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Effectiveness of Florbetapir (18F) PET Imaging in Changing Patient Management and the Relationship Between Scan Status and Cognitive Decline

Primary Purpose

Alzheimer's Disease

Status
Completed
Phase
Phase 4
Locations
International
Study Type
Interventional
Intervention
florbetapir (18F)
Sponsored by
Avid Radiopharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Alzheimer's Disease

Eligibility Criteria

50 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Patients may be enrolled in the mild impairment (not demented) group if the following criteria are met:

  1. Males or females ≥ 50 to <= 90 years of age.
  2. Have cognitive decline verified by a study partner or cognitive impairment verified by the study physician.
  3. Have a study partner who provides separate consent and is willing to accompany the patient on all of the study visits.
  4. Have an MMSE score of 24 to 30 inclusive.
  5. Can tolerate a 10-minute PET scan.
  6. Have the ability to cooperate and comply with all study procedures.
  7. Have an enrolling physician who has less than high confidence in their diagnosis for the patient related to the cognitive decline at the time of enrollment.
  8. Ability to provide informed consent for study procedures.

Patients may be enrolled in the dementia group if the following criteria are met:

  1. Are males or females ≥ 50 to <= 90 years of age.
  2. Meet clinical criteria for dementia.
  3. Have a caregiver who provides separate consent and is willing to accompany the patient on all of the study visits.
  4. Have an MMSE score of 16 to 24 inclusive.
  5. Have not received a clinical examination and/or laboratory test results that strongly indicates a non-neurodegenerative cause for the patients cognitive impairment.
  6. Can tolerate a 10-minute PET scan.
  7. Have the ability to cooperate and comply with all study procedures.
  8. Have an enrolling physician who has less than high confidence in their diagnosis for the patient related to the cognitive decline at the time of enrollment.
  9. Ability to provide informed consent for study procedures. (If the patient is incapable of giving informed consent, the patient's legal representative may consent on behalf of the patient but the patient must still confirm assent. This person may serve as the study partner as well).

Exclusion Criteria:

Patients will be excluded from enrollment if they:

  1. Have a current serious or unstable illness;
  2. The patient or enrolling physician knows the result of a previous amyloid imaging scan;
  3. The patient has a known brain lesion, pathology or alternative diagnosis that strongly explains the patient's clinical presentation;
  4. Are receiving any investigational medications, or have participated in a trial with investigational medications within the last 30 days;
  5. Have ever participated in an experimental study with an amyloid targeting agent (e.g. anti-amyloid immunotherapy, γ -secretase or β -secretase inhibitor) unless it can be documented that the patient received only placebo during the course of the trial;
  6. Have had a radiopharmaceutical imaging or treatment procedure within 7 days prior to the study imaging session; or
  7. Are females of childbearing potential who are not surgically sterile, not refraining from sexual activity or not using reliable methods of contraception.

Patients will also be excluded from enrollment if their enrolling physician:

  1. Does not consider Alzheimer's disease as a potential cause of the patient's cognitive decline.
  2. Is not the primary physician taking care of the patient with respect to the management of their cognitive impairment.
  3. Cannot categorize the patient as either: a) having a documented and completed evaluation for cognitive decline within the past 18 months old; or b) currently undergoing evaluation for cognitive decline.
  4. Is unwilling to suspend all testing and other evaluation procedures between the time of the baseline evaluation of the enrolling physician's diagnosis and management plan and the time the completion of the PET scan.

Sites / Locations

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Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Intervention

Control

Arm Description

Subjects will receive florbetapir (18F) PET scans and physicians will have immediate access to PET scan results.

