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    Clinical Trial Results:
    A Phase 3, Multinational, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study to Investigate the Clinical Efficacy and Safety of DiaPep277® in Newly Diagnosed Type 1 Diabetes Subjects

    Summary
    EudraCT number
    2009-015929-37
    Trial protocol
    HU   ES   DE   IT   AT   CZ   LT   FI  
    Global end of trial date
    28 Oct 2014

    Results information
    Results version number
    v1(current)
    This version publication date
    16 Jul 2016
    First version publication date
    16 Jul 2016
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    1001
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01103284
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Andromeda Biotech Ltd.
    Sponsor organisation address
    42 Hayarkon St., Yavne, Israel, 81227
    Public contact
    42 Hayarkon St. Industrial Area, Yavne 81227, Israel, Andromeda Biotech Ltd., +972 8 9387777,
    Scientific contact
    42 Hayarkon St. Industrial Area, Yavne 81227, Israel, Andromeda Biotech Ltd., +972 8 9387777,
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    28 Oct 2014
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    28 Oct 2014
    Global end of trial reached?
    Yes
    Global end of trial date
    28 Oct 2014
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary efficacy objective was to compare in subjects with Type 1 diabetes (T1D) the effect of DiaPep277® to Placebo on endogenous insulin secretion or pancreatic beta-cell function as measured by area under curve from 0 to 20 minutes (AUC 0-20min) of C-peptide concentration versus time from a glucagon stimulation test (GST).
    Protection of trial subjects
    The Guidelines of the World Medical Association Declaration of Helsinki in its revised edition (64th World Medical Association General Assembly, Fortaleza, Brazil, October 2013), the Guidelines of International Conference of Harmonization (ICH) Good Clinical Practice (GCP) (CPMP/ICH/135/95), and the demands of national drug and data protection laws and other applicable regulatory requirements were strictly followed during this study. This study also conformed to the laws and regulations of the countries in which it was conducted, as well as any applicable guidelines. All personnel involved in the study worked within the confines of the European Data Protection Directive as interpreted by each country’s laws.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    25 May 2010
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Czech Republic: 18
    Country: Number of subjects enrolled
    Austria: 6
    Country: Number of subjects enrolled
    Germany: 34
    Country: Number of subjects enrolled
    Israel: 61
    Country: Number of subjects enrolled
    Italy: 39
    Country: Number of subjects enrolled
    Belarus: 24
    Country: Number of subjects enrolled
    Spain: 12
    Country: Number of subjects enrolled
    Hungary: 16
    Country: Number of subjects enrolled
    Lithuania: 19
    Country: Number of subjects enrolled
    Poland: 30
    Country: Number of subjects enrolled
    Romania: 12
    Country: Number of subjects enrolled
    Russian Federation: 78
    Country: Number of subjects enrolled
    Serbia: 16
    Country: Number of subjects enrolled
    Canada: 2
    Country: Number of subjects enrolled
    United States: 96
    Country: Number of subjects enrolled
    Argentina: 11
    Worldwide total number of subjects
    474
    EEA total number of subjects
    186
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    474
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Newly diagnosed adult Type 1 Diabetes (T1D) subjects with residual beta-cell function were the target population for treatment with DiaPep277®, as it has the potential to prevent or delay further loss of beta-cell function.

    Pre-assignment
    Screening details
    897 subjects entered the study: 422 subjects failed screening; 475 subjects were randomized: a. 236 subjects randomized to DiaPep277® group: 194 completed study b. 239 subjects randomized to Placebo group but 1 subject was not treated with study drug: a total of 238 subjects in this group were included in Safety Population. 195 completed study

    Period 1
    Period 1 title
    Treatment (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    DiaPep277®
    Arm description
    Administration of 1 mg DiaPep277®, subcutaneously (s.c.) in the upper arm at 0, 1, 3, 6, 9, 12, 15, 18, 21, and 24 months, for a total of 10 administrations. DiaPep277: 1.0 mg dose in 0.5 mL of solution
    Arm type
    Experimental

    Investigational medicinal product name
    DiaPep277®
    Investigational medicinal product code
    DiaPep277®
    Other name
    Pharmaceutical forms
    Powder and solvent for emulsion for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    The fixed dose of DiaPep277® 1.0 mg was administered subcutaneously (s.c.) as a sterile 0.5 mL solution.

    Arm title
    Placebo
    Arm description
    Administration of placebo, subcutaneously (s.c.) in the upper arm at 0, 1, 3, 6, 9, 12, 15, 18, 21, and 24 months, for a total of 10 administrations. Placebo: 40 mg mannitol in 0.5 mL of solution. Dosing: 0, 1, 3, 6, 9, 12, 15, 18, 21, 24 months
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder and solvent for solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    The fixed dose of 1.0 mg placebo was administered subcutaneously (s.c.) as a sterile 0.5 mL solution.

