Anti-TNFα to Delay or Prevent Progression to Stage 3 T1D

Study Overview
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Brief Summary
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This will be a study conducted as a placebo-controlled, double blind, 1:1 randomized controlled clinical trial testing a Tumor Necrosis Factor Blocker (Anti-TNFα) substance versus placebo in subjects with a 2-year 50% risk of progression to stage 3 T1D across multiple centers. The trial will investigate the ability of Anti-TNFα to prevent or delay progression to Stage 3 T1D in the targeted patient population.

Official Title
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Tumor Necrosis Factor Blocker (Anti-TNFα) to Delay or Prevent Progression to Stage 3 T1D

Conditions
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Diabetes Mellitus, Type 1

Intervention / Treatment
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* Drug: Golimumab
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Potential participants must meet all of the following inclusion criteria: Age > 3 and < 46 years Willing to provide Informed Consent or have a parent or legal guardian provide informed consent if the subject is <18 years of age At least two or more diabetes-related biochemical autoantibodies insulin (mIAA), glutamic acid decarboxylase antibody (GADA), Islet cytoplasmic antibodies (ICA), islet antigen 2 (IA-2A), zinc transporter 8 (ZnT8A) present on the same sample. Of note, ICA and GADA positivity alone cannot be used to define eligibility in this trial). Must have at least two of the high-risk markers defined below (within 7 weeks (52 days) of screening visit if performed as part of TN01 Pathway to Prevention (PTP) study at time of screening; defining a 50% two-year progression risk): a. Abnormal glucose tolerance: i. 2-hr glucose ≥ 140 and <200 mg/dL, fasting glucose ≥ 110 and <126, or 30-, 60-, or 90-minute glucose ≥ 200 mg/dL b. HbA1c ≥ 5.7 c. Index60 ≥ 1.4 d. Diabetes Prevention Trial-Type 1 Risk Score (DPTRS) ≥ 7.4 Females of childbearing potential must agree to use abstinence or an effective birth control through the treatment period.( Males able to father children, must agree to use abstinence or an effective birth control during the treatment period. Subjects who are Epstein-Barr virus (EBV) seronegative at screening must be EBV Polymerase chain reaction (PCR) negative within 30 days of randomization and may not have had signs or symptoms of an EBV compatible illness lasting longer than 7 days within 30 days of randomization Be at least 4 weeks from last live immunization Be willing to forgo live vaccines through and 3 months after study drug treatment period Be up to date on all recommended vaccinations based on age of subject and willing to receive killed influenza vaccine when available for current or upcoming season. If prior treatment with active study agent from previous clinical trial, approval of medical monitor and investigator that such prior treatment does not impact risk for current study. Subjects who have met all above criteria must have the qualifying oral glucose tolerance test (OGTT) within 7 weeks (52 days) of randomization and baseline visit. Exclusion Criteria: Potential participants must not meet any of the following exclusion criteria: 1. Be immunodeficient or have clinically significant chronic lymphopenia: (Leukopenia (< 3,000 leukocytes /μL), neutropenia (<1,500 neutrophils/μL), lymphopenia (<800 lymphocytes/μL), or thrombocytopenia (<100,000 platelets/μL). 2. Have active signs or symptoms of acute infection at the time of randomization including Sars-Cov2. 3. Have evidence of prior or current tuberculosis infection as assessed interferon gamma release assay (QuantiFERON). 4. Be currently pregnant or lactating, or anticipate getting pregnant within the study period 5. Require chronic use of other immunosuppressive agents including use of inhaled, intranasal, or systemic steroids 6. Have evidence of current or past HIV, Hepatitis B, histoplasmosis, coccidioidomycosis, or current Hepatitis C infection. 7. Have any complicating medical issues or abnormal clinical laboratory results that may interfere with study conduct, or cause increased risk to include pre-existing pulmonary, GI, renal, cardio-vascular disease, neurological disease (i.e. demyelinating disease), psychiatric disease or blood count abnormalities. Note pre-existing treated celiac or thyroid disease are not exclusionary diagnoses. 8. Have a history of malignancies other than of skin 9. Evidence of liver dysfunction with aspartate aminotransferase (AST) or alanine aminotransferase (ALT) greater than 2 times the upper limits of normal 10. Evidence of renal dysfunction with creatinine greater than 1.5 times the upper limit of normal for age and sex. 11. Known history of congestive heart failure or left ventricular dysfunction. 12. Vaccination with a live virus within the last 4 weeks 13. Current or ongoing use of non-insulin pharmaceuticals that affect glycemic control within 30 days of screening (see section 4.5 for list of exclusionary pharmaceuticals). 14. Active participation in another intervention study in the previous 30 days 15. Known allergy to Anti-TNFα or latex. 16. Any condition that in the investigator's opinion may adversely affect study participation or may compromise the study results 17. Previously diagnosed with T1D according to American Diabetes Association (ADA) criteria

Ages Eligible for Study
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Minimum Age: 3 Years
Maximum Age: 46 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Treatment assignment (active drug: placebo) will be assigned in a parallel, randomized, 1:1 model. Randomization will be conducted using block randomization with variable block sizes with stratification on TrialNet study site and age group (< 12 years old vs. 12 years old or older).
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Golimumab<br>Golimumab for subcutaneous use | Drug: Golimumab<br>* For participants ≥45 kg, 50 mg of golimumab will be administered subcutaneously For participants <45 kg, the dose of golimumab is 30 mg/m2 to maximum of 50 mg<br>* Other names: Simponi;|
| Placebo Comparator: Placebo<br>Placebo syringes and vials matching active drug | Drug: Placebo<br>* Inactive Drug<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The primary outcome is the elapsed time from random treatment assignment to the development of diabetes (T1D) or time of last contact among those randomized | The primary outcome is the elapsed time from random treatment assignment to the development of diabetes (T1D) or time of last contact among those randomized | 6 years |