Anakinra for the Treatment of Postprandial Hypoglycemia in a Patient With Total Gastrectomy and End-Stage Renal Disease (AnPHy-ReD)

May 5, 2026 updated by: Marc Donath

Anakinra for the Treatment of Recurrent Postprandial Hypoglycemia After Total Gastrectomy in a Patient With End-Stage Renal Disease

Post-meal low blood sugar (postprandial hypoglycemia) is a common problem after certain stomach surgeries like gastric bypass or stomach removal. It usually happens 1 to 3 hours after eating and can cause symptoms such as tiredness, hunger, sweating, dizziness, trouble speaking, or even fainting. Right now, there is no approved medication for this condition-only a careful diet reduced in sugars and refined carbohydrates can sometimes help reduce symptoms.

The AnPHy-ReD study is a personalized research study, designed for just one patient. This patient is a 52-year-old man who has been struggling with severe post-meal low blood sugar ever since his stomach was removed due to tumor in 2017. He also has end-stage kidney disease and needs dialysis three times a week.

The study is being conducted at the Cantonal Hospital of Olten in Switzerland and lasts 10 weeks, including 24 study visits. Most of these visits will happen during the patient's regular dialysis sessions. For 6 weeks, the patient will take either the drug Anakinra or a placebo (a substance with no active ingredient), in a randomly chosen order. Neither the patient nor the doctors will know which one he is taking at any given time.

During the study, the medical team will perform various tests, including physical check-ups and blood samples to look at sugar levels, various hormone levels and inflammation in the body. The patient will also wear a continuous glucose monitor (CGM) to track his blood sugar levels 24/7. In addition, he will do several mixed meal tests-this means drinking a shake containing fats, proteins, and sugars during a study appointment to see in real time how his body processes food, with doctors measuring changes in blood sugar, hormone and inflammation markers over time. During the study duration any side effects or symptoms will be closely monitored.

At the end of the study, the team will compare the results between the times the patient took Anakinra and the times he took the placebo. This will help find out if Anakinra can reduce sharp drops in blood sugar after meals and improve his overall condition.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

1

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Switzerland
    • Canton of Solothurn
      • Olten, Canton of Solothurn, Switzerland, 4600
        • Kantonsspital Olten
        • Contact:
        • Principal Investigator:
          • Matthias Hepprich, PD Dr. med.

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

This is an N-of-1 Trial, tailored-designed to a single participant.

  • total gastrectomy
  • severe episodes of postprandial hypoglycaemia after total gastrectomy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Placebo Comparator: Placebo Treatment Periods

The interventional period consists of four treatment blocks, each containing four visits. During each visit, the patient receives either Anakinra (A) or placebo (P) in a double-blinded manner, according to a randomized schedule. The sequence within each block (e.g., A-A-P-P or P-A-A-P) is randomly assigned in advance by an independent scientist, ensuring a balanced and unbiased comparison of treatments throughout the trial.

Study visits take place during the patient's regular dialysis sessions. On each visit, the assigned treatment is administered via the hemodialysis blood circuit over 1 minute during the last 30 minutes of each dialysis session by the dialysis personnel.
Drug: Placebo Comparator (0.9% NaCl)

Placebo comparator will be 0.9% saline solution. A similar size and type of syringe will be used as for the Anakinra syringe making it difficult to distinguish which treatment of the two the patient is receiving.

The patient will receive 0.9% saline solution intravenously through the haemodialysis circuit 30 minutes before the end of the dialysis session, following the same administration procedure as Anakinra to maintain blinding.
Experimental: Anakinra Treatment Periods
The interventional period consists of four treatment blocks, each containing four visits. During each visit, the patient receives either Anakinra (A) or placebo (P) in a double-blinded manner, according to a randomized schedule. The sequence within each block (e.g., A-A-P-P or P-A-A-P) is randomly assigned in advance by an independent scientist, ensuring a balanced and unbiased comparison of treatments throughout the trial. Study visits take place during the patient's regular dialysis sessions. On each visit, the assigned treatment is administered via the hemodialysis blood circuit over 1 minute during the last 30 minutes of each dialysis session by the dialysis personnel.
Drug: Anakinra (interleukin-1 receptor antagonist)

Anakinra (Kineret®; r-metHuIL-1ra, Swedish Orphan Biovitrum AB) is a recombinant, non-glycosylated form of the human interleukin-1 receptor antagonist (IL-1Ra). It is a clear, colourless-to-white solution, provided as a 150mg/mL solution in pre-filled syringes, each containing of 100 mg of Anakinra in 0.67ml.

On the assigned study days, the patient will receive in a double-blind manner 100 mg of Anakinra intravenously through the hemodialysis circuit, administered 30 minutes before the end of the dialysis session.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Mean Amplitude of Sensor Glucose Excursions (MAGE) during Anakinra treatment compared to placebo
Time Frame: Through the 40-day interventional period
Mean Amplitude of Sensor Glucose Excursions (MAGE) during Anakinra treatment compared to placebo, assessed using cumulative data from Continuous Glucose Monitoring System from all 48-hour treatment periods (48 hours following study-drug administration, Anakinra or Placebo).
Through the 40-day interventional period
Prevalence and severity of postprandial hypoglycaemia symptoms during Anakinra treatment compared to placebo
Time Frame: Through the 40-day interventional period

Prevalence and severity of postprandial hypoglycaemia symptoms during Anakinra treatment compared to placebo, assessed using cumulative data from Continuous Glucose Monitoring from all 48-hour treatment periods.

Post-prandial hypoglycaemia symptoms and their severity will be evaluated by the patient using the Edinburgh Hypoglycemia Symptom Scale (EHSS) and are accompanied by a decrease in blood glucose levels within the postprandial period as evaluated through the CGMS.

