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Type 1 Diabetes MellitusPhase 2TN40ANCT07216391

Platform Trial to Delay Stage 3 Diabetes: Comparing Teplizumab With ATG

A Phase 2 study testing Antithymocyte Globulin (ATG) and Teplizumab in people with Type 1 Diabetes Mellitus, run by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at 6 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

This is a 2-arm, multi-center, open label study to learn if ATG works the same or better than teplizumab in delaying or preventing Stage 3 Type 1 diabetes. Participants will be administered either 2 infusions of ATG or 14 infusions of teplizumab and will then be followed for at least 12-48 months after administration… Read more about this study

Who is it for?
Ages 4 to 34 years
Conditions the study is for
Type 1 Diabetes Mellitus
What is being tested?
Antithymocyte Globulin (ATG) and Teplizumab
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
60 participants
Where
6 sitesUnited States
Study dates
29 Jul 2026to 30 May 2030
Phase
Phase 2
Are there results?
Not yet: the study is under way

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 4 to 34 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Willing to provide informed consent or have a parent or legal guardians provide informed consent when the participant is <18 years of age.
  • Aged ≥4 to <35 years
  • A history of at least two or more diabetes-related biochemical autoantibodies (mIAA, GADA, ICA, IA-2A, ZnT8A) present on the same sample. In the absence of other antibodies, ICA and GADA positivity alone will not suffice for eligibility in this trial.
  • Participants must meet ADA stage 2 T1D glycemic criteria* by TrialNet testing within 100 days of the baseline visit.
  • The ADA definition of stage 2 T1D is characterized by glucose intolerance or dysglycemia in the presence of two or more islet autoantibodies, impaired fasting glucose (≥ 100mg/dL), impaired glucose tolerance (2-hour post 75g glucose load ≥ 140mg/dL), high glucose levels at intermediate time points on OGTT (30, 60, 90 min timepoints of ≥ 200 mg/dL), and/or HbA1c between 5.7% and 6.4% or ≥ 10% increase in HbA1c within a two year window, with the most recent HbA1c value obtained within 100 days of the baseline visit.
  • Participants, regardless of serostatus, must meet all of the following:
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  • Be EBV and CMV PCR negative prior to randomization
  • Be EBV and CMV PCR negative within 2 weeks prior to the baseline visit
  • Have no signs or symptoms of a CMV or EBV-compatible illness lasting longer than 7 days within 30 days prior to the baseline visit.
  • Be at least 8 weeks from last live immunization at the time of the baseline visit.
  • Be willing to forgo vaccines (other than non-live influenza and COVID-19) during the 3 months after study drug treatment period and forgo live vaccines for 12 months after study drug treatment period.
  • Must meet TrialNet eligibility minimum immunization recommendations found in Appendix A of the manual of operations (MOO).
  • With the exception of stage 2 T1D, participants must be healthy, as defined by absence of any other untreated diagnoses that the investigator deems to be a potential confounder.
  • If a female participant with reproductive potential, willing to avoid pregnancy (abstinence or adequate contraceptive method) through the completion of the study infusions and up to 3 months after study drug administration and undergo pregnancy testing prior to each study visit.
  • Must be residing or have accommodations within 1 hour of the infusion site during study drug infusions and must be within 1 hour of a medical care facility for 1 day after completion of infusions.
  • Participants must live in a location with rapid access to emergency medical services.

Who cannot join

  • Immunodeficiency or clinically significant chronic lymphopenia: (Leukopenia (<3,000 leukocytes/μL), neutropenia (<1,500 neutrophils/μL), lymphopenia (<1000 lymphocytes/μL), thrombocytopenia (<150,000 platelets/μL).
  • Hemoglobin less than 13 g/dL for adult men and less than 11.5g/dL for adult females and less than 11 g/dL for participants under age 18.
  • Active signs or symptoms of acute or chronic infection at the time of the baseline visit including SARS-Cov-2.
  • Uncontrolled autoimmune thyroid disease and/or celiac disease (participants must be well controlled for the previous 6 months).
  • Evidence of prior or current tuberculosis infection through any one or more of the following:
  • A history of latent or active TB
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  • Signs and/or symptoms of TB
  • Recent close contact with a person with known or suspected active TB unless appropriate prophylaxis for TB was given
  • A history of a chest X-ray consistent with active TB or old, inactive TB, or interferon gamma release assay IGRA (QuantiFERON) test
  • A history of a positive purified protein derivative (PPD) skin test result (>10 mm induration), or positive/repeatedly indeterminate on an interferon-gamma release assay (IGRA; e.g., QuantiFERON-TB test).
  • Currently pregnant or lactating or anticipate getting pregnant within the study period.
  • Require use of other immunosuppressive agents including chronic use of oral or intravenous injectable steroids.
  • Evidence of current or past HIV or Hepatitis B or current Hepatitis C infection.
  • Any complicating medical issues or abnormal clinical laboratory results that may interfere with study conduct, or cause increased risk to include pre-existing cardiac disease, COPD, sickle cell disease, Down syndrome, adrenal insufficiency, neurological disease, or blood count abnormalities.
  • A history of malignancies other than of skin.
  • Evidence of liver dysfunction with AST or ALT ≥ 2 times the upper limit of the reference range.
  • Evidence of renal dysfunction with creatinine ≥ 1.5 times the upper limit of the reference range.
  • Increased bilirubin ≥ 2 times (total) or ≥ 1.5 times (direct) the normal limit (Participants with documentation of Gilbert's Disease permitted).
  • Vaccination with a live vaccine within the last 8 weeks or killed/inactivated vaccine within the last 2 weeks of the baseline visit.
  • Current or ongoing use of non-insulin pharmaceuticals that affect glycemic control within 14 days of screening.
  • Prior treatment with Teplizumab or ATG (either in a previous clinical trial or clinically).
  • Has previously participated in a clinical trial for diabetes prevention and received active study agent within 6 months of treatment.
  • Known allergy to rabbits or rabbit derived products.
  • Prior adverse reactions to heparin.
  • Any condition that in the investigator's opinion may adversely affect study participation.
  • Any screening/baseline laboratory result not otherwise stated out of normal reference range and/or medical history that may increase the risk of the participant's participation in this trial.
  • Previously diagnosed with Stage 3 TID according to ADA criteria.

