- ICH GCP
- Registro degli studi clinici negli Stati Uniti
- Sperimentazione clinica NCT01346085
Calcineurin Inhibitor (CNI)-Free Immunosuppressive Regimen in T1D Patients Receiving Islet Transplantation (ECIT-1)
A Multi-step Trial Towards Single Donor Islet Transplantation in Type 1 Diabetic Patients, Using Calcineurin Inhibitor-free Immunosuppression
Panoramica dello studio
Stato
Condizioni
Intervento / Trattamento
Descrizione dettagliata
We designed the clinical trial as a single-arm, phase 1-2 trial conducted in two transplant centers (San Raffaele Scientific Institute, Milan, Italy; Cell Isolation and Transplantation Center, University of Geneva, Geneva, Switzerland) which used a common protocol for islet preparation, post-transplantation patient management and data collection. The trial is exploratory in nature and the target enrollment is 10 patients. The recruitment is competitive between the two centers and each patient is to receive at least 10,000 IE/kg. Up to three islet infusions are allowed per patients until insulin independence is reached, provided that partial islet function (i.e., fasting C-peptide ≥0.3 ng/mL) is maintained between infusions. We planned an individual follow-up of 3 years after the last islet infusion.
Patients with type 1 diabetes are eligible for this study. Major criteria for inclusion are: age 18-65 years; type 1 diabetes with onset <40 years of age; insulin treatment of at least 5 years at the time of enrollment; stimulated C-peptide in response to arginine <0.5 ng/ml; multiple (three or more) daily insulin injections or Continuous Subcutaneous Insulin Infusion; self-blood glucose monitoring ≥3 times/day; high glycemic instability and/or hypoglycemia unawareness; inability to consistently attain a glycated hemoglobin target of <7.5 % without severe hypoglycemia (defined as an hypoglycemic episode requiring the assistance by another person for its resolution) in the past 36 months despite medical management by a diabetes specialist. Major criteria for exclusion are: HbA1c >12%; BMI >30 kg/m2, or insulin requirement > 0.8 IU/kg/day; poorly controlled hypertension; untreated proliferative diabetic retinopathy; presence or history of macroalbuminuria (>300mg/g day) or estimated glomerular filtration rate <60 ml/min/1.73 m2 for females or <70 ml/min/1.73 m2 for males.
Tipo di studio
Iscrizione (Effettivo)
Fase
- Fase 2
- Fase 1
Contatti e Sedi
Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion Criteria:
- Male and female patients aged 18-65yr
- ability to provide written informed consent and comply with the study protocol procedures
- clinical history of type 1 diabetes with onset <40yr of age, on insulin for at least 5yr at the time of enrollment
- absent stimulated C-peptide (<0.5ng/ml) in response to arginine
- multiple (three or more) daily insulin injections or insulin pump therapy
- self blood glucose monitoring ≥3 times/day, supervised by a specialist physician
- high glycemic instability and hypoglycemia unawareness
- inability to consistently attain a HbA1c < 7.5 % target without experiencing severe hypoglycemia (assistance by another person) in the past 36 months despite appropriate medical management.
Exclusion Criteria:
- HbA1c >12%
- BMI >30 kg/m2, or insulin requirement of > 0.8 IU/kg/day;
- poorly controlled hypertension;
- untreated proliferative diabetic retinopathy;
- presence or history of macroalbuminuria (>300mg/g day) or measured glomerular filtration rate <60 ml/min/1.73 m2 for females and <70 ml/min/1.73 m2 for males
- for female participants: positive pregnancy test, presently breast-feeding, or unwilling to use effective contraceptive measures for the duration of the study and 3 months after discontinuation
- for male participants: intent to procreate during the duration of the study or within 3 months after discontinuation or unwillingness to use effective measures of contraception;
- any history of malignancy within the previous 5 years, except for completely resected squamous or basal cell carcinoma of the skin;
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: N / A
- Modello interventistico: Assegnazione di gruppo singolo
- Mascheramento: Nessuno (etichetta aperta)
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
---|---|
Sperimentale: CNI-free single-group
|
Immunosuppression consisted of: (i) pre-Tx rapamycin treatment (0.1 mg/kg/day) for at least 30 days; (ii) induction therapy with ATG (1.5 mg/kg/day for 4 days starting at day -1) and a steroid bolus (methyl-prednisolone 500 mg, day -1) plus low dose steroids (prednisone, 10 mg/day) and interleukin-1 (IL-1) receptor antagonist (100 mg/day) for 2 weeks (with ATG and steroid bolus administered only prior to the 1st islet infusion; (iii) maintenance with rapamycin (0.1 mg/kg/day) plus mycophenolate mofetil (2 g/day).
