Study of Thymoglobulin to Arrest Newly Diagnosed Type 1 Diabetes (START)

The recruitment status of this study is unknown because the information has not been verified recently.
Verified January 2012 by National Institute of Allergy and Infectious Diseases (NIAID).
Recruitment status was  Active, not recruiting
Immune Tolerance Network (ITN)
Information provided by (Responsible Party):
National Institute of Allergy and Infectious Diseases (NIAID) Identifier:
First received: August 10, 2007
Last updated: January 8, 2013
Last verified: January 2012

Thymoglobulin is an antibody preparation that is commonly used to treat and prevent organ transplant rejection. The START trial aims to determine whether Thymoglobulin treatment can halt the progression of newly diagnosed type 1 diabetes when given within 12 weeks of disease diagnosis.

Condition Intervention Phase
Diabetes Mellitus, Type 1
Drug: Antithymocyte globulin
Drug: Placebo
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver)
Primary Purpose: Treatment
Official Title: Effect of Antithymocyte Globulin on Preserving Beta Cell Function in New Onset Type 1 Diabetes Mellitus

Resource links provided by NLM:

Further study details as provided by National Institute of Allergy and Infectious Diseases (NIAID):

Primary Outcome Measures:
  • 2-hour C-peptide AUC in response to MMTT [ Time Frame: Month 12 ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • 4-hour C-peptide AUC in response to MMTT [ Time Frame: Month 12 ] [ Designated as safety issue: No ]
  • Insulin use in units per kilogram body weight per day [ Time Frame: Months 12 and 24 ] [ Designated as safety issue: No ]
  • Proportion of subjects who are exogenous-insulin-free [ Time Frame: Months 12, 18, and 24, possibly up to 60 months ] [ Designated as safety issue: No ]
  • Major hypoglycemic events occurring since randomization [ Time Frame: Months 12 and 24 ] [ Designated as safety issue: Yes ]
  • 2-hour and 4-hour C-peptide AUC in response to an MMTT [ Time Frame: Months 24 ] [ Designated as safety issue: No ]
  • HbA1C levels [ Time Frame: Months 12 and 24 ] [ Designated as safety issue: No ]
  • Changes of C-peptide AUC (2 and 4 hours) over time [ Time Frame: Months 12 and 24 ] [ Designated as safety issue: No ]
  • Frequency and severity of all adverse events in participants receiving Thymoglobulin or placebo [ Time Frame: Day 1 to 24 months; possibly up to 60 months ] [ Designated as safety issue: Yes ]
  • The rate adverse events in participants receiving Thymoglobulin [ Time Frame: Day 1 to 24 months; possibly up to 60 months ] [ Designated as safety issue: Yes ]
    The adverse events include: Infusion reactions, cytokine release syndrome, opportunistic infections, lymphopenia, CD4/CD8 ratio, neutropenia, thrombocytopenia, serum sickness.

Enrollment: 58
Study Start Date: August 2007
Estimated Study Completion Date: June 2013
Primary Completion Date: June 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Thymoglobulin Drug: Antithymocyte globulin
Daily 4-day escalating dose
Other Name: Thymoglobulin
Placebo Comparator: Placebo Drug: Placebo
Daily 4-day saline solution

Detailed Description:

Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks the insulin-producing beta cells in the pancreas. Without these cells, the body cannot maintain proper blood glucose levels in response to daily activities, such as eating or exercise. Generally, at the time someone is diagnosed with type 1 diabetes, not all of a person's beta cells have been destroyed - between 15-40% remain healthy and are still able to produce insulin. Importantly, even small amounts of naturally produced insulin can improve blood sugar control, make daily management of diabetes less complicated, and reduce the risk of long term complications. Preserving the remaining precious beta cells is therefore the goal of the START trial.

The medication being tested in the START trial is called Thymoglobulin®, a mixture of specialized proteins called antibodies. Thymoglobulin attaches itself to white blood cells known as T cells, some of which are responsible for the immune system's attack on beta cells that occurs in type 1 diabetes. Thymoglobulin can change how T cells work, and can eliminate a large proportion of the T cells from the bloodstream temporarily. Treatment of new onset type 1 diabetes with Thymoglobulin is therefore expected to alter the behavior of the T cells to halt their attack, and also reduce T cell numbers, so that new T cells that grow in their place will learn to accept the beta cells, rather than attacking them.