    Number of subjects in period 1
    DiaPep277® Placebo
    Started
    236
    238
    At Least One Post-baseline Visit (FAS)
    233
    235
    Completed
    194
    195
    Not completed
    42
    43
         Use of unacceptable medication
    2
    -
         Termination by the Sponsor
    -
    1
         Consent withdrawn by subject
    14
    18
         Failed to meet entry criteria
    1
    -
         Adverse event, non-fatal
    -
    5
         Missing CRF entries
    1
    1
         Death
    2
    -
         Other
    2
    1
         Pregnancy
    3
    1
         Non-compliance
    6
    3
         Lost to follow-up
    9
    10
         Protocol deviation
    2
    2
         Dermal hypersensitivity
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    DiaPep277®
    Reporting group description
    Administration of 1 mg DiaPep277®, subcutaneously (s.c.) in the upper arm at 0, 1, 3, 6, 9, 12, 15, 18, 21, and 24 months, for a total of 10 administrations. DiaPep277: 1.0 mg dose in 0.5 mL of solution

    Reporting group title
    Placebo
    Reporting group description
    Administration of placebo, subcutaneously (s.c.) in the upper arm at 0, 1, 3, 6, 9, 12, 15, 18, 21, and 24 months, for a total of 10 administrations. Placebo: 40 mg mannitol in 0.5 mL of solution. Dosing: 0, 1, 3, 6, 9, 12, 15, 18, 21, 24 months

    Reporting group values
    DiaPep277® Placebo Total
    Number of subjects
    236 238 474
    Age categorical
    Overall, the mean age was 28.6 years (range: 20 to 45 years), with just over half of the subjects (51.7%) being 27 years of age or younger.
    Units: Subjects
        ≤ 27 years
    120 125 245
        > 27 years
    116 113 229
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    28.87 ± 6.75 28.5 ± 6.56 -
    Gender categorical
    Units: Subjects
        Male
    157 165 322
        Female
    79 73 152
    Race
    Race
    Units: Subjects
        Caucasian
    224 225 449
        Hispanic
    6 6 12
        Black
    3 4 7
        Oriental
    1 1 2
        Asian
    1 0 1
        Other
    0 2 2
        Unknown
    1 0 1
    Daily Insulin Dose
    Units: IU/kg/day
        arithmetic mean (standard deviation)
    0.305 ± 0.1587 0.317 ± 0.1649 -
    Fasting C-Peptide
    Units: nmol(s)/L
        arithmetic mean (standard deviation)
    0.388 ± 0.1473 0.407 ± 0.1731 -
    Subject analysis sets

    Subject analysis set title
    Safety population
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The Safety population, defined as all subjects who received at least one dose of study medication, consisted of 236 subjects in the DiaPep277® group and 238 subjects in the Placebo group.

    Subject analysis set title
    FAS population
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS population, defined as all randomized subjects who had a Baseline Visit and at least one scheduled post-Baseline Visit, consisted of 233 subjects in the DiaPep277® group and 234 subjects in the Placebo group. Note: Number of subjects in the Placebo group for the FAS is different in the analysis population table (234) versus the efficacy tables (235). This discrepancy is due to one subject who had a scheduled post-baseline visit, but did not have a post-baseline medication administration date. This subject was excluded from the Placebo group of the FAS in the analysis population table. However, this was not the intent of the Final SAP, and hence this subject was included in the Placebo group of the FAS in the efficacy tables (total: 468 patients).

    Subject analysis set title
    DiaPep277® (FAS)
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The DiaPep277® FAS population, defined as all randomized subjects who had a Baseline Visit and at least one scheduled post-Baseline Visit, consisted of 233 subjects (98.7%) in the DiaPep277® group.

    Subject analysis set title
    Placebo (FAS)
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The Placebo FAS population, defined as all randomized subjects who had a Baseline Visit and at least one scheduled post-Baseline Visit, consisted of 234 subjects (97.9%) in the Placebo group.

    Subject analysis set title
    DiaPep277® (Safety population)
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The DiaPep277® Safety population, defined as all subjects who received at least one dose of study medication, consisted of 236 subjects (100.0%) in the DiaPep277® group.

    Subject analysis set title
    Placebo (Safety population)
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The Placebo Safety population, defined as all subjects who received at least one dose of study medication, consisted of 238 subjects (99.6%) in the Placebo group.

