Type 1 Diabetes MellitusPhase 2FABULINUSNCT06111586
Frexalimab in Preservation of Endogenous Insulin Secretion Compared to Placebo in Adults and Adolescents on Top of Insulin Therapy (FABULINUS)
A Phase 2 study testing Frexalimab and Insulin in people with Type 1 Diabetes Mellitus, run by Sanofi at 79 sites in 16 countries.
Trial summary
This is a randomized, parallel group, double-blind Phase 2 study with a blinded extension evaluating the safety and efficacy of 3 dose levels of frexalimab in comparison with placebo in participants with newly diagnosed T1D on insulin treatment. Read more about this study
- Who is it for?
- Ages 12 to 35 years
- Conditions the study is for
- Type 1 Diabetes Mellitus
- What is being tested?
- Frexalimab and Insulin
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 197 participants
- Where
- 79 sitesin 16 countries
- Study dates
- 11 Dec 2023to 29 Oct 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 12 to 35 years
- All sexes
- No healthy volunteers
- Child, Adult
Who may be able to join
- Participants who meet the criteria of T1D according to American Diabetes Association
- Initiated exogenous insulin replacement therapy not longer than 90 days prior to screening visit at which random C-peptide will be assessed (V1).
- Receiving at least one of the following T1D standard of care (SOC), insulin hormone replacement therapy
- one or multiple daily injections (MDI) of basal insulin, prandial insulin and/or premixed insulin, or
- continuous subcutaneous insulin infusion (CSII)
- Participants must be positive for at least 1 of the following T1D autoantibodies confirmed by medical history and/or obtained at study screening:
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- Glutamic acid decarboxylase (GAD-65)
- Insulinoma Antigen-2 (IA-2)
- Zinc-transporter 8 (ZnT8) or
- Insulin (if obtained not later than 10 days after exogenous insulin therapy initiation)
- Have random C-peptide levels ≥ 0.2 nmol/L determined at screening visit.
- Be vaccinated according to the local vaccination schedule. Any vaccinations should take place at least 28 days prior to randomization for non-live vaccines and at least 3 months prior to randomization for live vaccines.
- Contraceptive use by men and women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies
- Participants body weight at screening must be at least 20kg.
Who cannot join
- Serious systemic viral, bacterial or fungal infection (eg, pneumonia, pyelonephritis), infection requiring hospitalization or IV antibiotics or significant 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 (eg, osteomyelitis) 30 days before and during screening.
- Participants with a history of invasive opportunistic infections, such as, but not limited to histoplasmosis, listeriosis, coccidioidomycosis, candidiasis, pneumocystis jirovecii, and aspergillosis, regardless of resolution.
- 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. Blood testing (eg, QuantiFERON® TB Gold test) is strongly preferred; if not available, any local approved TB test is allowed.
- Evidence of any clinically significant, severe or unstable, acute or chronically progressive, uncontrolled infection, medical or surgical condition (eg, but not limited to, cerebral, cardiac, pulmonary, renal, hepatic, gastrointestinal, neurologic, acquired or inherited bone/skeletal disorders including repeated bone fractures for unknown reason, juvenile osteoporosis, osteogenesis imperfecta, osteochondropathies, or any known immune deficiency), or any condition that may affect participant safety in the judgment of the Investigator (including vaccinations which are not updated based on local regulation).
- History or current hypogammaglobulinemia.
- History of a systemic hypersensitivity reaction or significant allergies, other than localized injection site reaction, to any humanized mAb. Clinically significant multiple or severe drug allergies, intolerance to topical corticosteroids, or severe post-treatment hypersensitivity reactions (including, but not limited to, erythema multiforme major, linear IgA dermatosis, toxic epidermal necrolysis, and exfoliative dermatitis).
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- Has other autoimmune diseases (eg, rheumatoid arthritis [RA], polyarticular juvenile idiopathic arthritis [pJIA], psoriatic arthritis [PsA], ankylosing spondylitis [AS], MS, SLE), that require treatment with biologic drugs (mono or polyclonal antibodies) or systemic corticosteroid therapy (at discretion of investigator).
