Diabetes Mellitus, Type 1
September 15, 2014
Eli Lilly issued results of phase III trials
of glargine (Lantus) for type 1 diabetes.
IMAGINE-1 was a 78-week, open-label study
designed to compare BIL (n=295) with insulin
glargine (n=160) in combination with mealtime
insulin in patients with type 1 diabetes.
IMAGINE-3 was a 52-week, double-blind,
randomized study designed to compare BIL
(n=664) with insulin glargine (n=450) in
combination with mealtime insulin in patients
with type 1 diabetes. Significantly more
patients taking BIL versus those taking insulin
glargine achieved an HbA1c of less than 7%.
Both trials also showed the rate of nocturnal
hypoglycemia was significantly lower in patients
taking BIL than in those taking insulin
glargine. In both trials there was a statistically
significant increase in the rate of total hypoglycemia
for patients taking BIL compared
with those taking insulin glargine due to a
higher rate of daytime hypoglycemic events.
In the open-label IMAGINE-1 trial, patients
taking BIL reported a statistically significant
higher rate of severe hypoglycemic events.
However, in the larger, blinded IMAGINE-3
trial the rate of severe hypoglycemic events
for treatment with BIL was numerically lower
compared with insulin glargine, but was
not statistically significant. Lilly is on track
to file a submission with regulators by the
end of the Q1 2015.
April 28, 2014
Lexicon Pharmaceuticals reported results
of a phase II study of LX4211 in type 1 diabetes.
In this multicenter study, 33 patients with poorly
controlled type 1 diabetes on either an insulin
pump or multiple insulin injection therapy were
randomized 1:1 to receive either placebo or
a 400mg dose of LX4211 orally once per day
before breakfast for four weeks. The placebo-controlled,
double-blind, 28-day study reduced
the total daily mealtime bolus insulin dose by
32% compared to 6% for placebo (p=0.007),
while significantly improving glycemic control
with a mean HbA1c reduction of 0.55% in the
LX4211-treated group compared to a reduction
of only 0.06% with placebo (p=0.002). This improvement
was accompanied by significant improvement
in the time spent in a glucose range
of 70mg/dl-180mg/dl, a significant reduction in
time in hyperglycemic range, and no increase in
hypoglycemia. Multiple measures indicated that
LX4211 treatment resulted in reduced variability
in blood glucose levels. Overall, LX4211 was
well-tolerated with no discontinuations of study
medication due to adverse events. These results
demonstrate the effectiveness of LX4211 as an
adjunct to insulin in type 1 diabetes in a longerterm
phase III program.
April 21, 2014
Adocia released results of a phase IIa trial
of BioChaperone Lispro in comparison
to Eli Lilly’s Humalog commercial insulin
for type 1 diabetes. In this double-blind,
crossover study, the pharmacokinetic
and pharmacodynamic characteristics of
BioChaperone Lispro were compared to those
of Humalog in 36 patients who received
single 0.2U/kg doses of BioChaperone Lispro
and Humalog under automated euglycemic
clamp conditions (ClampArt, target blood
glucose 100mg/dL, clamp duration six
hours post-dosing). BioChaperone Lispro
had a significantly faster rate of absorption
than Humalog with an increase in the early
insulin exposure of 170% (primary endpoint,
AUCLispro_0-30min 23.7 ± 11.4 v. 9.5 ± 6.2
hmU/L; p<0.0001). The time to peak insulin
concentration was reduced by more than
35% (Tmax 42 ± 11 v. 69 ± 22 min; p<0.0001).
BioChaperone Lispro was cleared from the
blood significantly earlier than Humalog,
reflected in the time to half-maximum insulin
levels after Tmax (late T 50% max = 141 ± 43
v. 173 ± 41 min, p<0.0001). The acceleration
of insulin Lispro absorption translated into
a significant acceleration of insulin action.
The metabolic effect is triggered significantly
earlier for BioChaperone Lispro than for
Humalog with 30% faster onset of action
(T onset = 23.1 ± 7.0 v. 34.4 ± 15.3 min;
p<0.0001). The early metabolic effect is
increased by 69% relative to Humalog during
the first hour after administration
(AUCGIR_0-1h = 218 ± 88 v. 129 ± 63mg/kg;
p<0.0001). The time to reach the maximal
observed hypoglycemic effect is significantly
shorter relative to Humalog (TGIR_max = 99 ±
42 v. 133 ± 45 min; p=0.0002). Another clinical
trial is planned to start in Germany.
