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Safety Study of AADvac1, a Tau Peptide-KLH-Conjugate Active Vaccine to Treat Alzheimer's Disease

Primary Purpose

Alzheimer Disease

Status
Completed
Phase
Phase 1
Locations
Austria
Study Type
Interventional
Intervention
AADvac1
Placebo
Sponsored by
Axon Neuroscience SE
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alzheimer Disease focused on measuring Alzheimer disease, tau protein, neurofibrillary degeneration, disease-modifying

Eligibility Criteria

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

Inclusion Criteria:

  1. Diagnosis of probable Alzheimer's disease based on the NINCDS/ADRDA criteria.
  2. MMSE 15-26.
  3. stable dose of Alzheimer's Disease treatment since 3 months before screening visit or being untreated.
  4. Hachinski Ischemia Scale ≤ 4.
  5. MRI consistent with the diagnosis of AD.
  6. Informed consent capability
  7. Written informed consent signed and dated by the patient & caregiver.
  8. Age between 50 and 85 years.
  9. Availability of partner/caregiver.
  10. Adequate visual and auditory abilities and German language skills for neuropsychological testing.
  11. Females either surgically sterile or 2+ years postmenopausal.
  12. Participant on stable doses of all medications for concomitant illnesses according to medical history for at least 30 days prior to Visit 1 if considered relevant by the investigator.
  13. Sexually active males must be using reliable contraception methods or be surgically sterile.

Exclusion Criteria:

  1. Pregnant women.
  2. Participation in another clinical trial within 3 months before Visit 1.
  3. Patients not expected to complete the clinical trial.
  4. Presence or history of allergy to components of the vaccine, if considered relevant by the investigator.
  5. Contraindication for MRI imaging (e.g. metallic endoprosthesis, stent implantation in the last 6 months).
  6. Any of the following detected by brain MRI:

    • Thromboembolic infarction
    • Other focal lesions which may be responsible for the cognitive status of the patient
    • More than one lacunar infarct with a diameter of less than 1.5 cm in any dimension
    • Any lacunar infarct in a strategically important location such as the thalamus, hippocampus of either hemisphere, head of the left caudate
    • White matter lesions involving more than 25% of the hemispheric white matter
  7. Surgery (under general anaesthesia) within 3 months prior to study entry and scheduled surgery during the whole study period.
  8. History and/or presence of autoimmune disease, if considered relevant by the investigator.
  9. Recent (≤3 years since last specific treatment) history of cancer (Exceptions: basal cell carcinoma, intraepithelial cervical neoplasia).
  10. Active infectious disease (e.g., Hepatitis B, C).
  11. Presence and/or history of Immunodeficiency (e.g., HIV).
  12. Significant systemic illness, if considered relevant by the investigator.
  13. Hypothyroidism (patients with corrected hypothyroidism are eligible for the study if treatment has been stable for 3 months before study entry)
  14. History of significant psychiatric illness such as schizophrenia, bipolar affective disorder or major depression.
  15. Current depressive episode (Geriatric Depression Scale GDS >5 at Visit 1).
  16. Metabolic or toxic encephalopathy or dementia due to a general medical condition.
  17. Alcoholism or substance abuse within the past year (alcohol or drug intoxication).
  18. Wernicke's encephalopathy
  19. History or evidence of any other CNS disorder that could be the cause of dementia (infectious or inflammatory/demyelinating CNS conditions, Creutzfeldt-Jakob disease, Parkinson's disease, Huntington's disease, brain tumour, subdural haematoma, etc.)
  20. History or evidence of cerebrovascular disease (ischemic or haemorrhagic stroke, transient ischemic attack), or diagnosis of possible, probable or definite vascular dementia.
  21. Epilepsy.
  22. Prior and/or current treatment with experimental immunotherapeutics including IVIG or any vaccines for AD.
  23. Current treatment with immunosuppressive drugs.
  24. Change in dose of standard treatments for AD or hypothyroidism within 3 months prior to visit 1.
  25. Change in dose of previous and current medications which the patient is taking because of consisting illnesses according medical history within the last 30 days prior to visit 1, if considered clinically relevant by the investigator.

Sites / Locations

  • Medizinische Universitat Graz
  • Univeristätsklinik für Neurologie, PMU, Christian-Doppler Klinik
  • Medizinische Universitat Wien

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Experimental

Arm Label

Placebo (adjuvant in saline solution)

AADvac1

Arm Description

Placebo patients will receive 1 dose of placebo per month over 3 months, for a total of 3 administrations. Placebo consists of vaccine adjuvant in saline solution. Placebo is administered subcutaneously.

AADvac1 patients will receive 1 dose of AADvac1 per month over 3 months, for a total of 3 administrations. AADvac1 is a vaccine (single-use vials with solution ready for injection) AADvac1 is administered subcutaneously.