- History, clinical evidence, suspicion or significant risk for thromboembolic events, as well as myocardial infarction, stroke, antiphospholipid syndrome, other prothrombotic disorders and/or participants requiring antithrombotic treatment.
- Diabetes of forms other than autoimmune T1D that include but is not limited to genetic forms of diabetes, maturity-onset diabetes of the young (MODY), latent autoimmune diabetes of the adult (LADA), secondary to medications or surgery, type 2 diabetes by judgement of the investigator.
- History of malignancy of any organ system, treated or untreated, within 5 years of screening, regardless of whether there is evidence of local recurrence or metastases.
- Systemic corticosteroids (duration > 7 days), adrenocorticotropic hormone 1 month prior to screening.
- Any IV, IM or SC administered biologic treatments, < 3 months or < than 5 half-lives (whichever is longer), prior to randomization.
- Any live (attenuated or viral-vector) vaccine (including but not limited to varicella zoster, oral polio, nasal influenza, rabies) within 3 months prior to randomization.
- Any non-live (inactivated, mRNA, recombinant, conjugate, toxoid) vaccine administered less than 28 days prior to randomization.
- Other medications not compatible or interfering with IMP at discretion of investigator.
- Any immunosuppressive therapy within 12 weeks prior to randomization.
- Course of Thymoglobulin®, teplizumab or other immunomodulatory treatments at any time.
- Any drugs that may be used for treatment of T1D and type 2 diabetes other than insulin including but not limited to metformin, glucagon-like peptide 1 (GLP-1) agonists and sodium-glucose co-transporter-2 and 1 (SGLT2/1) inhibitor and verapamil within 2 weeks prior to screening.
- Abnormal laboratory test(s) at screening.
- The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.
Trial locations and contacts
79 sites in 16 countries.
79 sites in 16 countries
United States14 sites
University of Colorado - Anschutz Medical Campus- Site Number : 8400003
Aurora, Colorado, 80045
Joslin Diabetes Center - Boston- Site Number : 8400015
Boston, Massachusetts, 02215
University at Buffalo - Downtown Campus- Site Number : 8400004
Buffalo, New York, 14203
University of North Carolina at Chapel Hill- Site Number : 8400001
Chapel Hill, North Carolina, 27514
Cincinnati Children's Hospital Medical Center- Site Number : 8400019
Cincinnati, Ohio, 45229
University of Texas - Southwestern Medical Center- Site Number : 8400011
Dallas, Texas, 75390
University of Florida College of Medicine- Site Number : 8400010
Gainesville, Florida, 32610
Rocky Mountain Diabetes and Osteoporosis Center- Site Number : 8400009
Idaho Falls, Idaho, 83404
University of Miami Hospital- Site Number : 8400013
Miami, Florida, 33136
AdventHealth Orlando- Site Number : 8400002
Orlando, Florida, 32803
The Children's Hospital of Philadelphia Site Number : 8400005
Philadelphia, Pennsylvania, 19104
University of California San Francisco - Mission Bay- Site Number : 8400012
San Francisco, California, 94158
Benaroya Research Institute at Virginia Mason- Site Number : 8400016
Seattle, Washington, 98101
NorthShore University Health System - Endeavor Health Medical Group - Skokie - Woods Drive- Site Number : 8400007
Skokie, Illinois, 60077
