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    Clinical Trial Results:
    A Randomized, Double Blind, Placebo-Controlled, Phase 2 Study to Assess the Safety, Tolerability and Efficacy of ISIS 426115 (an Antisense Glucocorticoid Receptor Antagonist) Administered Subcutaneously Once Weekly for 6 Weeks to Patients with Type 2 Diabetes Mellitus Being Treated with Metformin

    Summary
    EudraCT number
    2013-002172-40
    Trial protocol
    RO  
    Global end of trial date
    09 Apr 2015

    Results information
    Results version number
    v1(current)
    This version publication date
    07 Nov 2019
    First version publication date
    07 Nov 2019
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    ISIS426115-CS2
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Ionis Pharmaceuticals, Inc.
    Sponsor organisation address
    2855 Gazelle Court, Carlsbad, United States, CA 92010
    Public contact
    Ionis Pharmaceuticals, Ionis Pharmaceuticals, 011 800-679-4747, patients@ionisph.com
    Scientific contact
    Ionis Pharmaceuticals, Ionis Pharmaceuticals, 011 800-679-4747, patients@ionisph.com
    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
    09 Apr 2015
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    09 Apr 2015
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The main objective of this study was to evaluate the safety and tolerability of ISIS-GCCRRx subcutaneous injection (dosage: 210 milligrams per week [mg/wk]) in combination with metformin vs. metformin + placebo.
    Protection of trial subjects
    Each subject, or legally acceptable representative, signed an informed consent form before participating in the study.
    Background therapy
    Subjects were on a stable dose of metformin (at least 1000 mg/day) for a minimum of 3 months prior to screening evaluations and continued their stable dose throughout the study.
    Evidence for comparator
    -
    Actual start date of recruitment
    03 Mar 2014
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Canada: 7
    Country: Number of subjects enrolled
    Romania: 13
    Country: Number of subjects enrolled
    South Africa: 18
    Worldwide total number of subjects
    38
    EEA total number of subjects
    13
    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)
    26
    From 65 to 84 years
    12
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Subjects must have been on a stable dose of metformin (at least 1000 mg/day) alone for a minimum of 3 months prior to screening evaluations and were required to continue their stable doses of metformin treatment throughout the study.

    Period 1
    Period 1 title
    Overall Study (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
    Placebo
    Arm description
    Subjects received ISIS-GCCRRx-matching placebo on alternate days during the first week and then once weekly for 5 weeks, plus daily metformin per individual regimen.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Subjects received ISIS-GCCRRx placebo-matching, subcutaneous (SC) injections, on alternate days during the first week and then once weekly for 5 weeks, plus daily metformin per individual regimen.

    Arm title
    ISIS-GCCRRx, 210 mg
    Arm description
    Subjects received ISIS-GCCRRx, 210 mg, administered by SC on alternate days during the first week and then once weekly for 5 weeks, plus daily metformin per individual regimen.
    Arm type
    Experimental

    Investigational medicinal product name
    ISIS-GCCRRx
    Investigational medicinal product code
    Other name
    ISIS 426115
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Subject received ISIS-GCCRRx, 210 mg, administered by SC on alternate days during the first week and then once weekly for 5 weeks, plus daily metformin per individual regimen.

    Number of subjects in period 1
    Placebo ISIS-GCCRRx, 210 mg
    Started
    13
    25
    Completed
    13
    22
    Not completed
    0
    3
         Voluntary Withdrawal
    -
    1
         Adverse Events
    -
    1
         Ineligibility
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Subjects received ISIS-GCCRRx-matching placebo on alternate days during the first week and then once weekly for 5 weeks, plus daily metformin per individual regimen.

    Reporting group title
    ISIS-GCCRRx, 210 mg
    Reporting group description
    Subjects received ISIS-GCCRRx, 210 mg, administered by SC on alternate days during the first week and then once weekly for 5 weeks, plus daily metformin per individual regimen.

    Reporting group values
    Placebo ISIS-GCCRRx, 210 mg Total
    Number of subjects
    13 25 38
    Age categorical
    Units: Subjects
        < 18
    0 0 0
        18 <= and <= 41
    1 1 2
        41 < and <= 65
    6 20 26
        > 65
    6 4 10
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    59.92 ( 12.57 ) 56.84 ( 8.63 ) -
    Gender categorical
    Units: Subjects
        Female
    4 16 20
        Male
    9 9 18

    End points

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    End points reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Subjects received ISIS-GCCRRx-matching placebo on alternate days during the first week and then once weekly for 5 weeks, plus daily metformin per individual regimen.

    Reporting group title
    ISIS-GCCRRx, 210 mg
    Reporting group description
    Subjects received ISIS-GCCRRx, 210 mg, administered by SC on alternate days during the first week and then once weekly for 5 weeks, plus daily metformin per individual regimen.