March 10, 2014
Adocia released results of a formulation
combining insulin analog Glargine (Lantus,
Sanofi) and insulin analog Lispro (Humalog,
Eli Lilly), using Adocia’s BioChaperone technology.
The trial was a double-blind, two-way
crossover study that enrolled 20 patients with
type 1 diabetes under euglycemic clamp
conditions. All patients were treated with
BioChaperone Combo and Humalog Mix 25 at
the same dose of 0.8IU/kg. The composition
of BioChaperone Combo is based on 75/25
basal prandial ratio as in Humalog Mix 25.
Pharmacokinetic (PK) and pharmacodynamic
(PD) measurements were taken as patients
were monitored for 30 hours after administration.
BioChaperone Combo had a faster
than 30% onset of action as compared to
Humalog Mix. Almost all patients treated with
BioChaperone Combo experienced a minimal
duration of action in excess of 30 hours (end
of monitoring). Both formulations of insulins
(BioChaperone Combo and Humalog Mix)
September 2, 2013
MannKind issued results of a phase III clinical trial of AFREZZA (insulin human [rDNA origin]) Inhalation Powder in patients with type 1 diabetes, administered using MannKind’s (Gen2) inhaler. The randomized, open-label study involved 518 patients with type 1 diabetes on basal/bolus insulin therapy studied at sites in the U.S., Russia, Ukraine and Brazil. After a four-week run-in period to optimize their basal insulin, patients entered a 24-week treatment period. The treatment period consisted of 12 weeks of prandial insulin optimization with continued basal titration followed by a 12-week period during which subjects maintained stable doses of insulin (prandial and basal). A1c levels decreased comparably in the AFREZZA-Gen2 group (-0.21%) and the insulin aspart group (-0.40%). The 95% confidence interval (0.02% to 0.36%) of the between-group difference did not exceed the predetermined threshold of 0.40%, thereby establishing non-inferiority between AFREZZA-Gen2 and insulin aspart, which was the primary endpoint of the study.
May 27, 2013
Rhythm released results from a phase Ib trial of RM-131 for diabetic gastroparesis in type 1 diabetes. This randomized, double-blind, placebo-controlled, single-dose, two-period crossover study enrolled 10 patients with type 1 diabetes, a history and symptoms of diabetic gastroparesis and documentation of delayed gastric emptying. Subjects received a single dose of RM-131 100mcg. Results showed RM-131 significantly accelerates early gastric emptying and reduces upper gastrointestinal (GI) symptoms in type 1 diabetic patients. The median gastric emptying half-time was reduced by ~55%. RM-131 was generally well tolerated, with no serious adverse events. The FDA has granted Fast Track review status to RM-131 for the treatment of diabetic gastroparesis.
January 9, 2012
Osiris released interim results from a phase II trial of Prochymal, a formulation of adult mesenchymal stem cells, for the treatment of type I diabetes. This double-blind, placebo-controlled trial enrolled 63 subjects who received Prochymal (from unrelated adult donors) or placebo, both with standard of care. The primary endpoint was measurement of C-peptide produced during a Mixed Meal Tolerance Test. The interim assessment at one year showed no significant differences in the rates of disease progression, as measured by stimulated C-peptide levels. There was a trend towards fewer hypoglycemic events for subjects treated with Prochymal as compared to controls. Systemic infusions of Prochymal were well-tolerated and there were no differences in adverse events between the Prochymal and placebo groups and no reactions to the infusions.
April 5, 2010
Living Cell Technologies issued positive interim results from a phase II trial of DiabeCell for the treatment of type I diabetes. This open label trial planned to enroll 8 subjects with difficult to control or unstable type I diabetes. Data are from the first four subjects who received 10,000 islet equivalents/kg body weight (IEQ/kg) DiabeCell encapsulated porcine islets implanted into the abdomen via a laparoscopic procedure. Data showed significantly improved control of blood glucose and two subjects eliminated or reduced life-threatening episodes of hypoglycaemic unawareness. In the first subject who was treated and followed for 24 weeks after implant, daily insulin dose was reduced by 25% and hypoglycaemic unawareness was completely eliminated. The next phase of this trial is currently underway in New Zealand.
