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Afrezza® INHALE-1 Study in Pediatrics (INHALE-1)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04974528
Recruitment Status : Recruiting
First Posted : July 23, 2021
Last Update Posted : January 5, 2024
Sponsor:
Collaborator:
Jaeb Center for Health Research
Information provided by (Responsible Party):
Mannkind Corporation

Brief Summary:

INHALE-1 is a Phase 3, open-label, randomized clinical study evaluating the efficacy and safety of Afrezza in combination with a basal insulin (i.e., the Afrezza group) versus insulin aspart, insulin lispro or insulin glulisine in combination with a basal insulin (i.e., the Rapid-acting Insulin Analog [RAA] injection group) in pediatric subjects with type 1 or type 2 diabetes mellitus. Following 26 weeks of randomized treatment (i.e., Afrezza or RAA injection combined with a basal insulin), all subjects will enter a treatment extension where subjects will receive Afrezza until Week 52. The purpose of the treatment extension is to assess safety and efficacy with continued use of Afrezza.

Pediatric subjects ≥4 and <18 years of age will be enrolled in this study. Subjects will be randomly assigned in a 1:1 ratio to either the Afrezza group or the RAA injection group.

The study is composed of:

  • Up to 5-week screening/run-in period
  • 26 week randomized treatment period
  • 26-week treatment extension
  • 4-week follow-up period

Condition or disease Intervention/treatment Phase
Diabetes Mellitus, Type 1 Diabetes Mellitus, Type 2 Biological: Afrezza Biological: Rapid-acting Insulin Analog Biological: Basal Insulin Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 264 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: INHALE-1: A 26-week Primary Treatment Phase, With 26-week Extension, Open-label, Randomized Clinical Trial Evaluating the Efficacy and Safety of Afrezza® Versus Rapid-acting Insulin Analog Injections, Both in Combination With a Basal Insulin, in Pediatric Subjects With Type 1 or Type 2 Diabetes Mellitus
Actual Study Start Date : September 29, 2021
Estimated Primary Completion Date : February 2024
Estimated Study Completion Date : April 2025

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Afrezza (Technosphere Insulin) + Basal Insulin

Individualized dose of Afrezza (Technosphere Insulin) for each patient before each meal (breakfast, lunch, and dinner) for 26 weeks.

Individualized basal insulin (insulin degludec, insulin glargine or insulin detemir) for each patient.

Biological: Afrezza

Pharmaceutical form: powder

Route of administration: inhalation

Other Name: Technosphere Insulin

Biological: Basal Insulin

Pharmaceutical form: solution for injection

Route of administration: subcutaneous

Other Names:
  • insulin glargine
  • insulin degludec
  • insulin detemir
  • Lantus®
  • Abasaglar®
  • Basaglar®
  • Semglee®
  • Toujeo®
  • Tresiba®
  • Levemir®

Active Comparator: RAA Injection + Basal Insulin

Individualized dose of RAA injection (insulin aspart, insulin lispro or insulin glulisine) for each patient for 26 weeks.

Individualized basal insulin (insulin degludec, insulin glargine or insulin detemir) for each patient.

Biological: Rapid-acting Insulin Analog

Pharmaceutical form: clear and colorless solution for injection

Route of administration: subcutaneous

Other Names:
  • insulin aspart
  • insulin lispro
  • insulin glulisine
  • Novolog®
  • Fiasp®
  • Humalog®
  • Admelog®
  • Apidra®

Biological: Basal Insulin

Pharmaceutical form: solution for injection

Route of administration: subcutaneous

Other Names:
  • insulin glargine
  • insulin degludec
  • insulin detemir
  • Lantus®
  • Abasaglar®
  • Basaglar®
  • Semglee®
  • Toujeo®
  • Tresiba®
  • Levemir®




Primary Outcome Measures :
  1. Change in HbA1c [ Time Frame: 26 weeks ]
    Change in HbA1c from baseline to Week 26, for noninferiority assessment


Secondary Outcome Measures :
  1. Change in Fasting Plasma Glucose (FPG) [ Time Frame: 26 weeks ]
    Change in FPG from baseline to Week 26, for superiority assessment

  2. Event rate of pooled level 2 and level 3 hypoglycemia [ Time Frame: 26 weeks ]
    Event rate of pooled level 2 and level 3 hypoglycemia (SMBG < 54 mg/dL and/or severe hypoglycemic events reported on the adverse event CRF) during the 26 -week randomized treatment period, for superiority assessment.