Subjects will receive florbetapir (18F) PET scans but physicians will be blinded to PET scan results for 12 months

Outcomes

Primary Outcome Measures

Clinical and Diagnostic Change in Patient Management
Comparison of the percentage of patients who have a change in management from baseline to 3 months for patients who receive scan results immediately (intervention arm) and those who receive scan results 12 months later (control arm).
Change in ADAS-Cog 11 Total Score
Change from baseline in the Alzheimer's Disease Assessment Scale - cognitive subscale (ADAS-cog) 11 Score in patients with mild impairment by positive or negative florbetapir (18F) PET scan result (Aß+/Aß-). ADAS-Cog scores (range 0-70) indicate performance on a series of 11 cognitive tasks where 0 indicates the highest level of cognitive performance and 70 indicates the lowest level of cognitive performance. Change in ADAS-Cog scores were calculated by subtracting the baseline score from the 12 month score. A change in ADAS-Cog greater than 0 indicates a deterioration in cognitive performance whereas a change in ADAS-Cog less than 0 indicates improved cognitive performance.

Secondary Outcome Measures

Change in Patient's Clinical Diagnosis
Comparison of the percentage of patients who have a change in diagnosis from baseline to 3 months for patients in the intervention and control arms for whom the scan result was not predicted by the initial diagnosis.
Change in Diagnostic Confidence
Comparison of the percentage point change in the physician's diagnostic confidence from baseline to month 3 in the intervention and control arms for patients whose scan result was predicted by their baseline clinical diagnosis. Diagnostic confidence was recorded by the physician as a whole number percent from 0-100% and the change in confidence was calculated by subtracting the baseline confidence from the confidence recorded at the specified timepoint. Values greater than zero reflect increased diagnostic confidence; values less than zero reflect decreased diagnostic confidence.
Change in Patient Management: Advice/Counseling
Comparison of the percentage of patients in the intervention and control arms who have a change in management relating to advice and counseling from baseline to 3 months.
Change in Caregiver Self-efficacy
Comparison of the change in self-efficacy between intervention and control arms. Change in self-efficacy is defined as the difference between total score on the Fortinsky: Family caregivers' self-efficacy for managing dementia scale at Follow-up (3 months) and baseline. Self-efficacy for managing dementia is defined in terms of specific behaviors or tasks that can be learned, and that are highly relevant to daily management of the disease process. The scale consists of 10 questions, each with responses ranging from 1 (not at all certain) to 10 (very certain). The total score is calculated by summing the response for each item. The total score ranges from 10 to 100, with increasing scores representing increasing caregiver self-efficacy.
Change in Patient Management: Individual Categories
Compare the percentage of patients with a change from baseline in the individual patient management categories at 3 months in the interventional and control arms.The individual categories are: Major diagnostic tests, Alzheimer's/cognition medication, neuropsychological tests, physician follow-up for re-evaluation or specialist referral.

Full Information

First Posted
October 5, 2012
Last Updated
July 8, 2016
Sponsor
Avid Radiopharmaceuticals
Collaborators
Eli Lilly and Company
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1. Study Identification

Unique Protocol Identification Number
NCT01703702
Brief Title
Effectiveness of Florbetapir (18F) PET Imaging in Changing Patient Management and the Relationship Between Scan Status and Cognitive Decline
Official Title
A Randomized, Multicenter, Multicountry Study to Evaluate the Effectiveness of Florbetapir (18F) PET Imaging in Changing Patient Management and to Evaluate the Relationship Between Florbetapir (18F) PET Scan Status and Cognitive Decline
Study Type
Interventional

2. Study Status

Record Verification Date
July 2016
Overall Recruitment Status
Completed
Study Start Date
October 2012 (undefined)
Primary Completion Date
April 2015 (Actual)
Study Completion Date
April 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Avid Radiopharmaceuticals
Collaborators
Eli Lilly and Company

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This study is designed to determine the effectiveness of florbetapir (18F) in changing patient management and to evaluate the association between scan status and cognitive decline.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alzheimer's Disease