Outcomes

Primary Outcome Measures

Tolerability and safety profile of AADvac1 in patients with mild-to-moderate Alzheimer's disease
Safety is assessed via recording of all Adverse Events and Adverse Events Patients are observed via: MRI Clinical & neuro-psychiatric observation Cognitive testing ECG Blood biochemistry, hematology, coagulation measurement Urine analysis

Secondary Outcome Measures

Immunogenicity of AADvac1
Measurement of: Titres of antibodies reactive with AADvac1 Titres of antibodies reactive with Alzheimer tau protein Antibody isotype profiles

Full Information

First Posted
May 7, 2013
Last Updated
October 9, 2015
Sponsor
Axon Neuroscience SE
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1. Study Identification

Unique Protocol Identification Number
NCT01850238
Brief Title
Safety Study of AADvac1, a Tau Peptide-KLH-Conjugate Active Vaccine to Treat Alzheimer's Disease
Official Title
A 3-months Randomized, Placebo-controlled, Parallel Group, Double-blinded, Multi-centre, Phase I Study to Assess Tolerability & Safety of AADvac1 Applied to Patients With Mild-Moderate Alzheimer's Disease With 3-months Open Label Extension
Study Type
Interventional

2. Study Status

Record Verification Date
October 2015
Overall Recruitment Status
Completed
Study Start Date
May 2013 (undefined)
Primary Completion Date
March 2015 (Actual)
Study Completion Date
March 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Axon Neuroscience SE

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This first-time-in-man study is mainly designed to assess the safety and tolerability of AADvac1 in the treatment of Alzheimer's disease. AADvac1 is a vaccine directed against pathologically modified Alzheimer tau protein that is the main constituent of neurofibrillary tangles (NFTs), and is intended to be a disease-modifying treatment for Alzheimer's disease, i.e. to halt its progress. As this study is a Phase I study focused on tolerability and safety, efficacy will be assessed in an exploratory manner.
Detailed Description
AADvac1 is a candidate therapeutic vaccine for Alzheimer's disease that targets misfolded tau protein, a common denominator of neurofibrillary pathology. Based on preclinical results, the intervention is expected to reduce the number of neurofibrillary tangles, remove hyperphosphorylated tau protein and reduce the amount of oligomerized and insoluble pathological tau in the brain, to halt the spread of neurofibrillary pathology through the brain, and thus prevent associated cognitive decline. The vaccine's antigenic determinant is a synthetic peptide derived from a tau protein sequence, which is coupled to keyhole limpet hemocyanin (KLH) and uses aluminum hydroxide (Alhydrogel) as an adjuvant. At present AADvac1 is intended as an active immunotherapy for patients with diagnosed Alzheimer's disease (AD). Patients will receive 3 - 6 immunization doses; the raised titers of therapeutic antibodies and possible benefits of the treatment can extend beyond the duration of the study. Because of the central role of pathological misfolded tau protein in the etiology of AD, the vaccine is expected to be more effective than active or passive immunotherapies aiming to eliminate the amyloid β plaques that have been clinically investigated so far.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alzheimer Disease
Keywords
Alzheimer disease, tau protein, neurofibrillary degeneration, disease-modifying

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
30 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Placebo (adjuvant in saline solution)
Arm Type
Placebo Comparator
Arm Description
Placebo patients will receive 1 dose of placebo per month over 3 months, for a total of 3 administrations. Placebo consists of vaccine adjuvant in saline solution. Placebo is administered subcutaneously.
Arm Title
AADvac1
Arm Type
Experimental
Arm Description
AADvac1 patients will receive 1 dose of AADvac1 per month over 3 months, for a total of 3 administrations. AADvac1 is a vaccine (single-use vials with solution ready for injection) AADvac1 is administered subcutaneously.
Intervention Type
Biological
Intervention Name(s)
AADvac1
Other Intervention Name(s)
(no commercial or INN name assigned yet)
Intervention Description
AADvac1 is intended as an active vaccination for disease-modifying treatment of Alzheimer's disease.
Intervention Type
Other
Intervention Name(s)
Placebo
Other Intervention Name(s)
(no other names)
Intervention Description
The placebo contains the same buffer and adjuvant as AADvac1, but lacks the API.
Primary Outcome Measure Information:
Title
Tolerability and safety profile of AADvac1 in patients with mild-to-moderate Alzheimer's disease
Description
Safety is assessed via recording of all Adverse Events and Adverse Events Patients are observed via: MRI Clinical & neuro-psychiatric observation Cognitive testing ECG Blood biochemistry, hematology, coagulation measurement Urine analysis
Time Frame
Tolerability & safety are assessed over a period of 3 months / 3 administrations
Secondary Outcome Measure Information:
Title
Immunogenicity of AADvac1
Description
Measurement of: Titres of antibodies reactive with AADvac1 Titres of antibodies reactive with Alzheimer tau protein Antibody isotype profiles
Time Frame
Immune response to the vaccine will be assessed over 3 months / 3 administrations
Other Pre-specified Outcome Measures:
Title
Patient cognition
Description
Tests used: ADAS-Cog (Alzheimer's Disease Assessment Scale-cognitive subscale) COWAT (Controlled oral word association test) Category fluency
Time Frame
3 months / 3 administrations, with an optional 3 months open label extension phase (3+3 administrations)

