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Diabetes Mellitus, Type 1Phase 2Meld-ATGNCT04509791

MELD-ATG: Phase II, Dose Ranging, Efficacy Study of Anti-thymocyte Globulin (ATG) Within 6 Weeks of Diagnosis of Type 1 Diabetes (T1D)

A Phase 2 study testing Anti-Human Thymocyte Immunoglobulin, Rabbit in people with Diabetes Mellitus, Type 1, run by Universitaire Ziekenhuizen KU Leuven at 14 sites in 8 countries.

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

This study has been set up within the framework of the INNODIA network. INNODIA is a global partnership between 31 academic institutions, 6 industrial partners, a small sized enterprise and 2 patient organizations, bringing their knowledge and experience together with one common goal: "To fight type 1 diabetes". Read more about this study

Who is it for?
Ages 5 to 25 years
Conditions the study is for
Diabetes Mellitus, Type 1
What is being tested?
Anti-Human Thymocyte Immunoglobulin, Rabbit
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
114 participants
Where
14 sitesin 8 countries
Study dates
24 Nov 2020to 16 Dec 2024
Phase
Phase 2
Are there results?
None posted in the registry

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 5 to 25 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • has given written informed consent to participate; or have a parent or legal guardian provide written informed consent. Individual under the age of consent will be asked to assent to trial participation
  • be aged > 5 years to < 25 years at written informed consent/assent
  • have been diagnosed with T1d within 3-9 weeks of planned treatment day 1
  • have random C-peptide levels > 200 pmol/L measured at screening, as tested centrally
  • have 1 or more diabetes-related autoantibody (GADA, IA-2A or ZnT8A) present at screening, as tested centrally
  • will be > 6 weeks form last live immunisation at planned treatment day 1 and be willing to forgo live vaccines during the trial until 6 months post treatment
  • be willing to comply with intensive diabetes management

Who cannot join

  • Type 2 diabetes
  • Evidence of prior or current tuberculosis (TB) infection
  • Clinically significant abnormal full blood count (FBC), renal function or liver function at screening
  • Requiring use of other immunosuppressive or immunomodulation agents, including chronic use of systemic steroids
  • any active chronic infections at screening, or any active acute or chronic infections at baseline or on treatment day, which would contraindicate any additional immunosuppression
  • seropositive for human immunodeficiency virus (HIV),hepatitis B of hepatitis C infection at screening
Show all 14Show fewer
  • positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) based on local testing regimen
  • unwilling to use appropriate contraception if sexually active during the trial, from date of written informed consent until completion of the 12-month follow-up visit
  • any history of malignancies, other than skin
  • current or ongoing use of non-insulin pharmaceuticals that effect glycaemic control
  • active participation in another T1D treatment interventional trial in the previous 30 days prior to screening ( excluding treatment with insulin)
  • any prior treatment with ATG, Abatacept or Anti-CD3 monoclonal antibody (Anti-CD3)
  • known allergy to ATG or to similar products
  • any condition, complicating medical issues, or abnormal clinical laboratory results that the investigator judges may adversely affect trial conduct, cause increased risk to the participant, or compromise the trial results

Trial locations and contacts

14 sites in 8 countries.

14 sites in 8 countries

Belgium4 sites
  • Universitair Ziekenhuis Antwerpen

    Antwerp

  • Universitair ziekenhuis Brussel

    Brussels

  • Universite Libre de Bruxelles

    Brussels

  • Universitaire Ziekenhuizen Leuven

    Leuven

Other trials in Belgium

United Kingdom3 sites
  • Cambridge University Hospitals NHS Trust

    Cambridge

  • The Royal London Hospital - Barts Health NHS Trust

    London

  • Oxford University Hospitals NHS Foundation Trust

    Oxford, Oxon, OX3 9DU

Other trials in United Kingdom

Austria2 sites
  • Medical University of Graz

    Graz

  • Medical University of Vienna

    Vienna

Other trials in Austria

Denmark1 site
  • Herlev University Hospital

    Herlev

Other trials in Denmark

Finland1 site
  • Helsinki University Hospital Children and Adolescents

    Helsinki

Other trials in Finland

Germany1 site
  • Hannoversche Kinderheilanstalt Auf der Bult

    Hannover

Other trials in Germany

Italy1 site
  • IRCCS Ospedale San Raffaele

    Milan

Other trials in Italy

Slovenia1 site
  • University Medical Centre Ljubljana

    Ljubljana

Other trials in Slovenia

About this study

This study has been set up within the framework of the INNODIA network. INNODIA is a global partnership between 31 academic institutions, 6 industrial partners, a small sized enterprise and 2 patient organizations, bringing their knowledge and experience together with one common goal: "To fight type 1 diabetes". (www.innodia.eu) The overall aim of INNODIA is to advance in a decisive way how to predict, stage, evaluate and prevent the onset and progression of type 1 diabetes (T1D).