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
641 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Intervention
Arm Type
Experimental
Arm Description
Subjects will receive florbetapir (18F) PET scans and physicians will have immediate access to PET scan results.
Arm Title
Control
Arm Type
Experimental
Arm Description
Subjects will receive florbetapir (18F) PET scans but physicians will be blinded to PET scan results for 12 months
Intervention Type
Drug
Intervention Name(s)
florbetapir (18F)
Other Intervention Name(s)
18F-AV-45, florbetapir F 18, AV-45, Amyvid
Intervention Description
Single i.v. bolus injection of 370MBq (10 mCi) followed by saline flush, 50 minutes prior to imaging, 10 minute image duration
Primary Outcome Measure Information:
Title
Clinical and Diagnostic Change in Patient Management
Description
Comparison of the percentage of patients who have a change in management from baseline to 3 months for patients who receive scan results immediately (intervention arm) and those who receive scan results 12 months later (control arm).
Time Frame
Baseline and 3 months
Title
Change in ADAS-Cog 11 Total Score
Description
Change from baseline in the Alzheimer's Disease Assessment Scale - cognitive subscale (ADAS-cog) 11 Score in patients with mild impairment by positive or negative florbetapir (18F) PET scan result (Aß+/Aß-). ADAS-Cog scores (range 0-70) indicate performance on a series of 11 cognitive tasks where 0 indicates the highest level of cognitive performance and 70 indicates the lowest level of cognitive performance. Change in ADAS-Cog scores were calculated by subtracting the baseline score from the 12 month score. A change in ADAS-Cog greater than 0 indicates a deterioration in cognitive performance whereas a change in ADAS-Cog less than 0 indicates improved cognitive performance.
Time Frame
Baseline and 12 months
Secondary Outcome Measure Information:
Title
Change in Patient's Clinical Diagnosis
Description
Comparison of the percentage of patients who have a change in diagnosis from baseline to 3 months for patients in the intervention and control arms for whom the scan result was not predicted by the initial diagnosis.
Time Frame
Baseline and 3 months
Title
Change in Diagnostic Confidence
Description
Comparison of the percentage point change in the physician's diagnostic confidence from baseline to month 3 in the intervention and control arms for patients whose scan result was predicted by their baseline clinical diagnosis. Diagnostic confidence was recorded by the physician as a whole number percent from 0-100% and the change in confidence was calculated by subtracting the baseline confidence from the confidence recorded at the specified timepoint. Values greater than zero reflect increased diagnostic confidence; values less than zero reflect decreased diagnostic confidence.
Time Frame
Baseline and 3 months
Title
Change in Patient Management: Advice/Counseling
Description
Comparison of the percentage of patients in the intervention and control arms who have a change in management relating to advice and counseling from baseline to 3 months.
Time Frame
Baseline and 3 months
Title
Change in Caregiver Self-efficacy
Description
Comparison of the change in self-efficacy between intervention and control arms. Change in self-efficacy is defined as the difference between total score on the Fortinsky: Family caregivers' self-efficacy for managing dementia scale at Follow-up (3 months) and baseline. Self-efficacy for managing dementia is defined in terms of specific behaviors or tasks that can be learned, and that are highly relevant to daily management of the disease process. The scale consists of 10 questions, each with responses ranging from 1 (not at all certain) to 10 (very certain). The total score is calculated by summing the response for each item. The total score ranges from 10 to 100, with increasing scores representing increasing caregiver self-efficacy.
Time Frame
Baseline and 3 months
Title
Change in Patient Management: Individual Categories
Description
Compare the percentage of patients with a change from baseline in the individual patient management categories at 3 months in the interventional and control arms.The individual categories are: Major diagnostic tests, Alzheimer's/cognition medication, neuropsychological tests, physician follow-up for re-evaluation or specialist referral.
Time Frame