    Subject analysis sets values
    Safety population FAS population DiaPep277® (FAS) Placebo (FAS) DiaPep277® (Safety population) Placebo (Safety population)
    Number of subjects
    474
    468
    233
    235
    236
    238
    Age categorical
    Overall, the mean age was 28.6 years (range: 20 to 45 years), with just over half of the subjects (51.7%) being 27 years of age or younger.
    Units: Subjects
        ≤ 27 years
    245
    120
    125
        > 27 years
    229
    116
    113
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    28.6 ± 6.65
    ±
    ±
    ±
    28.87 ± 6.75
    28.5 ± 6.56
    Gender categorical
    Units: Subjects
        Male
    322
    157
    165
        Female
    152
    79
    73
    Race
    Race
    Units: Subjects
        Caucasian
    449
    224
    225
        Hispanic
    12
    6
    6
        Black
    7
    3
    4
        Oriental
    2
    1
    1
        Asian
    1
    1
    0
        Other
    2
    0
    2
        Unknown
    1
    1
    0
    Daily Insulin Dose
    Units: IU/kg/day
        arithmetic mean (standard deviation)
    0.311 ± 0.1618
    ±
    ±
    ±
    0.305 ± 0.1587
    0.317 ± 0.1649
    Fasting C-Peptide
    Units: nmol(s)/L
        arithmetic mean (standard deviation)
    0.398 ± 0.1609
    ±
    ±
    ±
    0.388 ± 0.1473
    0.407 ± 0.1731

    End points

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    End points reporting groups
    Reporting group title
    DiaPep277®
    Reporting group description
    Administration of 1 mg DiaPep277®, subcutaneously (s.c.) in the upper arm at 0, 1, 3, 6, 9, 12, 15, 18, 21, and 24 months, for a total of 10 administrations. DiaPep277: 1.0 mg dose in 0.5 mL of solution

    Reporting group title
    Placebo
    Reporting group description
    Administration of placebo, subcutaneously (s.c.) in the upper arm at 0, 1, 3, 6, 9, 12, 15, 18, 21, and 24 months, for a total of 10 administrations. Placebo: 40 mg mannitol in 0.5 mL of solution. Dosing: 0, 1, 3, 6, 9, 12, 15, 18, 21, 24 months

    Subject analysis set title
    Safety population
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The Safety population, defined as all subjects who received at least one dose of study medication, consisted of 236 subjects in the DiaPep277® group and 238 subjects in the Placebo group.

    Subject analysis set title
    FAS population
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The FAS population, defined as all randomized subjects who had a Baseline Visit and at least one scheduled post-Baseline Visit, consisted of 233 subjects in the DiaPep277® group and 234 subjects in the Placebo group. Note: Number of subjects in the Placebo group for the FAS is different in the analysis population table (234) versus the efficacy tables (235). This discrepancy is due to one subject who had a scheduled post-baseline visit, but did not have a post-baseline medication administration date. This subject was excluded from the Placebo group of the FAS in the analysis population table. However, this was not the intent of the Final SAP, and hence this subject was included in the Placebo group of the FAS in the efficacy tables (total: 468 patients).

    Subject analysis set title
    DiaPep277® (FAS)
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The DiaPep277® FAS population, defined as all randomized subjects who had a Baseline Visit and at least one scheduled post-Baseline Visit, consisted of 233 subjects (98.7%) in the DiaPep277® group.

    Subject analysis set title
    Placebo (FAS)
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The Placebo FAS population, defined as all randomized subjects who had a Baseline Visit and at least one scheduled post-Baseline Visit, consisted of 234 subjects (97.9%) in the Placebo group.

    Subject analysis set title
    DiaPep277® (Safety population)
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The DiaPep277® Safety population, defined as all subjects who received at least one dose of study medication, consisted of 236 subjects (100.0%) in the DiaPep277® group.

    Subject analysis set title
    Placebo (Safety population)
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The Placebo Safety population, defined as all subjects who received at least one dose of study medication, consisted of 238 subjects (99.6%) in the Placebo group.