Altri nomi:
|
Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
---|---|---|
The Proportion of Insulin Free Patients 3 Years After the Last Islet Infusion
Lasso di tempo: 3 year
|
Insulin independence is defined as no need for exogenous insulin, with adequate glycemic control [i.e., glycated hemoglobin <7% (normal range 3.5 - 6.0%), fasting glucose levels not exceeding 140 mg/dL (7.8 mmol/L) more than three times per week and 2-hour postprandial levels not exceeding 180 mg/dL (10 mmol/L) more than four times per week].
|
3 year
|
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
---|---|---|
Insulin Independence With Adequate Glycemic Control Throughout Follow-up
Lasso di tempo: up to 3 years
|
up to 3 years
|
|
Glycated Hemoglobin Levels Throughout Follow-up
Lasso di tempo: up to 3 years
|
up to 3 years
|
|
Basal and Stimulated Blood C-peptide Levels in Response to Arginine Challenge Throughout Follow-up
Lasso di tempo: up to 3 year
|
up to 3 year
|
|
the Reduction in Insulin Requirement Compared to Baseline
Lasso di tempo: up to 3 years
|
up to 3 years
|
|
Severe Hypoglycemic Events Since Completion of Transplant
Lasso di tempo: up to 3 years
|
up to 3 years
|
|
Any Adverse Event Throughout Follow-up
Lasso di tempo: up to 3 years
|
Among study participants there were no reports of death, post-transplantation lymphoproliferative disease, cancer, or opportunistic infections.
There was no evidence of cytomegalovirus disease, infection or serological activation (CMV early antigens negative during the whole follow-up), nor of Epstein-Barr clinical and serological reactivation (all patients were antibodies anti EBV positive before transplant, as per the inclusion criteria).
|
up to 3 years
|
Collaboratori e investigatori
Sponsor
Collaboratori
Investigatori
- Investigatore principale: Lorenzo Piemonti, MD, Fondazione Centro San Raffaele del Monte Tabor
- Investigatore principale: Thierry Berney, MD, Université de Genève
- Cattedra di studio: Antonio Secchi, MD, Fondazione Centro San Raffaele del Monte Tabor
- Direttore dello studio: Paola Maffi, MD, Cantro San Raffaele del Monte Tabor
Pubblicazioni e link utili
Pubblicazioni generali
- Piemonti L, Maffi P, Monti L, Lampasona V, Perseghin G, Magistretti P, Secchi A, Bonifacio E. Beta cell function during rapamycin monotherapy in long-term type 1 diabetes. Diabetologia. 2011 Feb;54(2):433-9. doi: 10.1007/s00125-010-1959-6. Epub 2010 Nov 3.
- Melzi R, Maffi P, Nano R, Sordi V, Mercalli A, Scavini M, Secchi A, Bonifacio E, Piemonti L. Rapamycin does not adversely affect intrahepatic islet engraftment in mice and improves early islet engraftment in humans. Islets. 2009 Jul-Aug;1(1):42-9. doi: 10.4161/isl.1.1.8881.
- Maffi P, Berney T, Nano R, Niclauss N, Bosco D, Melzi R, Mercalli A, Magistretti P, De Cobelli F, Battaglia M, Scavini M, Demuylder-Mischler S, Secchi A, Piemonti L. Calcineurin inhibitor-free immunosuppressive regimen in type 1 diabetes patients receiving islet transplantation: single-group phase 1/2 trial. Transplantation. 2014 Dec 27;98(12):1301-9. doi: 10.1097/TP.0000000000000396.