Baseline and 3 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients may be enrolled in the mild impairment (not demented) group if the following criteria are met: Males or females ≥ 50 to <= 90 years of age. Have cognitive decline verified by a study partner or cognitive impairment verified by the study physician. Have a study partner who provides separate consent and is willing to accompany the patient on all of the study visits. Have an MMSE score of 24 to 30 inclusive. Can tolerate a 10-minute PET scan. Have the ability to cooperate and comply with all study procedures. Have an enrolling physician who has less than high confidence in their diagnosis for the patient related to the cognitive decline at the time of enrollment. Ability to provide informed consent for study procedures. Patients may be enrolled in the dementia group if the following criteria are met: Are males or females ≥ 50 to <= 90 years of age. Meet clinical criteria for dementia. Have a caregiver who provides separate consent and is willing to accompany the patient on all of the study visits. Have an MMSE score of 16 to 24 inclusive. Have not received a clinical examination and/or laboratory test results that strongly indicates a non-neurodegenerative cause for the patients cognitive impairment. Can tolerate a 10-minute PET scan. Have the ability to cooperate and comply with all study procedures. Have an enrolling physician who has less than high confidence in their diagnosis for the patient related to the cognitive decline at the time of enrollment. Ability to provide informed consent for study procedures. (If the patient is incapable of giving informed consent, the patient's legal representative may consent on behalf of the patient but the patient must still confirm assent. This person may serve as the study partner as well). Exclusion Criteria: Patients will be excluded from enrollment if they: Have a current serious or unstable illness; The patient or enrolling physician knows the result of a previous amyloid imaging scan; The patient has a known brain lesion, pathology or alternative diagnosis that strongly explains the patient's clinical presentation; Are receiving any investigational medications, or have participated in a trial with investigational medications within the last 30 days; Have ever participated in an experimental study with an amyloid targeting agent (e.g. anti-amyloid immunotherapy, γ -secretase or β -secretase inhibitor) unless it can be documented that the patient received only placebo during the course of the trial; Have had a radiopharmaceutical imaging or treatment procedure within 7 days prior to the study imaging session; or Are females of childbearing potential who are not surgically sterile, not refraining from sexual activity or not using reliable methods of contraception. Patients will also be excluded from enrollment if their enrolling physician: Does not consider Alzheimer's disease as a potential cause of the patient's cognitive decline. Is not the primary physician taking care of the patient with respect to the management of their cognitive impairment. Cannot categorize the patient as either: a) having a documented and completed evaluation for cognitive decline within the past 18 months old; or b) currently undergoing evaluation for cognitive decline. Is unwilling to suspend all testing and other evaluation procedures between the time of the baseline evaluation of the enrolling physician's diagnosis and management plan and the time the completion of the PET scan.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Chief Medical Officer
Organizational Affiliation
Avid Radiopharmaceuticals
Official's Role
Study Director
Facility Information:
Facility Name
Research Site
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85006
Country
United States
Facility Name
Research Site
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85054
Country
United States
Facility Name
Research Site
City
Scottsdale
State/Province
Arizona
ZIP/Postal Code
85258
Country
United States
Facility Name
Research Site
City
Sun City
State/Province
Arizona
ZIP/Postal Code
85351
Country
United States
Facility Name
Research Site
City
Clearwater
State/Province
Florida
ZIP/Postal Code
33756
Country
United States
Facility Name
Research Site
City
Miami Beach
State/Province
Florida
ZIP/Postal Code
33140
Country
United States
Facility Name
Research Site
City
Orlando
State/Province
Florida
ZIP/Postal Code
32806
Country
United States
Facility Name
Research Site
City
West Palm Beach
State/Province
