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Evaluating Liraglutide in Alzheimer's Disease (ELAD)

Primary Purpose

Alzheimer's Disease

Status
Unknown status
Phase
Phase 2
Locations
United Kingdom
Study Type
Interventional
Intervention
Liraglutide
Placebo
Sponsored by
Imperial College London
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alzheimer's Disease

Eligibility Criteria

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

Inclusion Criteria:

  1. Capable of giving and capacity to give informed consent
  2. An individual who can act as a reliable study partner with regular contact (combination of face to face visits / telephone contact acceptable) who has sufficient subject interaction to provide meaningful input into rating scales and, if necessary, supervise or perform the injections, as judged by the investigator
  3. Diagnosis of Probable Alzheimer's disease according to Dubois criteria (Dubois, Feldman et al. 2007) or National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria
  4. Age from 50 years
  5. Mini-Mental State Examination (MMSE) score of ≥20 and CDR-Global score of 0.5 or 1
  6. Rosen Modified Hachinski Ischemic score ≤4
  7. On stable medication for 2 months before the screening visit; on or off cholinesterase inhibitors
  8. Fluency in English and evidence of adequate premorbid intellectual functioning
  9. Likely to be able to participate in all scheduled evaluations and complete all required tests

Exclusion Criteria:

  1. Patients on treatment for diabetes mellitus
  2. Any contraindications to the use of liraglutide as per the Summary of Product Characteristics (hepatic impairment, renal impairment with CKD stage 4 and above (eGFR <30 ml/min/1.73m2), inflammatory bowel disease). Patients with eGFR less than 45 ml/min/1.73m2 will have the renal function monitored very closely
  3. Significant neurological disease other than AD that may affect cognition
  4. MRI/CT showing unambiguous aetiological evidence of cerebrovascular disease with regard to their dementia or vascular dementia fulfilling NINCDS-AIREN criteria
  5. Current presence of a clinically significant major psychiatric disorder (e.g., Major Depressive Disorder) according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)
  6. Current clinically significant systemic illness that is likely to result in deterioration of the patient's condition or affect the patient's safety during the study
  7. History of epilepsy, where seizures or treatment could have contributed to cognitive impairment
  8. Treatment with immunosuppressive medications (e.g. systemic corticosteroids) within the last 90 days (topical and nasal corticosteroids and inhaled corticosteroids for asthma are permitted) or chemotherapeutic agents for malignancy within the last 3 years
  9. Myocardial infarction within the last 1 year
  10. History of cancer within the last 5 years, except localised skin cancer
  11. Other clinically significant abnormality on physical, neurological or laboratory examination that could compromise the study or be detrimental to the patient
  12. History of alcohol or drug dependence or abuse within the last 2 years
  13. Current use of anticonvulsant, anti-Parkinson's, anticoagulant (excluding the use of aspirin 325 mg/day or less) or narcotic medications. Subjects on anticoagulants will be allowed, but will not have an arterial line inserted
  14. Use of experimental medications for AD or any other investigational medication or device within 60 days. Patients who have been involved in a monoclonal antibody study are excluded unless it is known that they were receiving placebo in that trial
  15. Women of childbearing potential. Women who could become pregnant will be required to use adequate contraception throughout the trial
  16. Patients with a personal or family history of medullary thyroid carcinoma (MTC) and patients with multiple endocrine neoplasia type 2 (MEN2)
  17. Any contraindications to MRI scanning

Sites / Locations

  • Imperial College, Hammersmith Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Liraglutide

Placebo

Arm Description

Daily administration of 1.8 mg liraglutide by subcutaneous injection

Daily administration of matched placebo by subcutaneous injection

Outcomes

Primary Outcome Measures

The change in cerebral glucose metabolic rate
The change in cerebral glucose metabolic rate from baseline to follow up (12 months) in the treatment group compared with the placebo group.

