E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Children with congenital hyperinsulinism |
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E.1.1.1 | Medical condition in easily understood language |
Childrens with hereditary high level of insulin |
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E.1.1.2 | Therapeutic area | Diseases [C] - Congenital, Hereditary, and Neonatal Diseases and Abnormalities [C16] |
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 | 10061211 |
E.1.2 | Term | Hyperinsulinism |
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 | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To evaluate the efficacy of dasiglucagon in reducing glucose requirements in children with persistent CHI requiring continuous IV glucose administration to prevent/manage hypoglycemia. |
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E.2.2 | Secondary objectives of the trial |
To evaluate the safety and tolerability of dasiglucagon administered as a subcutaneous (SC) infusion in patients with CHI |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. CHI diagnosis established based on the following:
a. Hyperinsulinemia: plasma insulin above the limit of detection of the assay documented during an event of hypoglycemia, and/or
b. Hypofattyacidemia: plasma free fatty acid <1.7 mmol/L, and/or
c. Hypoketonemia: Beta-hydroxybutyrate <1.8 mmol/L, and/or
d. Glycemic response: an increase in PG of >30 mg/dL (1.7 mmol/L) after 1 mg IV or IM glucagon administration
2. Male or female, age ≥7 days and <12 months at screening
3. Body weight of ≥2.0 kg (4.4 lbs.)
4. Continuous IV glucose requirement to prevent hypoglycemia
5. One or both parents* or guardians of the patient must provide signed informed consent before any trial related activity is performed. (*according to local regulations) |
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E.4 | Principal exclusion criteria |
1. Is suspected of having a transient form of CHI (e.g., transient hyperinsulinism due to maternal diabetes or perinatal stress)
2. Was born preterm below 34 weeks of gestational age
3. Presence of hypertension or hypotension, including circulatory instability requiring supportive medication or presence of pheochromocytoma
4. Known or suspected presence of severe brain damage
5. Evidence of metabolic, endocrine, or syndromic causes of hypoglycemia not due to hyperinsulinism
6. Use of systemic corticosteroids, e.g., hydrocortisone >20 mg/m2 body surface area or equivalent within 5 days before screening
7. Prior use of lanreotide, sirolimus (mechanistic target of rapamycin [mTOR inhibitors]), anti-inflammatory biological agents, or other immune-modulating agents. Prior use of octreotide is allowed after a minimum of 48-hour washout before randomization.
8. Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >2.5 X the upper limit of normal (ULN), or estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m2 adjusted by a pediatric formula (e.g., Schwartz formula)
9. Any clinically significant abnormality identified on echocardiogram that in the opinion of the investigator would affect the subject’s ability to participate in the trial
10. Known history of laboratory test results obtained before screening that show presence of HIV, hepatitis B surface antigen, hepatitis C antibody, or hepatitis A immunoglobulin M
11. Any recognized clotting or bleeding disorder
12. Previous administration of dasiglucagon (previously referred to as ZP4207)
13. Known or suspected allergy to the trial drug or related products
14. Previous participation (randomization) in the clinical program (Trials ZP4207-17103 or -17109)
15. Has participated in an interventional clinical trial (investigational or marketed product) within 30 days of screening, or plans to participate in another clinical trial, except for 18F-Dopa PET CT/MRI investigation (where performed as a part of a research trial), which is allowed for diagnosis of focal CHI.
16. The use of prescription or non-prescription medications known to cause QT prolongation.
A screened patient will not be randomized if:
1. Mean IV glucose requirement is <10 mg/kg/min to maintain glycemia above 70 mg/dL (3.9 mmol/L) during the previous 24 hours prior to randomization
2. Use of glucagon within 24 hours before randomization.
3. Use of additional enteral glucose within 24 hours before randomization. Patients should be transitioned to IV glucose infusions only at least 24 hours before randomization.
4. Is not sufficiently clinically stable on IV GIR only (± diazoxide, as applicable), in the opinion of the investigator, to undergo the placebo-controlled randomized Part 1 of the trial (2x48 hours).
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E.5 End points |
E.5.1 | Primary end point(s) |
Part 1 (Day 1 to 4)
- Mean IV GIR in the last 12 hours of each treatment period during Part 1 (dasiglucagon or placebo administration) |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Period from 36h to 48 h and from 84h to 96h after the start of study treatment |
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E.5.2 | Secondary end point(s) |
Part 1 (Day 1 to 4, for each 48-hour treatment period)
1. Total amount (g) of carbohydrates administered (regardless of the route) per day.
Part 1 (Day 1 to 4, for each 48-hour treatment period)
• Mean IV GIR for each 48-hour treatment period during Part 1 (dasiglucagon or placebo administration)
• Mean IV GIR below 10 mg/kg/min in the last 12 hours of each treatment period during Part 1 (yes/no) (dasiglucagon or placebo administration)
Part 2 (Day 5 to 25, assessed from the start of treatment in part 2)
• Time to complete weaning off IV GIR.
• Hypoglycemia event rate, defined as number of hypoglycemic events (PG <70 mg/dL or 3.9 mmol/L), as detected by SMPG.
• Clinically significant hypoglycemia event rate, defined as number of events <54 mg/dL (3.0 mmol/L), as detected by SMPG.
• Time to actual hospital discharge.
• Time to pancreatic surgery (sub-total or total pancreatectomy).
• Total amount (g) of carbohydrates administered (regardless of the route) per day, together with amounts (g) of carbohydrates administered per day:
- via IV glucose infusion, or bolus (not as part of total parental nutrition),
- as part of total parenteral nutrition (if applicable),
- via oral route, and
- via NG tube or gastrostomy.
• CGM percent time in range 70-180 mg/dL (3.9-10.0 mmol/L).
• CGM percent time in hypoglycemia (<70 mg/dL or 3.9 mmol/L).
• CGM percent time in clinically significant hypoglycemia (<54 mg/dL or 3.0 mmol/L).
• Rate of hypoglycemia episodes, defined as number of episodes <70 mg/dL (3.9 mmol/L) for 15 min or more, as measured by CGM.
• Rate of clinically significant hypoglycemia episodes, defined as number of episodes <54 mg/dL (3.0 mmol/L) for 15 min or more, as measured by CGM.
• Extent of hypoglycemia (area over the glucose curve [AOCglucose] below 70 mg/dL [3.9 mmol/L]) as measured by CGM.
• Extent of clinically significant hypoglycemia (AOCglucose below 54 mg/dL [3.0 mmol/L]) as measured by CGM.
• CGM percent time in hyperglycemia (>180 mg/dL or 10.0 mmol/L). |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
- Continously during each 48 hour period of Part 1 (day 1-2 and day 3-4)
- Continously from day 5 to 25 of Part 2 |
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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 | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
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) | 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 | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
Period 1 (24 hrs): Randomised Test drug versus PLacebo. Period 2 (4 weeks): Open label-Test drug |
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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 | 2 |
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 |
Israel |
United States |
Germany |
United Kingdom |
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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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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 1 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 1 |
E.8.9.2 | In all countries concerned by the trial days | 0 |