For this, INNODIA has established a comprehensive and interdisciplinary network of clinical and basic scientists, who are leading experts in the field of T1D research in Europe and UK (United Kingdom), with complementary expertise from the areas of immunology, Beta-cell biology, biomarker research and T1D therapy, joining forces in a coordinated fashion with industry partners and two foundations, as well as with all major stakeholders in the process, including regulatory bodies and patients with T1D and their families.

Read more

The MELD-ATG trial is a phase II, Multi-centre, randomised, double-blind, placebo-controlled, Multi-arm parallel cohort trial.

  • to investigate the effect of 2.5 mg/kg og ATG on the preservation of stimulated C-peptide at 12 months compared to placebo
  • to identify the minimally effective dose of ATG that shows an effect on C-peptide when compared to placebo at 12 months
Read the detailed description

A phase II, Multi-centre, randomised, double-blind, placebo-controlled, Multi-arm parallel cohort trial.

Randomisation wil be stratified by age. The trial consist of seven cohorts. The first cohort of 30 participants will be randomised to placebo, 2.5 mg/kg, 1.5 mg/kg, 0.5 mg/kg and 0.1 mg/kg.

ATG total dose in a 1:1:1:1 allocation ratio. There will be an initial age step down selection of this cohort with recruitment starting with dose aged 12-25 years and, providing no new safety concerns are raised in the first 10 participants to receive active dose, progressing to all ages (5-25 years) The next two cohorts of 12 participants will be randomised to placebo, 2.5 mg/kg, and 2 specified middle ATG total doses in a 1:1:1:1 allocation ratio.

The next four cohorts of 15 participants will be randomised to placebo, 2.5 mg/kg, and a single selected middle ATG total doses in a 1:1:1 allocation ratio.

This design allows sequential adjustment of the middle doses to be explored following review of all safety and early efficacy data by the Independent Data Monitoring Committee ( IDMC) and Dose Determine Committee (DDC) to seek the minimum effective dose

Being tested
Anti-Human Thymocyte Immunoglobulin, Rabbit
Medical subject headings
Diabetes Mellitus, Type 1

What participants receive

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

  • Anti-Human Thymocyte Immunoglobulin, RabbitDrug

    Also called ATG

    MELD - ATG : Minimum effective low dose ant-human thymocyte globulin (rabbit)

Study groups in NCT04509791
Study groupRoleWhat they receive
placeboPlacebo comparatorplacebo arm
Receives: Drug: Anti-Human Thymocyte Immunoglobulin, Rabbit
2.5 mg ATG/kgActive comparatorthe trial consists of 7 cohorts. The first cohort of 30 participants will be randomised to placebo, 2.5 mg/kg, 1.5 mg/kg, 0.5 mg/kg en 0.1 mg/kg in a 1:1:1:1:1 allocation ratio
Receives: Drug: Anti-Human Thymocyte Immunoglobulin, Rabbit
1.5 mg ATG/kgActive comparatorthe next two cohorts of 12 participants will be randomised to placebo, 2.5 mg/Kg, and 2 specified middle ATG total doses in a 1:1:1:1 allocation ratio
Receives: Drug: Anti-Human Thymocyte Immunoglobulin, Rabbit
0.5 mg ATG/kgActive comparatorThe next four cohorts of 15 participants will be randomised to placebo, 2.5 mg/kg and a single selected middle ATG total dose in a 1:1:1 allocation ratio
Receives: Drug: Anti-Human Thymocyte Immunoglobulin, Rabbit
0.1 mg ATG/kgActive comparatorthe trial consists of 7 cohorts. The first cohort of 30 participants will be randomised to placebo, 2.5 mg/kg, 1.5 mg/kg, 0.5 mg/kg en 0.1 mg/kg in a 1:1:1:1:1 allocation ratio
Receives: Drug: Anti-Human Thymocyte Immunoglobulin, Rabbit

