Type 1 Diabetes study: Anti-thymocyte globulin vs Adalimumab
Official title A Randomized Phase 1/2 Trial of Low Dose Anti-thymocyte Globulin (ATG) With Subsequent Adalimumab or Verapamil in New Onset Type 1 Diabetes
ClinicalTrials.gov ID: NCT07061574
What this study is testing
What is Anti-thymocyte globulin (ATG)?
An investigational drug being studied as a potential treatment to preserve insulin secretion in people with recent‑onset type 1 diabetes. It is designed to bind to and deplete T‑cells, which are part of the immune system that attacks the insulin‑producing cells in the pancreas.
Also referred to as Thymoglobulin.
Plain-language explanation of the investigational treatment. It is being studied and is not an approved or proven therapy. The study team can confirm the details.
- What it's testing
- The study will find out whether this drug combination is safe and can keep the pancreas making insulin for up to two years.
- Who it's for
- People aged 9 to under 21 who have been recently diagnosed with stage 3 type 1 diabetes.
- What's involved
- Participants receive a low dose of anti‑thymocyte globulin, then are randomly given either adalimumab (an anti‑inflammatory drug) or verapamil (a blood‑pressure medication), with regular clinic visits and tests to measure insulin production.
- Time commitment
- The trial runs for about two years and includes scheduled visits and testing throughout that period.
- Phase 2: a mid-size study of how well it works
- You might receive a placebo (an inactive treatment) instead of the study drug, decided by chance.
A plain-language read of the study's public ClinicalTrials.gov listing. The study team confirms the details.
Who can take part
Ages 9 to 20
You may be able to join if
- Recent-onset stage 3 T1D diagnosed by standard ADA criteria, with the ability to be assigned by chance within 6 months from the date of T1D diagnosis...
- At least one positive T1D auto-antibody.
- If clearly positive (≥20% above local lab's ULN) at screening, repeat antibody testing for central lab is not required.
- Insulin auto-antibodies are only considered if exogenous insulin use is \<10 days when blood is drawn.
- Must have stimulated C-peptide levels ≥0.2 pmol/mL (≥0.6 ng/mL) measured during MMTT conducted prior to randomization.
You likely can't join if
- Prior treatment with ATG or known allergy to ATG or rabbit-derived products.
- Immunodeficient or have clinically significant chronic lymphopenia: Leukopenia (\<3,000 leukocytes /μL), neutropenia (\<1,500 neutrophils/μL)...
- Thrombocytopenia (\<100,000 platelets/μL) or anemia (hemoglobin \< 10g/dL).
- Leukocytosis (\>14,000/μL)
- Ongoing infection or had recently had a major infection requiring hospitalization or intravenous antibiotics.within 30 days prior to randomization.
- Have active signs or symptoms of acute infection at the time of randomization.
See the full eligibility criteria
Who can join
- Recent-onset stage 3 T1D diagnosed by standard ADA criteria, with the ability to be assigned by chance within 6 months from the date of T1D diagnosis and within 37 days of Screening Visit.
- At least one positive T1D auto-antibody.
- If clearly positive (≥20% above local lab's ULN) at screening, repeat antibody testing for central lab is not required.
- Insulin auto-antibodies are only considered if exogenous insulin use is \<10 days when blood is drawn.
- Must have stimulated C-peptide levels ≥0.2 pmol/mL (≥0.6 ng/mL) measured during MMTT conducted prior to randomization.
- Age 9 to \<21 years at the time of randomization.
- Body weight \>30kg.
- BMI \<95th percentile for age and gender.
- Willing to comply with intensive diabetes management.
- Female participants with childbearing potential are not currently pregnant, are willing to avoid pregnancy and breastfeeding, and to undergo pregnancy testing prior to MMTTs for the duration of the study. a.
- Male participants with potential to father children must be willing to use abstinence or adequate contraceptive methods for the duration of the study. a.
- Willing to provide informed consent and child assent as applicable.
- Willing to provide their primary endocrinologist's contact information and have their primary endocrinologist notified of their participation
- Sufficient cognitive ability, per investigator judgment, to provide informed consent for study participation on an IRB approved consent form.
- Able to read and understand English or Spanish (both participant and legally authorized representative, if applicable).
- Must be fully vaccinated for age.
- Must have been vaccinated for flu (if currently in flu season).
- Must be willing to not receive live vaccines throughout the treatment period.
- Must be willing to not use any non-insulin glucose-lowering agents such as GLP-1 agonists (including for weight loss indication), symlin, DPP-4 inhibitors, SGLT-2 inhibitors, biguanides, sulfonylureas) for the duration...
What rules you out
- Prior treatment with ATG or known allergy to ATG or rabbit-derived products.
- Immunodeficient or have clinically significant chronic lymphopenia: Leukopenia (\<3,000 leukocytes /μL), neutropenia (\<1,500 neutrophils/μL), lymphopenia (\<800 lymphocytes/μL).