Florida
ZIP/Postal Code
33407
Country
United States
Facility Name
Research Site
City
Shreveport
State/Province
Louisiana
ZIP/Postal Code
71130
Country
United States
Facility Name
Research Site
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
Research Site
City
Chestnut Hill
State/Province
Massachusetts
ZIP/Postal Code
02467
Country
United States
Facility Name
Research Site
City
Quincy
State/Province
Massachusetts
ZIP/Postal Code
02169
Country
United States
Facility Name
Research Site
City
Las Vegas
State/Province
Nevada
ZIP/Postal Code
89106
Country
United States
Facility Name
Research Site
City
Las Vegas
State/Province
Nevada
ZIP/Postal Code
89128
Country
United States
Facility Name
Research Site
City
Patchogue
State/Province
New York
ZIP/Postal Code
11772
Country
United States
Facility Name
Research Site
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States
Facility Name
Research Site
City
Greensboro
State/Province
North Carolina
ZIP/Postal Code
27405
Country
United States
Facility Name
Research Site
City
Providence
State/Province
Rhode Island
ZIP/Postal Code
02903
Country
United States
Facility Name
Research Site
City
Providence
State/Province
Rhode Island
ZIP/Postal Code
02906
Country
United States
Facility Name
Research Site
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84108
Country
United States
Facility Name
Research Site
City
Bennington
State/Province
Vermont
ZIP/Postal Code
05201
Country
United States
Facility Name
Research Site
City
Amiens
ZIP/Postal Code
80054
Country
France
Facility Name
Research Site
City
Bordeaux
ZIP/Postal Code
33076
Country
France
Facility Name
Research Site
City
Bron
ZIP/Postal Code
69500
Country
France
Facility Name
Research Site
City
Dijon
ZIP/Postal Code
21033
Country
France
Facility Name
Research Site
City
Lille
ZIP/Postal Code
59037
Country
France
Facility Name
Research Site
City
Marseille
ZIP/Postal Code
13385
Country
France
Facility Name
Research Site
City
Montpellier
ZIP/Postal Code
34000
Country
France
Facility Name
Research Site
City
Nancy
ZIP/Postal Code
54035
Country
France
Facility Name
Research Site
City
Nantes
ZIP/Postal Code
44093
Country
France
Facility Name
Research Site
City
Nice
ZIP/Postal Code
06003
Country
France
Facility Name
Research Site
City
Paris
ZIP/Postal Code
75651
Country
France
Facility Name
Research Site
City
Pessac
ZIP/Postal Code
33604
Country
France
Facility Name
Research Site
City
Reims
ZIP/Postal Code
51092
Country
France
Facility Name
Research Site
City
Rouen
ZIP/Postal Code
76031
Country
France
Facility Name
Research Site
City
Strasbourg
ZIP/Postal Code
67098
Country
France
Facility Name
Research Site
City
Toulouse
ZIP/Postal Code
31059
Country
France
Facility Name
Research Site
City
Tours
ZIP/Postal Code
37044
Country
France
Facility Name
Research Site
City
Villeurbanne
ZIP/Postal Code
69100
Country
France
Facility Name
Research Site
City
Bergamo
ZIP/Postal Code
24127
Country
Italy
Facility Name
Research Site
City
Brescia
ZIP/Postal Code
20125
Country
Italy
Facility Name
Research Site
City
Brescia
ZIP/Postal Code
25123
Country
Italy
Facility Name
Research Site
City
Florence
ZIP/Postal Code
50139
Country
Italy
Facility Name
Research Site
City
Genoa
ZIP/Postal Code
16128
Country
Italy
Facility Name
Research Site
City
Genoa
ZIP/Postal Code
16132
Country
Italy
Facility Name
Research Site
City
Milan
ZIP/Postal Code
20122
Country
Italy
Facility Name
Research Site
City
Milan
ZIP/Postal Code
20132
Country
Italy
Facility Name
Research Site
City
Milan
ZIP/Postal Code
20133
Country
Italy
Facility Name
Research Site
City
Milan
ZIP/Postal Code
20162
Country
Italy
Facility Name
Research Site
City
Modena
ZIP/Postal Code
41126
Country
Italy
Facility Name
Research Site
City
Monza
ZIP/Postal Code
20900
Country
Italy
Facility Name
Research Site
City
Padova
ZIP/Postal Code
35128
Country
Italy
Facility Name
Research Site
City
Parma
ZIP/Postal Code
43100
Country
Italy
Facility Name
Research Site
City
Perugia
ZIP/Postal Code
06132
Country
Italy
Facility Name
Research Site
City
Pisa
ZIP/Postal Code
56126
Country
Italy
Facility Name
Research Site
City
Rome
ZIP/Postal Code
00133
Country
Italy
Facility Name
Research Site
City
Rome
ZIP/Postal Code
00179
Country
Italy

12. IPD Sharing Statement

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Effectiveness of Florbetapir (18F) PET Imaging in Changing Patient Management and the Relationship Between Scan Status and Cognitive Decline

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