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SAFety and Efficacy of Human Anti-thymocyte ImmunoGlobUlin SAB-142 ARresting Progression of Type 1 Diabetes

NCT07187531 · SAb Biotherapeutics, Inc.
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Official title
A Phase 2b, Randomised, Double-Blind, Placebo-Controlled, Parallel-Arm Dose Finding Study Evaluating the Efficacy and Safety of SAB-142 for Delaying the Progression of Type 1 Diabetes (T1D) in Patients With Stage 3 New Onset of Type 1 Diabetes (NOT1D)
About this study
This is a Phase 2b, investigator- and participant-blinded, placebo-controlled, parallel-arm study to evaluate the efficacy, safety and tolerability of SAB 142 in patients with Stage 3 New Onset of Type 1 Diabetes (NOT1D).
Eligibility criteria
Inclusion Criteria: 1. Participant and/or appropriate legal guardian must have given written informed consent and/or assent according to local, regional and/or country specific guidance before any study-related activities are carried out and must be able to understand the full nature and purpose of the trial, including possible risks and adverse effects. 2. Males and females 15-40 years old at the time of randomisation in Part A. Males and females 5-40 years old\*, inclusive, at the time of randomisation in Part B. 3. Weight ≥16.0 kg at time of randomisation. 4. Participant has received a diagnosis of T1D according to American Diabetes Association criteria within 100 days of randomization. For participants who were initially misdiagnosed with Type 2 diabetes, time from misdiagnosis with Type 2 diabetes to randomization is 100 days. Note: The date of diagnosis is defined as the date of the first insulin dose or any other glucose lowering medication. An extension of no more than 14 days is permitted if a participant has planned and/or is required to receive a vaccination within 30 days prior to randomisation or is completing the 10 day CGM period. 5. Participant has random C-peptide levels of ≥0.2 nmol/L, measured during Screening. One random C-peptide retest during screening period is allowed. 6. Participant completed all scheduled samples for C-peptide collected during the MMTT test during Screening. 7. Participant has a positive result on testing for at least one of the following T1D-related autoantibodies during screening: * Glutamic acid decarboxylase 65 (GAD65) * Islet antigen 2 (IA-2) * Zinc transporter 8 (ZnT8) * Insulin autoantibodies (if testing within the first 14 days of insulin treatment) 8. Female participants: a. Must be of nonchildbearing potential, i.e., pre-pubertal\*, surgically sterilised (hysterectomy, bilateral salpingectomy, bilateral oophorectomy) at least 6 weeks before the screening, or postmenopausal (where postmenopausal is defined as no menses for 12 months without an alternative medical cause and a follicle stimulating hormone (FSH) level consistent with postmenopausal status, per local laboratory guidelines), or b. If of childbearing potential, must: i. Have a negative result on a serum (beta human chorionic gonadotropin \[β-HCG\]) at screening and a negative urine β-HCG pregnancy test prior to study drug administration on Day 1 of both treatment periods. ii. Agree not to become pregnant or donate ova from signing the consent form until the end of study visit. iii. If not exclusively in a same-sex relationship or abstinent as a committed lifestyle, must agree to use adequate contraception (which is defined as use of a condom by the male partner combined with use of a highly effective method of contraception from signing the consent and for the duration of the study. \* Note: Female participants will be considered to be pre-pubertal (and of nonchildbearing potential) if they have not yet started menstruation. This should also be verified by the parent(s)/guardian(s). If a female participant reaches menarche during the study, then she is to be considered as a woman of childbearing potential from that time forwards, and contraceptive requirements will apply. 9. Male participants, if not biologically or surgically sterilised, must: 1. Agree not to donate sperm from signing the consent form until EOS. 2. If engaging in sexual intercourse with a female partner who could become pregnant, agree to use adequate contraception (defined as use of a condom combined with use of a highly effective method of contraception from signing the consent form until EOS. 3. If engaging in sexual intercourse with a female partner who is not of childbearing potential or a same-sex partner, agree to use a condom from signing the consent form until EOS. 10. Prior to receiving study drug, participant must agree to receive locally, regionally and/or country-specific required age-appropriate immunisations. Participants are advised but not required to comply with the guidelines for immunosuppressed individuals and those with chronic disease (diabetes mellitus) according to current local, regional and/or country- specific guidelines. Note: Vaccines are permitted within the timeframes specified in exclusion criterion #17. 