Italy8 sites
Azienda Ospedaliera Universitaria Meyer IRCCS-Site Number : 3800003
Florence, Firenze, 50139
IRCCS Ospedale San Raffaele-Site Number : 3800006
Milan, Milano, 20132
Azienda Ospedaliera Universitaria 'Federico II'-Site Number : 3800009
Naples, Napoli, 80131
Azienda Ospedaliero-Universitaria Maggiore Della Carità-Site Number : 3800001
Novara, 28100
Ospedale Pediatrico Bambin Gesu IRCCS-Site Number : 3800007
Rome, Roma, 00165
AOU delle Marche - Ospedale G. Salesi-Site Number : 3800008
Torette, Ancona, 60020
Azienda Socio Sanitaria Territoriale Dei Sette Laghi - Ospedale Filippo del Ponte-Site Number : 3800002
Varese, 21100
Azienda Ospedaliera Universitaria Integrata Verona - Centro regionale di Diabetologia Pediatrica-Site Number : 3800004
Verona, 37126
Poland7 sites
Investigational Site Number : 6160008
Bialystok, Podlaskie Voivodeship, 15-274
Investigational Site Number : 6160002
Katowice, Silesian Voivodeship, 40-752
Investigational Site Number : 6160005
Lodz, Lódzkie, 92-213
Investigational Site Number : 6160009
Szczecin, West Pomeranian Voivodeship, 71-252
Investigational Site Number : 6160006
Warsaw, Masovian Voivodeship, 02-097
Investigational Site Number : 6160004
Warsaw, Masovian Voivodeship, 02-117
Investigational Site Number : 6160007
Warsaw, Masovian Voivodeship, 04-746
Spain7 sites
Investigational Site Number : 7240001
Barcelona, Barcelona [Barcelona], 08035
Investigational Site Number : 7240002
Esplugues de Llobregat, Barcelona [Barcelona], 08950
Investigational Site Number : 7240004
Málaga, 29010
Investigational Site Number : 7240005
Oviedo, Principality of Asturias, 33011
Investigational Site Number : 7240003
Seville, Sevilla, 41009
Investigational Site Number : 7240006
Valencia, 46010
Investigational Site Number : 7240007
Vitoria-Gasteiz, Álava, 01009
United Kingdom7 sites
Investigational Site Number : 8260003
Birmingham, England, B15 2TH
Investigational Site Number : 8260007
Birmingham, England, B4 6NH
Investigational Site Number : 8260001
Cambridge, Cambridgeshire, CB2 2QQ
Investigational Site Number : 8260009
Dundee, Dundee City, DD1 9SY
Investigational Site Number : 8260010
Glasgow, Glasgow City, G51 4TF
Investigational Site Number : 8260006
Harrow, London, City of, HA1 3UJ
Investigational Site Number : 8260004
Leicester, Leicestershire, LE5 4PW
Canada5 sites
Investigational Site Number : 1240007
London, Ontario, N6a 4l6
Investigational Site Number : 1240005
Montreal, Quebec, H3T 1C5
Investigational Site Number : 1240004
Montreal, Quebec, H4a 3j1
Investigational Site Number : 1240003
Montreal, Quebec, H4A 3T2
Investigational Site Number : 1240001
Vancouver, British Columbia, V5Y 3W2
France5 sites
Investigational Site Number : 2500004
Corbeil-Essonnes, 91106
Investigational Site Number : 2500005
Mont-de-Marsan, 40024
Investigational Site Number : 2500006
Paris, 75679
Investigational Site Number : 2500007
Pontoise, 95300
Investigational Site Number : 2500003
Saint-Herblain, 44800
Hungary5 sites
Investigational Site Number : 3480001
Balatonfüred, 8230
Investigational Site Number : 3480004
Budapest, 1089
Investigational Site Number : 3480002
Nyíregyháza, 4400
Investigational Site Number : 3480003
Nyíregyháza, 4400
Investigational Site Number : 3480006
Székesfehérvár, 8000
Finland4 sites
Investigational Site Number : 2460001
