Objectives The objective of this clinical trial is to assess whether ladarixin treatment has an effect to preserve β-cell function and delay the progression of T1D in adolescent and adult patients. The safety of ladarixin in the specific clinical setting will be also evaluated.
The study will be a phase 2, multicenter, double-blind, placebo-controlled study. It will randomize approximately 130-140 patients (with up to an estimated 15-20% adolescents), with recent onset (within 180 days from 1st insulin administration) type 1 diabetes (T1D), assigned (2:1) to receive either oral ladarixin treatment (400 mg b.i.d. for 13 cycles of 14 days on/14 days off - treatment group) or placebo (control group). Recruitment will be competitive among the study sites, until the planned number of patients is randomized. Ladarixin and placebo will be both administered for 1 year. All patients will be followed-up for 24 months from the 1st administration of the study medication. After the initial 12-m treatment period, all patients will enter into a 12-month follow-up (total period 24-month after first IMP administration). The study database (DB) will be locked when the last randomized patient has completed the month 12 visit (or being lost in follow-up), and relative data have been fully reconciled and cleaned; at that point, the DB will be unblinded and all endpoints, including the 6-month primary endpoint, will be analyzed, and the follow-up will continue under open-label conditions up to month 24.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
141
Change from baseline in 2-hour AUC of C-peptide response to the Mixed Model Tolerance Test (MMTT)
C-peptide level is an indirect measure of pancreatic beta-cell function. The MMTT was performed after an overnight fast, at baseline
Time frame: Month 6
Change from baseline in 2-hour AUC of C-peptide response to the MMTT
Time frame: Months 12, 18 and 24
Change in HbA1c from baseline
Time frame: Months 6, 12, 18 and 24
Time in range (TIR) by Continuous Glucose Monitoring (CGM)
Time frame: Months 6, 12, 18, 24
Proportion of patients with HbA1c <7% who did not experience severe hypoglycemic events during treatment
Time frame: Months 6, 12, 18, 24
Average (previous 3 days) daily insulin requirement (IU/kg/day)
Time frame: Months 6, 12, 18, 24
Proportion of patients with HbA1c <7% and daily insulin requirement <0.5 (IU/kg/day)
Time frame: Months 6, 12, 18, 24
Additional Glucose Variability Indices derived from CGM
Additional Glucose Variability Indices derived from CGM (glucose AUC outside the target range of 70 - 180 mg/dL, 2-hour postprandial glucose (PPG)).
Time frame: Months 6, 12, 18 and 24
Additional Glucose Variability Indices derived from MAGE
Additional Glucose Variability Indices derived from Mean Amplitude Glycemic Excursions (MAGE)
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University of Alabama at Birmingham (UAB) - The Kirklin Clinic (TKC) - Multidisciplinary Comprehensive Diabetes Clinic (MCDC)
Birmingham, Alabama, United States
Phoenician Centers for Research and Innovation
Phoenix, Arizona, United States
University of California San Diego
La Jolla, California, United States
Center of Excellence in Diabetes & Endocrinology (CEDE)
Sacramento, California, United States
University of Colorado School of Medicine - Barbara Davis Center for Childhood Diabetes (BDC) - Specialty Clinic
Aurora, Colorado, United States
Christiana Care Endocrinology Specialists
Newark, Delaware, United States
Diabetes Care Center - Hudson
Hudson, Florida, United States
Global Life Research Network
Miami, Florida, United States
AdventHealth (Florida Hospital) - Diabetes Institute - Orlando
Orlando, Florida, United States
Atlanta Diabetes Associates (ADA)
Atlanta, Georgia, United States
...and 47 more locations
Time frame: Months 6, 12, 18 and 24
Additional Glucose Variability Indices derived from CONGA-n
Additional Glucose Variability Indices derived from continuous overall net glycemic action (CONGA)-n
Time frame: Months 6, 12, 18 and 24
Additional Glucose Variability Indices derived from MODD
Additional Glucose Variability Indices derived from Mean Of the Daily Differences (MODD).
Time frame: Months 6, 12, 18 and 24
Additional Glucose Variability Indices derived from mean daily blood glucose, SD
Additional Glucose Variability Indices derived from mean daily blood glucose, SD (Standard Deviation).
Time frame: Months 6, 12, 18 and 24
Number of self-reported episodes of severe hypoglycemia
For the purpose of this study, a severe hypoglycemic event is defined as an event with one of the following symptoms: "memory loss, confusion, uncontrollable behavior, irrational behavior, unusual difficulty in awakening, suspected seizure, seizure, loss of consciousness, or visual symptoms", in which the subject was unable to treat him/herself and which was associated with either a blood glucose level \<54mg/dL or prompt recovery after oral carbohydrate, i.e. glucose, or glucagon administration.
Time frame: Months 6, 12, 18, 24
Percentage of patients not requiring insulin therapy
This outcome aims to assess the % of patients who do not require an insulin therapy
Time frame: Months 6, 12, 18, 24
Estimated Glucose Disposal Rate (eGDR)
Estimated Glucose Disposal Rate (eGDR) is a marker for the Assessment of Insulin Resistance and a validated clinical tool for estimating insulin sensitivity in type 1 diabetes.
Time frame: Months 6, 12, 18, 24