11. Participant agrees not to receive other forms of experimental treatment from the time of signing informed consent and for the duration of the study, particularly agents that may be immune modulatory in nature and/or stimulate pancreatic β cell regeneration or insulin secretion. 12. Participant has suitable venous access for blood sampling. 13. Participant is willing and able to comply with all study assessments and adhere to the protocol schedule and restrictions. Exclusion Criteria: 1. Participant has known allergy, hypersensitivity or moderate to severe allergic reaction including anaphylaxis to natural or recombinant antibodies, biologic treatments, passive vaccines, pork, or any other component of the study drug formulation (including biologic medications). 2. Participant has a known allergy or hypersensitivity to any of the protocol-required concomitant medications. 3. Participant has been an active participant in a therapeutic drug, invasive medical device, or vaccine clinical trial within 12 weeks before Screening Visit (SV)2. 4. Participant has received teplizumab or any investigational immunomodulatory anti-CD3 treatment within any timeframe prior to screening. 5. Participant has a significant uncontrolled renal, cardiac, vascular, pulmonary, gastrointestinal, neurologic, haematologic, rheumatologic, oncologic, psychiatric, or immune deficiency that may interfere with the participant's safely participating in the study or with interpretation of the safety and/or efficacy profile of investigational medicinal product (IMP). For any disorders, a participant with a stable, well-controlled condition that is not felt to interfere with study participation may be enrolled. 6. Participant has any autoimmune disease other than T1D (e.g., latent autoimmune diabetes in adults, rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, multiple sclerosis, systemic lupus erythaematous) that is currently managed with systemic immunotherapy, with the exception of clinically stable thyroid or celiac disease. 7. Participant is prone to infections, or has chronic, recurrent or opportunistic infectious disease, including but not limited to renal, respiratory or skin infections, Pneumocystis carinii, aspergillosis, latent or active granulomatous infection, histoplasmosis, or coccidioidomycosis. 8. Participant has a history of or serologic evidence at screening of current or past infection with human immunodeficiency virus (HIV)-1 or 2, hepatitis B virus (HBV), or hepatitis C virus (HCV) antibodies. 9. Evidence of active or latent tuberculosis (TB) as documented by medical history and examination, chest X-rays (posterior anterior and lateral), and/or TB testing. Note: Blood testing (e.g., QuantiFERON® TB Gold test) is strongly preferred; if not available, any local approved TB test is allowed. 10. Serious systemic viral, bacterial, or fungal infection (e.g., pneumonia, pyelonephritis), infection requiring hospitalization or IV anti-infective treatments or significant acute or chronic viral (including history of recurrent or active herpes zoster, acute or active cytomegalovirus \[CMV\], Epstein-Barr Virus \[EBV\] as determined at screening), bacterial, or fungal infection (e.g., osteomyelitis) 30 days before and during screening. Note: Participants with confirmed active EBV or CMV infection based on polymerase chain reaction (PCR) test can be retested; asymptomatic participants with the most recent PCR-negative test are eligible for participation. Participants with an active mild infection at Screening may be enrolled once the symptoms have resolved and all I/E are met. Participants who have an active infection and/or fever ≥38.0°C (100.4°F) within the 48 hours prior to dose administration should not be dosed. 11. Participant has a diagnosis of significant liver disease or at screening ALT and/or AST \>2× or total bilirubin of \>1.5× of the age- and sex-specific upper limit of normal (ULN) according to the central laboratory and confirmed by repeated tests. Liver function tests can be repeated during screening and if normalised, participant maybe eligible for randomization. Note: Participants with Gilbert's syndrome are allowed to enrol if only total and/or indirect bilirubin are elevated above ULN while ALT, AST, and alkaline phosphatase (ALP) are within the normal laboratory ranges. 