Helsinki, 00029
Investigational Site Number : 2460004
Oulu, 90220
Investigational Site Number : 2460003
Tampere, 33520
Investigational Site Number : 2460002
Turku, 20521
Germany4 sites
Investigational Site Number : 2760003
Dresden, 01307
Investigational Site Number : 2760001
Hanover, 30173
Investigational Site Number : 2760002
Oldenburg in Holstein, 23758
Investigational Site Number : 2760004
Ulm, 89081
Austria3 sites
Investigational Site Number : 0400002
Graz, 8036
Investigational Site Number : 0400004
Linz, 4020
Investigational Site Number : 0400001
Vienna, 1090
Czechia3 sites
Investigational Site Number : 2030003
Ostrava, 708 52
Investigational Site Number : 2030002
Prague, 100 34
Investigational Site Number : 2030001
Prague, 150 06
Sweden3 sites
Investigational Site Number : 7520002
Solna, 171 64
Investigational Site Number : 7520001
Stockholm, 113 65
Investigational Site Number : 7520003
Stockholm, 118 83
Belgium2 sites
Investigational Site Number : 0560002
Brussels, 1090
Investigational Site Number : 0560001
Leuven, 3000
About this study
Official title: A Randomized, Double-blind, Placebo-controlled, Multi-center Phase 2b Study With a Blinded Extension and an Optional Open-label Extension-Assessing the Safety and Efficacy of Frexalimab, a CD40L-antagonist Monoclonal Antibody, for the Preservation of Pancreatic β-cell Function in Adults and Adolescents With Newly Diagnosed Type 1 Diabetes on Insulin Therapy
This is a randomized, parallel group, double-blind Phase 2 study with a blinded extension evaluating the safety and efficacy of 3 dose levels of frexalimab in comparison with placebo in participants with newly diagnosed T1D on insulin treatment.
Study details include:
Read more
Screening period: at least 3 weeks and up to 5 weeks. Enrollment date of the participant must take into consideration this constraint)
Double-blind treatment period 104 weeks:
Main treatment period: 52 weeks Blinded extension: 52 weeks Optional OLE period: 104 weeks Safety follow-up: 26 weeks The treatment duration will be up to 104 weeks , the total study duration will be up to 135 weeks for Part A and Part B.
If participants enter the OLE period, the treatment duration will be up to approximately 208 weeks , and the total study duration will be 240 weeks approximately .
- Conditions
- Type 1 Diabetes Mellitus
- Being tested
- Frexalimab, Placebo, Insulin
- 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.
FrexalimabDrug
IV Infusion at Day 1 SC Injection from W2 to W102
PlaceboDrug
IV Infusion at Day 1 SC Injection from W2 to W102
InsulinDrug
SC injection, dose and frequency will be established and/or adjusted by investigator
| Study group | Role | What they receive |
|---|---|---|
| Frexalimab Dose 1 | Experimental | Not described Receives: Drug: Frexalimab; Drug: Insulin |
| Frexalimab Dose 2 | Experimental | Not described Receives: Drug: Frexalimab; Drug: Insulin |
| Frexalimab Dose 3 | Experimental | Not described Receives: Drug: Frexalimab; Drug: Insulin |
| Placebo | Placebo comparator | Matching Placebo Receives: Drug: Placebo; Drug: Insulin |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in mean 2h mixed meal tolerance test (MMTT) stimulated C-peptide concentration, calculated from AUC from baseline to W52 for Part B (12-21 y.o.)