  3. Change in HbA1c [ Time Frame: 26 weeks ]
    Change in HbA1c from baseline to Week 26, for superiority assessment


Other Outcome Measures:
  1. Event rate of level 1 hypoglycemia (SMBG <70 mg/dL) [ Time Frame: 26 weeks ]
    Event rate of level 1 hypoglycemia during the 26-week randomized treatment period

  2. Change in percent Time In Range (glucose 70 - 180 mg/dL) [ Time Frame: 26 weeks ]
    Change in percent Time In Range from baseline to Week 26, using Continuous Glucose Monitoring (CGM)-derived data collected over the preceding 30 days for the 24-hour, daytime and nocturnal time periods

  3. Change in percent time with glucose <54 mg/dL [ Time Frame: 26 weeks ]
    Change in percent time with glucose <54 mg/dL from baseline to Week 26, using CGM-derived data collected over the preceding 30 days for the 24-hour, daytime and nocturnal time periods

  4. Change in percent Time Below Range (glucose <70 mg/dL) [ Time Frame: 26 weeks ]
    Change in percent Time Below Range from baseline to Week 26, using CGM-derived data collected over the preceding 30 days for the 24-hour, daytime and nocturnal time periods

  5. Change in percent Time Above Range (glucose >180 mg/dL) [ Time Frame: 26 weeks ]
    Change in percent Time Above Range from baseline to Week 26, using CGM-derived data collected over the preceding 30 days for the 24-hour, daytime and nocturnal time periods

  6. Percentage of subjects with HbA1c <7.0% [ Time Frame: At Week 26 ]
    Percentage of subjects with HbA1c <7.0% at Week 26

  7. Score of Diabetes Treatment Satisfaction Questionnaire (DTSQ) Change (c)-Teen [ Time Frame: At Week 26 ]
    Score of DTSQ(c)-Teen at Week 26 in the Afrezza group (score ranges from -24 to 24, with higher score means greater satisfaction)

  8. Score of Diabetes Treatment Satisfaction Questionnaire (DTSQ) Change (c)-Parent [ Time Frame: At Week 26 ]
    Score of DTSQ(c)-Parent at Week 26 in the Afrezza group (score ranges from -30 to 30, with higher score means greater satisfaction)

  9. Change in scores of DTSQ Status (s)-Teen [ Time Frame: 26 weeks ]
    Change in scores of DTSQ(s)-Teen from baseline to Week 26 (change in score ranges from -48 to 48, with higher score means greater satisfaction)

  10. Change in scores of DTSQ Status (s)-Parent [ Time Frame: 26 weeks ]
    Change in scores of DTSQ(s)-Parent from baseline to Week 26 (change in scores ranges from -60 to 60, with higher score means greater satisfaction)

  11. Change in HbA1c [ Time Frame: 52 weeks (and 26 weeks if required) ]
    Change in HbA1c from baseline to Week 52 (and change from Week 26 to Week 52 if required) in subjects who switch from treatment with RAA injections to Afrezza at Week 26

  12. Change in FPG [ Time Frame: 52 weeks (and 26 weeks if required) ]
    Change in FPG from baseline to Week 52 (and change from Week 26 to Week 52 if required) in subjects who switch from treatment with RAA injections to Afrezza at Week 26

  13. Change in percent Time In Range, Time Below Range and Time Above Range [ Time Frame: 52 weeks (and 26 weeks if required) ]
    Change in percent Time In Range, Time Below Range and Time Above Range from baseline to Week 52 (and change from Week 26 to Week 52 if required) in subjects who switch from treatment with RAA injections to Afrezza at Week 26; using CGM-derived data collected over the preceding 30 days for the 24-hour, daytime, and nocturnal periods

