- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00336674
Trial of Intranasal Insulin in Children and Young Adults at Risk of Type 1 Diabetes (INITII)
A Randomised, Double-blind, Placebo-controlled Trial of Intranasal Insulin (440 IU) in Children and Young Adults at Risk of Type 1 Diabetes: Intranasal Insulin Trial II
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Autoimmune diseases are the outcome of dysregulated immune responses to self-antigens. Type 1 diabetes (T1D), previously known as insulin-dependent or juvenile diabetes, is an autoimmune disease in which the body's immune system reacts against and destroys the insulin-producing β cells in the islets of the pancreas. T1D classically affects children and young adults. Approximately 15% of people with diabetes have this form of the disease and no treatment is currently available to prevent it. Asymptomatic individuals in the pre-clinical stage of T1D can be identified by the presence of circulating antibodies to the islet autoantigens (pro)insulin, glutamic acid decarboxylase (GAD) and tyrosine phosphatase-like insulinoma antigen 2 (IA2). (Pro)insulin is the only autoantigen that is specific for β cells and several lines of evidence demonstrate that it plays a key role in driving autoimmune β-cell destruction.
The ability to use self-antigens as tools to induce protective immunity, free from the side effects of conventional non-specific immunosuppression, is the 'Holy Grail' of autoimmune disease therapy. Animal models provide proof-of-concept for such antigen-specific therapy. For example, in the non-obese diabetic (NOD) mouse, a model of spontaneous T1D, transgenic over-expression of proinsulin in antigen-presenting cells in the immune system during development or in transferred bone marrow stem cells completely prevented diabetes. On a more practical and translatable level, immune tolerance to an antigen can be achieved by administering antigen to the mucosal immune system. Thus, immune responses to antigen are suppressed by feeding antigen ('oral tolerance') or by administering antigen to the naso-respiratory mucosa .
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
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New South Wales
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Westmead, New South Wales, Australia, 2145
- The Children's Hospital at Westmead
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Queensland
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Brisbane, Queensland, Australia, 4101
- Mater Children's Hospital
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South Australia
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North Adelaide, South Australia, Australia, 5006
- Womens and Childrens Hospital
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Victoria
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Melbourne, Victoria, Australia, 3050
- Royal Melbourne Hospital
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Western Australia
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Subiaco, Western Australia, Australia, 6840
- Princess Margaret Hospital
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Auckland, New Zealand
- University of Auckland
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- First-degree or second-degree relative of a person with Type 1 diabetes (T1D) diagnosed before age 40.
- Age 4-30 years if first-degree relative; age 4-20 years if second-degree relative.
- Confirmed serum antibodies to two or more islet antigens.
- Normal oral glucose tolerance test (OGTT).
- First phase insulin response (FPIR) at or above threshold - Primary Stratum - greater than or equal to 10th percentile for siblings, offspring and second-degree relatives of person with T1D (greater than or equal to 100uU/ml if aged 8 or more years OR greater than or equal to 60 uU/ml if aged less than 8) and greater than or equal to the 1st percentile for parents of someone with T1D (greater than ore equal to 60uU/ml). Secondary Stratum: Greater than or equal 1st percentile, less than 10th percentile for siblings, offspring and second-degree relatives of someone with T1D (greater than or equal to 50uU/ml less than 100 uU/ml if aged greater than or equal to 8 years or greater than or equal to 20 uU/ml less than 60uU/ml if aged less than 8 years)
- Provision of written consent. -
Exclusion Criteria:
- History of treatment with insulin or oral hypoglycemic agents
- Known diabetes by ADA/WHO criteria
- Pregnant or lactating or of child-bearing potential not using an adequate method of contraception
- Concomitant disease or treatment which may interfere with assessment or cause immunosuppression, as judged by the investigators.
- Uncorrected vitamin D deficiency
- Known alcohol or drug abuse, psychiatric or other condition that could be associated with poor compliance.
- Known liver disease, or persisting elevation of plasma Aspartate transaminase (AST) or Alanine transaminase (ALT) levels.
- Impaired renal function
Any defect or pathology of nasal passage which would preclude application of the intranasal spray.
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Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: DV001
Recombinant human intranasal insulin formulation in a buffered solution of benzalkonium chloride and glycerol presented in multi-dose nasal spray devices with actuators (Pfeiffer) designed to deliver 100ul spray doses to nasal mucosa.
The product is formulated at a dose strength of 1100 IU / mL (40mg/mL) manufacturing formulation.
The product will be self administered by eligible participants as two 100 microlitre spray doses per nostril.
Treatment will be administered daily for 7 consecutive days then on one day each week for 12 months.
Participants will be followed until they develop diabetes or until 5 years after the last participant has been randomised (maximum period of follow up is expected to be 10 years.
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440IU Insulin
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Placebo Comparator: Placebo
Placebo insulin carrier solution of benzalkonium chloride and glycerol presented in multi-dose nasal spray devices with actuators (Pfeiffer) designed to deliver 100ul spray doses to nasal mucosa.
The product will be self administered by participants as two 100 microlitre spray doses per nostril.
Treatment will be administered daily for 7 consecutive days then on one day each week for 12 months.
Participants will be followed until they develop diabetes or until 5 years after the last participant has been randomised (maximum period of follow up is expected to be 10 years.
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Placebo insulin carrier solution containing benzalkonium chloride and glycerol
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Diagnosis of Diabetes AT 5 years according to American Diabetes Association / World Health Organization (ADA/WHO) criteria.
Time Frame: 1 year of treatment 9 years follow up
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Defined as the presence of 2 or more of the following diagnostic criteria including diabetic fasting blood glucose level, diabetic 2 hour postprandial blood glucose level, diabetic HbA1c and symptoms
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1 year of treatment 9 years follow up
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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B cell function
Time Frame: 1 year of treatment 9 years follow up
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Measured as glucose and insulin responses in Oral glucose tolerance test (OGTT) 6 monthly
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1 year of treatment 9 years follow up
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Insulin Action
Time Frame: 1 year of treatment 9 years follow up
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Insulin resistance measured by Homeostasis of model assessment - resistance (HOMA-R) 6 monthly
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1 year of treatment 9 years follow up
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Immune function
Time Frame: 1 year of treatment 9 years follow up
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Measured by levels of circulating antibodies to insulin, Glutamic acid decarboxylase (GAD) and Tyrosine phosphatase - like insulinoma antigen (IA-2) and T cell responses to proinsulin, denatured insulin, GAD and tetanus at 5 years
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1 year of treatment 9 years follow up
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Leonard C Harrison, MBBS MD DSc, Melbourne Health
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- INIT II
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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