mixed meal tolerance test (MMTT) stimulated C-peptide concentration is to be calculated from AUC
Measured: Baseline to Week 52
Secondary outcomes (27)
Time in range (70-180 mg/dL), assessed by CGM at W52 and W104(part B)
Measured: At Week 52 and Week 104
Proportion of participants who remain C-peptide positive (mean 2h MMTT stimulated C-peptide concentration ≥0.2 nmol/L) at W52 and W104(part B)
mixed meal tolerance test (MMTT) stimulated C-peptide concentration is to be calculated from AUC
Measured: At Week 52 and Week 104
Proportion of participants with reduction from baseline to W52 and W104 of less than 10% in mean 2h MMTT stimulated C-peptide concentration(part B)
mixed meal tolerance test (MMTT) stimulated C-peptide concentration is to be calculated from AUC
Measured: From baseline to Week 52 and Week 104
Proportion of participants with partial remission at W52 and W104 (defined as IDAA1c score ≤9.0, where it is calculated as HbA1c [%] + 4x insulin dose [IU/kg/day])(part B)
Measured: At Week 52 and Week 104
Change from baseline to W52 and W104 in insulin dose [IU/kg/day](part B)
Measured: From baseline to Week 52 and Week 104
HbA1c level at Week 52 and Week 104(part B)
Measured: at Week 52 and Week 104
Proportion of participants with HbA1c ≤6.5% and requiring no injections of exogenous insulin at W52 and W104(part B)
Measured: At Week 52 and Week 104
Proportion of participants with HbA1c ≤6.5% and requiring ≤0.25 IU of insulin at W52 and W104(part B)
Measured: At Week 52 and Week 104
Proportion of participants with HbA1c <7% at W52 and W104(part B)
Measured: At Week 52 and Week 104
Incidence of treatment emergent adverse events (TEAEs), serious adverse events (SAEs), adverse events of special interest (AESIs) and TEAEs leading to treatment discontinuation
Measured: Until Week 130
Number of participants with at least one hypoglycemic event
Measured: Until Week 130
Number of participants with at least one hyperglycemic episode
Measured: Until Week 130
Number of participants with at least one diabetic ketoacidosis (DKA) event
Measured: Until Week 130
Number of participants with clinically significant changes in vital signs, electrocardiogram (ECG), and/or laboratory evaluation
Measured: Until Week 130
Height and growth rate over time (for participants <18 y.o. at screening)
Measured: Until Week 130
Frexalimab plasma concentrations over time
Measured: Until Week 104
Incidence of anti-drug antibodies (ADAs) over time
Measured: Until Week 130
Change from baseline to W52 and W104 in PedsQL Diabetes Symptoms domain score (all participants≥8 y.o.) (part B)
Measured: From baseline to Week 52 and Week 104
Change from baseline to W52 and W104 in Pediatric Quality of Life (PedsQL) Diabetes Management domain score (all participants≥8 y.o.) (part B)
Measured: From baseline to Week 52 and Week 104
Change from baseline to W52 and W104 in Problem Areas In Diabetes (PAID) total score (all participants)(part B)
Measured: From baseline to Week 52 and Week 104
Change from baseline to W52 and W104 in Diabetes Treatment Satisfaction Questionnaires (DTSQs) total and item scores (all participants)(part B)
Measured: From baseline to Week 52 and Week 104
Change from baseline to W52 and W104 in PAID immediate and theoretical domain scores (caregivers of all participants 12-17 y.o.)(part B)
Measured: From baseline to Week 52 and Week 104
Change from baseline to W52 and W104 in DTSQs Total and item scores (caregivers of all participants 12-17 y.o.)(part B)
Measured: From baseline to Week 52 and Week 104
Time in tight range (TITR, 70 - 140 mg/dL), assessed by CGM at W52 and W104(part B)
Measured: Time in tight range (TITR, 70 - 140 mg/dL), assessed by CGM at W52 and W104
Change from baseline to W104 in mean 2h mixed meal tolerance test (MMTT) stimulated C-peptide concentration, calculated from AUC(part B)
Measured: From baseline to Week 104
Change from baseline to W52 and W104 in IDAA1c score(part B)
Measured: From baseline to Week 52
HbA1c level change from baseline to Week 52 and Week 104(part B)
Measured: From baseline to Week 52 and Week 104
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted1 Nov 2023
- Study start11 Dec 2023
- Primary completion28 Apr 2027 (estimated)
- Study completion29 Oct 2030 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Type 1 Diabetes MellitusStudies of the same condition, open and under way.
