Evaluation of Effectiveness and Safety of the Rituximab Immunotherapy Plus Insulin Therapy Compared to Insulin Therapy Alone in Adolescents With Recent-Onset Type 1 Diabetes Mellitus

Status: Recruiting
Location: See all (2) locations...
Intervention Type: Biological
Study Type: Interventional
Study Phase: Phase 2
SUMMARY

Type 1 diabetes (T1D) is caused by destruction of pancreatic islet beta-cells that produce insulin - the hormone required for glucose uptake by body tissues and organs. Since loss of beta-cells leads to insulin deficiency, blood glucose increases and the symptoms of T1D (thirst, hunger, excessive urination) appear. Inability of patient's tissues and organs to utilize glucose results in rapid weight loss and life-threatening acute T1D complications - ketosis and coma. To ensure glucose consumption by tissues and organs and to prevent acute complications, all patients with T1D need lifelong therapy with insulin. Insulin therapy is also necessary to prevent long-term T1D complications (eye, renal, nerve, and heart problems). By the time T1D is diagnosed, 80-90% of beta-cells have already been destroyed. However, 10-20% viable insulin-producing beta-cells remain in the pancreas over several months and even years after T1D diagnosis. The higher the percentage of the remaining beta-cells, the smaller the risk of long-term complications. Destruction of beta-cells in T1D has an autoimmune origin. It means that the patient's immune system, which is normally targeted at microbes, viruses, and other non-self substances, mistakenly destroys the beta-cells. The key role in this autoimmune reaction is played by specific cells of the immune system: T- and B-lymphocytes. T-lymphocytes directly damage the beta-cells, while B-lymphocytes support T-lymphocytes activity via antigen presentation mechanisms. Rituximab is a drug that specifically eliminates B-lymphocytes from the blood based on the CD20 surface molecule expressed on their surface, as a target. Notably, a subset of currently active T cells, including those potentially associated with pathogenesis of multiple sclerosis, also express CD20 marker on their surface. This makes them a potentially another critically important target of rituximab. In 2009 - 2014, a multicenter study in the U. S. and Canada showed that a single three-week course of rituximab infusions slightly but significantly had improved survival of residual beta-cells and their insulin-producing capacity in patients with recent-onset T1D. However, this beneficial action of rituximab lasted for only one year. We hypothesized that the repeated courses of rituximab performed over a period of 5 months could produce more profound and durable elimination of pathogenic B- and T- cells, and as a consequence prolonged survival of residual beta-cells and insulin secretion without serious adverse events. Testing this hypothesis is the goal of our study

Eligibility
Participation Requirements
Sex: All
Minimum Age: 12
Maximum Age: 18
Healthy Volunteers: f
View:

• Is 12 years to 17 years 5 months of age, inclusive, at the time of randomization/initiation of rituximab administration

• Body weight 34-80 kg for males, and 37-80 for females

• Has received a diagnosis of type 1 diabetes mellitus (T1D), ICD-10 codes E10.1 or E10.9, according to the criteria from the Russian Association of Endocrinologists

• The duration of T1D (time from diagnosis to screening) is \< 4 months

• Is able to be randomized and initiate rituximab infusions within 4 months (122 days) of the formal T1D diagnosis

• Has a peak stimulated C-peptide of ≥ 200 pmol/L from a MMTT at screening

• Is positive for at least one of T1D-related autoantibodies (ICA, GADA, IA-2A, ZnT8A) at screening

• Participant AND his/her legally authorized representative have signed the Informed Consent Form

• Citizenship of the Russian Federation

Locations
Other Locations
Russian Federation
I.M. Sechenov First Moscow State Medical University (Sechenov University)
RECRUITING
Moscow
Russian Children's Clinical Hospital, Pirogov Russian National Research Medical University
RECRUITING
Moscow
Contact Information
Primary
Elena E Petryaykina, M.D.
director@rdkb.ru
+79039756179
Backup
Alexei V Timofeev, Ph.D.
alvaltim@gmail.com
+79161608994
Time Frame
Start Date: 2024-04-19
Estimated Completion Date: 2028-03-31
Participants
Target number of participants: 116
Treatments
Experimental: Intervention Arm: Rituximab Plus Insulin Therapy Arm
In the Rituximab Plus Insulin Therapy Arm, patients will receive repeated courses of rituximab along with their routine insulin therapy
No_intervention: Insulin Therapy Only Arm
In the Insulin Therapy Only Arm, patients will receive their routine insulin therapy
Sponsors
Leads: Pirogov Russian National Research Medical University

This content was sourced from clinicaltrials.gov