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Trial record 41 of 2310 for:    digestive | Recruiting, Not yet recruiting, Available Studies | United States

Efficacy, Safety and Tolerability of ISIS 304801 in People With Partial Lipodystrophy With an Open-Label Extension

This study is currently recruiting participants.
Verified November 1, 2017 by National Institutes of Health Clinical Center (CC) ( National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) )
Sponsor:
ClinicalTrials.gov Identifier:
NCT02639286
First Posted: December 24, 2015
Last Update Posted: November 7, 2017
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) )
  Purpose

Background:

Partial lipodystrophy is a deficiency of body fat in parts of the body (usually the arms and legs). People with partial lipodystrophy often get high blood triglyceride (fat) level, insulin resistance, diabetes and other problems. Researchers think the new drug ISIS 304801 can help treat health problems caused by partial lipodystrophy.

Objective:

To see if ISIS 304801 will improve blood fat (triglyceride levels), diabetes, and liver disease, and reduce some risks for heart disease caused by partial lipodystrophy.

Eligibility:

Adults at least 18 years old with partial lipodystrophy.

Design:

Participants will be screened during a 1-week stay at NIH. They will have:

Blood and urine tests

Physical exam.

Assignment to get either the study drug or placebo.

Instructions for how to inject the drug.

Body measurements.

Heart tests.

Participants will give themselves injections of the drug or placebo once a week at home. Some may test blood sugar by finger pricks. They will have monthly phone calls and nurse visits to take blood tests.

After 4 months, participants may continue the study for 1 year. All participants will get the study drug.

Participants will have study visits at NIH every 4 months. These may include:

Insulin sensitivity measurement: Insulin and sugar will be infused through 2 intravenous (IV) lines in the arms. Blood will be drawn.

Sugar and fat metabolism measured by IV infusions and blood tests.

Special x-ray scan to measure body fat.

Liquid meal then blood collected by IV catheter in the arm.

Magnetic resonance imaging scans.

Neck ultrasound.

Questionnaires.

Liver biopsy (optional)

Injection of heparin (a blood thinner) before a blood test.

After finishing the drug, participants will have 1 nurse visit and 1 visit to NIH.


Condition Intervention Phase
Lipodystrophy Drug: ISIS 304801 Drug: Placebo Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Randomized, Double Blind, Placebo-Controlled Study to Assess Efficacy, Safety and Tolerability of ISIS 304801 in Patients With Partial Lipodystrophy With an Open-Label Extension

Resource links provided by NLM:


Further study details as provided by National Institutes of Health Clinical Center (CC) ( National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) ):

Primary Outcome Measures:
  • To evaluate the efficacy of 16 weeks of ISIS 304801compared to placebo on the change inlog10 fasting triglycerides (TG). [ Time Frame: 16 weeks ]

Secondary Outcome Measures:
  • To evaluate the efficacy of 16 weeks of ISIS 304801 as compared to placebo (between group comparison) on additional lipid, glycemic, hepatic, and cardiovascular parameters, as well as safety and tolerability of ISIS 304801. [ Time Frame: 16 weeks ]

Estimated Enrollment: 20
Study Start Date: December 23, 2015
Estimated Study Completion Date: December 31, 2018
Estimated Primary Completion Date: December 31, 2018 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Study Drug
300 mg of study drug administered
Drug: ISIS 304801
300 mg or placebo administered as SC
Placebo Comparator: Placebo
Placebo administered via SC
Drug: Placebo
Placebo administered via SC

Detailed Description:

Background:

Lipodystrophy is a rare disease of deficient adipose mass, characterized by severe hypertriglyceridemia as well as insulin resistance, diabetes mellitus, fatty liver disease, acute pancreatitis, and early cardiovascular events. Apolipoprotein C-III (apoC-III) regulates triglyceride metabolism, and apoC-III levels strongly correlate with serum triglycerides in a variety of patient populations. Patients with genetically low levels of apoC-III have lower triglycerides and reduced cardiovascular disease, while individuals with genetically elevated levels of apoC-III have higher triglycerides and increased non-alcoholic fatty liver disease and insulin resistance. Pharmacologic reduction of apoC-III using anti-sense oligonucleotides (ASOs) reduce triglycerides by ~60-70% in a tested patient populations.

Aim:

The purpose of this study is to determine if apoC-III reduction using an ASO to apoC-III (ISIS 304801) will reduce triglycerides and improve insulin resistance, diabetes, and hepatic steatosis in patients with lipodystrophy.

The primary hypothesis to be tested is:

  1. ISIS 304801will reduce log10 fasting serum triglycerides.

    Secondary and tertiary hypotheses to be tested are:

  2. ISIS 304801will improve glucose metabolism by improving insulin resistance.
  3. ISIS 304801 will reduce hepatic steatosis.
  4. ISIS 304801 will improve cardiovascular risk markers.

