G-Pen™ Compared to Lilly Glucagon for Hypoglycemia Rescue in Adults With Type 1 Diabetes

G-Pen™ (Glucagon Injection) Compared to Lilly Glucagon (Glucagon for Injection [RDNA Origin]) for Induced Hypoglycemia Rescue in Adults With T1D: a Phase 3 B Multi-Centered, Randomized, Controlled, Single Blind, 2-Way Crossover Study to Evaluate Efficacy and Safety

This is a non-inferiority, multi-center, randomized, controlled, single-blind, two-way crossover efficacy and safety study in subjects with Type 1 diabetes mellitus. The study involves two daytime clinical research center (CRC) visits with random assignment to receive G-Pen™ glucagon 1 mg during one period and Lilly Glucagon 1 mg during the other. Each daytime visit is preceded by an overnight stay in the CRC. In the morning of the inpatient study visit, the subject is brought into a state of hypoglycemia through IV administration of regular insulin diluted in normal saline. After a hypoglycemic state with plasma glucose < 50 mg/dL is verified, the subject is administered a dose of G-Pen or Lilly Glucagon via subcutaneous injection. Plasma glucose levels are monitored for up to 180 minutes post-dosing, with a value of >70.0 mg/dL within 30 minutes of glucagon administration indicating a positive response. After 3 hours, the subject is given a meal and discharged when medically stable. After a wash-out period of 7 to 28 days, subjects return to the CRC, and the procedure are repeated with each subject crossed over to the other treatment. A follow-up visit as a safety check is conducted 2-7 days following administration of the final dose of study drug.

Study Overview

• Status: Completed
• Conditions: Type 1 Diabetes Mellitus; Severe Hypoglycemia; Insulin Hypoglycemia
• Intervention / Treatment: Drug: G-Pen; Drug: Lilly Glucagon

• Study Type: Interventional
• Enrollment (Actual): 81
• Phase: Phase 3

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M4G 3E8
      • LMC ESD, Inc.
  • Quebec
    • Montréal, Quebec, Canada, H3P 3P1
      • Altasciences Algorithme Pharma
• United States
  • California
    • Chula Vista, California, United States, 91911
      • ProSciento, Inc.
    • Walnut Creek, California, United States, 94598
      • Diablo Clinical Research, Inc.
  • Georgia
    • Atlanta, Georgia, United States, 30318
      • Atlanta Diabetes Associates
  • Washington
    • Renton, Washington, United States, 98057
      • Rainier Clinical Research Center, Inc.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Males and females diagnosed with type 1 diabetes mellitus for at least 24 months.
2. Current usage of daily insulin treatment that includes having an assigned "correction factor" for managing hyperglycemia.
3. Age 18-75 years, inclusive.
4. Random serum C-peptide concentration < 0.5 ng/mL.
5. Willingness to follow all study procedures, including attending all clinic visits.
6. Subject has provided informed consent as evidenced by a signed/dated informed consent form completed before any trial-related activities occur.

Exclusion Criteria:

