E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
A soluble fusion protein, CTLA-4 Ig, is to be used for the prevention of abnormal glucose tolerance and diabetes in relatives at risk of developing the disease. |
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E.1.1.1 | Medical condition in easily understood language |
High blood sugar and Type 1 Diabetes |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nutritional and Metabolic Diseases [C18] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10066284 |
E.1.2 | Term | Diabetes prophylaxis |
E.1.2 | System Organ Class | 10042613 - Surgical and medical procedures |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective of the study is to determine whether treatment of subjects at risk for diabetes with Abatacept results in delay or prevention of abnormal glucose tolerance. |
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E.2.2 | Secondary objectives of the trial |
Secondary objectives will determine whether treatment with Abatacept is superior to placebo with respect to the incidence of Type 1 Diabetes Mellitus, determine whether treatment with Abatacept is superior to placebo with respect to C peptide responses to oral glucose, as obtained from timed collections during longitudinal tests, to compare the safety and tolerability of Abatacept to placebo, and to assess the effects of treatment on mechanistic outcomes. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Study subjects must be or have: 1. Participant in TrialNet Natural History/Pathway to Prevention Study (TN01) and thus, a relative of a proband with T1DM. 2. Between the ages of 1-45 years at the time of enrollment in TN01 and age ≥ 6 at time of randomization in this trial. 3. Willing to provide Informed Consent or have a parent or legal guardian provide informed consent the subject is <18 years of age. 4. Normal glucose tolerance by OGTT within 7 weeks (no more than 52 days) of baseline (visit 0). If previous abnormal glucose tolerance, has had two consecutive OGTTs with normal glucose tolerance. a. Fasting plasma glucose < 110 mg/dL (6.1 mmol/L), and b. 2 hour plasma glucose <140 mg/dL (7.8 mmol/L), and c. 30, 60, or 90 minute value on OGTT< 200mg/dL (11.1 mmol/L) 5. At least two diabetes-related autoantibodies confirmed to be present on two occasions, not including mIAA*. Confirmation of 2 positiveautoantibodies must occur within the six months prior to randomization, but the confirmation does not have to involve the same 2 autoantibodies. 6. Weight ≥ 16 kg at Baseline Visit. 7. If a female participant with reproductive potential (defined as having begun menses), willing to avoid pregnancy during treatment with Abatacept and up to 14 weeks after the last dose and undergo pregnancy testing prior to each infusion. 8. At least three months from date of last live immunization. 9. Willing to forgo live vaccines while receiving treatment on study or within three months following last study drug administration. |
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E.4 | Principal exclusion criteria |
Potential participants must not meet any of the following exclusion criteria: 1. Abnormal Glucose Tolerance or Diabetes a. Fasting plasma glucose ≥ 110 mg/dL (6.1 mmol/L), or b. 2 hour plasma glucose ≥ 140 mg/dL (7.8 mmol/L), or c. 30, 60, 90 minute plasma glucose during OGTT ≥ 200 mg/dL (11.1 mmol/L) 2. Insulin autoantibodies (mIAA). 3. Immunodeficient or have clinically significant chronic lymphopenia. 4. Have an active infection at time of randomization. 5. Have a positive PPD test result or history of previously treated TB, or positive interferon-gamma release assay (IGRA) test. 6. Be currently pregnant or lactating, or anticipate getting pregnant within 14 weeks of the last study drug administration. 7. Use of medications known to influence glucose tolerance. 8. Require use of other immunosuppressive agents. 9. Have serologic evidence of current or past HIV, Hepatitis B (positive for Hepatitis B core antibody or surface antigen), or Hepatitis C infection. 10. Have serological evidence of current CMV infection. 11. Have evidence of active EBV infection. 12. Have any complicating medical issues or abnormal clinical laboratory results that interfere with study conduct or cause increased risk. These include pre-existing cardiac disease, COPD, neurological, or blood count abnormalities (such as lymphopenia, leukopenia, or thrombocytopenia). 13. Have a history of malignancies. 14. Have Multiple Sclerosis. 15. Have demonstrated allergies to abatacept or any of its excipients (maltose, sodium dihydrogen phosphate monohydrate and sodium chloride). 4. Have an active infection at time of randomization. 5. Have a positive PPD test result or history of previously treated TB, or positive interferongamma release assay (IGRA) test. 6. Be currently pregnant or lactating, or anticipate getting pregnant within 3 months of the last study drug administration 7. Use of medications known to influence glucose tolerance. 8. Require use of other immunosuppressive agents. 9. Have serologic evidence of current or past HIV, Hepatitis B (positive for Hepatitis B core antibody or surface antigen), or Hepatitis C infection. 10. Have serological evidence of current CMV infection. 11. Have evidence of active EBV infection. 12. Have any complicating medical issues or abnormal clinical laboratory results that interfere with study conduct or cause increased risk. These include pre-existing cardiac disease, COPD, neurological, or blood count abnormalities (such as lymphopenia, leukopenia, or thrombocytopenia). 13. Have a history of malignancies. 14. Have Mulitiple Sclerosis 15. Have demonstrated allergies to abatacept or any of its excipients (maltose, dihydrogen phosphate monohydrate and sodium chloride.) |
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E.5 End points |
E.5.1 | Primary end point(s) |
The elapsed time from treatment randomisation to the development of abnormal glucose tolerance. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
The elapsed time from the development of abnormal glucose tolerance to the development of type 1 diabetes. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | Yes |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 5 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Finland |
Germany |
Italy |
New Zealand |
Sweden |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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If the accrual rate is 50 patients per year, with the above assumptions it is estimated that the enrollment period will last approximately 4 years and a study duration of approximately 6 years will provide a sufficient number of events to detect the assumed treatment difference. Participants who develop AGT will remain on study and be followed according to protocol to assess the secondary objective of time until T1DM development. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 6 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 6 |