Secondary Outcome Measures

The change in z-scores for the ADAS Exec, MRI changes, microglial activation, and CSF markers
The change in z-scores for the ADAS Exec, MRI changes, microglial activation, and CSF markers
The incidence and severity of treatment emergent adverse events
The incidence and severity of treatment emergent adverse events or clinically important changes in safety assessments over 12 months.
The change in microglial activation
To establish whether there is a reduction in microglial activation in subjects with mild AD following daily subcutaneous injection of liraglutide for 1 year using TSPO PET scanning compared with subjects receiving placebo injections in a subgroup of patients
The change in tau deposition
The change in the hippocampal, entorhinal and other cortical changes in tau deposition in treatment group compared to the placebo group in a subgroup of subjects.
The change in cortical amyloid
Changes in levels of cortical amyloid load in treatment group compared to the placebo group in a subgroup of subjects.

Full Information

First Posted
April 24, 2013
Last Updated
June 6, 2019
Sponsor
Imperial College London
Collaborators
King's College Hospital NHS Trust, University of Oxford, University of Southampton, Avon and Wiltshire Mental Health Partnership NHS Trust
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1. Study Identification

Unique Protocol Identification Number
NCT01843075
Brief Title
Evaluating Liraglutide in Alzheimer's Disease
Acronym
ELAD
Official Title
Evaluating the Effects of the Novel GLP-1 Analogue, Liraglutide, in Patients With Mild Alzheimer's Disease (ELAD Study)
Study Type
Interventional

2. Study Status

Record Verification Date
June 2019
Overall Recruitment Status
Unknown status
Study Start Date
January 2014 (Actual)
Primary Completion Date
December 2019 (Anticipated)
Study Completion Date
December 2019 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Imperial College London
Collaborators
King's College Hospital NHS Trust, University of Oxford, University of Southampton, Avon and Wiltshire Mental Health Partnership NHS Trust

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a 12-month, multicentre randomised double-blind placebo-controlled Phase IIb study in patients with mild Alzheimer's dementia (AD). Patients will be randomised on a 1:1 ratio to receive liraglutide or matching placebo.
Detailed Description
The investigators aim to recruit patients with mild Alzheimer's dementia as defined by the National Institute of Neurological and Communicative Disorders and Stroke - Alzheimer's Disease and Related Disorder Association (NINCDS-ADRDA) Criteria for Probable Alzheimer's Dementia or meeting Dubois criteria for early AD, with Mini Mental State Evaluation score of at least 20 out of a maximum of 30 and a CDR Global score of 0.5 or 1. .

