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Efficacy of Circadin® 2 mg in Patients With Mild to Moderate Alzheimer Disease Treated With AChE Inhibitor

Primary Purpose

Alzheimer's Disease, Sleep Disorder

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Circadin
Placebo
Sponsored by
Neurim Pharmaceuticals Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alzheimer's Disease focused on measuring Alzheimer's Disease, Acetylcholinesterase inhibitor, cognitive function, Circadin, Sleep disturbances

Eligibility Criteria

50 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Written informed consent as dictated by local legal circumstances.
  2. Age range: adult patients between 50-85 years of age.
  3. Gender: men and women. Women of child bearing potential or within two years of the menopause must have a negative urine pregnancy test at the Screening Visit.
  4. A documented history of confirmed Alzheimer's disease
  5. Dementia severity: MMSE score > 15,
  6. Stable AChE inhibitor dose for 2 months prior to Screening visit.
  7. Stable medications for non-excluded concurrent medical conditions for four weeks prior to the screening visit.
  8. Stable doses of B12 and/or Folic acid supplements for at least 3 months prior to enrollment and throughout the study.
  9. Cranial image: no evidence of focal disease to account for dementia (established by CT, PET or MRI). If there is no such available scan (CT, PET or MRI), one must be performed prior to enrollment.
  10. Health: Physically acceptable for the study with no pathology likely to occur during or immediately after the study, as confirmed by medical history and exam and ECG.
  11. Clinical laboratory values must be within normal limits, or judged not clinically significant by the investigator.
  12. Residence: Stable home situation with no planned move during the 28-week investigational period.
  13. A family member or a regular caregiver that will be available for visits and will ensure compliance. The caregiver must speak fluent Hebrew, Russian or English.
  14. Ability to ingest oral medication and participate in all scheduled evaluations.
  15. Ability to spend 2 daily hours outdoors exposed to sunlight.

Exclusion Criteria:

  1. Severe agitation.
  2. Unstable medical condition, mental retardation.
  3. moderate to severe depression as defined by DSM-IV
  4. Use of benzodiazepines or other hypnotics during the study and the preceding four weeks.
  5. Use of Circadin® during the two weeks prior to study enrollment.
  6. Pharmacological immunosuppression.
  7. Participation in a clinical trial with any investigational agent within two months prior to study enrollment.
  8. Alcoholism.
  9. Known or suspected hypersensitivity to exogenous melatonin or melatonin receptor agonists.
  10. Patients with rare hereditary problems of galactose intolerance, the LAPP lactose deficiency or glucose mal absorption.
  11. Renal Failure with creatinine >150 micromol/l.
  12. Hepatic Failure with ASAT; ALAT; GGT levels above three times the upper normal limit.
  13. Clinically significant abnormal laboratory findings which have not been approved by the Safety Officer (sponsor)
  14. Other serious diseases that could interfere with patient assessment.
  15. Caregivers who are unwilling or unable to give informed consent or otherwise fulfill requirements of the study.
  16. Untreated B12 and/or Folic acid deficiency.

Sites / Locations

  • Meridien Research
  • Meridien Research
  • Exodon LLC
  • Scranton Medical Institute
  • Merchav clinics
  • CPS Research

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Circadin

Placebo

Arm Description

Drug

drug

Outcomes

Primary Outcome Measures

Change From Baseline to 24 Weeks in ADAS-cog
ADAS-cog (Alzheimer's Disease Assessment Scale-cognitive subscale) is a cognitive testing instrument used in clinical trials. It consists of 11 tasks measuring the disturbances of memory, language, praxis, attention, and other cognitive abilities that are often referred to as the core symptoms of AD. The test comprises 11 items summed to a total score ranging from 0 to 70, with lower scores indicating less severe impairment. A negative change indicates an improvement from baseline. ADAS-cog was measured at base line and at end of treatment after 24 weeks.

