Osilodrostat for Glycemic Control in Mild Autonomous Cortisol Secretion (MACS) With Difficult-To-Control Type 2 Diabetes - A Randomized, Double-Blind, Placebo-Controlled Phase 2 Study (GLYCOSIL-MACS)
This single-centre, randomized, double-blind, placebo-controlled phase 2 trial investigates whether lowering cortisol with osilodrostat improves blood-glucose control in adults with mild autonomous cortisol secretion (MACS) and difficult-to-control type 2 diabetes. Forty-four participants are randomly assigned 1:1 to osilodrostat or matching placebo, taken once daily for 12 weeks, together with a blinded hydrocortisone/placebo for stress (sick-day) dosing. The primary outcome is the change in HbA1c from baseline to week 12; secondary outcomes include continuous glucose monitoring (CGM) metrics, cardiometabolic parameters, cortisol measures and quality of life. Participants are followed for a safety visit 4 weeks after the end of treatment.
Przegląd badań
Status
Interwencja / Leczenie
Szczegółowy opis
MACS is a common, mild form of endogenous hypercortisolism that may adversely affect glucose metabolism. In participants with confirmed MACS and difficult-to-control type 2 diabetes, this trial tests whether pharmacological cortisol reduction with osilodrostat improves glycaemic control. After a screening visit and a 14-day CGM run-in, participants are randomized 1:1 to osilodrostat 1 mg once daily at 18:00 (single optional escalation to 2 mg after 14 days, safety-guided) or matching placebo for 12 weeks; both arms receive a blinded hydrocortisone/placebo for stress dosing (double-dummy). Background glucose- and blood-pressure-lowering therapy is continued and adjusted only per predefined safety algorithms. Assessments include HbA1c, continuous glucose monitoring, blood pressure, lipids, anthropometrics, DXA body composition and bone density, plasma/salivary/urinary cortisol, quality-of-life and sleep questionnaires, and safety laboratory and ECG monitoring. The primary analysis is an ANCOVA of the change in HbA1c at week 12 in the intention-to-treat population under a treatment-policy estimand; CGM endpoints are analysed with mixed-effects models for repeated measures.
Typ studiów
Zapisy (Szacowany)
Faza
- Faza 2
Kontakty i lokalizacje
Kontakt w sprawie studiów
- Nazwa: Beckey Trinh, PD, MD, PhD
- Numer telefonu: +41612655078
- E-mail: beckey.trinh@usb.ch
Lokalizacje studiów
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Basel, Szwajcaria
- University Hospital Basel, Clinic of Endocrinology, Diabetology & Metabolism
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Kontakt:
- Beckey Trinh, PD, MD, PhD
- Numer telefonu: +41612655078
- E-mail: beckey.trinh@usb.ch
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Kryteria uczestnictwa
Kryteria kwalifikacji
Wiek uprawniający do nauki
Akceptuje zdrowych ochotników
Płeć kwalifikująca się do nauki
Opis
Inclusion Criteria:
- Age 18 to <75 years.
- Confirmed MACS per ESE 2023 guidelines: serum cortisol >50 nmol/L after 1 mg dexamethasone suppression test, low ACTH and DHEAS, and uni-/bilateral adrenal adenoma(s) or macronodular/micronodular/diffuse bilateral adrenal hyperplasia on CT or MRI.
- Morning serum cortisol >300 nmol/L.
- Difficult-to-control type 2 diabetes: HbA1c >7.0% despite one of - ≥3 glucose-lowering medications; insulin plus ≥1 glucose-lowering medication; ≥2 glucose-lowering medications and ≥1 micro-/macrovascular complication; or ≥2 glucose-lowering and ≥2 blood-pressure-lowering medications.
- Stable background pharmacotherapy for ≥4 weeks before the first study visit.
- For persons of childbearing potential: agreement to abstinence or contraception with a failure rate ≤1%/year during treatment and for 1 month after the last dose.
Exclusion Criteria:
- Age ≥75 years (osilodrostat not sufficiently studied in this age group per the SmPC).
- Known hypersensitivity to osilodrostat, its excipients, or the placebo.
- Planned adrenalectomy before completion of the study.
- Malignant adrenal tumour.