We will also explore the mechanism of action of apoC-III ASO by studying lipoprotein lipase activity and lipoprotein particle distribution.

Methods:

This study will enroll up to 20 patients with partial lipodystrophy with a goal of 10 study completers. The study will be conducted in two phases. The first is a 16-week, randomized, double-blind, placebo-controlled design. Subjects will be treated with ISIS 304801 at a target dose of 300 mg per week or placebo. Following this phase, all subjects will enter a 12 month open-label extension in which they will receive active drug. Patients who experience benefit (triglyceride lowering greater than or equal to 50%) may receive an additional 12 months of open-label drug (up to 24 months, total). Measurement of the primary outcome (serum triglycerides) and key secondary outcomes will be performed at baseline prior to the intervention, after 13 weeks (primary outcome only) or 16 weeks (primary and secondary outcomes) of blinded drug or placebo, and after an additional 4 months of active drug in subjects initially randomized to placebo.

  Eligibility

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:
  • Age greater than or equal to 18 years at enrollment (the time of informed consent, week -1)
  • Fasting TG levels greater than or equal to 500 mg/dL (greater than or equal to 5.7 mmol/L) at enrollment. If the fasting TG value is <500 mg/dL (<5.7 mmol/L) but greater than or equal to 350 mg/dL (greater than or equal to 4.0 mmol/L) up to two additional tests may be performed in order to qualify, and a single level greater than or equal to 500 mg/dL will permit enrollment.

OR

  • Fasting TG levels greater than or equal to 200 mg/DL (2.6mmol/L) with a hemoglobin A1C over 7%.
  • Willing to maintain their customary physical activity level and to follow a diet moderate in carbohydrates and fats with a focus on complex carbohydrates and replacing saturated for unsaturated fats
  • Clinical diagnosis of lipodystrophy based on deficiency of subcutaneous body fat in a partial fashion assessed by physical examination, and low skinfold thickness in anterior thigh by caliper measurement: men (less than or equal to 10mm) and women (less than or equal to 22mm), plus one of the following:

    • Genetic diagnosis of familial PL (e.g., mutations in LMNA, PPARG, AKT2, or PLIN1 genes) OR

      • Family history of familial PL or abnormal and similar fat distribution PLUS 1 minor criterion (below), OR
      • 2 minor criteria (below) in the absence of genetic diagnosis of family history
      • MINOR Criteria
      • Diabetes mellitus with requirement for high doses of insulin, eg, requiring greater than or equal to 200 U/day,greater than or equal to 2 U/kg/day, or currently taking U-500 insulin
      • Presence of acanthosis nigricans on physical examination
      • History of polycystic ovary syndrome (PCOS) or PCOS-like symptoms (hirsutism, oligomenorrhea, and/or polycystic ovaries)
      • History of pancreatitis associated with hypertriglyceridemia
      • Evidence of non-alcoholic fatty liver disease: Hepatomegaly and/or elevated transaminases in the absence of a known cause of liver disease or Radiographic evidence of hepatic steatosis (e.g., on ultrasound or CT)
  • Satisfy one of the following:

    • Females: Non-pregnant and non-lactating; surgically sterile (e.g., tubal occlusion, hysterectomy, bilateral salpingectomy, bilateral oophorectomy), post-menopausal (defined as 12 months of spontaneous amenorrhea in females >55 years of age or, in females less than or equal to 55 years, 12 months of spontaneous amenorrhea without an alternative medical cause and follicle-stimulating hormone (FSH) levels in the postmenopausal range for the laboratory involved), abstinent, or if engaged in sexual relations of child-bearing potential, patient is using an acceptable contraceptive method from time of signing the informed consent form until at least 13 weeks after the last dose of Study Drug administration.
    • Males: Surgically sterile, abstinent, or if engaged in sexual relations with a female of child bearing potential, patient is utilizing an acceptable contraceptive method from the time of signing the informed consent form until at least 13 weeks after the last dose of study drug administration.

Note: Abstinence is only an effective method of birth control when this is the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods), declaration of abstinence for the duration of a trial and withdrawal are not acceptable methods of contraception.

EXCLUSION CRITERIA:

  • A diagnosis of generalized lipodystrophy
  • Current or history of autoimmune diseases (even with a diagnosis of PL) unless approved by the Investigator and Sponsor Medical Monitor
  • Acute pancreatitis within 4 weeks of enrollment
  • History within 6 months of enrollment of acute or unstable cardiac ischemia (myocardial infarction, acute coronary syndrome, new onset angina), stroke, transient ischemic attack, or unstable congestive heart failure requiring a change in medication
  • Major surgery within 3 months of enrollment
  • History of heart failure with New York Heart Association functional classification (NYHA) greater than Class II
  • Uncontrolled hypertension (blood pressure [BP] >160/100 mm Hg)
  • Any of the following laboratory values at enrollment:

    • Cardiac troponin I >ULN
    • LDL-C >130 mg/dL (measured by vertical auto profile ultracentrifugation) on maximal tolerated statin therapy
    • Hemoglobin HbA1c greater than or equal to 9.5%
    • Hepatic:

      • Total bilirubin >ULN
      • ALT >3.0 x ULN
      • AST >3.0 x ULN
    • Renal:

      • Persistently positive (2 out of 3 tests greater than or equal to trace positive) for blood on urine dipstick. In the event of a positive test eligibility may be confirmed with urine microscopy showing less than or equal to 5 red blood cells per high power field (urine will be screened at admission and repeated if abnormal)
      • Two out of three consecutive tests greater than or equal to 1+ for protein on urine dipstick. In the event of a positive test eligibility may be confirmed by a quantitative total urine protein measurement of < 1g/24 hrs (urine will be screened at admission and repeated if abnormal)
      • Estimated creatinine clearance calculated according to the formula of Cockcroft and Gault <60 mL/min
    • Platelet count below 140,000 K/uL
    • Clinically significant (as determined by the Investigator or Sponsor) abnormalities on laboratory examination that will increase risk to the patient or interfere with data integrity
  • Uncontrolled hypothyroidism (abnormal thyroid function tests should be approved by the Investigator)
  • History within 6 months of enrollment of screening of drug or alcohol abuse
  • History of bleeding diathesis or coagulopathy or clinically significant abnormality in coagulation parameters at enrollment
  • Active infection requiring systemic antiviral or antimicrobial therapy that will not be completed prior to enrollment
  • Known history of or positive test for human immunodeficiency virus (HIV), hepatitis C or chronic hepatitis B
  • Malignancy within 5 years, except for basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix that has been successfully treated
  • Treatment with another investigational drug, biological agent, or device within one month of enrollment, or 5 half-lives of investigational agent, whichever is longer
  • Unwilling to comply with contraceptive and lifestyle (diet/exercise) requirements
  • Use of any of the following:

    • Use of metreleptin within the last 3 months prior to enrollment
    • Antidiabetic, lipid lowering, or atypical antipsychotic medication, unless on a stable dose for at least 3 months prior to enrollment
    • Insulin unless on a stable daily insulin dose regimen ( 20 %) for at least 4 weeks prior to enrollment
    • Use of nicotinic acid or derivatives within the last 4 weeks prior to enrollment
    • Systemic corticosteroids or anabolic steroids within 6 weeks prior to enrollment unless approved by the Investigator
    • Antihypertensive medication unless on a stable dose for at least 4 weeks prior to enrollment
    • Tamoxifen, estrogens or progestins unless on a stable dose for at least 4 months prior to enrollment and dose and regimen expected to remain constant throughout the study
    • Oral anticoagulants unless on a stable dose for at least 4 weeks prior to enrollment and regular clinical monitoring is performed
    • Prior exposure to ISIS 304801
    • Anti-obesity drugs [e.g., the combination of phentermine and extended-release topiramate (Osymia, orlistat (Xenical), liraglutide [rDNA origin] injection (Saxenda) and lorcaserin (Belvig), phentermine, amphetamines, herbal preparations] within 12 weeks prior to screening
    • Any other medication unless stable at least 4 weeks prior to enrollment (occasional or intermittent use of over-the-counter medications will be allowed at Investigator s discretion)
  • Blood donation of 50 to 499 mL within 30 days or of >499 mL within 60 days
  • Have any other conditions, which, in the opinion of the Investigator or the Sponsor would make the patient unsuitable for inclusion, or could interfere with the patient participating in or completing the study
  Contacts and Locations
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): NCT02639286


Contacts
Contact: Megan S Startzell, R.N. (301) 402-6371 megan.startzell@nih.gov

Locations
United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike Recruiting
Bethesda, Maryland, United States, 20892
Contact: For more information at the NIH Clinical Center contact Patient Recruitment and Public Liaison Office (PRPL)    800-411-1222 ext TTY8664111010    prpl@mail.cc.nih.gov   
Sponsors and Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Investigators
Principal Investigator: Rebecca J Brown, M.D. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
  More Information

Additional Information:
Publications:
Responsible Party: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
ClinicalTrials.gov Identifier: NCT02639286     History of Changes
Other Study ID Numbers: 160038
16-DK-0038
First Submitted: December 23, 2015
First Posted: December 24, 2015
Last Update Posted: November 7, 2017
Last Verified: November 1, 2017

Keywords provided by National Institutes of Health Clinical Center (CC) ( National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) ):
Lipodystrophy
Hypertriglyceridemia

Additional relevant MeSH terms:
Lipodystrophy
Skin Diseases, Metabolic
Skin Diseases
Lipid Metabolism Disorders
Metabolic Diseases