E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Body processes [G] - Metabolic Phenomena [G03] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10067585 |
E.1.2 | Term | Type 2 diabetes mellitus |
E.1.2 | System Organ Class | 10027433 - Metabolism and nutrition disorders |
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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 this study will be to evaluate the efficacy of alogliptin 25 mg once daily (QD) compared to placebo when administered as monotherapy, or when added onto a background of metformin alone, insulin alone, or a combination of metformin and insulin, as measured by the glycosylated hemoglobin (HbA1c) change from Baseline at Week 26 in pediatric subjects with T2DM. |
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E.2.2 | Secondary objectives of the trial |
To evaluate the HbA1c change from Baseline after treatment with alogliptin as compared with placebo at Weeks 12, 18, 39, and 52.
To evaluate the safety of alogliptin compared to placebo by assessing:
- The incidence of hypoglycemic events, treatment emergent adverse events (TEAEs), clinical laboratory parameters, electrocardiogram (ECG) readings, physical examinations, and vital signs for Weeks 26 and 52.
- The effects on biomarkers of bone turnover (bone-specific alkaline phosphatase and C-terminal telopeptide [CTX]) markers at Weeks 26 and 52.
- The effects on CD26 surface antigen levels at Weeks 26 and 52. |
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
Subjects will have the option to provide a separate consent for pharmacogenomic sample collection to be used in a pharmacogenomic sub-study, which details are included in the main study protocol. Specific purposes include:
- Identifying genetic reasons why certain people respond differently to alogliptin.
- Finding out more information about how alogliptin works.
- Generating information needed for research, development, and regulatory approval of tests to predict response to alogliptin.
- Identifying variations in genes related to the biological target of alogliptin
This information may be used, for example, to develop a better understanding of the safety and efficacy of alogliptin and other study medications, and for improving the efficiency, design and study methods of future research studies.
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E.3 | Principal inclusion criteria |
Subject eligibility is determined according to the following criteria prior to entry into the study:
1. A confirmed diagnosis of T2DM using American Diabetes Association (ADA) and World Health Organization (WHO) criteria (laboratory determinations of FPG >126 mg/dL, random glucose >200 mg/dL [≥11.10 mmol/L], HbA1c ≥6.5%, or 2-hour oral glucose tolerance test [OGTT] glucose ≥200 mg/dL), documented in the subjects’ medical record.
2. Male or female subjects, 10 to 17 years of age, inclusive, at the time of randomization.
For subjects who have had the diagnosis of T2DM for less than 1 year and/or who are taking insulin prior to randomization, the following criteria must also be met:
3. The subject must have a fasting C-peptide concentration ≥0.6 ng/mL (≥0.20 nmol/L) (drawn at least 1 week after treatment for ketosis or acidosis, if applicable).
4. No presence of autoantibodies as documented by glutamic acid decarboxylase [GAD] 65 and islet antigen [IA]-2 antibodies below the upper limit of the normal reference ranges at randomization.
5. The subject must have a BMI >85th percentile, documented at randomization.
6. The subject is thought to be able to swallow the tablet containing the study medication.
7. A male subject who is sexually active with a female partner of childbearing potential* agrees to use adequate contraception* from signing of informed consent throughout the duration of the study.
8. A female subject of childbearing potential* who is sexually active with a male partner agrees to use routinely adequate contraception* from signing of informed consent throughout the duration of the study.
*Female subjects of childbearing potential are defined as reaching Tanner Stage 3. Definitions and acceptable methods of contraception are defined in Protocol Section 9.1.9 Contraception and Pregnancy Avoidance Procedure and reporting responsibilities are defined in Section 9.1.10 Pregnancy.
9. The subject and his/her legal representative (ie, parents or legal guardians) are able and willing to provide written informed consent/assent.
10. The subject and his/her legal representative (ie, parents or legal guardians) are capable of understanding and complying with the protocol requirements, including scheduled clinic appointments.
11. The subject and his/her legal representative (ie, parents or legal guardians) are able and willing to monitor their own blood glucose concentrations with a home glucose monitor and complete subject diaries.
For subjects who have had the diagnosis of T2DM for less than 1 year and/or who are taking insulin at Screening, additional criteria will need to be met prior to randomization (refer to Section 7.3 of the Study Protocol). |
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E.4 | Principal exclusion criteria |
Any subject who meets any of the following criteria will not qualify for entry into the study:
1. The subject is treatment naive
2. The subject has a history of hypersensitivity or allergy to alogliptin, other DPP-4 inhibitors, metformin, insulin or related compounds.
3. The subject has a confirmed diagnosis of type 1 diabetes mellitus or maturity-onset diabetes of the young (MODY).
4. The subject has a hemoglobin level <11.0 g/dL (<110 g/L) for males and <10.0 g/dL (<100 g/L) for females.
5. The subject has a history of any hemoglobinopathy that may affect determination of HbA1c levels.
6. The subject has a history of bariatric surgery.
7. The subject has a history of proliferative diabetic retinopathy within the 6 months prior to Screening.
8. The subject has had an episode of diabetic ketoacidosis (DKA) at any time after diagnosis of T2DM.
9. The subject has a history of pancreatitis.
10. Serum creatinine ≥1.5 mg/dL for male subjects or ≥1.4 mg/dL for female subjects, or creatinine clearance <60 mL/min based on calculation by central lab using the Schwartz formula for estimated glomerular filtration rate (eGFR) at the Screening Visit.
11. The subject has a documented history of infection with human immunodeficiency virus or chronic active viral hepatitis.
12. The subject has any unstable endocrine, psychiatric or severe rheumatic disorder, or major illness or debility that, in the Investigator’s opinion, prohibits the subject from being a suitable candidate for and/or completing the study, or may affect the interpretability of his/her efficacy or safety data.
13. Female subjects who are pregnant, planning to become pregnant, or who admit to sexual activity without appropriate contraception.
14. The subject and/or his/her legal representative (ie, parents or legal guardians) is unable to understand verbal or written English, or any other language for which a certified translation of the approved informed consent/assent is available.
15. The subject and/or his/her legal representative (ie, parents or legal guardians) is an immediate family member (ie, child or sibling) of a study site employee who is involved in the conduct of this study. |
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E.5 End points |
E.5.1 | Primary end point(s) |
HbA1c change from Baseline to Week 26 |
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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) |
Efficacy:
- HbA1c change from Baseline at Weeks 12, 18, 39, and 52.
Safety:
- Physical examination findings.
- Vital sign measurements.
- 12-lead ECG abnormalities.
- Adverse events (AEs).
- Incidence of infections (Total and urinary and respiratory tract infections) and hypersensitivity reactions.
- Incidence of hypoglycemia.
- Clinical laboratory evaluations (hematology, serum chemistry, and urinalysis).
- Change from Baseline in biomarkers of bone turnover (bone-specific alkaline phosphatase and CTX) at Weeks 26 and 52.
- Change from Baseline in CD26 surface antigen levels at Weeks 26 and 52. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Various time points including Weeks 26 and 52 – given that other are checked more often and some such as AEs have no specific timepoint (ongoing for IDMC and total for CSR) |
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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 | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
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 | Yes |
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) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
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 | Yes |
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
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 21 |
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 |
Brazil |
Germany |
Israel |
Italy |
Mexico |
Poland |
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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Definition of the end of the trial is the last visit of the last subject. |
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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 | 3 |
E.8.9.1 | In the Member State concerned months | 9 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 5 |
E.8.9.2 | In all countries concerned by the trial days | 14 |