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Pancreatitis, Chronic; Diabetes; TransplantPhase 4NCT02713997

Anti-inflammatory Therapy to Improve Outcomes After TPIAT

A Phase 4 study testing etanercept and Alpha 1-Antitrypsin in people with Pancreatitis, Chronic; Diabetes; Transplant, run by University of Minnesota at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Patients with severe chronic pancreatitis may be candidates to have their pancreas removed and their islets transplanted into the liver to reduce the risk of diabetes mellitus, a procedure called total pancreatectomy with islet autotransplant (TPIAT). Read more about this study

Who is it for?
Ages 18 to 65 years
What is being tested?
etanercept and Alpha 1-Antitrypsin
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
43 participants
Where
1 siteUnited States
Study dates
Dec 2016to 1 May 2025
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18- 68 years. .
  • Scheduled for total pancreatectomy and IAT at University of Minnesota (UM). All patients who are approved for pancreatectomy and IAT at UM are reviewed by a multi-disciplinary committee including surgeons, gastroenterologists specializing in pancreatic disease, a pain specialist, psychologist, and endocrinologist to confirm the diagnosis of chronic pancreatitis and candidate suitability for surgery.
  • Able to provide informed consent

Who cannot join

  • Pre-existing diagnosis of diabetes mellitus, fasting blood glucose >115 mg/dl, or hemoglobin A1c level >6.0% because these are all evidence of inadequate beta-cell mass.
  • Use of any of the following treatments in the 30 days prior to enrollment: insulin, metformin, sulfonylureas, glinides, thiazolidinediones, Glucagon Like Peptide (GLP)-1 agonists, dipeptidyl peptidase (DPP-4) inhibitors, or amylin.
  • Immunoglobulin (IgA) deficiency (serum level <5 mg/dL), which has been associated with hypersensitivity to alpha-1 antitrypsin.
  • Alanine aminotransferase (ALT) or aspartate aminotransferase (AST)>2.5 times the upper limit of normal (ULN). Bilirubin >ULN, unless due to benign diagnosis such as Gilbert's.
  • Known history of human immunodeficiency virus (HIV) infection, hepatitis B (chronic), or hepatitis C (chronic).
  • History of tuberculosis (TB) (latent or active disease), or positive TB skin test.
Show all 18Show fewer
  • History of symptomatic fungal lung infection.
  • History of multiple sclerosis, transverse myelitis, Guillain Barre, or other suspected demyelinating disease, due to risk of exacerbation of these conditions with use of etanercept; or prior history of systemic lupus erythematosus
  • Any of the following hematologic abnormalities: severe anemia (hgb <10 g/dL), thrombocytopenia (<150/mm3), or neutropenia (<1.0 x109/L).
  • Current use or expected use of oral or injected corticosteroids, or any mediation likely to affect glucose tolerance. However, use of hydrocortisone for physiologic replacement, or use of any topical, inhaled, or intranasal glucocorticoid is permitted.
  • Current or expected use of any other immunosuppressive agent.
  • Known hypersensitivity to etanercept or A1AT.
  • Any condition that is likely, in the opinion of the patient's medical providers, to necessitate use of TNF alpha therapeutically in the future (such as psoriatic arthritis).
  • Known coagulopathy, or need for anticoagulant therapy preoperatively (coumadin, enoxaparin), or any history of pulmonary embolism.
  • For females, plans to become pregnant or unwillingness to use birth control for the study duration.
  • Inability to comply with the study protocol.
  • Untreated psychiatric illness that may interfere with ability to give informed consent, or other developmental delay or neurocognitive disorder that impairs with a patient's ability to consent on their own behalf.
  • Any other medical condition that, in the opinion of the investigator, may interfere with the patient's ability to successfully and safely complete the trial.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Minnesota

    Minneapolis, Minnesota, 55455

Other trials in United States

About this study

Official title: Anti-inflammatory Therapy to Improve Outcomes in Patients With Chronic Pancreatitis Undergoing Total Pancreatectomy Islet Autotransplantation

Patients with severe chronic pancreatitis may be candidates to have their pancreas removed and their islets transplanted into the liver to reduce the risk of diabetes mellitus, a procedure called total pancreatectomy with islet autotransplant (TPIAT). However, over half of patients who have a TPIAT will need to remain on some supplemental insulin life-long after the procedure. We will study therapies that may reduce damage to transplanted islets, and thereby improve long-term outcomes.