- More trials run by SanofiThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- Parallel groups
- Masking
- Triple blind
- Who is masked
- Participant, Care provider, Investigator
- Enrolment
- 197 participants (actual)
Sponsor and investigators
- Lead sponsor
- Sanofi
- Sponsor type
- Industry (pharma, biotech, devices)
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06111586
- Sponsor's protocol ID
- DRI17476
- Other IDs
- U1111-1275-9618, 2022-500531-36
- Acronym
- FABULINUS
- Status last verified
- Oct 2026
- First submitted
- 27 Oct 2023
- Last updated
- 2 Nov 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- Yes: Qualified researchers may request access to patient level data and related study documents including the clinical study report, study protocol with any amendments, blank case report form, statistical analysis plan, and dataset specifications. Patient level data will be anonymized and study documents will be redacted to protect the privacy of trial participants. Further details on Sanofi's data sharing criteria, eligible studies, and process for requesting access can be found at: https://vivli.org
Publications
Cherkas A, Rotthaeuser B, Porksen N, Labard P, Nguyen-Pascal ML, Coudert M, Berthou B, Baccara-Dinet M, Boka G, Peakman M, Reschke F, Haller MJ. A Phase 2 Trial of Frexalimab, a CD40L Antagonist, in Adolescents and Adults With Recent-Onset Type 1 Diabetes (FABULINUS): Rationale and Study Design. Diabetes Obes Metab. 2026 Aug;28(8):6584-6594. doi: 10.1111/dom.70785. Epub 2026 May 27.
PubMed 42203212
Study at a glance
From the registry record, last updated by the sponsor on 2 Nov 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized, Double-blind, Placebo-controlled, Multi-center Phase 2b Study With a Blinded Extension and an Optional Open-label Extension-Assessing the Safety and Efficacy of Frexalimab, a CD40L-antagonist Monoclonal Antibody, for the Preservation of Pancreatic β-cell Function in Adults and Adolescents With Newly Diagnosed Type 1 Diabetes on Insulin Therapy
- ClinicalTrials.gov ID
- NCT06111586
- Acronym / sponsor ID
- FABULINUS / DRI17476
- Conditions
- Type 1 Diabetes Mellitus
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 197 participants (actual)
- Lead sponsor
- SanofiIndustry (pharma, biotech, devices)
- Study start
- 11 Dec 2023 (actual)
- Primary completion
- 28 Apr 2027 (estimated)
- Study completion
- 29 Oct 2030 (estimated)
- First posted
- 1 Nov 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This is a randomized, parallel group, double-blind Phase 2 study with a blinded extension evaluating the safety and efficacy of 3 dose levels of frexalimab in comparison with placebo in participants with newly diagnosed T1D on insulin treatment.
Study details include:
Screening period: at least 3 weeks and up to 5 weeks. Enrollment date of the participant must take into consideration this constraint)
Double-blind treatment period 104 weeks:
Main treatment period: 52 weeks Blinded extension: 52 weeks Optional OLE period: 104 weeks Safety follow-up: 26 weeks The treatment duration will be up to 104 weeks , the total study duration will be up to 135 weeks for Part A and Part B.
If participants enter the OLE period, the treatment duration will be up to approximately 208 weeks , and the total study duration will be 240 weeks approximately .
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, care provider, investigator)
- Number of arms
- 4
| Arm | Type | Receives |
|---|---|---|
| Frexalimab Dose 1 | Experimental | Drug: Frexalimab, Drug: Insulin |
| Frexalimab Dose 2 | Experimental | Drug: Frexalimab, Drug: Insulin |
| Frexalimab Dose 3 | Experimental | Drug: Frexalimab, Drug: Insulin |
| Placebo | Placebo comparator | Drug: Placebo, Drug: InsulinMatching Placebo |
Who may qualify
- Ages
- 12 to 35 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult
Key inclusion criteria (14 listed)
- Participants who meet the criteria of T1D according to American Diabetes Association
- Initiated exogenous insulin replacement therapy not longer than 90 days prior to screening visit at which random C-peptide will be assessed (V1).
- Receiving at least one of the following T1D standard of care (SOC), insulin hormone replacement therapy
- Participants must be positive for at least 1 of the following T1D autoantibodies confirmed by medical history and/or obtained at study screening:
- Have random C-peptide levels ≥ 0.2 nmol/L determined at screening visit.