12. An individual has any of the following haematologic parameters, confirmed by repeat tests, during Screening: * Lymphocyte count: \<1000/μL * Neutrophil count: \<1500/μL * Platelet count: \<100 000 platelets/μL * Haemoglobin: \<10 g/dL Note: Specific haematologic, oncologic or other systemic conditions that might otherwise result in exclusion and/or is heretofore unrecognised should be considered in individuals who have one or more blood cell counts below or above the normal ranges. 13. Current or prior (within 5× half-lives before SV2) treatment that is known to cause a significant, ongoing change in the course of T1D or immunologic status, including systemic glucocorticoids, verapamil, baricitinib, and others. Note: Inhaled and topical corticosteroids are allowed. Short courses, i.e., approximately 2 weeks or less, of systemic corticosteroids for transient conditions are allowed. 14. Current or prior (within 5× half-lives before SV2) use of drugs other than insulin to treat hyperglycaemia (e.g., metformin, sulfonylureas, glinides, thiazolidinediones, exenatide, liraglutide, glucagon-like peptide 1 agonists \[glucagon-like peptide-1\], dipeptidyl peptidase-4 \[DPP-IV\] inhibitors, or amylin). 15. Current or prior (within 5× half-lives before SV2) use of any medication known to significantly influence glucose tolerance (e.g., atypical antipsychotics, diphenylhydantoin, niacin). 16. Current or planned highly restrictive dietary regimen(s) that would interfere with participant well-being or impact to investigational drug. 17. Recent or planned vaccinations as follows: * Live vaccines (e.g., varicella, measles, mumps, rubella, cold-attenuated intranasal influenza vaccine, and smallpox): Within the 30 days before dosing or within 60 days following dosing; or planned/required within 30 days prior to or 60 days following Day 1 of TP2. * Recombinant, inactivated or otherwise "non-live" vaccines: Within the 30 days before dosing or within 60 days following dosing; or planned/required within 30 days prior to or 60 days following Day 1 of TP2. 18. Female is lactating and/or plans to lactate with the intent to provide her own breast milk to a baby at any point during the study. 19. An individual who has a history of alcohol, drug, or chemical abuse within 12 months prior to study screening (positive tetrahydrocannabinol is allowed) Note: Abuse is defined according to local, regional and/or country specific guidance. Participants who are tested positive for illicit substances but have a prescription medication to manage their concomitant conditions such as attention-deficit/hyperactivity disorder (ADHD) or others are allowed to participate in the study. 20. An individual who has a medical, psychological or social condition that, in the opinion of the Investigator, would interfere with safe and proper completion of the trial. 21. An individual who is an employee of the Investigator or study site, with direct involvement in the proposed study or other studies under the direction of that Investigator or study site.
Study design
Enrollment target: 159 participants
Allocation: randomized
Masking: double
Age groups: child, adult
Timeline
Starts: 2025-11-25
Estimated completion: 2028-12
Last updated: 2026-02-12
Interventions
Drug: High Dose SAB-142Drug: Low Dose SAB-142Other: Placebo
Primary outcomes
  • Part A: Incidence of treatment-emergent adverse events (TEAEs), adverse events of special interest (AESIs), and serious adverse events (SAEs) (From dose administration through Week 4)
  • Part B: Area under the concentration-time curve (AUC) of C-peptide after a 2 hour mixed meal tolerance test (MMTT) (From dose administration up to Month 12)
Sponsor
SAb Biotherapeutics, Inc. · industry
Contacts & investigators
ContactSenior Manager Clinical Operations · contact · SAFEGUARD@sab.bio · 1-844-763-1890
All locations (65)
University of California San Francisco Benioff Children's HospitalNot Yet Recruiting
San Francisco, California, United States
University of Colorado - Barbara Davis Center for DiabetesRecruiting
Aurora, Colorado, United States
University of Florida College of MedicineRecruiting
Gainesville, Florida, United States
University of Miami - Gables One TowerNot Yet Recruiting
Miami, Florida, United States
Children's Healthcare of Atlanta (CHOA) - Center for Advanced PediatricsNot Yet Recruiting
Atlanta, Georgia, United States
IUH - Riley Hospital for Children - Riley Outpatient Center - Pediatric Diabetes & EndocrinologyNot Yet Recruiting
Indianapolis, Indiana, United States
Harvard Medical School - Joslin Diabetes Center and Joslin Clinical (JDS)Not Yet Recruiting
Boston, Massachusetts, United States
Children's Mercy Hospital Kansas - Pediatric Care ClinicNot Yet Recruiting
Kansas City, Missouri, United States
University at Buffalo MD Physicians GroupNot Yet Recruiting
Buffalo, New York, United States