Trial locations and contacts

6 sites in 1 country. Contact the study team or a site near you to ask about taking part.

6 sites in 1 country

United States6 sites, 6 recruiting
  • Barbara Davis Center

    Aurora, Colorado, 80045

    Leah Galvez Valencia, 303-724-4992, leah.galvezvalencia@ucdenver.edu

    Lexie Chesshir, 303-724-8615, lexie.chesshir@CUANSCHUTZ.EDU

    Recruiting
  • University of Florida

    Gainesville, Florida, 32610

    Jennifer Hosford, (352) 294-5759, jennifer.hosford@medicine.ufl.edu

    Danielle Poulton, 352-294-5761, Danielle.Poulton@medicine.ufl.edu

    Recruiting
  • Yale University

    New Haven, Connecticut, 06511

    Marcia DeSousa, 203-737-4805, marcia.desousa@yale.edu

    Jennifer Sherr, MD

    Recruiting
  • Columbia University

    New York, New York, 10032

    Amy Doytchinov, 212-851-5494, as8064@cumc.columbia.edu

    Cecelia Lim, 212-851-5494, cl4874@cumc.columbia.edu

    Recruiting
  • University of Pittsburgh

    Pittsburgh, Pennsylvania, 15224

    Kelli DeLallo, 412-692-5210, kelli.delallo@chp.edu

    Ingrid Libman, MD

    Recruiting
  • Benaroya Research Institute

    Seattle, Washington, 98101

    Arlene Colmenares, (206) 287-5627, AColmenares@benaroyaresearch.org

    Kimberly Varner, 206-341-8934, kvarner@benaroyaresearch.org

    Recruiting

Other trials in United States

About this study

Official title: Adaptive Platform Trial to Delay Progression From Stage 2 to Stage 3 Type 1 Diabetes: Comparing Teplizumab With Low-dose Anti-Thymocyte Globulin (ATG) Protocol TN-40A

This is a 2-arm, multi-center, open label study to learn if ATG works the same or better than teplizumab in delaying or preventing Stage 3 Type 1 diabetes. Participants will be administered either 2 infusions of ATG or 14 infusions of teplizumab and will then be followed for at least 12-48 months after administration, depending on timepoint enrolled into the study. If the primary endpoint demonstrates a positive signal and as decided by TrialNet, there is potential for a study extention. This would extend follow-up visits for a possible study duration of about 9 years among the earliest enrollees of the initial study.

Read the detailed description

This protocol will enroll 60 participants between the ages of 4 and 34 with Stage 2 Type 1 diabetes. Oral glucose tolerance testing will be done at the screening, baseline visit (V0) and at 3, 6 and 12 months in the first year after study drug administration. Eligible study participants will be randomized to recieve either 2 doses of ATG over 2-3 days or 14 doses of teplizumab given once daily over 14 consecutive days. Safety labs will also be done during select study visits to monitor the participant's health. Once the treatment phase has been completed, participants will have 3 in-person study visits in year one of the study with interim contact to assess adverse events and symptoms of diabetes. After year one of the study, participants will continue in-person follow-up visits every 6 months until the last enrolled participant completes the 12-month visit or develops Stage 3 Type 1 diabetes, whichever occurs first. The total initial study duration is expected to last 3-4 years. There is a possibility the study will be extended after the initial study duration, dependent upon the primary outcome (DPTRS at the month 6 visit) and as determined by TrialNet. If the study extension is done, participants would be presented an additional consent form to opt into additional follow-up visits which would increase total time in study to about 9 years.

Being tested
Antithymocyte Globulin (ATG), Teplizumab
Keywords
TrialNet, T1D, Teplizumab, ATG
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.