Key exclusion criteria (20 listed)
- Serious systemic viral, bacterial or fungal infection (eg, pneumonia, pyelonephritis), infection requiring hospitalization or IV antibiotics or significant 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 (eg, osteomyelitis) 30 days before and during screening.
- Participants with a history of invasive opportunistic infections, such as, but not limited to histoplasmosis, listeriosis, coccidioidomycosis, candidiasis, pneumocystis jirovecii, and aspergillosis, regardless of resolution.
- 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. Blood testing (eg, QuantiFERON® TB Gold test) is strongly preferred; if not available, any local approved TB test is allowed.
- Evidence of any clinically significant, severe or unstable, acute or chronically progressive, uncontrolled infection, medical or surgical condition (eg, but not limited to, cerebral, cardiac, pulmonary, renal, hepatic, gastrointestinal, neurologic, acquired or inherited bone/skeletal disorders including repeated bone fractures for unknown reason, juvenile osteoporosis, osteogenesis imperfecta, osteochondropathies, or any known immune deficiency), or any condition that may affect participant safety in the judgment of the Investigator (including vaccinations which are not updated based on local regulation).
- History or current hypogammaglobulinemia.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| FrexalimabIV Infusion at Day 1 SC Injection from W2 to W102 | Drug | Frexalimab Dose 1, Frexalimab Dose 2, Frexalimab Dose 3 |
| PlaceboIV Infusion at Day 1 SC Injection from W2 to W102 | Drug | Placebo |
| InsulinSC injection, dose and frequency will be established and/or adjusted by investigator | Drug | Frexalimab Dose 1, Frexalimab Dose 2, Frexalimab Dose 3, Placebo |
Primary outcome
Change in mean 2h mixed meal tolerance test (MMTT) stimulated C-peptide concentration, calculated from AUC from baseline to W52 for Part B (12-21 y.o.)
Time frame: Baseline to Week 52
mixed meal tolerance test (MMTT) stimulated C-peptide concentration is to be calculated from AUC
27 secondary outcomes
Time in range (70-180 mg/dL), assessed by CGM at W52 and W104(part B)
Time frame: At Week 52 and Week 104
Proportion of participants who remain C-peptide positive (mean 2h MMTT stimulated C-peptide concentration ≥0.2 nmol/L) at W52 and W104(part B)
Time frame: At Week 52 and Week 104
Proportion of participants with reduction from baseline to W52 and W104 of less than 10% in mean 2h MMTT stimulated C-peptide concentration(part B)
Time frame: From baseline to Week 52 and Week 104
Proportion of participants with partial remission at W52 and W104 (defined as IDAA1c score ≤9.0, where it is calculated as HbA1c [%] + 4x insulin dose [IU/kg/day])(part B)
Time frame: At Week 52 and Week 104
Change from baseline to W52 and W104 in insulin dose [IU/kg/day](part B)
Time frame: From baseline to Week 52 and Week 104
HbA1c level at Week 52 and Week 104(part B)
Time frame: at Week 52 and Week 104
Proportion of participants with HbA1c ≤6.5% and requiring no injections of exogenous insulin at W52 and W104(part B)
Time frame: At Week 52 and Week 104
Proportion of participants with HbA1c ≤6.5% and requiring ≤0.25 IU of insulin at W52 and W104(part B)
Time frame: At Week 52 and Week 104
Proportion of participants with HbA1c <7% at W52 and W104(part B)
Time frame: At Week 52 and Week 104
Incidence of treatment emergent adverse events (TEAEs), serious adverse events (SAEs), adverse events of special interest (AESIs) and TEAEs leading to treatment discontinuation
Time frame: Until Week 130
Number of participants with at least one hypoglycemic event
Time frame: Until Week 130
Number of participants with at least one hyperglycemic episode
Time frame: Until Week 130
Number of participants with at least one diabetic ketoacidosis (DKA) event
Time frame: Until Week 130
Number of participants with clinically significant changes in vital signs, electrocardiogram (ECG), and/or laboratory evaluation
Time frame: Until Week 130
