of clinically important hypoglycemia events as defined by total measured glucose value of \<54 mg/dL (3.0 mM/L) over each approximately 12-week period ending at Weeks 12, 24, 36, and 52 by a single blood glucose level, and by CGM, ≥10 consecutive minutes with glucose \<54 mg/dL
Time frame: 12, 24, 36, 52 weeks
Treatment effect on daily Insulin requirements
Total daily insulin requirements in units per kilogram (kg) body weight
Time frame: 24, 52 weeks
Treatment effect on HbA1c
Change in HbA1c from baseline at Weeks 24 and 52
Time frame: baseline, 24, 52 weeks
Treatment effect on log-transformed MMTT C-peptide area under the curve (AUC)
Repeated measures analysis of change from baseline in the log-transformed MMTT C-peptide AUC at 12, 16, 24, and 52 weeks
Time frame: 12, 16, 24, 52 weeks
Treatment effect on GCM measurement of glucose levels l< 70 and <55 mg/dL
Number of times the CGM reports glucose levels of \<70 and \<55 mg/dL
Time frame: 12, 16, 24, 52 weeks
Treatment effect on a Clinical responder analysis
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University of California San Francisco
San Francisco, California, United States
Mills-Peninsula Medical Center
San Mateo, California, United States
Stanford University
Stanford, California, United States
Barbara Davis Center - University of Colorado Denver
Denver, Colorado, United States
Yale University
New Haven, Connecticut, United States
University of Florida
Gainesville, Florida, United States
Baptist Health Research Institute
Jacksonville, Florida, United States
University of Miami Diabetes Research Institute
Miami, Florida, United States
University of South Florida Diabetes Center
Tampa, Florida, United States
...and 13 more locations
A clinical responder analysis defined as no change or an increase in C-peptide AUC from baseline between treatment and placebo at Weeks 12, 16, and 24 weeks. Upon completion of 52 week data, a similar analysis will include the 52 week data.
Time frame: 12, 16, 24, 52 weeks
Treatment effect on non-fasting or fasting C-peptide single test
Fasting or non-fasting C-peptide levels at baseline and at weeks 12, 16, 24, 52
Time frame: baseline, 12, 16, 24, 52 weeks
Treatment effect on HbA1c
Proportion of subjects in each treatment arm with HbA1c levels \<6.5% at Week 52
Time frame: 52 weeks
Treatment effect on CGM parameters
Time in range of 70-180 mg/dL
Time frame: 12, 16, 24, 52
Treatment effect on CGM parameters
Time \> 180 mg/dL;
Time frame: 12, 16, 24, 52
Treatment effect on CGM parameters
Time \> 250 mg/dL
Time frame: 12, 16, 24, 52
Treatment effect on CGM parameters
Mean Glucose Coefficient of Variation
Time frame: 12, 16, 24, 52
Treatment effect on CGM parameters
Low Blood Glucose Index (LBGI)
Time frame: 12, 16, 24, 52
Treatment effect on CGM parameters
Glucose \<70 mg/dL
Time frame: 12, 16, 24, 52
Treatment effect on CGM parameters
Area Under the Curve (AUC70)
Time frame: 12, 16, 24, 52
Treatment effect on other measures of hypoglycemia
Severe hypoglycemia (SH) events (impaired or loss of consciousness requiring assistance of another).
Time frame: 12, 16, 24, 52 weeks
Treatment effect on 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: 12, 16, 24, 52 weeks
Treatment effect on other measures of hypoglycemia
Total time \<70 mg/dL by CGM.
Time frame: 12, 16, 24, 52 weeks
Treatment effect on other measures of hypoglycemia
Nocturnal hypoglycemia, i.e. severe or documented symptomatic episodes (as defined above) occurring after the subject has retired for the primary sleeping period.
Time frame: 12, 16, 24, 52 weeks
Immunologic - Quantum dot (Q-dot) responses
Quantum dot (Q-dot) responses within the qualifying subpopulation to confirm induction of specific autoantigen tolerance
Time frame: at Week 52
Immunologic - Quantum dot (Q-dot) responses
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 effect of treatment and predictive values of antibody response
Regulatory/protective humoral immune response to proinsulin/insulin
Time frame: at Week 52
Immunologic - determine effect of treatment and predictive values of antibody response
Serum insulin autoantibody affinity for subjects
Time frame: at Week 52
Immunologic - determine effect of treatment and predictive values of antibody response
Insulin autoantibody isotypes (IgA and IgM) and IgG subclasses;;serum insulin, glutamic acid decarboxylase, IA-2, and ZnT8 antibodies by radio-binding assay (RBA) assay; competition assays of serum insulin and proinsulin IgM and IgG antibodies.
Time frame: at Week 52
Immunologic - determine effect of treatment and predictive values of antibody response
Serum insulin, glutamic acid decarboxylase, IA-2, and ZnT8 antibodies by radio-binding assay (RBA) assay
Time frame: at Week 52
Immunologic - determine effect of treatment and predictive values of antibody response
Competition assays of serum insulin and proinsulin IgM and IgG antibodies.
Time frame: at Week 52
Safety Variables
Clinical laboratory tests (hematology, chemistry, urinalysis)
Time frame: 12, 16, 24, 52 weeks
Safety Variables
Urine pregnancy test (UPT) for women of childbearing potential (WOCBP)c
Time frame: 12, 16, 24, 52 weeks
Safety Variables
Use of concomitant medications
Time frame: 12, 16, 24, 52 weeks
Safety Variables
Analysis of reported Adverse event (AEs)
Time frame: 12, 16, 24, 52 weeks
Safety Variables
Number of subjects with injection site reactions
Time frame: 12, 16, 24, 52 weeks
Safety Variables
Number of subjects with severe hypoglycemia or hyperglycemia events monitored by CGM
Time frame: 12, 16, 24, 52 weeks
Events of Special Interest
Number of subjects with systemic or hypersensitivity reactions associated with injection, which consist of fever, chills, headache, nausea, vomiting, and/or other signs and symptoms, such as anaphylaxis, wheezing dyspnea, urticaria, and hypotension
Time frame: 12, 16, 24, 52 weeks