  14. Change in HbA1c [ Time Frame: 52 weeks ]
    Change in HbA1c from baseline to Week 52 in subjects who receive Afrezza in both the randomized treatment period and the treatment extension

  15. Change in FPG [ Time Frame: 52 weeks ]
    Change in FPG from baseline to Week 52 in subjects who receive Afrezza in both the randomized treatment period and the treatment extension

  16. Change in percent Time In Range, Time Below Range and Time Above Range [ Time Frame: 52 weeks ]
    Change in percent Time In Range, Time Below Range and Time Above Range from baseline to Week 52 in subjects who receive Afrezza in both the randomized treatment period and the treatment extension; using CGM-derived data collected over the preceding 30 days for the 24-hour, daytime, and nocturnal periods

  17. Score of DTSQ(c)-Teen at Week 52 [ Time Frame: At Week 52 ]
    Score of DTSQ(c)-Teen at Week 52 (after 6 months of Afrezza treatment) in subjects who switch from RAA injections to Afrezza (score ranges from -24 to 24, with higher score means greater satisfaction)

  18. Score of DTSQ(c)-Parent at Week 52 [ Time Frame: At Week 52 ]
    Score of DTSQ(c)-Parent at Week 52 (after 6 months of Afrezza treatment) in subjects who switch from RAA injections to Afrezza (score ranges from -30 to 30, with higher score means greater satisfaction)

  19. Change in scores of DTSQ(s)-Teen [ Time Frame: 52 weeks ]
    Change in scores of DTSQ(s)-Teen from baseline to Week 52 (changes in score ranges from -48 to 48, with higher score means greater satisfaction)

  20. Change in scores of DTSQ(s)-Parent [ Time Frame: 52 weeks ]
    Change in scores of DTSQ(s)-Parent from baseline to Week 52 (change in scores ranges from -60 to 60, with higher score means greater satisfaction)

  21. Event rates of hypoglycemic events [ Time Frame: 52 weeks ]
    Event rates and incidence of total, nocturnal, and severe hypoglycemic events from baseline to Week 52

  22. Incidence of hypoglycemic events [ Time Frame: 52 weeks ]
    Incidence of total, nocturnal, and severe hypoglycemic events from baseline to Week 52

  23. Incidence and severity of Treatment Emergent Adverse Events (TEAEs) and Serious Adverse Events (SAEs) [ Time Frame: 52 weeks ]
    Incidence and severity of TEAEs and SAEs from baseline to Week 52

  24. Incidence and severity of Adverse Events of Special Interest (AESIs) [ Time Frame: 52 weeks ]
    Incidence and severity of AESIs (i.e., acute bronchospasm, clinically relevant decline in pulmonary function [>15% decline from baseline percent predicted FEV1 accompanied by respiratory symptoms], hypersensitivity reactions [including anaphylaxis], use of asthma reliever medication, initiation or use of asthma controller medication, use of corticosteroid bursts, asthma exacerbations, hospitalization for asthma exacerbation, events of level 3 hypoglycemia, and diabetic ketoacidosis [DKA]) as well as the number of subjects with AESIs and number of individual events

  25. Change in percent predicted Forced Expiratory Volume in 1 Second (FEV1) [ Time Frame: 56 weeks ]
    Change from baseline to Weeks 13, 26, 39, 52, and 56 in percent predicted FEV1



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   4 Years to 17 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Assent from the pediatric subject, as appropriate, and fully informed consent from the parent(s) or legal guardian, as required by both state and federal laws and the local Institutional Review Board (IRB)
  • Subjects ≥4 and <18 years of age
  • Clinical diagnosis of type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) per the Investigator and have been using insulin for at least 6 months for T1DM, or at least 3 months for T2DM
  • Treatment with basal-bolus insulin therapy delivered by multiple daily injections for at least 2 weeks
  • Bolus insulins are restricted to the RAAs insulin lispro, insulin aspart or insulin glulisine, including biosimilar products
  • Basal insulins are restricted to insulin glargine, insulin degludec or insulin detemir, including biosimilar products
  • Access to stable WiFi connection
  • HbA1c ≥7.0% and ≤11%
  • Average prandial dose of insulin ≥2 units per meal
  • Utilized CGM for ≥70% of the time over a consecutive 14-day period preceding randomization