N.C. Children's Hospital - Children's Specialty Clinics - Chapel Hill at Carolina Pointe IINot Yet Recruiting
Chapel Hill, North Carolina, United States
Sanford Medical Center FargoNot Yet Recruiting
Fargo, North Dakota, United States
The Children's Hospital of PhiladelphiaNot Yet Recruiting
Philadelphia, Pennsylvania, United States
Cook Children's Medical CenterNot Yet Recruiting
Fort Worth, Texas, United States
Texas Children's Hospital - Clinical Care Center - Pediatric Renal ClinicNot Yet Recruiting
Houston, Texas, United States
University of Virginia Health System - Pediatric Diabetes ClinicNot Yet Recruiting
Charlottesville, Virginia, United States
Benaroya Research Institute at Virginia MasonRecruiting
Seattle, Washington, United States
Mary Bridge Children's Outpatient Center - TacomaNot Yet Recruiting
Tacoma, Washington, United States
Queensland Children's HospitalNot Yet Recruiting
Brisbane, Australia
Government of Western Australia - Child and Adolescent Health Service - Perth Children's HospitalNot Yet Recruiting
Nedlands, Australia
The Royal Children's Hospital MelbourneNot Yet Recruiting
Parkville, Australia
The Royal Melbourne Hospital (RMH)Recruiting
Parkville, Australia
Royal North Shore Hospital (RNSH)Recruiting
St Leonards, Australia
Westmead HospitalNot Yet Recruiting
Westmead, Australia
Medizinische Universitaet Graz - Klinik fuer Innere MedizinNot Yet Recruiting
Graz, Austria
Medizinische Universität InnsbruckNot Yet Recruiting
Innsbruck, Austria
Medizinische Universitaet Graz - Universitaetsklinik fuer Kinder und JugendheilkundeNot Yet Recruiting
Vienna, Austria
Medizinische Universitaet Wien - Universitaetsklinik fuer Kinder und JugendheilkundeNot Yet Recruiting
Vienna, Austria
Universitair Ziekenhuis BrusselNot Yet Recruiting
Jette, Belgium
UZ LeuvenNot Yet Recruiting
Leuven, Belgium
Groupe sante CHC - Clinique du MontLegiaNot Yet Recruiting
Liège, Belgium
Steno Diabetes CenterNot Yet Recruiting
Herlev, Denmark
Helsingin Yliopistollinen KeskussairaalaNot Yet Recruiting
Helsinki, Finland
Turun Yliopistollinen Keskussairaala (TYKS)Not Yet Recruiting
Turku, Finland
Universite Paris Descartes - Institut CochinNot Yet Recruiting
Paris, France
Assistance Publique-Hopitaux de Paris (AP-HP) - Hopital Universitaire Robert-DebreNot Yet Recruiting
Paris, France
Klinikum AugsburgNot Yet Recruiting
Augsburg, Germany
Hannoversche KinderheilanstaltNot Yet Recruiting
Hanover, Germany
Technische Universität MunichNot Yet Recruiting
Oberschleißheim, Germany
IRCCS Ospedale San RaffaeleNot Yet Recruiting
Milan, Italy
Azienda Ospedaliero Universitaria Maggiore della Carità di NovaraNot Yet Recruiting
Turin, Italy
Azienda Ospedaliera Universitaria Integrata Verona-Ospedale della Donna e del Bambino_Borgo TrentoNot Yet Recruiting
Verona, Italy
Hospital of Lithuanian University of Health Sciences Kauno KlinikosNot Yet Recruiting
Kaunas, Lithuania
Waitemata District Health Board- North Shore HospitalRecruiting
Auckland, New Zealand
Aotearoa Clinical TrialsRecruiting
Auckland, New Zealand
New Zealand Clinical Research - ChristchurchNot Yet Recruiting
Christchurch, New Zealand
Dunedin HospitalNot Yet Recruiting
Dunedin, New Zealand
Waikato HospitalNot Yet Recruiting
Hamilton, New Zealand
Wellington Regional HospitalNot Yet Recruiting
Wellington, New Zealand
Uniwersytecki Szital Klniczny w OpoluNot Yet Recruiting
Opole, Poland
SZPITAL KLINICZNY im. Karola Jonschera - UNIWERSYTETU MEDYCZNEGO im. Karola MarcinkowskiegoNot Yet Recruiting
Poznan, Poland
Warszawski Uniwersytet Medyczny - Klinika PediatriiNot Yet Recruiting
Warsaw, Poland
Instytut DiabetologiiNot Yet Recruiting
Warsaw, Poland
MTZ Clinical Research Sp. z o.o.Not Yet Recruiting
Warsaw, Poland
University Children's Hospital Ljubljana (UCHL)Not Yet Recruiting
Ljubljana, Slovenia
Hospital de CrucesNot Yet Recruiting
Barakaldo, Spain
Hospital Universitario Virgen de la VictoriaNot Yet Recruiting
Málaga, Spain
Hospital Universitario Virgen MacarenaNot Yet Recruiting
Seville, Spain
Cambridge University Hospitals NHS Foundation Trust - Addenbrookes HospitalNot Yet Recruiting
Cambridge, United Kingdom
Noahs Ark Childrens Hospital for WalesNot Yet Recruiting
Cardiff, United Kingdom
NHS Lothian - Royal Hospital for Sick ChildrenNot Yet Recruiting
Edinburgh, United Kingdom
Alder Hey Children's NHS Foundation TrustNot Yet Recruiting
Liverpool, United Kingdom
Barts Health NHS Trust - The Royal London HospitalNot Yet Recruiting
London, United Kingdom
University College London Hospitals NHS Foundation Trust - University College HospitalNot Yet Recruiting
London, United Kingdom
Nottingham University Hospitals NHS Trust - Queen's Medical Centre (QMC)Not Yet Recruiting
Nottingham, United Kingdom
Oxford University Hospitals NHS Trust - John Radcliffe HospitalNot Yet Recruiting
Oxford, United Kingdom