    Primary: Change From Baseline in Glucagon-Stimulated C-Peptide AUC at 24 Months

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    End point title
    Change From Baseline in Glucagon-Stimulated C-Peptide AUC at 24 Months
    End point description
    Change in Beta-cell function, measured as stimulated C-peptide secretion 0, 2, 6, 10 and 20 minutes post administration [area under the curve (AUC), 0-20 minutes] at baseline and 24 months, during a glucagon stimulation test (GST). The change in AUC was calculated per patient by subtracting the baseline AUC from the 24 month AUC.
    End point type
    Primary
    End point timeframe
    Baseline and 24 months.
    End point values
    DiaPep277® (FAS) Placebo (FAS)
    Number of subjects analysed
    233 [1]
    235 [2]
    Units: nmol × minute/L
        arithmetic mean (standard error)
    -5.2 ± 0.27
    -4.83 ± 0.3
    Notes
    [1] - DiaPep277: 1.0 mg dose in 0.5 mL of solution Dosing: 0, 1, 3, 6, 9, 12, 15, 18, 21, 24 months
    [2] - Placebo: 40 mg mannitol in 0.5 mL of solution. Dosing: 0, 1, 3, 6, 9, 12, 15, 18, 21, 24 months
    Statistical analysis title
    The change from Baseline in AUC0-20min
    Comparison groups
    DiaPep277® (FAS) v Placebo (FAS)
    Number of subjects included in analysis
    468
    Analysis specification
    Pre-specified
    Analysis type
    other [3]
    P-value
    = 0.33 [4]
    Method
    Mixed models analysis
    Parameter type
    Mean difference (net)
    Point estimate
    -0.37
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.14
         upper limit
    0.39
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.39
    Notes
    [3] - The Mixed-Effect Model Repeated Measure (MMRM) was adjusted for the following baseline covariates: age, C-peptide, insulin dose by body weight and AUC
    [4] - The a priori threshold for statistical significance was 0.05

    Secondary: Percentage of Subjects That Achieve Good Glycemic Control: HbA1c<7%

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    End point title
    Percentage of Subjects That Achieve Good Glycemic Control: HbA1c<7%
    End point description
    The percentage of subjects achieving good glycemic control, i.e. an HbA1c <7% at study end (Month 25). If HbA1c was missing at Month 25, but the Month 24 value was available, then the Month 24 value was used to calculate the percentage of subjects with an HbA1c ≤ 7% at study end.
    End point type
    Secondary
    End point timeframe
    24 and 25 months
    End point values
    DiaPep277® (FAS) Placebo (FAS)
    Number of subjects analysed
    233 [5]
    235 [6]
    Units: Percentage of subjects
        number (confidence interval 95%)
    47 (40 to 54)
    47 (40 to 55)
    Notes
    [5] - DiaPep277: 1.0 mg dose in 0.5 mL of solution Dosing: 0, 1, 3, 6, 9, 12, 15, 18, 21, 24 months
    [6] - Placebo: 40 mg mannitol in 0.5 mL of solution. Dosing: 0, 1, 3, 6, 9, 12, 15, 18, 21, 24 months
    Statistical analysis title
    Percentage of Subjects Achieving HbA1c ≤ 7%
    Comparison groups
    DiaPep277® (FAS) v Placebo (FAS)
    Number of subjects included in analysis
    468
    Analysis specification
    Pre-specified
    Analysis type
    other [7]
    P-value
    = 0.68 [8]
    Method
    Mixed models analysis
    Parameter type
    Odds ratio (OR)
    Point estimate
    0.99
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.66
         upper limit
    1.52
    Notes
    [7] - The MMRM model was adjusted for the following covariates: age, Baseline C-peptide, Baseline insulin dose adjusted for body weight, and Baseline AUC.
    [8] - A priori threshold for statistical significance was 0.05

    Secondary: Frequency of Hypoglycemic Events

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    End point title
    Frequency of Hypoglycemic Events
    End point description
    Total number of days with at least one hypoglycemic event recorded
    End point type
    Secondary
    End point timeframe
    Baseline to 25 Months
    End point values
    DiaPep277® (FAS) Placebo (FAS)
    Number of subjects analysed
    233 [9]
    235 [10]
    Units: days
    1955
    3264
    Notes
    [9] - DiaPep277: 1.0 mg dose in 0.5 mL of solution Dosing: 0, 1, 3, 6, 9, 12, 15, 18, 21, 24 months
    [10] - Placebo: 40 mg mannitol in 0.5 mL of solution Dosing: 0, 1, 3, 6, 9, 12, 15, 18, 21, 24 months
    No statistical analyses for this end point

