Clinical trial NCT03667053: Trial to Confirm the Efficacy and Safety of Dasiglucagon in the Treatment of Hypoglycemia in T1DM Children
Official title: Phase 3, Randomized, Double-blind, Placebo/Active-controlled, Parallel-arm Trial to Assess Efficacy, Safety, and Pharmacokinetics of Dasiglucagon Relative to Placebo/GlucaGen® as Rescue Therapy for Severe Hypoglycemia in Children With T1DM Treated With Insulin
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Hypoglycemia
Keywords: Glucagon
Dasiglucagon
Lead sponsor: Zealand Pharma
Sponsor class: INDUSTRY
First posted: 2018-09-12
Enrollment: 42
Sex: ALL
Minimum age (years): 6
Maximum age (years): 17
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: A phase 3, randomized, double-blind, placebo- and active-controlled, parallel-arm trial to assess the efficacy, safety, and pharmacokinetics of dasiglucagon relative to placebo and GlucaGen® when administered as a rescue therapy for severe hypoglycemia in children with type 1 diabetes mellitus (T1DM) treated with insulin

Detailed description: At least 40 children ≥6 years and \<18 years of age with T1DM were planned to be randomized into the trial (2:1:1 for dasiglucagon:placebo:GlucaGen) and stratified by age intervals: 6 years to \<12 years, and 12 years to \<18 years; and by injection site (abdomen or thigh). A minimum of 16 patients were enrolled into each age group, including a minimum of 8 patients in each age group in the dasiglucagon treatment arm. In Germany only, a staggered approach was applied, whereby a positive safety assessment needed to be available for at least 10 patients in the age group of 12 years to \<18 years who had completed the dosing visit in the overall trial before younger patients (6 to 11 years of age) were allowed to be enrolled.

Eligibility criteria: Inclusion Criteria:

1. Following receipt of verbal and written information about the trial, patient, parent(s) or guardian(s) of the patient must provide signed informed consent before any trial-related activity is carried out
2. Female or male patients with T1DM for at least 1 year, diagnostic criteria as defined by the American Diabetes Association; and receiving daily insulin
3. At least 6.0 years of age (inclusive) and less than 18.0 years
4. Body weight ≥20 kg
5. Female patients must meet one of the following criteria:

   a. Participant is of childbearing potential and agrees to use one of the accepted contraceptive regimens throughout the entire duration of the trial from screening until last follow-up visit. An acceptable method of contraception includes at least one of the following: i. Abstinence from heterosexual intercourse ii. Systemic contraceptives (birth control pills, injectable/implant/ insertable hormonal birth control products, transdermal patch); if the participant is using systemic contraceptives, she must use an additional form of acceptable contraception (iii or iv, below) iii. Intrauterine device (with and without hormones) iv. Condom with spermicide or b. Participant is of non-childbearing potential due to pre-puberty status or a medical condition confirmed by the investigator
6. Male patients must meet the following criteria: If sexually active, uses condom and partner practices contraception during the trial from screening and until last follow-up visit
7. Willingness to adhere to the protocol requirements

   -

   Exclusion Criteria:

1. Females who are pregnant according to a positive urine pregnancy test, actively attempting to get pregnant, or are lactating 2. Known or suspected allergy to trial product(s) or related products 3. History of anaphylaxis or symptoms of severe systemic allergy (such as angioedema) 4. Previous randomization in this trial 5. History of an episode of severe hypoglycemia that required a third party assistance within a month prior to screening visit 6. History of hypoglycemic events associated with seizures or hypoglycemia unawareness in the last year prior to screening 7. History of epilepsy or seizure disorder 8. Receipt of any investigational drug within 3 months prior to screening 9. Active malignancy within the last 5 years 10. Congestive heart failure, New York Heart Association class II-IV 11. Current bleeding disorder, including anti-coagulant treatment 12. Known presence or history of pheochromocytoma (i.e. adrenal gland tumor) or insulinoma (i.e. insulin secreting pancreas tumor) 13. Use of a daily systemic beta-blocker drug, indomethacin, warfarin or anticholinergic drugs in the previous 28 days before Day 1 of this trial 14. Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) \>2.5 × the upper limit of the normal range (ULN), bilirubin \>1.5 × ULN, estimated glomerular filtration rate \<30 mL/min/1.73 m2 according to the Modification of Diet in Renal Disease study definition, or altered electrolyte values of clinical relevance for cardiac conduction, as judged by the investigator 15. Clinically significant abnormal electrocardiogram (ECG) at screening as judged by the investigator 16. Clinically significant illness within 4 weeks before screening, as judged by the investigator 17. Surgery or trauma with significant blood loss within the last 2 months prior to screening 18. Patients with mental incapacity or language barriers which preclude adequate understanding or cooperation, who are unwilling to participate in the trial, or who in the opinion of the investigator should not participate in the trial 19. Any condition interfering with trial participation or evaluation or that could be hazardous to the patient 20. The use of prescription or non-prescription medications known to cause QT prolongation

-

Primary outcomes:
measure: Time to Plasma Glucose Recovery
timeFrame: 0-45 minutes after dosing
Secondary outcomes:
measure: Plasma Glucose Recovery
timeFrame: 0-30 minutes after dosing: assessed at 10, 15, 20 and 30 minutes after study drug injection
measure: Plasma Glucose Changes From Baseline
timeFrame: 0-30 minutes after dosing: assessed at 10, 15, 20 and 30 minutes after study drug injection
measure: Pharmacodynamics - Area Under the Effect Curve (0-30 Minutes)
timeFrame: 0-30 minutes
measure: Administration of Rescue IV Glucose Infusion After IMP Injection
timeFrame: 0-45 minutes
measure: Time to First IV Glucose Infusion After IMP Administration
timeFrame: 0-45 minutes
measure: Pharmacokinetics: AUC0-30 Min
timeFrame: 0-30 minutes
measure: Pharmacokinetics: AUC0-300min
timeFrame: 0-300 minutes
measure: Pharmacokinetics: AUC0-inf
timeFrame: 0-300 minutes
measure: Pharmacokinetics: Cmax
timeFrame: 0-300 minutes
measure: Pharmacokinetics: Tmax
timeFrame: 0-300 minutes
measure: Pharmacokinetics: λz
timeFrame: 0-300 minutes
measure: Pharmacokinetics: t½
timeFrame: 0-300 minutes
measure: Pharmacokinetics: CL/f
timeFrame: 0-300 minutes
measure: Pharmacokinetics: Vz/f
timeFrame: 0-300 minutes
measure: Pharmacokinetics: MRT
timeFrame: 0-300 minutes
Other outcomes:
Locations:
city: Escondido
country: United States
facility: AMCR Institute, Inc
state: California
city: New Haven
country: United States
facility: Yale University School of Medicine
state: Connecticut
city: Indianapolis
country: United States
facility: Indiana University, Department of Pediatrics
state: Indiana
city: Hannover
country: Germany
facility: Auf der Bult - Diabetes Center for Children
city: Ljubljana
country: Slovenia
facility: University Medical Center Ljubljana, Children's Hospital, Department for Endocrinology, Diabetes and Metabolism
Study officials:
affiliation: Zealand Pharma A/S
name: Christina M Sylvest, MSc Pharm
role: STUDY_DIRECTOR
References: