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Compassionate Use of Metreleptin in Previously Treated People With Generalized Lipodystrophy

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ClinicalTrials.gov Identifier: NCT02262832
Recruitment Status : Recruiting
First Posted : October 13, 2014
Last Update Posted : November 8, 2019
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:

- Generalized lipodystrophy can cause high blood fat levels and resistance to insulin. This can lead to health problems including diabetes. Researchers have found that the drug metreleptin improves health in people with this disease.

Objective:

- To test the safety and effectiveness of metreleptin.

Eligibility:

  • People ages 6 months and older with generalized lipodystrophy who:
  • have received metreleptin through NIH studies AND
  • cannot get it through approved or compassionate use mechanisms in their home country.

Design:

  • Participants will come to NIH approximately every 6 months during year one, then every 1 2 years. Financial assistance may be available for travel within the U.S.
  • At visits, participants will get a supply of metreleptin to take home for daily injections. They will have:
  • plastic catheter placed in an arm vein.
  • blood tests, urine collection, and physical exam.
  • oral glucose tolerance test, drinking a sweet liquid.
  • ultrasound of the heart, liver, uterus, and ovaries. A gel and a probe are placed on the skin and pictures are taken of the organs.
  • echocardiogram, which takes pictures of the heart with sound waves.
  • Resting Metabolic Rate taken. A plastic hood is worn over the head while the oxygen they breathe is measured.
  • Participants will have up to 3 DEXA scan x-rays per year.
  • Participants may have:
  • annual bone x-rays.
  • liver biopsies every few years. A needle will be inserted into the liver to obtain a small piece. Participants will sign a separate consent for this.
  • Participants must be seen regularly by their local doctors and have blood tests at least every 3 6 months at home.

Condition or disease Intervention/treatment Phase
Lipodystrophy Diabetes Hyperlipidemia Drug: Metreleptin Phase 3

Detailed Description:

Leptin is an adipocyte-derived hormone that can be thought of as a signal from adipose tissue to the rest of the body conveying information about long-term nutritional status. Patients with the very rare condition of generalized lipodystrophy have leptin deficiency secondary to lack of adipose tissue. The combination of leptin deficiency and ectopic lipid deposition in patients with lipodystrophy leads to metabolic complications including severe insulin resistance and diabetes, hypertriglyceridemia, nonalcoholic steatohepatitis, and polycystic ovarian syndrome. Between 2000 and 2014, the NIDDK IRP conducted an open-label clinical trial of the recombinant human leptin analog, metreleptin, in patients with generalized and partial forms of lipodystrophy. This study showed that metreleptin ameliorates metabolic and endocrine abnormalities in lipodystrophy, including reducing food intake, improving insulin resistance and diabetes, reducing ectopic lipid, and normalizing reproduction. Based on these data, metreleptin was approved by the FDA in February, 2014, for patients with generalized, but not partial, lipodystrophy.

Currently, metreleptin is not available as an approved drug outside the US and Japan, and it is available on a compassionate use basis only in a few additional countries. The purpose of this study is twofold:

  1. To provide access to metreleptin to patients with generalized lipodystrophy, including those who have previously received metreleptin through NIH studies (protocols 02-DK-0022 and 13-DK- 0057) AND/OR who cannot obtain metreleptin through approved or compassionate use mechanisms in their home country
  2. To continue to collect data on the long-term efficacy of metreleptin in ameliorating the metabolic complications of generalized lipodystrophy.

Metreleptin will be given at doses of less than or equal to 0.24 mg/kg/day, adjusted based on body weight and metabolic control. Patients will be seen approximately once per year at NIH for evaluation, and potentially less frequently for those who are medically stable and have difficulty traveling to the US. Laboratory evaluation will be obtained more frequently by the patient s home providers as clinically indicated. The primary outcomes of the study are improvements in serum triglycerides and hemoglobin A1c levels. Secondary outcomes include measures of steatohepatitis and ectopic lipid, body composition, bone mineral density and bone mineral metabolism, and pituitary and reproductive function.

Metreleptin is supplied by Aegerion Pharmaceuticals. Neither the NIH nor Aegerion Pharmaceuticals can guarantee that leptin will be available for these patients indefinitely and/or after the study ends.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Compassionate Use of Metreleptin in Previously-Treated Patients With Generalized Lipodystrophy
Actual Study Start Date : October 9, 2014
Estimated Primary Completion Date : July 31, 2025
Estimated Study Completion Date : July 31, 2025


Arm Intervention/treatment
Leptin study drug
Administration of study drug SQ BID
Drug: Metreleptin
administered subcutaneously 1-2 times/day.




Primary Outcome Measures :
  1. Serum triglycerides [ Time Frame: every 6-12 months ]
    Improvements in lab value

  2. Serum hemoglobin A1C [ Time Frame: every 6-12 months ]
    Improvements in lab value


Secondary Outcome Measures :
  1. Steatohepatosis [ Time Frame: every 12 months ]
    stable or improvements

  2. Pituitary & Reproductive Function [ Time Frame: every 12 months ]
    stable or improvements

  3. Ectopic lipid & body composition [ Time Frame: every 12 months ]
    stable or improvements

  4. Bone mineral density & metabolism [ Time Frame: every 12 months ]
    stable or improvements



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:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:

    1. Age greater than or equal to 6 months.
    2. Generalized lipodystrophy (either congenital or acquired).
    3. Those who cannot obtain metreleptin through approved or compassionate use mechanisms in their home country.

EXCLUSION CRITERIA:

  1. Availability of metreleptin to the patient either as an approved drug, or through local compassionate use or expanded access programs.
  2. Known HIV infection or HIV-associated lipodystrophy.
  3. Any medical condition or medication that will increase risk to the subject.
  4. Current alcohol or substance abuse.
  5. Subjects who have a known hypersensitivity to E. coli derived proteins (as leptin is derived from such proteins).

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): NCT02262832


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, 9000 Rockville Pike Recruiting
Bethesda, Maryland, United States, 20892
Contact: For more information at the NIH Clinical Center contact Office of Patient Recruitment (OPR)    800-411-1222 ext TTY8664111010    prpl@cc.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)

Additional Information:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
ClinicalTrials.gov Identifier: NCT02262832     History of Changes
Other Study ID Numbers: 150003
15-DK-0003
First Posted: October 13, 2014    Key Record Dates
Last Update Posted: November 8, 2019
Last Verified: November 1, 2019

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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) ):
Diabetes
Leptin
Lipodystrophy
Hypertriglyceridemia
Additional relevant MeSH terms:
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Lipodystrophy, Congenital Generalized
Lipodystrophy
Hyperlipidemias
Dyslipidemias
Lipid Metabolism Disorders
Metabolic Diseases
Skin Diseases, Metabolic
Skin Diseases
Lipid Metabolism, Inborn Errors
Metabolism, Inborn Errors
Genetic Diseases, Inborn