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

8. Arms, Groups, and Interventions

Arm Title
Liraglutide
Arm Type
Experimental
Arm Description
Daily administration of 1.8 mg liraglutide by subcutaneous injection
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Daily administration of matched placebo by subcutaneous injection
Intervention Type
Drug
Intervention Name(s)
Liraglutide
Other Intervention Name(s)
Victoza
Intervention Description
Daily subcutaneous injection
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Daily subcutaneous injection
Primary Outcome Measure Information:
Title
The change in cerebral glucose metabolic rate
Description
The change in cerebral glucose metabolic rate from baseline to follow up (12 months) in the treatment group compared with the placebo group.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
The change in z-scores for the ADAS Exec, MRI changes, microglial activation, and CSF markers
Description
The change in z-scores for the ADAS Exec, MRI changes, microglial activation, and CSF markers
Time Frame
12 months
Title
The incidence and severity of treatment emergent adverse events
Description
The incidence and severity of treatment emergent adverse events or clinically important changes in safety assessments over 12 months.
Time Frame
12 months
Title
The change in microglial activation
Description
To establish whether there is a reduction in microglial activation in subjects with mild AD following daily subcutaneous injection of liraglutide for 1 year using TSPO PET scanning compared with subjects receiving placebo injections in a subgroup of patients
Time Frame
12 months
Title
The change in tau deposition
Description
The change in the hippocampal, entorhinal and other cortical changes in tau deposition in treatment group compared to the placebo group in a subgroup of subjects.
Time Frame
12 months
Title
The change in cortical amyloid
Description
Changes in levels of cortical amyloid load in treatment group compared to the placebo group in a subgroup of subjects.
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Capable of giving and capacity to give informed consent An individual who can act as a reliable study partner with regular contact (combination of face to face visits / telephone contact acceptable) who has sufficient subject interaction to provide meaningful input into rating scales and, if necessary, supervise or perform the injections, as judged by the investigator Diagnosis of Probable Alzheimer's disease according to Dubois criteria (Dubois, Feldman et al. 2007) or National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria Age from 50 years Mini-Mental State Examination (MMSE) score of ≥20 and CDR-Global score of 0.5 or 1 Rosen Modified Hachinski Ischemic score ≤4 On stable medication for 2 months before the screening visit; on or off cholinesterase inhibitors Fluency in English and evidence of adequate premorbid intellectual functioning Likely to be able to participate in all scheduled evaluations and complete all required tests Exclusion Criteria: Patients on treatment for diabetes mellitus Any contraindications to the use of liraglutide as per the Summary of Product Characteristics (hepatic impairment, renal impairment with CKD stage 4 and above (eGFR <30 ml/min/1.73m2), inflammatory bowel disease). Patients with eGFR less than 45 ml/min/1.73m2 will have the renal function monitored very closely Significant neurological disease other than AD that may affect cognition MRI/CT showing unambiguous aetiological evidence of cerebrovascular disease with regard to their dementia or vascular dementia fulfilling NINCDS-AIREN criteria Current presence of a clinically significant major psychiatric disorder (e.g., Major Depressive Disorder) according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Current clinically significant systemic illness that is likely to result in deterioration of the patient's condition or affect the patient's safety during the study History of epilepsy, where seizures or treatment could have contributed to cognitive impairment Treatment with immunosuppressive medications (e.g. systemic corticosteroids) within the last 90 days (topical and nasal corticosteroids and inhaled corticosteroids for asthma are permitted) or chemotherapeutic agents for malignancy within the last 3 years Myocardial infarction within the last 1 year History of cancer within the last 5 years, except localised skin cancer Other clinically significant abnormality on physical, neurological or laboratory examination that could compromise the study or be detrimental to the patient History of alcohol or drug dependence or abuse within the last 2 years Current use of anticonvulsant, anti-Parkinson's, anticoagulant (excluding the use of aspirin 325 mg/day or less) or narcotic medications. Subjects on anticoagulants will be allowed, but will not have an arterial line inserted Use of experimental medications for AD or any other investigational medication or device within 60 days. Patients who have been involved in a monoclonal antibody study are excluded unless it is known that they were receiving placebo in that trial Women of childbearing potential. Women who could become pregnant will be required to use adequate contraception throughout the trial Patients with a personal or family history of medullary thyroid carcinoma (MTC) and patients with multiple endocrine neoplasia type 2 (MEN2) Any contraindications to MRI scanning
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Paul Edison, PhD FRCPI
Organizational Affiliation
Imperial College London
Official's Role
Principal Investigator
Facility Information:
Facility Name
Imperial College, Hammersmith Hospital
City
London
ZIP/Postal Code
W12 0NN
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
30944040
Citation
Femminella GD, Frangou E, Love SB, Busza G, Holmes C, Ritchie C, Lawrence R, McFarlane B, Tadros G, Ridha BH, Bannister C, Walker Z, Archer H, Coulthard E, Underwood BR, Prasanna A, Koranteng P, Karim S, Junaid K, McGuinness B, Nilforooshan R, Macharouthu A, Donaldson A, Thacker S, Russell G, Malik N, Mate V, Knight L, Kshemendran S, Harrison J, Holscher C, Brooks DJ, Passmore AP, Ballard C, Edison P. Evaluating the effects of the novel GLP-1 analogue liraglutide in Alzheimer's disease: study protocol for a randomised controlled trial (ELAD study). Trials. 2019 Apr 3;20(1):191. doi: 10.1186/s13063-019-3259-x. Erratum In: Trials. 2020 Jul 19;21(1):660.
Results Reference
derived
PubMed Identifier
27871675
Citation
Muscogiuri G, DeFronzo RA, Gastaldelli A, Holst JJ. Glucagon-like Peptide-1 and the Central/Peripheral Nervous System: Crosstalk in Diabetes. Trends Endocrinol Metab. 2017 Feb;28(2):88-103. doi: 10.1016/j.tem.2016.10.001. Epub 2016 Oct 27.
Results Reference
derived

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Evaluating Liraglutide in Alzheimer's Disease

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