The postprandial period is defined as the 3 hours following meal intake. A minimum blood glucose cut-off value is not required for symptom reporting. Each treatment period spans the 48 hours following study-drug administration (Anakinra or Placebo).
Through the 40-day interventional period

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Time Below Range (TBR)
Time Frame: Through the 40-day interventional period
Time Below Range (TBR): The percentage and total duration of sensor glucose readings below thresholds of 3.3 mmol/L, 3.0 mmol/L, and 2.7 mmol/L during Anakinra treatment compared to placebo, assessed using cumulative data from all 48-hour treatment periods (48 hours following study-drug administration, Anakinra or Placebo).
Through the 40-day interventional period
Time in hyperglycaemia
Time Frame: Through the 40-day interventional period
Time in hyperglycaemia: The percentage and total duration of sensor glucose readings above 10 mmol/L during Anakinra treatment compared to Placebo, assessed using cumulative data from all 48-hour treatment periods (48 hours following study-drug administration, Anakinra or Placebo).
Through the 40-day interventional period
Pattern of Sensor Glucose
Time Frame: Through the 40-day interventional period
Pattern of Sensor Glucose: The slope of postprandial glucose measurements calculated as the maximal rate of increase and decrease of glucose levels observed over 20 minutes in the postprandial period, compared between Anakinra treatment and placebo, based on data from all 48-hour treatment periods (48 hours following study-drug administration, Anakinra or Placebo). The postprandial period is defined as the 3 hours following meal intake.
Through the 40-day interventional period
Comparison of Glycemic Variability and Extremes Between Interventional and Screening Period
Time Frame: From screening at Day -14 through the 40-day interventional period
Comparison of the entire interventional period with the screening period regarding to the following parameters as defined above: Time Below Range, Time in hyperglycaemia, Pattern of Sensor Glucose, and Mean Amplitude of Glucose Excursions.
From screening at Day -14 through the 40-day interventional period
Effect of Anakinra vs. Placebo on Glycemic and Hormonal Responses During Mixed Meal Tolerance Test
Time Frame: Immediately after Mixed-meal tolerance test

Changes following treatment with Anakinra compared to placebo during a Mixed Meal Tolerance Test in the AUC, peak and nadir values, and slopes of:

  • Glucose
  • Insulin
  • c-peptide
  • GLP-1
  • Glucagon
  • Cortisol
Immediately after Mixed-meal tolerance test
Changes in Fasting Metabolic and Inflammatory Biomarkers After the Interventional Period Compared to Baseline
Time Frame: Through the 40-day interventional period
Changes following the entire interventional period in levels of fasting insulin, c-peptide, glucagon, HbA1c, IL-1Ra, IL-6, TNF-a, IL-18 and hsCRP as compared to Baseline.
Through the 40-day interventional period
Comparison of Prevalence and Severity of Postprandial Hypoglycemia Symptoms Between the Interventional and Screening Periods
Time Frame: From screening at Day -14 through the 40-day interventional period

Prevalence and severity of postprandial hypoglycaemia symptoms during the whole interventional period compared to the Screening period.

Post-prandial hypoglycaemia symptoms and their severity will be evaluated by the patient using the Edinburgh Hypoglycemia Symptom Scale (EHSS) and are accompanied by a decrease in blood glucose levels within the postprandial period as evaluated through the CGMS.

The postprandial period is defined as the 3 hours following meal intake. A minimum blood glucose cut-off value is not required for symptom reporting.-Each treatment period spans the 48 hours following study-drug administration (Anakinra or Placebo).
From screening at Day -14 through the 40-day interventional period
Subjective patient's daily preference for treatment period
Time Frame: Through the 40-day interventional period
The patient will be asked to provide feedback on the treatment periods, indicating which study days he found the treatment more tolerable or beneficial. This subjective assessment will take into account factors such as comfort, side effects, and overall experience during the interventional period.
Through the 40-day interventional period
Adverse events of interest
Time Frame: From first dose of anakinra (Visit 4, Day 3) through the 40-day interventional Period and 15-day follow-up period

Adverse events of interest: AEs of interest include adverse events that can be expected during a treatment with Anakinra.

  • Identification of hypersensitivity reaction during the Interventional period.
  • Detection of any infection during the interventional period.
  • Detection of Neutropenia during the interventional period, defined as absolute neutrophil count <1000/mm³.
  • Detection of Thrombocytopenia during the Interventional period, defined as platelet count <100 000/mm³.
From first dose of anakinra (Visit 4, Day 3) through the 40-day interventional Period and 15-day follow-up period
Serious Adverse Events
Time Frame: From screening on Day -14 through the 40-day interventional period and 15-day follow-up period
A Serious Adverse Event (SAE) is classified as any untoward medical occurrence that results in death, is life-threatening, requires in-patient hospitalization or prolongation of existing hospitalisation, results in persistent or significant disability/incapacity, or is a congenital anomaly/birth defect.
From screening on Day -14 through the 40-day interventional period and 15-day follow-up period

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Marc Donath

Collaborators

Kantonsspital Baden

Investigators

  • Principal Investigator: Matthias Hepprich, PD Dr. med., University of Basel, Claraspital Basel

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

July 1, 2026

Primary Completion (Estimated)

October 1, 2026

Study Completion (Estimated)

December 1, 2026

Study Registration Dates

First Submitted

March 9, 2026

First Submitted That Met QC Criteria

May 5, 2026

First Posted (Actual)

May 12, 2026

Study Record Updates

Last Update Posted (Actual)

May 12, 2026

Last Update Submitted That Met QC Criteria

May 5, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2025-00684

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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