Two promising anti-inflammatory therapies are available to protect islets from damage at the time of transplant: (1) the Tumor Necrosis Factor (TNF)-alpha inhibitor etanercept and (2) the serine protease inhibitor alpha-1 antitrypsin. Both agents are commercially available for clinical trials. Proof-of-principle for etanercept has been demonstrated in type 1 diabetic allotransplant recipients, in whom a 10 day course of etanercept early post-transplant significantly improved long-term insulin independence, due to better survival of the transplanted beta cell mass in the engraftment period. Alpha-1 antitrypsin (A1AT) reduces inflammatory cytokines, protects against cytokine-induced beta cell apoptosis, and prolongs islet graft survival in mice and intraportal IAT non-human primates.

This initial 3-arm drug-treatment clinical trial will investigate the use of Etanercept and A1AT to improve IAT function at 90 days and 1 and 2 years post-TPIAT compared to standard care. Forty-five patients undergoing TPIAT will be randomized 1:1:1 to receive either: 1) etanercept (50 mg on day 0; 25 mg on days 3, 7, 10, 14, and 21), 2) alpha-1 antitrypsin (90 mg/kg IV days -1, +3, 7, 14, 21, 28) or 3) standard care. Patients will have mechanistic assessments drawn in the early post-operative period including inflammatory cytokines and chemokines and measures of beta cell loss. Metabolic testing will occur at 90, 365, and 730 days post-TPIAT, including mixed meal tolerance testing, IV glucose tolerance testing, and glucose-potentiated arginine-induced insulin secretion (GPAIS).

Read the detailed description

For patients with severe pancreatitis refractory to medical and endoscopic therapy, total pancreatectomy (TP) with islet autotransplantation (IAT) may be considered. While 90% of TPIAT recipients have some function of the transplanted islet graft, only about 1/3rd come completely off insulin. The long-term goal of the proposed research is to develop new therapies that will increase the number of patients who are non-diabetic following islet autotransplant. Such therapies may also benefit recipients of islet allotransplant for type 1 diabetes.

Following islet transplantation, the islets must acutely survive the stress of the procedure, and then they must engraft in the liver and establish a vascular supply. The greater the functional islet mass engrafted, the lower the risk of post-operative diabetes. It has been estimated that more than half of the islet mass may be lost in the early post-transplant period in islet transplant recipients. Beta cell apoptosis is common during the first month post-transplant and is upregulated in the presence of inflammatory cytokines such as TNF-alpha. Thus, a major contributor to islet loss is the inflammatory damage sustained by the transplanted islets in the early post-transplant period; we propose to directly target this destructive process.

Two promising anti-inflammatory therapies are available to address this problem: (1) the TNF-alpha inhibitor etanercept and (2) the serine protease inhibitor alpha-1 antitrypsin. Both agents are commercially available for clinical trials. Proof-of-principle for etanercept has been demonstrated in type 1 diabetic allotransplant recipients, in whom a 10 day course of etanercept early post-transplant significantly improved long-term insulin independence, due to better survival of the transplanted beta cell mass in the engraftment period. Alpha-1 antitrypsin (A1AT) reduces inflammatory cytokines, protects against cytokine-induced beta cell apoptosis, and prolongs islet graft survival in mice and intraportal IAT non-human primates.

This initial 3-arm drug-treatment clinical trial will investigate the use of Etanercept and A1AT to improve IAT function at 90 days and 1 and 2 years post-TPIAT compared to standard care. Forty-five patients undergoing TPIAT will be randomized 1:1:1 to receive either: 1) etanercept (50 mg on day 0; 25 mg on days 3, 7, 10, 14, and 21), 2) alpha-1 antitrypsin (90 mg/kg IV days -1, +3, 7, 14, 21, 28) or 3) standard care. Patients will have mechanistic assessments drawn in the early post-operative period including inflammatory cytokines and chemokines and measures of beta cell loss. Metabolic testing will occur at 90, 365, and 730 days post-TPIAT, including mixed meal tolerance testing, IV glucose tolerance testing, and glucose-potentiated arginine-induced insulin secretion (GPAIS). The latter measures the maximally stimulated acute C-peptide response (ACRmax) as the best estimate of islet mass and the primary endpoint (at day 90) for this study. Results will be used to select the most promising agent for future study in a randomized, blinded multi-center clinical trial.