September 22, 2008
MannKind issued positive results from a phase III trial of their Technosphere Insulin System for the treatment of type I diabetes. This study (009) enrolled 565 subjects with type I diabetes in the United States, Europe and Latin America. The subjects received prandial inhalations of Technosphere Insulin (the TI group) or prandial subcutaneous injections of insulin aspart. Both groups also received daily subcutaneous injections of basal insulin (insulin glargine). The primary objective was to compare the efficacy, as expressed by the change in A1C levels, between the two treatment arms. Over the 52-week study duration, A1C levels decreased comparably in the two treatment groups, with a between-group difference of -0.24%, thus establishing non-inferiority. Comparable A1C target levels were also reached between the two treatment groups. Secondary endpoints were also reached. Fasting blood glucose (FBG) levels decreased significantly in the TI group compared to the FBG levels observed in the insulin aspart group (p<0.01). In the TI arm, mean FBG had decreased by 48.8 mg/dL at the 52-week time period compared to a decrease of 20.2 mg/dL in the comparator group. There was also a significant difference in weight loss versus weight gain. Subjects receiving TI lost an average of 4.3 pounds over the 52-week treatment period compared to the average gain of 3.0 pounds in the insulin aspart group (p=0.02). The TI group also exhibited significantly lower mean postprandial blood glucose levels (p<0.01) and significantly fewer hypoglycemic events (p<0.02). Based on positive phase III results, MannKind plans to submit an NDA by late 2008 or early 2009.
January 28, 2008
Diamyd Medical issued positive long-term results from a phase IIb trial of Diamyd for the treatment of type I diabetes. This randomized study enrolled seventy pediatric and adolescent subjects in Sweden. The subjects received two single injections of Diamyd or placebo. The primary endpoint was preservation of beta cell function as measured by C-peptide. Thirty months after the first injection, preservation of insulin was significantly higher in subjects receiving Diamyd, both in the fasting state and after meal stimulation, compared with placebo-treated subjects. Diamyd also increased GAD antibody levels at fifteen and twenty one months post-injection. Based on the data, phase III trials are planned.
Indevus reported results from a phase III trial of Nebido for the treatment of hypogonadism. This open label trial enrolled one hundred and thirty male subjects with hypogonadism. The subjects received an initial injection of 750 mg of Nebido, followed four weeks later by an additional 750 mg loading injection and then 750 mg injections every ten weeks thereafter. The primary endpoint was responder analysis, defined as a one who, during steady state, had an average concentration of serum total testosterone (Cavg) within the normal range (300 to 1000 ng/dL). The primary response endpoint was met if at least 75% of patients achieved a Cavg within this normal range. In addition, maximum testosterone (Cmax) levels were evaluated. This endpoint was reached if no subjects exceeded a testosterone concentration of 2500 ng/dL, no more than 5% exceeded a concentration of 1800 ng/dL, and no more than 15% of exceeded a concentration of 1500 ng/dL. Of the one hundred and seventeen subjects who completed the study, 94% had Cavg levels within the normal range. None of these subjects exceeded a testosterone level of either 2500 ng/dL or 1800 ng/dL, and nine (7.7%) had a peak level exceeding 1500 ng/dL. Steady state testosterone pharmacokinetics were achieved within weeks under the new regimen, whereas the 1000 mg regimen reached steady state pharmacokinetics after several months. An NDA is currently under review by the FDA for a 1,000 mg dose of Nebido. Based on the results, Indevus intends to ask for approval of this 750 mg regimen rather than the higher treatment schedule.
April 24, 2006
MannKind announced results of a phase II trial of Technosphere insulin for the treatment of Type 1 diabetes. Results from the study indicated that the drug was non-inferior to an approved regimen of insulin injection, with both treatments significantly improving HbA1c scores from baseline (0.83% vs. 0.99%, respectively). The mean increase in post-prandial glucose was also non-inferior for Technosphere insulin, and trended towards superiority (18.7 mg/dl vs. 46.8 mg/dl; p=0.09); total post-prandial glucose fluctuation was considerably lower for the inhaled drug (+96.7 mg/dl to -136.2 mg/dl from baseline, total 232.9 mg/dl; vs. +400.6 mg/dl to -182.2 mg/dl, total 582.8 mg/dl). At 12 weeks, there was a significant 1.3 kg difference in mean body weight from baseline (-0.41 kg vs. +0.89 kg; p=0.0018). This controlled study enrolled 110 patients, who received either inhaled Technosphere insulin or an approved regimen of NovoLog (insulin aspart) plus Lantus (insulin glargine) via injection for 12 weeks.