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Study of Growth Hormone Inhibition Using Pegvisomant in Severe Insulin Resistance

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ClinicalTrials.gov Identifier: NCT05470504
Recruitment Status : Not yet recruiting
First Posted : July 22, 2022
Last Update Posted : October 6, 2022
Sponsor:
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) )

Brief Summary:

Background:

Lipodystrophy (LD) syndromes are a group of rare disorders that affect how a person s body can store and use fat tissue. Many people with LDs become severely insulin resistant. Some people are insulin resistant because of a variant in the insulin receptor gene. Insulin resistance causes many health problems.

Objective:

To learn if blocking the effects of growth hormone in the body will help people with severe insulin resistance.

Eligibility:

Adults aged 18 to 65 years with either a known variant in the insulin receptor gene or with a diagnosis of partial LD.

Design:

Participants will have 2 hospital stays, about 1 month apart. Each stay will be 3 or 4 nights.

During each hospital stay, participants will have many tests. They will have a physical exam with blood tests. They will have all of their urine collected for a 24-hour period. They will have scans to measure their muscle, bone, and fat tissues. They will have tests to measure metabolism and insulin sensitivity. They may have an optional biopsy of fat tissue.

During the first hospital visit, participants will learn how to give themselves shots of a drug (pegvisomant) that blocks growth hormone. The drug is injected under the skin. Participants will continue to give themselves these shots once a day at home.

After the first hospital visit, participants will talk on the phone with members of the study team once each week. After 2 weeks they will have blood drawn for tests.

Participants will stop the shots after the second hospital visit.


Condition or disease Intervention/treatment Phase
Insulin Receptor Mutation Partial Lipodystrophy Drug: Pegvisomant Phase 2

Detailed Description:

STUDY DESCRIPTION

The role of growth hormone (GH) in mediating pathological consequences of inadequate lipid storage will be studied in rare patient populations with high lipolysis and severe metabolic syndrome. Specifically, patients with partial lipodystrophy and pathogenic variants in the insulin receptor gene (INSR) will be studied before and after 1 month of administration of pegvisomant (a GH receptor blocker).

OBJECTIVES

Primary Objective:

Establish proof of concept that GH blockade reduces adipose tissue lipolysis in humans with severe insulin resistance.

Secondary Objectives:

Determine the effects of pegvisomant on lipolytic products and IGF-1.

ENDPOINTS

Primary Endpoint:

Adipose tissue lipolysis measured by glycerol and palmitate rates of appearance using stable isotope tracers.

Secondary Endpoints:

Free fatty acids (FFA), glycerol, IGF-1.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 25 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase II Study of Growth Hormone Inhibition Using Pegvisomant In Severe Insulin Resistance
Estimated Study Start Date : October 11, 2022
Estimated Primary Completion Date : January 30, 2025
Estimated Study Completion Date : January 30, 2025

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Hormones
Drug Information available for: Pegvisomant

Arm Intervention/treatment
1
open label pegvisomant
Drug: Pegvisomant
30 mg subcutaneously every day for 4 weeks.




Primary Outcome Measures :
  1. Glycerol rate of appearance (Ra) normalized to fat mass, Palmitate Ra normalized to fat mass [ Time Frame: 1 month ]
    Estimate the magnitude and variability of the effect of pegvisomant, 30 mg subcutaneously once daily for 1 month, on adipose tissue lipolysis rate in subjects with pathogenic variants in the insulin receptor and partial lipodystrophy.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA

To be eligible to participate in this study, an individual must meet all the following criteria:

  • Either

    • Known pathogenic variant in the insulin receptor gene, either dominant negative or recessive, OR
    • Clinical diagnosis of partial lipodystrophy based on reduction in adipose tissue outside the normal range in selected adipose depots (including, at a minimum, the gluteofemoral depot) with preservation of adipose tissue in other depots.
  • Male or female, aged 18-65 years.
  • Completed linear growth and puberty.

EXCLUSION CRITERIA

An individual who meets any of the following criteria will be excluded from participation in this study:

  • Use of niacin or other drugs that directly affect lipolysis within 8 weeks prior to enrollment.
  • Patients taking anticoagulants (blood thinning medications).
  • Use of non-steroidal anti-inflammatory medications (e.g., aspirin, ibuprofen) 2 weeks prior to the biopsy date (in patients who choose to undergo biopsy).
  • Changes in medications for diabetes or dyslipidemia within 2 weeks prior to enrollment.
  • In subjects with partial lipodystrophy only, use of insulin within 2 weeks prior to enrollment.
  • Pregnancy or lactation.
  • For females of reproductive potential: inability or unwillingness to use contraception during study participation and for an additional 1 month after the end of pegvisomant administration.
  • For males of reproductive potential: inability or unwillingness to use condoms or other methods to ensure effective contraception with partner during the study and for an additional 1 month after the end of pegvisomant administration.
  • Known allergic reactions pegvisomant or any of its components.
  • Clinically significant liver disease, evidenced by any of the following:

    • ALT or AST >3 times the upper limit of normal at screening.
    • Current known liver disease other than steatohepatitis (e.g., autoimmune or viral hepatitis).
    • History of cirrhosis
  • Triglycerides >1500 mg/dL (non-fasting) or >1000 mg/dL (fasting) at screening.
  • Hemoglobin A1c >10% at screening.
  • Any other medical condition or medication that, in the judgement of the investigator, will increase risk to the subject or impede the measurement of study outcomes.
  • Inability of subject to understand or the unwillingness to sign a written informed consent document.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05470504


Contacts
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Contact: Megan S Startzell, R.N. (301) 402-6371 megan.startzell@nih.gov
Contact: Rebecca J Brown, M.D. (301) 594-0609 brownrebecca@mail.nih.gov

Locations
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United States, Maryland
National Institutes of Health Clinical Center
Bethesda, Maryland, United States, 20892
Contact: For more information at the NIH Clinical Center contact Office of Patient Recruitment (OPR)    800-411-1222 ext TTY dial 711    ccopr@nih.gov   
Sponsors and Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Investigators
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Principal Investigator: Rebecca J Brown, M.D. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
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Responsible Party: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
ClinicalTrials.gov Identifier: NCT05470504    
Other Study ID Numbers: 10000756
000756-DK
First Posted: July 22, 2022    Key Record Dates
Last Update Posted: October 6, 2022
Last Verified: September 29, 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: .Result of the study will be disseminated to participants upon publication.

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) ):
Pegvisomant
Severe Insulin Resistance
Growth Hormone Inhibition
LIPOLYSIS
Additional relevant MeSH terms:
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Lipodystrophy
Insulin Resistance
Hyperinsulinism
Glucose Metabolism Disorders
Metabolic Diseases
Skin Diseases, Metabolic
Skin Diseases
Lipid Metabolism Disorders