- Type 1 diabetes; new-onset diabetes (<1 year).
- Systemic glucocorticoid therapy within 3 months, or planned use.
- Current/recent intake of medications affecting adrenal steroidogenesis or cortisol assessment.
- Concomitant therapy with clinically relevant drug-drug interactions with osilodrostat (strong CYP3A4 inhibitors; strong CYP3A4/CYP2B6 inducers; QT-prolonging medicinal products).
- Participation in another interventional trial within the last 30 days.
- Pregnancy or breastfeeding; WOCBP unwilling to use highly effective contraception.
- Excessive alcohol consumption; severe untreated sleep apnea; night-shift work.
- Severe psychiatric, medical or surgical illness.
- Severe renal impairment (eGFR < 30 mL/min/1.73 m²), hemodialysis or end-stage renal disease.
- Liver cirrhosis Child-Pugh B or C.
- Refractory hypokalemia or hypomagnesemia (not correctable to K ≥4.0 and Mg ≥1.0 mmol/L before first dose).
- QTc > 480 ms on baseline ECG, or known congenital long QT syndrome.
- Uncontrolled arterial hypertension (≥ 160/100 mmHg despite therapy)
- Uncontrolled thyroid disease
- Severe cardiovascular disease (NYHA class III-IV heart failure, myocardial infarction or unstable angina within the previous 6 months, or clinically significant arrhythmia)
- History of breast or endometrial carcinoma
Plan studiów
Jak projektuje się badanie?
Szczegóły projektu
- Główny cel: Leczenie
- Przydział: Randomizowane
- Model interwencyjny: Przydział równoległy
- Maskowanie: Poczwórny
Broń i interwencje
Grupa uczestników / Arm |
Interwencja / Leczenie |
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Eksperymentalny: Osilodrostat
Osilodrostat 1 mg once daily at 18:00 for 12 weeks (single optional escalation to 2 mg after 14 days), plus blinded hydrocortisone 10 mg for stress/sick-day dosing only. |
1 mg film-coated tablet, orally once daily at 18:00; optional single escalation to 2 mg after 14 days; 12 weeks. blinded stress/sick-day (rescue) dosing only, per written instructions |
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Komparator placebo: Placebo
Placebo once daily at 18:00 for 12 weeks, plus blinded placebo for hydrocortisone (identical schedule). |
placebo tablet, orally once daily at 18:00; 12 weeks placebo tablet for stress-dosing regimen |
Co mierzy badanie?
Podstawowe miary wyniku
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
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Change from baseline in HbA1c at week 12
Ramy czasowe: Baseline and week 12
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Between-group difference in HbA1c change (%). Time Frame: Baseline and week 12 |
Baseline and week 12
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Miary wyników drugorzędnych
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
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CGM Time in Range (3.9-10.0 mmol/L, %)
Ramy czasowe: baseline, week 6 and week 12
|
14-day windows preceding baseline, week 6 and week 12. |
baseline, week 6 and week 12
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CGM Time in Tight Range (3.9-7.8 mmol/L, %)
Ramy czasowe: baseline, week 6 and week 12
|
14-day windows preceding baseline, week 6 and week 12. |
baseline, week 6 and week 12
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CGM Time below range (<3.9 and <3.0 mmol/L, %)
Ramy czasowe: baseline, week 6 and week 12
|
14-day windows preceding baseline, week 6 and week 12 |
baseline, week 6 and week 12
|
|
CGM Time above range (>10.0 and >13.9 mmol/L, %)
Ramy czasowe: baseline, week 6 and week 12
|
14-day windows preceding baseline, week 6 and week 12. |
baseline, week 6 and week 12
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Change in blood pressure
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Change in lipid profile
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Change in body weight and waist/hip circumference
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Change in DXA-derived body composition
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Proportion of participants requiring reduction of hypoglycemia-causing therapy (insulin/sulfonylurea)
Ramy czasowe: Baseline to week 12
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Baseline to week 12
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Change in antihypertensive medication
Ramy czasowe: Baseline to week 12
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Baseline to week 12
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Change in plasma cortisol
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Change in salivary cortisol
Ramy czasowe: Baseline to week 12
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Baseline to week 12
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Change in 24-h urinary cortisol
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Change from baseline in health-related quality of life (SF-36)