    Primary: Change from Baseline in Serum Fasting Fructosamine

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    End point title
    Change from Baseline in Serum Fasting Fructosamine
    End point description
    The Per-Protocol Set (PPS) included randomised subjects with a measure at Baseline and at least 1 post-baseline serum fructosamine measure; received 3 loading doses of ISIS-GCCRRx or placebo in the first week and all 8 doses of ISIS-GCCRRx or placebo within 49 days of the first dose; had no dose adjustments; and had no significant protocol deviations that would be expected to affect efficacy assessments.
    End point type
    Primary
    End point timeframe
    Baseline to Week 7
    End point values
    Placebo ISIS-GCCRRx, 210 mg
    Number of subjects analysed
    13
    22
    Units: micromoles per litre (µmol/L)
        arithmetic mean (standard error)
    4.85 ( 7.42 )
    3.00 ( 6.07 )
    Statistical analysis title
    Placebo vs ISIS-GCCRRx 210 mg
    Comparison groups
    Placebo v ISIS-GCCRRx, 210 mg
    Number of subjects included in analysis
    35
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.851
    Method
    ANOVA
    Confidence interval

    Secondary: Percentage of Subjects with Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs)

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    End point title
    Percentage of Subjects with Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs)
    End point description
    An adverse event (AE) is any unfavourable and unintended sign (including a clinically significant abnormal laboratory finding, for example), symptom, or disease temporally associated with the study or use of investigational drug product, whether or not the AE is considered related to the investigational drug product. TEAE was defined as an event that occurred during or after initiation of study treatment and before the end of follow-up period. SAE, as determined by the Investigator or Sponsor, meets any of the following criteria: results in death; is life-threatening; requires inpatient hospitalisation or prolongation of existing hospitalisation; results in persistent or significant incapacity or substantial disruption of ability to conduct normal life functions; or results in congenital anomaly or birth defect in the offspring of the subject (whether the subject is male or female). The Safety Set included all randomised subjects who received at least 1 dose of ISIS-GCCRRx or placebo.
    End point type
    Secondary
    End point timeframe
    Up to 18 weeks
    End point values
    Placebo ISIS-GCCRRx, 210 mg
    Number of subjects analysed
    13
    25
    Units: percentage of subjects
    number (not applicable)
        TEAEs
    38.5
    88.0
        SAEs
    0
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Up to 18 weeks
    Adverse event reporting additional description
    The Safety Set included all subjects who were randomized and received at least one dose of study drug.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    16.0
    Reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Subjects received ISIS-GCCRRx-matching placebo on alternate days during the first week and then once weekly for 5 weeks, plus daily metformin per individual regimen.

    Reporting group title
    ISIS-GCCRRx, 210 mg
    Reporting group description
    Subjects received ISIS-GCCRRx, 210 mg, administered by subcutaneous injections (SC) on alternate days during the first week and then once weekly for 5 weeks, plus daily metformin per individual regimen.

    Serious adverse events
    Placebo ISIS-GCCRRx, 210 mg
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 13 (0.00%)
    0 / 25 (0.00%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Placebo ISIS-GCCRRx, 210 mg
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    5 / 13 (38.46%)
    20 / 25 (80.00%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    0 / 13 (0.00%)
    2 / 25 (8.00%)
         occurrences all number
    0
    2
    Orthostatic hypotension
         subjects affected / exposed
    0 / 13 (0.00%)
    2 / 25 (8.00%)
         occurrences all number
    0
    9
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 25 (0.00%)
         occurrences all number
    3
    0
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    1 / 13 (7.69%)
    2 / 25 (8.00%)
         occurrences all number
    2
    2
    Injection site erythema
         subjects affected / exposed
    0 / 13 (0.00%)
    14 / 25 (56.00%)
         occurrences all number
    0
    54
    Injection site nodule
         subjects affected / exposed
    0 / 13 (0.00%)
    2 / 25 (8.00%)
         occurrences all number
    0
    4
    Injection site oedema
         subjects affected / exposed
    0 / 13 (0.00%)
    2 / 25 (8.00%)
         occurrences all number
    0
    6
    Injection site pain
         subjects affected / exposed
    0 / 13 (0.00%)
    11 / 25 (44.00%)
         occurrences all number
    0
    55
    Injection site pruritus
         subjects affected / exposed
    0 / 13 (0.00%)
    9 / 25 (36.00%)
         occurrences all number
    0
    36
    Injection site swelling
         subjects affected / exposed
    0 / 13 (0.00%)
    4 / 25 (16.00%)
         occurrences all number
    0
    20
    Vessel puncture site haematoma
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 25 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal disorders
    Abdominal pain upper
         subjects affected / exposed
    0 / 13 (0.00%)
    2 / 25 (8.00%)
         occurrences all number
    0
    2
    Diarrhoea
         subjects affected / exposed
    1 / 13 (7.69%)
    2 / 25 (8.00%)
         occurrences all number
    1
    2
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 25 (4.00%)
         occurrences all number
    1
    1
    Musculoskeletal and connective tissue disorders
    Muscle spasms
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 25 (4.00%)
         occurrences all number
    1
    1
    Infections and infestations
    Conjunctivitis
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 25 (0.00%)
         occurrences all number
    1
    0
    Influenza
         subjects affected / exposed
    1 / 13 (7.69%)
    1 / 25 (4.00%)
         occurrences all number
    1
    1
    Lower respiratory tract infection
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 25 (0.00%)
         occurrences all number
    1
    0
    Upper respiratory tract infection
         subjects affected / exposed
    1 / 13 (7.69%)
    2 / 25 (8.00%)
         occurrences all number
    1
    2
    Urinary tract infection
         subjects affected / exposed
    1 / 13 (7.69%)
    2 / 25 (8.00%)
         occurrences all number
    3
    4
    Metabolism and nutrition disorders
    Hyperkalaemia
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 25 (0.00%)
         occurrences all number
    1
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    14 Apr 2014
    - Clarified existing eligibility requirements for renal function and included an exclusion criterion based on glycaemic parameters. - Simplified compliance with screening procedures: the screening fasting plasma glucose (FPG) assessment period was lengthened, and the screening visit window was shortened. - Revised the Safety Monitoring and Stopping Rules for Liver Chemistry Tests for increased surveillance of subject safety.

    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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