- Thrombocytopenia (\<100,000 platelets/μL) or anemia (hemoglobin \< 10g/dL).
- Leukocytosis (\>14,000/μL)
- Ongoing infection or had recently had a major infection requiring hospitalization or intravenous antibiotics.within 30 days prior to randomization.
- Have active signs or symptoms of acute infection at the time of randomization.
- Have evidence of prior or current tuberculosis infection as assessed interferon gamma release assay (QuantiFERON-TB Gold), or a positive test for latent tuberculosis.
- Have evidence of current or past HIV or Hepatitis B or current Hepatitis C infection.
- History of serious bacterial, viral, fungal, or other opportunistic infections.
- Have active signs or symptoms of CMV or EBV compatible illness lasting more than 7 days within 30 days of randomization.
- Have positive CMV and/or EBV PCR test within 30 days prior to randomization.
- Have positive COVID-19 self-antigen test within 3 days of randomization.
- History of underlying cardiac disease (ex. left ventricular dysfunction, hypertrophic cardiomyopathy), certain arrhythmias (e.g.
- Blood pressure (either systolic or diastolic) \<5th percentile for age, gender, and height on two out of three measurements.
- Pulse \<2.5th percentile for age and gender on two out of three measurements.
- History of vasovagal syncopal episodes related to hypotension.
- History of malignancies other than of skin.
- Any immunomodulators, including systemic steroids or participation in prior research study in which a potential participant received an immunomodulatory agent (may participate if received placebo only).
- Current or previous use of Teplizumab, Adalimumab, or Verapamil.
- Ongoing use of medications known to influence glycemia or glucose tolerance. Only topical steroids are allowed.
- Need to use of any of the following medications during the study: beta blocker, seizure medication (carbamazepine, phenobarbital, phenytoin), other antihypertensive medications, HMG-CoA reductase inhibitors, lithium...
- Receipt of live vaccine (e.g., varicella, measles, mumps, rubella, cold-attenuated intranasal influenza vaccine, bacillus Calmette-Guerin, and smallpox) within the 90 days before randomization.
- Any known hypersensitivity reaction to any of the study medications or their components.
- Unable to swallow pills (tested with an inert imitation tablet in clinic at screening).
- History of significant allergy (e.g., anaphylaxis) to milk or soy proteins in the Boost drink required for study MMTT testing.
- Current use of hydroxyurea or unable to avoid hydroxyurea use during the study (interferes with accuracy of Dexcom sensor).
- Established history of allergy or severe reaction to adhesive or tape that must be used in the study.
- Participation in another treatment research study that involves diabetes care or immune modulation, unless the participant is able to confirm that they were in the placebo arm.
- Alcohol or drug abuse
- Untreated or inadequately treated mental illness
- Liver disease or LFTs \>2x ULN.
- Renal disease or creatinine greater than 1.5x ULN.
- Other autoimmune diseases except for stable and treated hypothyroidism Graves' disease, or celiac disease (e.g., symptom-free on a gluten free diet).
- Nervous system disorder including but not limited to Guillain-Barre Syndrome, multiple sclerosis, progressive multifocal leukoencephalopathy.
- History of multiple abdominal surgeries and/or at increased risk for bowel obstruction.
- Any clinical or laboratory conditions that the investigator feels would interfere with the study or participant safety (e.g., increased risk to pre-existing disease).
The study team makes the final eligibility decision.
Where it is enrolling
- San Francisco, California, United States
- New Haven, Connecticut, United States
- Gainesville, Florida, United States
- Miami, Florida, United States
- Indianapolis, Indiana, United States
- Minneapolis, Minnesota, United States
- Buffalo, New York, United States
- Pittsburgh, Pennsylvania, United States
- Houston, Texas, United States
- Seattle, Washington, United States
Questions & answers
Do participants get paid in this trial?
This listing doesn't specify compensation. Many trials still reimburse travel or offer a stipend, so it's worth asking the study team when you connect.
Is it free to join, and do I need insurance?
Searching and applying through BridgeMD is free. In clinical trials the study-related treatment and visits are generally provided at no cost to you. You usually don't need insurance to take part, but confirm specifics with the study team.
How long does this study last?
The listing doesn't state an exact length. The study team walks you through the schedule and number of visits before you decide to enroll.
Who can join this trial?
This study is enrolling all sexes, 9 years to 20 years. The study team makes the final eligibility decision.
Where is this trial taking place?
This study is enrolling now at San Francisco, California, United States; New Haven, Connecticut, United States; Gainesville, Florida, United States; Miami, Florida, United States; Indianapolis, Indiana, United States; Minneapolis, Minnesota, United States and 4 more locations. Enter your location above to see the nearest enrolling site and check your eligibility.
Explore other conditions
BridgeMD is an information and trial-matching tool that is independent of the study sponsor. Details come from ClinicalTrials.gov. The study team decides eligibility, and your own doctor gives medical advice.