Exclusion Criteria:

  • History of recent blood transfusions (within previous 3 months), hemoglobinopathies, or any other conditions that affect HbA1c measurements
  • Recent history of asthma (defined as using any medications to treat within the last year), any other clinically important pulmonary disease (e.g., cystic fibrosis or bronchopulmonary dysplasia), or significant congenital or acquired cardiopulmonary disease
  • History of serious complications of diabetes (e.g., active proliferative retinopathy or symptomatic autonomic neuropathy), or likely need for specific treatment for diabetic retinopathy (laser photocoagulation, vitrectomy, other) in the next year
  • FEV1 and FEV1/forced vital capacity (FVC) ≤80% of predicted Global Lung Function Initiative (GLI) value
  • Inability to achieve an acceptable FEV1 and FVC reading for subjects ≥8 years of age would make the subject ineligible
  • For subjects <8 years of age who are unable to achieve an acceptable FVC reading, FEV1 only may be assessed; inability to achieve an acceptable FEV1 would make the subject ineligible
  • Respiratory tract infection within 14 days before screening (subject may return 14 days after resolution of symptoms for rescreening)
  • Inability or unwillingness to perform study procedures
  • Exposure to any investigational product(s), including drugs or devices, in the past 30 days
  • Any disease other than diabetes or exposure to any medication that, in the judgment of the Investigator, may impact glucose metabolism and current or anticipated acute uses of glucocorticoids or weight loss medications, with the exception of metformin and/or GLP-1 agonists (if GLP-1 agonists used for at least the 3 months prior to enrollment) in subjects with T2DM
  • Use of antiadrenergic drugs (e.g., clonidine)
  • Any concurrent illness (other than diabetes mellitus) not controlled by a stable therapeutic regimen
  • Current uncontrolled eating disorder (e.g., anorexia or bulimia nervosa)
  • Current drug or alcohol abuse or a history of drug or alcohol abuse that, in the opinion of the Investigator or the Sponsor, would make the subject an unsuitable candidate for participation in the study
  • Smoking (includes cigarettes, cigars, pipes, marijuana, and vaping devices) for the preceding 6 months and/or positive urine cotinine test
  • Female subject who is pregnant, breast-feeding, intends to become pregnant, or is of child-bearing potential, sexually active and not using adequate contraceptive methods as required by local regulation or practice
  • An event of severe hypoglycemia, as judged by the Investigator, within the last 90 days prior to screening
  • An episode of DKA requiring hospitalization within the last 90 days prior to screening

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04974528


Contacts
Layout table for location contacts
Contact: Johanna Ulloa 818-661-5000 inhale1@mannkindcorp.com

Locations
Show Show 40 study locations
Sponsors and Collaborators
Mannkind Corporation
Jaeb Center for Health Research
Investigators
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Study Director: Kevin Kaiserman Mannkind Corporation
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Responsible Party: Mannkind Corporation
ClinicalTrials.gov Identifier: NCT04974528    
Other Study ID Numbers: MKC-TI-155 Part 2
First Posted: July 23, 2021    Key Record Dates
Last Update Posted: January 5, 2024
Last Verified: September 2023

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Mannkind Corporation:
Diabetes Mellitus
Insulin
Inhaled
Afrezza
Technosphere
Pediatric
Additional relevant MeSH terms:
Layout table for MeSH terms
Diabetes Mellitus
Diabetes Mellitus, Type 2
Diabetes Mellitus, Type 1
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Autoimmune Diseases
Immune System Diseases
Insulin
Insulin, Globin Zinc
Insulin Glargine
Insulin Aspart
Insulin Lispro
Insulin Detemir
Insulin glulisine
Insulin, Short-Acting
Hypoglycemic Agents
Physiological Effects of Drugs