Polyclonal Anti-T-Lymphocyte Globulin (ATG) in Type 1 Diabetes

The Use of Polyclonal Anti-T-Lymphocyte Globulin to Prevent Progression of Autoimmune Beta-Cell Destruction in Recent Type 1 Diabetes

The primary objective of the study is:

• To compare the effect of ATG treatment together with intensified insulin therapy (Group 1) on fasting and glucagon-stimulated C-peptide production with that of intensified insulin therapy only (Group 2) in type 1 diabetes mellitus of recent onset

Secondary objectives are:

• To compare the insulin doses between the two groups at 6, 12, 18, and 24 months after diabetes onset
• To compare the course of the specific humoral markers of autoimmunity between the groups
• To evaluate the significance of in vitro testing of specific T-cell activation by an autoantigen in the long-term follow-up in type 1 diabetes
• To assess the safety of ATG treatment in type 1 diabetes

Study Overview

• Status: Unknown
• Conditions: Diabetes Mellitus, Type 1
• Intervention / Treatment: Drug: Polyclonal anti-T-cell antibodies

Detailed Description

This is a randomized, controlled, single-blind and parallel group study. After admission to the hospital, initial physical and laboratory examinations will be performed. Laboratory tests and medical treatment not related to the experimental protocol (except for immunosuppressive drugs) will be performed as clinically needed. Patients who fulfill the inclusion criteria and give their informed consent to participate in the study will be randomized to be treated either with a course of ATG-Fresenius together with intensified insulin therapy (Group 1) or with intensified insulin therapy only (Group 2).

For the study purpose, clinical and laboratory status of the patients will be assessed at 14 occasions (screening, visit 1 - visit 14). Thereafter, an extended follow-up study is planned with evaluations every 6 months.

Patients will be referred to the research institution by cooperating general practitioners and diabetes specialists, preferably before initiation of insulin therapy. After diabetes confirmation (according to WHO criteria) and initial clinical and biochemical examinations (typical for all patients with recent onset diabetes) the purpose, potential risk and benefits and the design of the study will be explained. Subjects willing to participate in the study will be asked to give their written informed consent.

All patients will be actively educated in diabetes management and intensified insulin therapy (3 - 4 daily injections of human insulin, glucose self-monitoring) will be initiated according to individual needs. In subjects randomized to Group 1, 4 doses of ATG Fresenius (first dose of 9 mg/kg of body weight, then 3 consecutive doses of 3 mg/kg) will be administered intravenously over 4 hours. Subjects in Group 2 will be treated with saline infusion (500 ml) on the same days. 1 hour before the first ATG administration, a cutaneous tolerance test (0.2 ml of the final solution) will be performed. Approximately 10 days after admission the patients will be dismissed. Besides scheduled ambulant visits, all subjects will be followed-up as clinically needed. In Paediatric patients (age 15-18 years), recommendations of a paediatric endocrinologist concerning diabetes management will be respected.

After completion of the study each patient's diabetes specialist will be acquainted with the course of the treatment so far and the patients will be treated according to individual needs. They will be seen regularly once per year in the Department of Diabetes in IKEM for the next 3 years.

Discontinuation of the study:

Participation in the study may be at all times stopped according to the patient's will. Should this require the medical status of the patients, the study may be interrupted based on the investigator's decision during the period of ATG administration.

Study population:

Twenty four patients with type 1 diabetes mellitus of recent onset will be followed in the Institute for Clinical and Experimental Medicine in Prague. Inclusion criteria will be:

• Type 1 diabetes mellitus of known duration up to 6 weeks
• Men and women 15 - 35 years old, body mass index up to 32 kg/m2, exclusion of gravidity in women
• Insulin dose up to 40 IU per day for no longer than 1 month
• C-peptide level ≥ 0.3 pmol/ml 4 min. following iv. administration of 1 ml glucagon
• No previous immunosuppressive therapy, no concurrent severe infection, granulocyte count ≥ 2 x 10^9/l, platelet count ≥ 120 x 10^9/l

• Study Type: Interventional
• Enrollment: 28
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Czech Republic
  • Prague, Czech Republic, 14021
    • Recruiting
    • Institute for Clinical and Experimental Medicine, Department of Diabetes
    • Contact: Frantisek Saudek, MD.; Email: frsa@medicon.cz
    • Principal Investigator: Frantisek Saudek, MD
    • Sub-Investigator: Petr Boucek, MD.
    • Sub-Investigator: Tereza Havrdova

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 15 years to 35 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Type 1 diabetes
• Body mass index up to 32 kg/m2
• Exclusion of gravidity in women
• Known diagnosis of diabetes of less than 6 weeks
• Insulin dose of up to 40 IU per day for no longer than 1 month
• Positive for at least one autoantibody (GAD, IA2, ICA)
• C-peptide level ≥ 0.3 pmol/ml 4 min. following intravenous (IV) administration of 1 ml glucagon
• No concurrent severe infection
• Granulocyte count ≥ 2 x 10^9/l
• Platelet count ≥ 120 x 10^9/l

Exclusion Criteria:

• Other non-diabetes related autoimmune disease
• Previous immunosuppressive therapy
• Any clinical impairment precluding immunosuppressive therapy
• Leucopenia or thrombocytopenia

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Educational/Counseling/Training
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

What is the study measuring?

Primary Outcome Measures

Outcome Measure
C-peptide production

Secondary Outcome Measures

Outcome Measure
Insulin dose
Diabetes remission rate

Collaborators and Investigators

• Sponsor: Institute for Clinical and Experimental Medicine
• Collaborators: Ministry of Health, Czech Republic
• Investigators: Study Chair: Frantisek Saudek, MD., Institute for Clinical and Experimental Medicine, Prague

Publications and helpful links

General Publications

• Saudek F, Havrdova T, Boucek P, Karasova L, Novota P, Skibova J. Polyclonal anti-T-cell therapy for type 1 diabetes mellitus of recent onset. Rev Diabet Stud. 2004 Summer;1(2):80-8. doi: 10.1900/RDS.2004.1.80. Epub 2004 Aug 10.

Study record dates

Study Major Dates

• Study Start: November 1, 2000
• Study Completion: December 1, 2007

Study Registration Dates

• First Submitted: September 11, 2005
• First Submitted That Met QC Criteria: September 11, 2005
• First Posted (Estimate): September 19, 2005

Study Record Updates

• Last Update Posted (Estimate): January 9, 2007
• Last Update Submitted That Met QC Criteria: January 8, 2007
• Last Verified: February 1, 2004

More Information

Terms related to this study

• Keywords: Type 1 diabetes mellitus; Polyclonal antibodies; Immune intervention; Type 1 diabetes of recent onset; C-peptide level 0.3 pmol/l or higher; Positivity of at least one marker of autoimmunity (diabetes)
• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Immune System Diseases; Autoimmune Diseases; Endocrine System Diseases; Diabetes Mellitus; Diabetes Mellitus, Type 1; Physiological Effects of Drugs; Immunologic Factors; Antibodies
• Other Study ID Numbers: KD CD IKEM 1; NB/6541-3 IGA MZCR