E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Treatment of subjects with type 1 diabetes mellitus with residual beta cell function (RBCF), with the goal of preserving RBCF |
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E.1.1.1 | Medical condition in easily understood language |
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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 | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10067584 |
E.1.2 | Term | Type 1 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 |
• To evaluate the safety and tolerability of CFZ533 in subjects with new onset T1DM. • To evaluate effects of CFZ533 on pancreatic beta cell function in subjects with new-onset T1DM. |
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E.2.2 | Secondary objectives of the trial |
• To evaluate the pharmacokinetics of CFZ533 in subjects with new onset T1DM. • To evaluate the treatment effect of CFZ533 on remission or partial remission in subjects with new onset T1DM. • To evaluate durability of effects of CFZ533 on pancreatic beta cell function in subjects with new-onset T1DM.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Written informed consent, and if needed assent from the child on the trial, must be obtained before any assessment is performed. 2. Males and females aged between 12 and 21 years (inclusive, and enrolled in stages) at screening. 3. Body weight range from 30 to 125 kg (inclusive). 4.Evidence of one or more type 1 diabetes autoantibody(ies) against: glutamic acid decarboxylase (anti-GAD), protein tyrosine, phosphataselike protein (anti-IA-2); zinc transporter 8 (anti-ZnT8); islet cell (cytoplasmic) (anti-ICA) at screening or baseline in the central laboratory OR historical clinical record of one or more of the T1DM diabetes autoantibodies. As part of the historical record insulin autoantibodies (IAA) may have been used as part of the autoantibody panel but the blood sample must have been obtained prior to or within one week of starting exogenous insulin treatment. 5. Able to receive first dose of study drug within 56 days of diagnosis of T1DM (which may be extended to within 100 days of diagnosis in the event a screening assessment needs to be confirmed or vaccine administered). 6. Peak stimulated C-peptide levels ≥0.2 nmol/L (0.6 ng/mL) following standard liquid mixed meal tolerance test (MMTT), to be conducted when the subject is metabolically stable, at least 2 weeks from diagnosis and within 56 days prior to randomization (or within 100 days of diagnosis in the event a screening assessment needs to be confirmed or vaccine is required). 7. Study participants are to complete all recommended immunizations with live, attenuated vaccine at least eight weeks prior and killed, inactivated vaccine at least two weeks prior to first dose with study drug and in accordance with local immunization guidelines. In the event a subject has not had all vaccinations recommended according to local guidance, the screening period may be extended beyond 56 days to allow these vaccinations to be administered, but first dose of study drug must be administered within 100 days of diagnosis of T1DM. 8. A negative pregnancy test at screening is required for all sexually mature female subjects prior to participation in the study. 9. Subject and/or guardian must be able to communicate well with the investigator, to understand and comply with the requirements of the study. |
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E.4 | Principal exclusion criteria |
1. Diabetes forms other than auto immune type 1 such as maturity-onset diabetes of the young (MODY), latent autoimmune diabetes of the adult (LADA), acquired diabetes (secondary to medications or surgery), T2DM by judgement of the investigator. 2. Diabetic ketoacidosis within 2 weeks of the baseline MMTT test. 3. Polyglandular auto immune disease, Addison's disease, pernicious anemia, celiac sprue. Treated, stable Hashimoto's thyroiditis is not exclusionary. 4. Any of the following abnormal laboratory values at screening • total white blood cell count (WBC) outside the range 1,500- 15,000/mm3(1.5-15.0 x 109/L) • neutrophil count(<1500/mm3)(<1.5 X 109 / L) • lymphocyte count<500/mm3(<0.5 X 109 / L) • hemoglobin (Hgb)<8.0 g/dL • platelets<100,000/mm3(<100 x 109/L) 5. History of immunodeficiency disorders, such as HyperIgM syndrome; history of recurrent infections suggestive of immunodeficiency disorders. 6. History of or active coagulation disorder with increased thromboembolic risk; aPTT and PT/ INR below lower limit of normal prior to inclusion. 