  • Antithymocyte Globulin (ATG)Drug

    Thymoglobulin

  • TeplizumabDrug

    Intravenous infusions of teplizumab given for 14 consecutive days. For participants ages 8-34 each infusion will take a minimum of 30 minutes. For participants ages 4-7 each infusion will take a minimum of 2 hours. Each infusion will also be followed by an observation period of at least 30 minutes.

Study groups in NCT07216391
Study groupRoleWhat they receive
ATGExperimentalAntithymocyte globulin (ATG) will be intravenously administered over two days, with a total of 2 infusion periods. The first dose (0.5mg/kg) will be infused over a minimum of 6 hours, and the second dose (2mg/kg) over a minimum of 4 hours with a maximum infusion time for each infusion of 10 hours. Infusions may be administered either in a hospital or outpatient setting at the investigator's or institutions discretion.
Receives: Drug: Antithymocyte Globulin (ATG)
TeplizumabActive comparatorIntravenous infusions of teplizumab will be given for 14 consecutive days. For participants between the ages of 8-34 each infusion will be given over a minimum of 30 minutes. For participants between the ages of 4-7 the infusion will be given over a minimum of 2 hours. Vital signs will be monitored for at least 30 minutes after each infusion. If reactions to the infusion occur participants may be monitored for at least 2 hours after the study drug infusion. The total dose for the 14-day course is approximately 11,240 µg/m².
Receives: Drug: Teplizumab

What is being measured

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

  1. Change in DPTRS at six months

    DPTRS is calculated as DPTRS = (1.569 x log-BMI) - (0.056 x age) + (0.813 x glucose sum from 30 to 120 min /100) - (0.848 x C-peptide sum from 30 to 120 min/10) + (0.476 x log-fasting C-peptide), where the units are years for age, kg/m2 for BMI, mg/dl for glucose, ng/ml for C-peptide

    Measured: 6 months after completion of study drug administration

Secondary outcomes (7)
  1. Progression to Stage 3 T1D

    Elapsed time from study drug administration to the development of diabetes or time of last contact among those randomized

    Measured: 6 months after study drug administration

  2. OGTT glucose AUC

    Mean area under the stimulated glucose curve (AUC) over the 2-hour oral glucose tolerance test.

    Measured: 6 months after study drug administration

  3. M120 score

    This is an aggregated score from multiple measurements calculated as follows:

    M120 = 0.448×(sex) + 0.631×(IA-2A) - 0.0302×(age) + 0.0605×(BMI)

    + 1.380×(HbA1c) + 0.0265×(120 min glucose) - 0.191×(120 min C-peptide), where the units for BMI, age, glucose, C-peptide and HbA1c are, respectively, kg/m2, years, mg/dl, ng/ml and percentage units. Sex was assigned a score of 1 for male and 2 for female, and IA-2A status assigned 0 for absent and 1 for present. Glucose is converted from mmol/l to mg/dl by multiplying by 18; C-peptide is converted from nmol/l to ng/ml by dividing by 3.00; and HbA1c is converted from mmol/mol to percentage units by adding 23.5 and then dividing by 10.93.

    Measured: 6 months after study drug administration

  4. Index 60

    This is an aggregated score from multiple measurements calculated as follows:

    Index60 = 0.3695×loge(fasting C-peptide) + 0.0165×(60 min glucose) - 0.3644×(60 min C-peptide), where the units for glucose and C-peptide are, respectively, mg/dl and ng/ml. Glucose is converted from mmol/l to mg/dl by multiplying by 18; C-peptide is converted from nmol/l to ng/ml by dividing by 3.00.

    Measured: 6 months after study drug administration

  5. OGTT C-peptide AUC

    Mean area under the stimulated C-peptide curve (AUC) over the 2-hour oral glucose tolerance test

    Measured: 6 months after study drug administration

  6. HbA1c

    Measured as a percentage of total hemoglobin

    Measured: 6 months after study drug administration

  7. Continuous Glucose Monitoring (CGM)

    Measures of CGM glucose range and variability

    Measured: 6 months after study drug administration

Timeline

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

  1. First posted14 Oct 2025
  2. Study start29 Jul 2026
  3. Primary completion30 Nov 2029 (estimated)
  4. Study completion30 May 2030 (estimated)

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
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
This trial will enroll 60 participants who will be randomly assigned in a 2:1 allocation to the following treatment arms: 40 participants will be randomized to ATG and 20 participants will be randomized to teplizumab.
Masking
None (open label)
Enrolment
60 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07216391
Sponsor's protocol ID
TN40A
Acronym
TN40A
Status last verified
Sep 2026
First submitted
22 Sep 2025
Last updated
9 Sep 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes: Data will be available at the NIDDK Central Repository

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Antithymocyte Globulin (ATG) and Teplizumab in people with Type 1 Diabetes Mellitus, run by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at 6 sites 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 16 inclusion and 27 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: looking for participants now, as of the sponsor's last update on 9 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites 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 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Melissa Parker (813-396-9378, melissa.parker@epi.usf.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in DPTRS at six months (time frame: 6 months after completion of study drug administration). 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 Sep 2026.

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