1. Pregnancy: For women of childbearing potential, there is a requirement for a negative urine pregnancy test and for agreement to use contraception throughout the study and for 7 days after the last dose of study glucagon. Acceptable contraception includes birth control pill / patch / vaginal ring, Depo-Provera, Norplant, an IUD, the double barrier method (the woman uses a diaphragm and spermicide and the man uses a condom), or abstinence.
2. Breastfeeding: Nursing mothers will be allowed into the study. However, breast feeding during the during inpatient study visits and for 48 hours after each dose of study drug is not allowed.
3. HbA1c >9.0% at Screening.
4. BMI > 40 kg/m2.
5. Renal insufficiency (serum creatinine greater than 3.0 mg/dL) or end-stage renal disease. requiring renal replacement therapy.
6. Serum ALT or AST equal to or greater than 3 times the upper limit of normal.
7. Hepatic synthetic insufficiency as defined as a serum albumin of less than 3.0 g/dL.
8. Hematocrit of less than or equal to 30%.
9. BP readings at Screening where SBP <90 or >150 mm Hg, and DBP <50 or >100 mm Hg.
10. Clinically significant ECG abnormalities.
11. Use of > 2.0 U/kg total insulin dose per day.
12. Inadequate venous access.
13. Congestive heart failure, NYHA class III or IV.
14. History of myocardial infarction, unstable angina, or revascularization within the past 6 months.
15. History of a cerebrovascular accident in past 6 months or with major neurological deficits.
16. Active malignancy within 5 years from Screening, except basal cell or squamous cell skin cancers. History of breast cancer or malignant melanoma will be exclusionary.
17. Major surgical operation within 30 days prior to Screening.
18. Current seizure disorder (other than with suspect or documented hypoglycemia).
19. Current bleeding disorder, treatment with warfarin, or platelet count below 50 x 10e9 per liter.
20. History of pheochromocytoma or disorder with increased risk of pheochromocytoma (MEN 2, neurofibromatosis, or Von Hippel-Lindau disease).
21. History of insulinoma.
22. History of allergies to glucagon or glucagon-like products, or any history of significant hypersensitivity to glucagon or any related products or to any of the excipients (DMSO & trehalose) in the investigational formulation.
23. History of glycogen storage disease.
24. Subject tests positive for HIV, HCV or HBV infection (HBsAg+) at Screening.
25. Active substance or alcohol abuse (more than 21 drinks/wk. for males or 14 drinks/wk. for females). Subjects reporting active marijuana use or testing positive for tetrahydrocannabinol (THC) via rapid urine test will be allowed to participate in the study at the discretion of the Investigator.
26. Administration of glucagon within 28 days of Screening.
27. Participation in other studies involving administration of an investigational drug or device within 30 days or 5 half-lives, whichever is longer, before Screening for the current study and during participation in the current study.
28. Any reason the Investigator deems exclusionary.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: G-Pen followed by Lilly Glucagon; 1 mg G-Pen at the first treatment visit followed by 1 mg Lilly Glucagon at the second treatment visit	Drug: G-Pen; 1 mg subcutaneous injection of G-Pen (glucagon injection) administered via auto-injector; Other Names: glucagon; Drug: Lilly Glucagon; 1 mg subcutaneous injection of Lilly Glucagon (glucagon injection [RNDA Origin]); Other Names: GEK
Other: Lilly Glucagon followed by G-Pen; 1 mg Lilly Glucagon at the first treatment visit followed by 1 mg G-Pen at the second treatment visit	Drug: G-Pen; 1 mg subcutaneous injection of G-Pen (glucagon injection) administered via auto-injector; Other Names: glucagon; Drug: Lilly Glucagon; 1 mg subcutaneous injection of Lilly Glucagon (glucagon injection [RNDA Origin]); Other Names: GEK

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Subjects With a Positive Glucose Response	Increase in plasma glucose concentration from below 50.0 mg/dL to greater than 70.0 mg/dL within 30 minutes after receiving glucagon	0 to 30 minutes post dose