7. Tuberculosis infection assessed by positive QuantiFERON TB-Gold test(QFT) at screening. Subjects with a positive QFT test may participate in the study if further work up establishes conclusively that the subject has no evidence of active tuberculosis. If presence of latent tuberculosis is established, then anti tuberculosis treatment must have been initiated and maintained according to local country guidelines 8. Chronic infection with Hepatitis B(HBV) or Hepatitis C(HCV). A positive HBV surface antigen(HBsAg) test at screening excludes a subject. Subjects with a positive HCV antibody test should have HCV RNA levels measured. Subjects with positive(detectable) HCV RNA should be excluded. 9. Positive human immune virus test(ELISA and Western Blot) at screening. 10. Evidence of EBV, CMV, HSV, and/or SARS-CoV-2 infection by viral load above laboratory upper limit of normal or only positive IgM serology in the absence of positive IgG at screening. Rescreening permitted in persistently asymptomatic or post-symptomatic subjects, but study drug must be able to be administered within 100 days of diagnosis of T1D and viral load must be negative and IgG titers positive. 11. Major dental work(tooth extractions or dental surgery with access to dental pulp) within 8 days of first dose; febrile illness within 48 hrs of first dose. 12. Use of other investigational drugs or use of immunosuppressive agents at the time of enrollment, or within 5 half-lives of enrollment, or until the expected PD effect has returned to baseline, whichever is longer; or longer if required by local regulations. 13. History of multiple and recurring allergies or allergy to the investigational compound/compound class being used in this study. Multiple and recurring allergies refer to known allergies to the investigational compound, to immunoglobulin based therapies, or to multiple drug classes. Dust mites, hay fever, and similar environmental allergies are not exclusionary. 14. History of severe hypersensitivity reaction or anaphylaxis to biological agents, e.g. human monoclonal antibody. 15. History of malignancy of any organ system(other than localized basal cell carcinoma of the skin), treated or untreated, within 5 years of screening, regardless of whether there is evidence of local recurrence or metastases. 16. Active serious psychiatric disorders(diagnosed or treated by a psychiatrist), such as eating disorders and psychosis or history thereof. 17. Any complicating medical issues or clinically abnormal laboratory results that may cause an increased safety risk to the subject as judged by the investigator. 18. Ongoing, and up to 2 weeks prior to screening, use of medications that may affect glucose control. A course of oral steroids<10 days if medically required is permissible with sponsor notification. 19. History of drug abuse, nicotine or harmful alcohol use within 12 months prior to first dose, or evidence (as determined by the investigators) of such abuse at screening. Harmful alcohol use by adolescents (age 13-18 years) is to be determined by the investigator, based on local culture and laws. Harmful cannabinoid use will be made by the Investigator based on local culture and law. 20. Use of any prescription drugs other than those allowed by this protocol Section 6 within 2 weeks prior to first dose. 21. Taking medications prohibited by the protocol. 22. Pregnant or nursing(lactating) women. 23. Women of child-bearing potential, defined as all women, who are sexually active, physiologically capable of becoming pregnant(e.g. menstruating), unless they are using highly effective methods of contraception during dosing and for 14 weeks after stopping the investigational drug. See protocol for these methods of contraception. |
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E.5 End points |
E.5.1 | Primary end point(s) |
1) Proportion of subjects with adverse events (AE)/serious adverse events (SAE) in treatment groups.
2) Stimulated C-peptide AUC by mixed meal tolerance test (MMTT). |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
1) 16 months
2) 12 months |
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E.5.2 | Secondary end point(s) |
1) Free CFZ533 plasma concentration.
2) Proportion of subjects with full or partial remission.
3) Stimulated C-peptide AUC by MMTT. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1) day 1; 1 week; and 12 months
2) 12 months
3) 20 weeks from last dose |
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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 | No |
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 | 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 | 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 | 22 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
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 | 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 | 4 |
E.8.9.2 | In all countries concerned by the trial months | 7 |
E.8.9.2 | In all countries concerned by the trial days | 7 |