Following an initial screening appointment, eligible participants will be randomly assigned to one of two groups: Group 1 will receive the study treatment while Group 2 is a control group that will receive a placebo. Each participant has a 2 in 3 chance of being assigned to the treatment group, and a 1 in 3 chance of being assigned to the placebo. The START trial is a blinded study, so neither participants nor study physicians will know to which group an individual has been assigned. All participants will receive intensive diabetes management. Participants in both groups will be admitted to the hospital for 5-8 days to receive infusions of either the study drug or placebo.

The duration of the study is 2 years. Participants will have 8 follow-up appointments in the first year and 4 visits in the second year. Most of these visits will last 1- 2 hours. A review of interval health, a physical exam, an assessment of diabetes control including recent 5 day insulin use and blood sugar testing, and blood collection for laboratory testing will occur at each visit. Four of the visits will last about 5 hours, during which participants will undergo mixed-meal tolerance testing. This involves drinking a special drink, similar to a milkshake, and having blood specimens taken over a 4-hour period.

Subjects will be reimbursed for travel and parking expenses, and will receive compensation for their participation in the longer mixed meal tolerance test visits.


Ages Eligible for Study:   12 Years to 35 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Diagnosis of type 1 diabetes (according to American Diabetes Association [ADA] criteria) within the 100 days of enrollment.
  • Positive for one or more autoantibodies (anti-glutamic acid decarboxylase [GAD], anti-insulin, or IA-2 autoantibodies)
  • Peak stimulated C-peptide level >0.4 pmol/mL or >1.2ng/mL following an MMTT
  • Serologic evidence of prior EBV infection
  • Willing to use acceptable forms of contraception

Exclusion Criteria:

  • Any sign of active infection (e.g., hepatitis, tuberculosis, EBV, CMV, or toxoplasmosis) at screening
  • Positive for HIV, tuberculosis, or hepatitis B at screening
  • Prior history of any significant cardiac disease, such as congestive heart failure, arrhythmia, or structural defects, or suspicion thereof
  • Use of glucocorticoids in the 28 days prior to study entry; or topical use of glucocorticoids
  • Use of diabetes medications (other than insulin) that may affect glucose homeostasis, such as metformin, sulfonylureas, thiazolidinediones, or amylin
  • Evidence of liver dysfunction
  • Evidence of kidney disease
  • Pregnancy or plan to become pregnant
  • Leukopenia (<3,000 leukocytes/µL), neutropenia (<1,500neutrophils/µL), lymphopenia (<800 lymphocytes/µL), or thrombocytopenia (<125,000 platelets/µL).
  • Prior treatment with rabbit ATG or known hypersensitivity or exposure to rabbit sera-derived products.
  • Vaccination with a live virus within the last 6 weeks before enrollment.
  • Prior or current therapy that is known to cause a significant, ongoing change in the course of T1DM or immunologic status.
  • Any condition that may compromise study participation or may confound the interpretation of the study results.
  Contacts and Locations
Please refer to this study by its identifier: NCT00515099

United States, California
Children's Hospital/USC School of Medicine
Los Angeles, California, United States, 90027
Children's Hospital and Research Center
Oakland, California, United States, 92609
UCSD/San Diego Children's Hospital
San Diego, California, United States, 92123
Diabetes Center at UCSF
San Francisco, California, United States, 94143
United States, Colorado
Barbara Davis Center for Childhood Diabetes, University of Colorado
Aurora, Colorado, United States, 80010
United States, Georgia
Emory Children's Center
Atlanta, Georgia, United States, 30322
United States, Minnesota
University of Minnesota
Minneapolis, Minnesota, United States, 55455
United States, Missouri
Children's Mercy Hospital
Kansas City, Missouri, United States, 64108
United States, Pennsylvania
University of Pennsylvania/Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States, 19104
Sponsors and Collaborators
Immune Tolerance Network (ITN)
Principal Investigator: Stephen Gitelman, MD University of California, San Francisco
  More Information

Additional Information:
No publications provided

Responsible Party: National Institute of Allergy and Infectious Diseases (NIAID) Identifier: NCT00515099     History of Changes
Other Study ID Numbers: DAIT ITN028AI
Study First Received: August 10, 2007
Last Updated: January 8, 2013
Health Authority: United States: Food and Drug Administration
United States: Institutional Review Board

Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):
juvenile diabetes
autoimmune diabetes
Diabetes Mellitus, Insulin-Dependent
Diabetes Mellitus, Juvenile-Onset
Type 1 Diabetes Mellitus

Additional relevant MeSH terms:
Diabetes Mellitus, Type 1
Diabetes Mellitus
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Autoimmune Diseases
Immune System Diseases
Antilymphocyte Serum
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions processed this record on April 16, 2014