Being tested
etanercept, Alpha 1-Antitrypsin
Medical subject headings
Pancreatitis, Bronchiolitis Obliterans Syndrome, Diabetes Mellitus

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • etanerceptDrug

    Also called Enbrel

    50 mg on day 0 SQ; 25 mg subcutaneous (SQ) on days 3, 7, 10, 14, and 21 relative to TPIAT

  • Alpha 1-AntitrypsinDrug

    Also called Aralast NP

    90 mg/kg intravenous infusion on days -1, and +3, 7, 14, 21, and 28 post-transplant

Study groups in NCT02713997
Study groupRoleWhat they receive
Standard CareNo interventionPatients in the standard care arm will undergo the usual procedure of TPIAT with no ancillary therapies provided.
etanerceptExperimentalPatients in the etanercept arm will undergo the usual procedure of TPIAT with additional therapy of etanercept.
Receives: Drug: etanercept
alpha-1 antitrypsinExperimentalPatients in the alpha-1 antitrypsin arm will undergo the usual procedure of TPIAT with additional therapy of alpha-1 antitrypsin (Aralast NP)
Receives: Drug: Alpha 1-Antitrypsin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Maximal Acute C-peptide Response to Glucose (ACRmax)

    derived from times 0-5 minute C-peptide measures on glucose potentiated arginine stimulation at day 90 post-TPIAT

    Measured: day 90

Secondary outcomes (18)
  1. ACRmax

    derived from times 0- 5 minute C-peptide values from glucose potentiated arginine

    Measured: 1 year

  2. Maximal Acute Insulin Response to Glucose (AIRmax)

    derived from times 0- 5 minute insulin values from glucose potentiated arginine

    Measured: day 90

  3. Insulin Independence

    no insulin use for >14 days

    Measured: 1 year

  4. Insulin Dose (Unit/Day)

    calculated by average daily insulin dose from 2 weeks of logs

    Measured: day 90

  5. ACRmax

    derived from times 0- 5 minute C-peptide values from glucose potentiated arginine

    Measured: 2 year

  6. Maximal Acute Insulin Response to Glucose (AIRmax)

    derived from times 0- 5 minute insulin values from glucose potentiated arginine

    Measured: 1 year

  7. Maximal Acute Insulin Response to Glucose (AIRmax)

    derived from times 0- 5 minute insulin values from glucose potentiated arginine

    Measured: 2 year

  8. Insulin Independence

    no insulin use for >14 days

    Measured: 2 year

  9. Insulin Dose (Unit/Day)

    calculated by average daily insulin dose from 2 weeks of logs

    Measured: 1 year

  10. Insulin Dose (Unit/Day)

    calculated by average daily insulin dose from 2 weeks of logs

    Measured: 2 year

  11. Area Under the Curve (AUC) C-peptide

    calculated as area under the curve from every 30 minute C-peptide values on mixed meal tolerance test (MMTT)

    Measured: 90 days

  12. Area Under the Curve (AUC) C-peptide

    calculated as area under the curve from every 30 minute C-peptide values on mixed meal tolerance test (MMTT)

    Measured: 1 year

  13. Area Under the Curve (AUC) C-peptide

    calculated as area under the curve from every 30 minute C-peptide values on mixed meal tolerance test (MMTT)

    Measured: 2 year

  14. AUC Glucose

    calculated as area under the curve from every 30 minute glucose values on MMTT

    Measured: 90 days

  15. AUC Glucose

    calculated as area under the curve from every 30 minute glucose values on MMTT

    Measured: 1 year

  16. AUC Glucose

    calculated as area under the curve from every 30 minute glucose values on MMTT

    Measured: 2 year

  17. Absence of Severe Hypoglycemia (SHE) With A1c <7%

    no events meeting American Diabetes Association (ADA criteria for SHE day 28- 365)

    Measured: 1 year

  18. Absence of Severe Hypoglycemia (SHE) With A1c <7%

    no events meeting American Diabetes Association (ADA criteria for SHE day 28- 365)

    Measured: 2 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Mar 2016 (estimated)
  2. Study startDec 2016
  3. Primary completion1 Jul 2023
  4. Study completion1 May 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
43 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02713997
Sponsor's protocol ID
PEDS-2016-22934
Other IDs
R01DK109914
Status last verified
May 2026
First submitted
29 Feb 2016
Last updated
9 Jun 2026
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing etanercept and Alpha 1-Antitrypsin in people with Pancreatitis, Chronic; Diabetes; Transplant, run by University of Minnesota at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 18 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 9 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 26 Sep 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Maximal Acute C-peptide Response to Glucose (ACRmax) (time frame: day 90). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Jun 2026.

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