Ramy czasowe: Baseline and week 12
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8 subscales + physical/mental component summaries, 0-100, higher = better |
Baseline and week 12
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Change from baseline in disease-specific quality of life (CushingQoL questionnaire)
Ramy czasowe: Baseline and week 12
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higher = better |
Baseline and week 12
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Change from baseline in sleep quality (Pittsburgh Sleep Quality Index, PSQI)
Ramy czasowe: Baseline and week 12
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global score 0-21, higher = worse sleep |
Baseline and week 12
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Inne miary wyników
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
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Change from baseline in bone mineral density by DXA (g/cm²)
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Change from baseline in serum β-CTX (C-terminal telopeptide of type I collagen)
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Change from baseline in serum P1NP (procollagen type I N-terminal propeptide)
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Change from baseline in total alkaline phosphatase (U/L)
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Change from baseline in bone-specific alkaline phosphatase
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Change from baseline in the clinical Cushing severity score
Ramy czasowe: Baseline and week 12
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Li et al. 2023 clinical severity score; 0-22, higher = more severe |
Baseline and week 12
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Change from baseline in handgrip strength
Ramy czasowe: Baseline and week 12
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hand dynamometer; kg, best of three |
Baseline and week 12
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Change from baseline in the five-times sit-to-stand test
Ramy czasowe: Baseline and week 12
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seconds; lower = better |
Baseline and week 12
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Serum interleukin-6
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Serum TNF-α
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Serum IL-1Ra
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Serum hs-CRP
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Plasma and 24-h urinary steroid metabolome
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Circadian clock-gene expression (whole-blood RNA)
Ramy czasowe: Baseline and week 12
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Baseline and week 12
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Współpracownicy i badacze
Sponsor
Śledczy
- Główny śledczy: Beckey Trinh, PD, MD, PhD, University Hospital, Basel, Switzerland
Publikacje i pomocne linki
Daty zapisu na studia
Główne daty studiów
Rozpoczęcie studiów (Szacowany)
Zakończenie podstawowe (Szacowany)
Ukończenie studiów (Szacowany)
Daty rejestracji na studia
Pierwszy przesłany
Pierwszy przesłany, który spełnia kryteria kontroli jakości
Pierwszy wysłany (Rzeczywisty)
Aktualizacje rekordów badań
Ostatnia wysłana aktualizacja (Rzeczywisty)
Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości
Ostatnia weryfikacja
Więcej informacji
Terminy związane z tym badaniem
Słowa kluczowe
Dodatkowe istotne warunki MeSH
- Choroby układu hormonalnego
- Choroby metaboliczne
- Zaburzenia metabolizmu glukozy
- Cukrzyca
- Choroby nadnerczy
- Nadczynność kory nadnerczy
- Choroby żywieniowe i metaboliczne
- Cukrzyca typu 2
- Zespół Cushinga
- Hormony
- Hormony, substytuty hormonów i antagoniści hormonów
- Związki policykliczne
- Ciężarne
- Steroidy
- Związki sterownika
- Ciążone
- Pusta
- 11-hydroksykortykosteroidy
- Hydroksykortykosteroidy
- Hormony kory nadnerczy
- 17-hydroksykortykosteroidy
- Hydrokortyzon
- Osilodrostat
Inne numery identyfikacyjne badania
- GLYCOSIL-MACS
- 2026-01499 (Inny identyfikator: BASEC / Ethics Committee Northwest and Central Switzerland, EKNZ)
- 205.123670 (Inny identyfikator: Swissmedic)
- SNCTP000007077 (Inny identyfikator: Swiss National Clinical Trials Portal)
Plan dla danych uczestnika indywidualnego (IPD)
Planujesz udostępniać dane poszczególnych uczestników (IPD)?
Opis planu IPD
Coded study data are held by the sponsor in Switzerland; only anonymised/aggregated data and the final report are shared externally, per the protocol data-protection section.
Informacje o lekach i urządzeniach, dokumenty badawcze
Bada produkt leczniczy regulowany przez amerykańską FDA
Bada produkt urządzenia regulowany przez amerykańską FDA
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