    Secondary: Mean Number of Days With at Least One Hypoglycemic Event

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    End point title
    Mean Number of Days With at Least One Hypoglycemic Event
    End point description
    End point type
    Secondary
    End point timeframe
    Baseline to 25 Months.
    End point values
    DiaPep277® (FAS) Placebo (FAS)
    Number of subjects analysed
    233 [11]
    235 [12]
    Units: days
        arithmetic mean (standard error)
    13 ± 2.3
    35.4 ± 7.6
    Notes
    [11] - DiaPep277: 1.0 mg dose in 0.5 mL of solution Dosing: 0, 1, 3, 6, 9, 12, 15, 18, 21, 24 months
    [12] - Placebo: 40 mg mannitol in 0.5 mL of solution Dosing: 0, 1, 3, 6, 9, 12, 15, 18, 21, 24 months
    Statistical analysis title
    Mean Number of Days With at Least One Hypoglycemic
    Comparison groups
    DiaPep277® (FAS) v Placebo (FAS)
    Number of subjects included in analysis
    468
    Analysis specification
    Pre-specified
    Analysis type
    other [13]
    P-value
    = 0.07 [14]
    Method
    Negative binomial regression
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.38
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.02
         upper limit
    0.79
    Notes
    [13] - The number of hypoglycemia events during the study was analyzed using a negative binomial regression model, with number of events as the dependent variable, and treatment, age, baseline daily insulin dose, and baseline C-peptide as covariates. The log of duration in the study for each patient was used as an offset variable in the model.
    [14] - Standard multiple imputation was used to predict the number and timing of hypoglycemic events after discontinuing the study for subjects who did not remain in the study until Month 25.

    Other pre-specified: Percentage of Subjects Requiring a Daily Insulin Dose ≤ 0.5 IU/kg at End of Study

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    End point title
    Percentage of Subjects Requiring a Daily Insulin Dose ≤ 0.5 IU/kg at End of Study
    End point description
    Percentage of subjects requiring a daily insulin dose ≤ 0.5 IU/kg at end of study (25 Months). If insulin dose was missing at Month 25, but the Month 24 value was available, then the Month 24 value was used to calculate the percentage of subjects with a daily insulin dose ≤ 0.5 IU/kg at study end.
    End point type
    Other pre-specified
    End point timeframe
    24 and 25 months
    End point values
    DiaPep277® (FAS) Placebo (FAS)
    Number of subjects analysed
    233 [15]
    235 [16]
    Units: Percentage of Subjects
    63
    57
    Notes
    [15] - DiaPep277: 1.0 mg dose in 0.5 mL of solution Dosing: 0, 1, 3, 6, 9, 12, 15, 18, 21, 24 months
    [16] - Placebo: 40 mg mannitol in 0.5 mL of solution Dosing: 0, 1, 3, 6, 9, 12, 15, 18, 21, 24 months
    Statistical analysis title
    Percentage subjects requiring daily insulin dose
    Comparison groups
    Placebo (FAS) v DiaPep277® (FAS)
    Number of subjects included in analysis
    468
    Analysis specification
    Pre-specified
    Analysis type
    other [17]
    P-value
    = 0.44 [18]
    Method
    Mixed models analysis
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.3
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.66
         upper limit
    1.52
    Notes
    [17] - The MMRM model was adjusted for the following covariates: age, Baseline C-peptide, Baseline insulin dose adjusted for body weight, and Baseline AUC
    [18] - The a priori threshold for statistical significance was 0.05

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events (AE) data were collected from the time of subject enrollment through one month after the final product administrations (Total of 25 months after first study product administration)
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    17.0
    Reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Administration of placebo, subcutaneously (s.c.) in the upper arm at 0, 1, 3, 6, 9, 12, 15, 18, 21, and 24 months, for a total of 10 administrations. Placebo: 40 mg mannitol in 0.5 mL of solution. Dosing: 0, 1, 3, 6, 9, 12, 15, 18, 21, 24 months

    Reporting group title
    DiaPep277®
    Reporting group description
    Administration of 1 mg DiaPep277®, subcutaneously (s.c.) in the upper arm at 0, 1, 3, 6, 9, 12, 15, 18, 21, and 24 months, for a total of 10 administrations. DiaPep277: 1.0 mg dose in 0.5 mL of solution