Secondary Outcome Measures

Change From Baseline to 24 Weeks in iADL
Instrumental Activities of Daily Living (iADL). The scale rates activities that represent key life tasks that people need to manage. These tasks are valuable for evaluating persons with early-stage disease, both to assess the level of disease and to determine the person's ability to care for himself or herself. Scores of 0 or 1 are given to every task (Bathing, Dressing, Tolieting, transferring, Continence and Feeding) to a total score of 6. , while 0 represents a patient who is very dependent and 6 represents patient who is independent. iADL was measured at base line and at end of treatment after 24 weeks.
Change From Baseline to 24 Weeks in MMSE
The Mini Mental State Examination (MMSE) is a brief assessment instrument used to assess cognitive function in elderly patients. The MMSE can be used to screen for cognitive impairment and as a measurement of cognition over time and with pharmacologic treatment. The instrument is divided into 2 sections. The first section measures orientation, memory, and attention: the maximum score is 21. The second section tests the ability of the patient to name objects, follow verbal and written commands, write a sentence, and copy figures: the maximum score is 9. The scoring range for the MMSE is 0-30. Higher score represents better performance. MMSE was measured at base line and at end of treatment after 24 weeks.

Full Information

First Posted
July 15, 2009
Last Updated
May 29, 2018
Sponsor
Neurim Pharmaceuticals Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT00940589
Brief Title
Efficacy of Circadin® 2 mg in Patients With Mild to Moderate Alzheimer Disease Treated With AChE Inhibitor
Official Title
A Double-blind, Parallel Group, Randomized, Placebo Controlled Study of the Efficacy of Circadin® 2mg in Patients With Mild to Moderate Alzheimer Disease (AD) Treated With Acetylcholinesterase (AChE) Inhibitor
Study Type
Interventional

2. Study Status

Record Verification Date
May 2018
Overall Recruitment Status
Completed
Study Start Date
September 2009 (undefined)
Primary Completion Date
February 2013 (Actual)
Study Completion Date
May 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Neurim Pharmaceuticals Ltd.

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The aim of this exploratory randomized, placebo controlled study is to evaluate the efficacy of Circadin® 2mg in patients with mild to moderate Alzheimer Disease (AD) treated with the acetylcholinesterase (AChE) inhibitor. The effects of add-on Circadin® 2mg vs. placebo on the decline in cognitive skills and global functioning, as well as on daytime somnolence and will be assessed.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alzheimer's Disease, Sleep Disorder
Keywords
Alzheimer's Disease, Acetylcholinesterase inhibitor, cognitive function, Circadin, Sleep disturbances