Height and growth rate over time (for participants <18 y.o. at screening)
Time frame: Until Week 130
Frexalimab plasma concentrations over time
Time frame: Until Week 104
Incidence of anti-drug antibodies (ADAs) over time
Time frame: Until Week 130
Change from baseline to W52 and W104 in PedsQL Diabetes Symptoms domain score (all participants≥8 y.o.) (part B)
Time frame: From baseline to Week 52 and Week 104
Change from baseline to W52 and W104 in Pediatric Quality of Life (PedsQL) Diabetes Management domain score (all participants≥8 y.o.) (part B)
Time frame: From baseline to Week 52 and Week 104
Change from baseline to W52 and W104 in Problem Areas In Diabetes (PAID) total score (all participants)(part B)
Time frame: From baseline to Week 52 and Week 104
Change from baseline to W52 and W104 in Diabetes Treatment Satisfaction Questionnaires (DTSQs) total and item scores (all participants)(part B)
Time frame: From baseline to Week 52 and Week 104
Change from baseline to W52 and W104 in PAID immediate and theoretical domain scores (caregivers of all participants 12-17 y.o.)(part B)
Time frame: From baseline to Week 52 and Week 104
Change from baseline to W52 and W104 in DTSQs Total and item scores (caregivers of all participants 12-17 y.o.)(part B)
Time frame: From baseline to Week 52 and Week 104
Time in tight range (TITR, 70 - 140 mg/dL), assessed by CGM at W52 and W104(part B)
Time frame: Time in tight range (TITR, 70 - 140 mg/dL), assessed by CGM at W52 and W104
Change from baseline to W104 in mean 2h mixed meal tolerance test (MMTT) stimulated C-peptide concentration, calculated from AUC(part B)
Time frame: From baseline to Week 104
Change from baseline to W52 and W104 in IDAA1c score(part B)
Time frame: From baseline to Week 52
HbA1c level change from baseline to Week 52 and Week 104(part B)
Time frame: From baseline to Week 52 and Week 104
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Nov 2026.
- Derived from this study: PubMed 42203212Cherkas A, Rotthaeuser B, Porksen N, Labard P, Nguyen-Pascal ML, Coudert M, Berthou B, Baccara-Dinet M, Boka G, Peakman M, Reschke F, Haller MJ. A Phase 2 Trial of Frexalimab, a CD40L Antagonist, in Adolescents and Adults With Recent-Onset Type 1 Diabetes (FABULINUS): Rationale and Study Design. Diabetes Obes Metab. 2026 Aug;28(8):6584-6594. doi: 10.1111/dom.70785. Epub 2026 May 27.
- DRI17476 Plain Language Results SummaryLink provided by the sponsor.
- Individual participant dataSharing planned: Yes. Qualified researchers may request access to patient level data and related study documents including the clinical study report, study protocol with any amendments, blank case report form, statistical analysis plan, and dataset specifications. Patient level data will be anonymized and study documents will be redacted to protect the privacy of trial participants. Further details on Sanofi's data sharing criteria, eligible studies, and process for requesting access can be found at: https://vivli.org
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
79 sites in 16 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing Frexalimab and Insulin in people with Type 1 Diabetes Mellitus, run by Sanofi at 79 sites in 16 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 14 inclusion and 20 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: under way, not looking for participants, as of the sponsor's last update on 2 Nov 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 79 sites in United States, Italy, Poland, Spain, United Kingdom and 11 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?
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?
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?
Change in mean 2h mixed meal tolerance test (MMTT) stimulated C-peptide concentration, calculated from AUC from baseline to W52 for Part B (12-21 y.o.) (time frame: Baseline to Week 52). 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 NCT06111586, which also lists 1 linked publication.
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 2 Nov 2026.