    Serious adverse events
    Placebo DiaPep277®
    Total subjects affected by serious adverse events
         subjects affected / exposed
    10 / 238 (4.20%)
    15 / 236 (6.36%)
         number of deaths (all causes)
    0
    2
         number of deaths resulting from adverse events
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Benign muscle neoplasm
         subjects affected / exposed
    1 / 238 (0.42%)
    0 / 236 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Meniscus injury
         subjects affected / exposed
    0 / 238 (0.00%)
    1 / 236 (0.42%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Multiple injuries
         subjects affected / exposed
    1 / 238 (0.42%)
    0 / 236 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Hypoglycemic seizure
         subjects affected / exposed
    0 / 238 (0.00%)
    1 / 236 (0.42%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Loss of Consciousness
         subjects affected / exposed
    1 / 238 (0.42%)
    0 / 236 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pregnancy, puerperium and perinatal conditions
    Abortion spontaneous
         subjects affected / exposed
    0 / 238 (0.00%)
    1 / 236 (0.42%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Lymphadenitis
         subjects affected / exposed
    1 / 238 (0.42%)
    0 / 236 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    0 / 238 (0.00%)
    1 / 236 (0.42%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Duodenal ulcer haemorrhage
         subjects affected / exposed
    0 / 238 (0.00%)
    1 / 236 (0.42%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Incarcerated inguinal hernia
         subjects affected / exposed
    0 / 238 (0.00%)
    1 / 236 (0.42%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Anal fistula
         subjects affected / exposed
    1 / 238 (0.42%)
    0 / 236 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Nasal septum deviation
         subjects affected / exposed
    0 / 238 (0.00%)
    1 / 236 (0.42%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psychiatric disorders
    Depression
         subjects affected / exposed
    1 / 238 (0.42%)
    0 / 236 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Sympathetic posterior cervical syndrome
         subjects affected / exposed
    1 / 238 (0.42%)
    0 / 236 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Muscle disorder
         subjects affected / exposed
    1 / 238 (0.42%)
    0 / 236 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Meningitis viral
         subjects affected / exposed
    0 / 238 (0.00%)
    1 / 236 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    0 / 238 (0.00%)
    1 / 236 (0.42%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tick-borne viral encephalitis
         subjects affected / exposed
    0 / 238 (0.00%)
    1 / 236 (0.42%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sialoadenitis
         subjects affected / exposed
    1 / 238 (0.42%)
    0 / 236 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tonsillitis streptococcal
         subjects affected / exposed
    0 / 238 (0.00%)
    1 / 236 (0.42%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Diabetic ketoacidosis
         subjects affected / exposed
    0 / 238 (0.00%)
    2 / 236 (0.85%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Hypoglycaemia
         subjects affected / exposed
    3 / 238 (1.26%)
    1 / 236 (0.42%)
         occurrences causally related to treatment / all
    1 / 3
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diabetes mellitus inadequate control
         subjects affected / exposed
    0 / 238 (0.00%)
    1 / 236 (0.42%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 2%
    Non-serious adverse events
    Placebo DiaPep277®
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    172 / 238 (72.27%)
    171 / 236 (72.46%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    5 / 238 (2.10%)
    2 / 236 (0.85%)
         occurrences all number
    5
    2
    General disorders and administration site conditions
    Injection site pain
         subjects affected / exposed
    18 / 238 (7.56%)
    20 / 236 (8.47%)
         occurrences all number
    18
    20
    Asthenia
         subjects affected / exposed
    6 / 238 (2.52%)
    3 / 236 (1.27%)
         occurrences all number
    6
    3
    Fatigue
         subjects affected / exposed
    5 / 238 (2.10%)
    3 / 236 (1.27%)
         occurrences all number
    5
    3
    Immune system disorders
    Immune system disorder
         subjects affected / exposed
    6 / 238 (2.52%)
    6 / 236 (2.54%)
         occurrences all number
    6
    6
    Reproductive system and breast disorders
    Reproductive system and breast disorder
         subjects affected / exposed
    4 / 238 (1.68%)
    6 / 236 (2.54%)
         occurrences all number
    4
    6
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    8 / 238 (3.36%)
    5 / 236 (2.12%)
         occurrences all number
    8
    5
    Oropharyngeal pain
         subjects affected / exposed
    7 / 238 (2.94%)
    4 / 236 (1.69%)
         occurrences all number
    7
    4
    Respiratory disorder
         subjects affected / exposed
    6 / 238 (2.52%)