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time for Positive Glucose Response	Time from administration of glucagon for plasma glucose to rise from below 50.0 mg/dL to above 70.0 mg/dL	0 to 180 minutes post dose
Number of Subjects With a Positive Response for the Combination Endpoint: Positive Glucose Response/Positive Glucose Increase	A positive response for this endpoint is a return of plasma glucose to > 70 mg/dL or an increase in plasma glucose by ≥20 mg/dL within 30 minutes after receiving glucagon	0 to 30 minutes post dose
Number of Subjects With a Positive Glucose Increase	Increase in plasma glucose by ≥ 20.0 mg/dL within 30 minutes after receiving glucagon	0 to 30 minutes post dose
Time for Positive Glucose Increase	Time from administration of glucagon for plasma glucose to increase by ≥20 mg/dL from baseline	0 to 180 minutes post dose
Number of Subjects With a Positive Response for the Combination Endpoint: Positive Glucose Response/Relief of Neuroglycopenic Symptoms	A positive response for this endpoint is a return of plasma glucose to > 70 mg/dL or clearance of all neuroglycopenic symptoms of hypoglycemia within 30 minutes after receiving glucagon. Four symptoms were assessed: dizziness, blurred vision, difficulty in thinking and faintness.	0 to 30 minutes post dose
Number of Subjects With Relief of Neuroglycopenic Symptoms	Clearance of all neuroglycopenic symptoms of hypoglycemia within 30 minutes after receiving glucagon. Four symptoms were assessed: dizziness, blurred vision, difficulty in thinking and faintness.	0 to 30 minutes post dose
Time to Resolution of Autonomic Symptoms	Time from administration of glucagon to complete resolution of 4 autonomic symptoms of hypoglycemia. Symptoms included: sweating, tremor, palpitations and feeling of nervousness.	0 to 180 minutes post dose
Time to Resolution of Neuroglycopenic Symptoms	Time from administration of glucagon to complete resolution of 4 neuroglycopenic symptoms of hypoglycemia. Four symptoms were assessed: dizziness, blurred vision, difficulty in thinking and faintness.	0 to 180 minutes post dose
Time to Resolution of the Feeling of Hypoglycemia	Time from administration of glucagon to resolution of the overall sensation of hypoglycemia. Subjects were asked to answer yes/no to the question, "Do you feel hypoglycemic?" The time point as which the subject first answered "no" was considered the time of resolution.	0 to 180 minutes post dose
Glucose AUC	Area under the curve for plasma glucose.	0 to 180 minutes post dose - Blood samples for assessment of blood glucose concentration were collected every 5 minutes post-dose to 90 minutes, and then at 120, 150 and 180 minutes post dose.
Glucose Cmax	Maximum concentration of plasma glucose.	0 to 180 minutes post dose - Blood samples for assessment of blood glucose concentration were collected every 5 minutes post-dose to 90 minutes, and then at 120, 150 and 180 minutes post dose.
Glucose Tmax	Time to maximum concentration of plasma glucose. Blood samples for assessment of blood glucose concentration were collected every 5 minutes post-dose to 90 minutes, and then at 120, 150 and 180 minutes post dose.	0 to 180 minutes post dose
Glucagon Preparation and Administration Time	Time required to prepare and inject glucagon as measured between a "decision to dose" and completion of the injection	0 to 5 minutes pre-dose

Collaborators and Investigators

• Sponsor: Xeris Pharmaceuticals
• Collaborators: SGS S.A.; Integrated Medical Development

Publications and helpful links

General Publications

• Christiansen MP, Cummins M, Prestrelski S, Close NC, Nguyen A, Junaidi K. Comparison of a ready-to-use liquid glucagon injection administered by autoinjector to glucagon emergency kit for the symptomatic relief of severe hypoglycemia: two randomized crossover non-inferiority studies. BMJ Open Diabetes Res Care. 2021 Oct;9(1):e002137. doi: 10.1136/bmjdrc-2021-002137.

Study record dates

Study Major Dates

• Study Start (Actual): January 23, 2018
• Primary Completion (Actual): April 18, 2018
• Study Completion (Actual): May 3, 2018

Study Registration Dates

• First Submitted: February 13, 2018
• First Submitted That Met QC Criteria: February 13, 2018
• First Posted (Actual): February 20, 2018

Study Record Updates

• Last Update Posted (Actual): February 17, 2020
• Last Update Submitted That Met QC Criteria: February 13, 2020
• Last Verified: February 1, 2020

More Information

Terms related to this study

• Keywords: hypoglycemia; glucagon
• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Immune System Diseases; Autoimmune Diseases; Endocrine System Diseases; Diabetes Mellitus; Diabetes Mellitus, Type 1; Hypoglycemia; Physiological Effects of Drugs; Gastrointestinal Agents; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Incretins; Glucagon; Glucagon-Like Peptide 1
• Other Study ID Numbers: XSGP-303

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No