- Piemonti L, Everly MJ, Maffi P, Scavini M, Poli F, Nano R, Cardillo M, Melzi R, Mercalli A, Sordi V, Lampasona V, Espadas de Arias A, Scalamogna M, Bosi E, Bonifacio E, Secchi A, Terasaki PI. Alloantibody and autoantibody monitoring predicts islet transplantation outcome in human type 1 diabetes. Diabetes. 2013 May;62(5):1656-64. doi: 10.2337/db12-1258. Epub 2012 Dec 28.
Studiare le date dei record
Studia le date principali
Inizio studio
Completamento primario (Effettivo)
Completamento dello studio (Effettivo)
Date di iscrizione allo studio
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Stima)
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Stima)
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
Altri numeri di identificazione dello studio
- ECIT-1
Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .
Prove cliniche su Diabete di tipo 1
-
AmgenCompletato
-
Paolo MilaniReclutamentoAmiloidosi | Amiloidosi cardiaca | ATTR Amiloidosi Wild TypeItalia
-
Steen Hvitfeldt PoulsenReclutamentoATTR Amiloidosi Wild TypeDanimarca
-
Oncology Institute of Southern SwitzerlandUniversity of Kiel; Ente Ospedaliero Cantonale, BellinzonaCompletato
-
AmgenCompletatoCancro colorettale metastatico RAS wild-type
-
Henan Cancer HospitalCompletatoCancro colorettale metastatico KRAS, NRAS e BRAF V600E wild-type
-
Austin Neuromuscular CenterAlnylam PharmaceuticalsReclutamentoPolineuropatie | Amiloidosi da transtiretina | Amiloidosi correlata alla transtiretina di tipo selvaggio (ATTR). | Amiloidosi cardiaca da transtiretina wild-type | Amiloidosi ATTR di tipo selvaggioStati Uniti
-
Denver Health and Hospital AuthorityIscrizione su invitoDisturbo evitante restrittivo dell'assunzione di cibo | Anoressia Nervosa, Binge Eating/Purging Type | ARFIDE | Tipo restrittivo di anoressia nervosaStati Uniti
-
Rosemary Claire RodenChildren's Miracle NetworkIscrizione su invitoBulimia nervosa | Comportamento impulsivo | Eliminazione (disturbi alimentari) | Problemi alimentari | Disturbi alimentari in adolescenza | Anoressia Nervosa/Bulimia | Anoressia in adolescenza | Anoressia Nervosa, Atipica | Anoressia Nervosa, Binge Eating/Purging TypeStati Uniti
-
Oxford Brookes UniversityUniversity of OxfordCompletatoAttività fisica | Salute mentale Benessere 1 | Funzione cognitiva 1, sociale | Academic Attainment | Fitness TestingRegno Unito
Prove cliniche su CNI free immunosuppression
-
Johnson & Johnson Vision Care, Inc.CompletatoAcuità visiva, biomicroscopia con lampada a fessura (valutazione della colorazione corneale)Stati Uniti
-
Michigan Technological UniversityBlue Cross Blue Shield of Michigan FoundationAttivo, non reclutanteArtrosi al ginocchio | Lesioni al ginocchio | Artrite al ginocchioStati Uniti
-
Southern California College of Optometry at Marshall...Completato
-
Manchester University NHS Foundation TrustCambridge University Hospitals NHS Foundation Trust; Norfolk and Norwich University... e altri collaboratoriCompletatoDiabete mellito, tipo 1Regno Unito
-
Bausch & Lomb IncorporatedCompletatoUsura delle lenti a contattoStati Uniti
-
University College, LondonUniversity of RoehamptonCompletatoDepressione | Stress, Psicologico | Ansia
-
University Hospital, RouenNon ancora reclutamento
-
Talita Cumi Ltd.Non ancora reclutamentoDolore muscoloscheletrico | Paura di cadereRegno Unito
-
University GhentNikeCompletato