    4 / 236 (1.69%)
         occurrences all number
    6
    4
    Psychiatric disorders
    Psychiatric disorders
         subjects affected / exposed
    9 / 238 (3.78%)
    10 / 236 (4.24%)
         occurrences all number
    9
    10
    Investigations
    Blood creatine phosphokinase increased
         subjects affected / exposed
    3 / 238 (1.26%)
    6 / 236 (2.54%)
         occurrences all number
    3
    6
    Blood thyroid stimulating hormone increased
         subjects affected / exposed
    5 / 238 (2.10%)
    1 / 236 (0.42%)
         occurrences all number
    5
    1
    Injury, poisoning and procedural complications
    Laceration
         subjects affected / exposed
    5 / 238 (2.10%)
    2 / 236 (0.85%)
         occurrences all number
    5
    2
    Joint injury
         subjects affected / exposed
    5 / 238 (2.10%)
    0 / 236 (0.00%)
         occurrences all number
    5
    0
    Cardiac disorders
    Cardiac disorders
         subjects affected / exposed
    6 / 238 (2.52%)
    8 / 236 (3.39%)
         occurrences all number
    6
    8
    Nervous system disorders
    Headache
         subjects affected / exposed
    25 / 238 (10.50%)
    17 / 236 (7.20%)
         occurrences all number
    25
    17
    Migraine
         subjects affected / exposed
    5 / 238 (2.10%)
    1 / 236 (0.42%)
         occurrences all number
    5
    1
    Blood and lymphatic system disorders
    Blood and lymphatic system disorders
         subjects affected / exposed
    10 / 238 (4.20%)
    8 / 236 (3.39%)
         occurrences all number
    10
    8
    Eye disorders
    Eye disorders
         subjects affected / exposed
    6 / 238 (2.52%)
    4 / 236 (1.69%)
         occurrences all number
    6
    4
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    13 / 238 (5.46%)
    9 / 236 (3.81%)
         occurrences all number
    13
    9
    Diarrhoea
         subjects affected / exposed
    7 / 238 (2.94%)
    9 / 236 (3.81%)
         occurrences all number
    7
    9
    Abdominal pain
         subjects affected / exposed
    6 / 238 (2.52%)
    5 / 236 (2.12%)
         occurrences all number
    6
    5
    Toothache
         subjects affected / exposed
    6 / 238 (2.52%)
    5 / 236 (2.12%)
         occurrences all number
    6
    5
    Abdominal pain upper
         subjects affected / exposed
    4 / 238 (1.68%)
    5 / 236 (2.12%)
         occurrences all number
    4
    5
    Vomiting
         subjects affected / exposed
    7 / 238 (2.94%)
    4 / 236 (1.69%)
         occurrences all number
    7
    4
    Hepatobiliary disorders
    Hepatobiliary disorder
         subjects affected / exposed
    5 / 238 (2.10%)
    1 / 236 (0.42%)
         occurrences all number
    5
    1
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    3 / 238 (1.26%)
    7 / 236 (2.97%)
         occurrences all number
    3
    7
    Renal and urinary disorders
    Renal and urinary disorders
         subjects affected / exposed
    7 / 238 (2.94%)
    4 / 236 (1.69%)
         occurrences all number
    7
    4
    Endocrine disorders
    Hypothyroidism
         subjects affected / exposed
    5 / 238 (2.10%)
    2 / 236 (0.85%)
         occurrences all number
    5
    2
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    6 / 238 (2.52%)
    11 / 236 (4.66%)
         occurrences all number
    6
    11
    Arthralgia
         subjects affected / exposed
    4 / 238 (1.68%)
    5 / 236 (2.12%)
         occurrences all number
    4
    5
    Pain in extremity
         subjects affected / exposed
    8 / 238 (3.36%)
    3 / 236 (1.27%)
         occurrences all number
    8
    3
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    60 / 238 (25.21%)
    52 / 236 (22.03%)
         occurrences all number
    60
    52
    Upper respiratory tract infection
         subjects affected / exposed
    13 / 238 (5.46%)
    18 / 236 (7.63%)
         occurrences all number
    13
    18
    Influenza
         subjects affected / exposed
    17 / 238 (7.14%)
    15 / 236 (6.36%)
         occurrences all number
    17
    15
    Sinusitis
         subjects affected / exposed
    4 / 238 (1.68%)
    10 / 236 (4.24%)
         occurrences all number
    4
    10
    Gastroenteritis
         subjects affected / exposed
    9 / 238 (3.78%)
    7 / 236 (2.97%)
         occurrences all number
    9
    7
    Urinary tract infection
         subjects affected / exposed
    8 / 238 (3.36%)
    7 / 236 (2.97%)
         occurrences all number
    8
    7
    Bronchitis
         subjects affected / exposed
    5 / 238 (2.10%)
    7 / 236 (2.97%)
         occurrences all number
    5
    7
    Pharyngitis
         subjects affected / exposed
    9 / 238 (3.78%)
    5 / 236 (2.12%)
         occurrences all number
    9
    5
    Tonsillitis
         subjects affected / exposed
    6 / 238 (2.52%)
    4 / 236 (1.69%)
         occurrences all number
    6
    4
    Rhinitis
         subjects affected / exposed
    9 / 238 (3.78%)
    3 / 236 (1.27%)
         occurrences all number
    9
    3
    Metabolism and nutrition disorders
    Hypercholesterolemia
         subjects affected / exposed
    5 / 238 (2.10%)
    0 / 236 (0.00%)
         occurrences all number
    5
    0