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
73 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Circadin
Arm Type
Experimental
Arm Description
Drug
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
drug
Intervention Type
Drug
Intervention Name(s)
Circadin
Intervention Description
Prolonged Release melatonin (Circadin) 2mg tablets
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Matched placebo tablets, with identical features to the Circadin tablets
Primary Outcome Measure Information:
Title
Change From Baseline to 24 Weeks in ADAS-cog
Description
ADAS-cog (Alzheimer's Disease Assessment Scale-cognitive subscale) is a cognitive testing instrument used in clinical trials. It consists of 11 tasks measuring the disturbances of memory, language, praxis, attention, and other cognitive abilities that are often referred to as the core symptoms of AD. The test comprises 11 items summed to a total score ranging from 0 to 70, with lower scores indicating less severe impairment. A negative change indicates an improvement from baseline. ADAS-cog was measured at base line and at end of treatment after 24 weeks.
Time Frame
24 weeks
Secondary Outcome Measure Information:
Title
Change From Baseline to 24 Weeks in iADL
Description
Instrumental Activities of Daily Living (iADL). The scale rates activities that represent key life tasks that people need to manage. These tasks are valuable for evaluating persons with early-stage disease, both to assess the level of disease and to determine the person's ability to care for himself or herself. Scores of 0 or 1 are given to every task (Bathing, Dressing, Tolieting, transferring, Continence and Feeding) to a total score of 6. , while 0 represents a patient who is very dependent and 6 represents patient who is independent. iADL was measured at base line and at end of treatment after 24 weeks.
Time Frame
24 weeks
Title
Change From Baseline to 24 Weeks in MMSE
Description
The Mini Mental State Examination (MMSE) is a brief assessment instrument used to assess cognitive function in elderly patients. The MMSE can be used to screen for cognitive impairment and as a measurement of cognition over time and with pharmacologic treatment. The instrument is divided into 2 sections. The first section measures orientation, memory, and attention: the maximum score is 21. The second section tests the ability of the patient to name objects, follow verbal and written commands, write a sentence, and copy figures: the maximum score is 9. The scoring range for the MMSE is 0-30. Higher score represents better performance. MMSE was measured at base line and at end of treatment after 24 weeks.
Time Frame
24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent as dictated by local legal circumstances. Age range: adult patients between 50-85 years of age. Gender: men and women. Women of child bearing potential or within two years of the menopause must have a negative urine pregnancy test at the Screening Visit. A documented history of confirmed Alzheimer's disease Dementia severity: MMSE score > 15, Stable AChE inhibitor dose for 2 months prior to Screening visit. Stable medications for non-excluded concurrent medical conditions for four weeks prior to the screening visit. Stable doses of B12 and/or Folic acid supplements for at least 3 months prior to enrollment and throughout the study. Cranial image: no evidence of focal disease to account for dementia (established by CT, PET or MRI). If there is no such available scan (CT, PET or MRI), one must be performed prior to enrollment. Health: Physically acceptable for the study with no pathology likely to occur during or immediately after the study, as confirmed by medical history and exam and ECG. Clinical laboratory values must be within normal limits, or judged not clinically significant by the investigator. Residence: Stable home situation with no planned move during the 28-week investigational period. A family member or a regular caregiver that will be available for visits and will ensure compliance. The caregiver must speak fluent Hebrew, Russian or English. Ability to ingest oral medication and participate in all scheduled evaluations. Ability to spend 2 daily hours outdoors exposed to sunlight. Exclusion Criteria: Severe agitation. Unstable medical condition, mental retardation. moderate to severe depression as defined by DSM-IV Use of benzodiazepines or other hypnotics during the study and the preceding four weeks. Use of Circadin® during the two weeks prior to study enrollment. Pharmacological immunosuppression. Participation in a clinical trial with any investigational agent within two months prior to study enrollment. Alcoholism. Known or suspected hypersensitivity to exogenous melatonin or melatonin receptor agonists. Patients with rare hereditary problems of galactose intolerance, the LAPP lactose deficiency or glucose mal absorption. Renal Failure with creatinine >150 micromol/l. Hepatic Failure with ASAT; ALAT; GGT levels above three times the upper normal limit. Clinically significant abnormal laboratory findings which have not been approved by the Safety Officer (sponsor) Other serious diseases that could interfere with patient assessment. Caregivers who are unwilling or unable to give informed consent or otherwise fulfill requirements of the study. Untreated B12 and/or Folic acid deficiency.
Facility Information:
Facility Name
Meridien Research
City
Brooksville
State/Province
Florida
ZIP/Postal Code
34601
Country
United States
Facility Name
Meridien Research
City
Saint Petersburg
State/Province
Florida
ZIP/Postal Code
33709
Country
United States
Facility Name
Exodon LLC
City
Mount Arlington
State/Province
New Jersey
ZIP/Postal Code
07856
Country
United States
Facility Name
Scranton Medical Institute
City
Scranton
State/Province
Pennsylvania
ZIP/Postal Code
18503
Country
United States
Facility Name
Merchav clinics
City
Tel-Aviv
Country
Israel
Facility Name
CPS Research
City
Glasgow
ZIP/Postal Code
G20 0XA
Country
United Kingdom

12. IPD Sharing Statement

Citations:
PubMed Identifier
24971004
Citation
Wade AG, Farmer M, Harari G, Fund N, Laudon M, Nir T, Frydman-Marom A, Zisapel N. Add-on prolonged-release melatonin for cognitive function and sleep in mild to moderate Alzheimer's disease: a 6-month, randomized, placebo-controlled, multicenter trial. Clin Interv Aging. 2014 Jun 18;9:947-61. doi: 10.2147/CIA.S65625. eCollection 2014.
Results Reference
result
PubMed Identifier
33189083
Citation
McCleery J, Sharpley AL. Pharmacotherapies for sleep disturbances in dementia. Cochrane Database Syst Rev. 2020 Nov 15;11(11):CD009178. doi: 10.1002/14651858.CD009178.pub4.
Results Reference
derived

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Efficacy of Circadin® 2 mg in Patients With Mild to Moderate Alzheimer Disease Treated With AChE Inhibitor

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