What is being measured

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

  1. the area under the stimulated C-peptide response curve

    Measured: over the first 2 hours of a mixed meal tolerance test (MMTT) at 12 months post treatment

Secondary outcomes (7)
  1. the area under the stimulated C-peptide response curve

    Measured: over the first 2 hours of a MMTT at baseline, 3, 6 and 12 months

  2. dry blood spot (DBS) C-peptide measurements

    Measured: at all observation times

  3. Cluster of differentiation 4 (CD4) positive T cells and Cluster of differentiation 8 (CD8) positive T cells

    Measured: over 12 months

  4. HbA1c

    Measured: over 12 months

  5. insulin requirements

    The need for insulin (units) on a daily basis

    Measured: over 12 months

  6. T1D-associated autoantibodies (glutamic acid decarboxylase antibodies (GADA), insulin auto-antibodies (IAA), IA-2 antibodies (IA-2A) and Zinc transporter 8 antibodies (ZnT8A))

    The presence of T1D-associated autoantibodies

    Measured: over 12 months

  7. continuous glucose monitoring (CGM) measurements ( time in range, time above time below)

    Measured: over 12 months

Timeline

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

  1. First posted12 Aug 2020
  2. Study start24 Nov 2020
  3. Primary completion16 Dec 2024
  4. Study completion16 Dec 2024

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 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Sequential
Model description
the trial design consists of 7 cohorts, each recruited sequentially, with between 3 and 5 treatment arms ( there will be fewer arms for later cohorts)
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
114 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04509791
Sponsor's protocol ID
S63466
Other IDs
2019-003265-17, 2019
Acronym
Meld-ATG
Status last verified
Jan 2025
First submitted
7 Aug 2020
Last updated
10 Jan 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Wilhelm-Benartzi CS, Miller SE, Bruggraber S, Picton D, Wilson M, Gatley K, Chhabra A, Marcovecchio ML, Hendriks AEJ, Morobe H, Chmura PJ, Bond S, Aschemeier-Fuchs B, Knip M, Tree T, Overbergh L, Pall J, Arnaud O, Haller MJ, Nitsche A, Schulte AM, Mathieu C, Mander A, Dunger D. Study protocol: Minimum effective low dose: anti-human thymocyte globulin (MELD-ATG): phase II, dose ranging, efficacy study of antithymocyte globulin (ATG) within 6 weeks of diagnosis of type 1 diabetes. BMJ Open. 2021 Dec 7;11(12):e053669. doi: 10.1136/bmjopen-2021-053669.

    PubMed 34876434
  • Mathieu C, Wych J, Hendriks AEJ, Van Ryckeghem L, Tree T, Chmura P, Moller C, Casteels K, Danne T, Reschke F, Smigoc Schweiger D, Battelino T, Johannesen J, Rami-Merhar B, Pieber T, De Block C, Evans M, Hilbrands R, Bosi E, Willemsen RH, Basu S, Pulkkinen MA, Knip M, Cnop M, Nitsche A, Schulte AM, Niemoller E, Peakman M, Wilhelm-Benartzi C, Gillespie D, Overbergh L, Mander AP, Marcovecchio ML; INNODIA. Minimum effective low dose of antithymocyte globulin in people aged 5-25 years with recent-onset stage 3 type 1 diabetes (MELD-ATG): a phase 2, multicentre, double-blind, randomised, placebo-controlled, adaptive dose-ranging trial. Lancet. 2025 Sep 27;406(10510):1375-1388. doi: 10.1016/S0140-6736(25)01674-5. Epub 2025 Sep 18.

    PubMed 40976248

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Anti-Human Thymocyte Immunoglobulin, Rabbit in people with Diabetes Mellitus, Type 1, run by Universitaire Ziekenhuizen KU Leuven at 14 sites in 8 countries.

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 7 inclusion and 14 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 10 Jan 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 14 sites in Belgium, United Kingdom, Austria, Denmark, Finland and 3 more countries. 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. Some participants in this study may receive a placebo. 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 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

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

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

the area under the stimulated C-peptide response curve (time frame: over the first 2 hours of a mixed meal tolerance test (MMTT) at 12 months post treatment). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04509791, which also lists 2 linked publications.

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 10 Jan 2025.

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