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    08 Apr 2010
    Protocol Version 1.1: version submitted in the initial applications to European regulatory authorities for approval. Summary of changes from original protocol (v.1.0, 08 February 2010) 1. Change of “patient” into “subject” throughout the protocol 2. Clarify storage conditions and temperature monitoring 3. Add a 10th administration of study medication at Visit 10 4. Add Visit 11 as the final follow-up/termination visit, at Month 25 5. Table 2: Add Regular Chemistry tests at all visits where other laboratory tests are run (Visits 1, 2, 4,6, 8 and 11) 6. Added text on the purpose of the CGMS use in the study and how the participating sites will be selected 7. Clarify that regardless of CGMS measurements, regular self-measurements of blood glucose should be continued 8. Added text on the purpose of performing the HLA typing as an exploratory study and the intended analysis of outcome data 9. Correct typo in name of enzyme: aspartate aminotransferase (AST) instead of alanine aminotransferase 10. Due to extension of the overall follow-up of period per subject from 24 to 25 months and the addition of an 11th visit (see changes #2 & #3, above), the final follow-up period was shortened from 3 months to 1 month. Accordingly, the follow-up of AE after last administration of study medication 11. Contact details for i3 Drug Safety Team in North America was added 12. Clarification of the correct form for reporting pregnancy during the study 13. Clarification that the Baseline for the MMTT will be either the Qualification Visit or Pre-Visit 1, if Qualification Visit is unnecessary 14. Correct typo, Qualification Visit occurs 1-3 weeks before Visit 1, not 2-4 weeks 15. Clarification regarding Informed Consent Process: a. “A person designated by the Investigator” was added as someone who can give the explanations about the study b. Participation in both HLA typing and CGMS sub-studies is voluntary, and subjects will sign separate ICFs if they wish to participate
    14 Nov 2010
    Protocol Version 2.1 Rationale for amendment: most of the changes introduced into the protocol were extended explanations and clarifications regarding target population, time lines and procedures; Repeated queries from the sites indicated that some sections were not clear enough and might have resulted in different interpretation by different investigators. Significant issues that had to be clarified included: - Target population: the eligibility of subjects who were first diagnosed for months or years as T2D or LADA was questioned. This was clearly addressed in this protocol amendment. - Exclusion due to other diseases: subject with resolved basal cell or cervix carcinoma were allowed, as well as subjects that require systemic inhalers to treat/prevent asthma attacks. - Screening-Qualification Period-Randomization: timelines between the visits at the start of the study, how to handle subjects who require more time to reach optimal glycemic control, or who have to be re-screened. Clear time windows were provided for each visit up to randomization/Visit 1 - The original protocol required total fasting and no insulin medication on the morning of performing a beta-cell function test: it was recognized that this could often result in blood glucose level higher than the recommended range by the time the test is administered. Detailed recommendations were provided to the investigators in the Study Reference Manual so they could instruct their patients to take some insulin in the morning, according to actual blood glucose. - At the request of the German Federal Agency (BfArM), extra focus was placed on identifying and following-up incipient autoimmune diseases and immune effects.
    03 Sep 2012
    Protocol Version 3.0 The reason for amending the protocol was mainly to better define the secondary endpoints, the statistical analysis and the handling of missing data. These changes were due to better understanding of the clinical outcome based on the availability of the final results from the first phase 3 study, protocol 901.
    17 Dec 2013
    Protocol Version 4.0 List of Changes: 1. Primary efficacy endpoint defined as the change from Baseline to End of Study of glucagon-stimulated C-peptide secretion, measured as area under the curve (AUC). This is a change from change in mixed-meal induced C-peptide secretion. 2. Major clinical benefit parameters were defined, as suggested by FDA communication and clinical advisory board (CAB). These included glycemic control, insulin dose and hypoglycemic events. These parameters were already defined a secondary endpoints, but then they were highlighted as the main clinical endpoints. 3. Updates were introduced to the statistical section, following recommendations received from the FDA and input from CAB. These include: a. Re-definition of Primary, Major Clinical (secondary) efficacy endpoints, as described above. b. Definition of primary population for evaluation of efficacy as ITT subjects who had at least the Baseline and one post-baseline efficacy data (FDA recommendation). c. Definition of Completers Population analysis as main sensitivity analysis for primary efficacy (FDA recommendation). d. Use of mixed-model repeated measurements (MMRM) analysis, with pre-defined co-variants, for analysis of primary and secondary beta-cell function parameters (FDA recommendation). 4. Addition of liver enzyme testing at the visits of 9, 15, 21 & 25 months, according to DSMB recommendations. 5. Definition of how to proceed with safety assessment and IMP administration in cases of elevated liver enzymes, according to DSMB recommendation.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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