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: Diagnosis of probable Alzheimer's disease based on the NINCDS/ADRDA criteria. MMSE 15-26. stable dose of Alzheimer's Disease treatment since 3 months before screening visit or being untreated. Hachinski Ischemia Scale ≤ 4. MRI consistent with the diagnosis of AD. Informed consent capability Written informed consent signed and dated by the patient & caregiver. Age between 50 and 85 years. Availability of partner/caregiver. Adequate visual and auditory abilities and German language skills for neuropsychological testing. Females either surgically sterile or 2+ years postmenopausal. Participant on stable doses of all medications for concomitant illnesses according to medical history for at least 30 days prior to Visit 1 if considered relevant by the investigator. Sexually active males must be using reliable contraception methods or be surgically sterile. Exclusion Criteria: Pregnant women. Participation in another clinical trial within 3 months before Visit 1. Patients not expected to complete the clinical trial. Presence or history of allergy to components of the vaccine, if considered relevant by the investigator. Contraindication for MRI imaging (e.g. metallic endoprosthesis, stent implantation in the last 6 months). Any of the following detected by brain MRI: Thromboembolic infarction Other focal lesions which may be responsible for the cognitive status of the patient More than one lacunar infarct with a diameter of less than 1.5 cm in any dimension Any lacunar infarct in a strategically important location such as the thalamus, hippocampus of either hemisphere, head of the left caudate White matter lesions involving more than 25% of the hemispheric white matter Surgery (under general anaesthesia) within 3 months prior to study entry and scheduled surgery during the whole study period. History and/or presence of autoimmune disease, if considered relevant by the investigator. Recent (≤3 years since last specific treatment) history of cancer (Exceptions: basal cell carcinoma, intraepithelial cervical neoplasia). Active infectious disease (e.g., Hepatitis B, C). Presence and/or history of Immunodeficiency (e.g., HIV). Significant systemic illness, if considered relevant by the investigator. Hypothyroidism (patients with corrected hypothyroidism are eligible for the study if treatment has been stable for 3 months before study entry) History of significant psychiatric illness such as schizophrenia, bipolar affective disorder or major depression. Current depressive episode (Geriatric Depression Scale GDS >5 at Visit 1). Metabolic or toxic encephalopathy or dementia due to a general medical condition. Alcoholism or substance abuse within the past year (alcohol or drug intoxication). Wernicke's encephalopathy History or evidence of any other CNS disorder that could be the cause of dementia (infectious or inflammatory/demyelinating CNS conditions, Creutzfeldt-Jakob disease, Parkinson's disease, Huntington's disease, brain tumour, subdural haematoma, etc.) History or evidence of cerebrovascular disease (ischemic or haemorrhagic stroke, transient ischemic attack), or diagnosis of possible, probable or definite vascular dementia. Epilepsy. Prior and/or current treatment with experimental immunotherapeutics including IVIG or any vaccines for AD. Current treatment with immunosuppressive drugs. Change in dose of standard treatments for AD or hypothyroidism within 3 months prior to visit 1. Change in dose of previous and current medications which the patient is taking because of consisting illnesses according medical history within the last 30 days prior to visit 1, if considered clinically relevant by the investigator.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Reinhold Schmidt, Professor
Organizational Affiliation
Medizinische Universität Graz
Official's Role
Principal Investigator
Facility Information:
Facility Name
Medizinische Universitat Graz
City
Graz
State/Province
Steiermark
ZIP/Postal Code
8036
Country
Austria
Facility Name
Univeristätsklinik für Neurologie, PMU, Christian-Doppler Klinik
City
Salzburg
ZIP/Postal Code
5020
Country
Austria
Facility Name
Medizinische Universitat Wien
City
Wien
ZIP/Postal Code
1090
Country
Austria

12. IPD Sharing Statement

Citations:
PubMed Identifier
30355322
Citation
Novak P, Schmidt R, Kontsekova E, Kovacech B, Smolek T, Katina S, Fialova L, Prcina M, Parrak V, Dal-Bianco P, Brunner M, Staffen W, Rainer M, Ondrus M, Ropele S, Smisek M, Sivak R, Zilka N, Winblad B, Novak M. FUNDAMANT: an interventional 72-week phase 1 follow-up study of AADvac1, an active immunotherapy against tau protein pathology in Alzheimer's disease. Alzheimers Res Ther. 2018 Oct 24;10(1):108. doi: 10.1186/s13195-018-0436-1.
Results Reference
derived
PubMed Identifier
27955995
Citation
Novak P, Schmidt R, Kontsekova E, Zilka N, Kovacech B, Skrabana R, Vince-Kazmerova Z, Katina S, Fialova L, Prcina M, Parrak V, Dal-Bianco P, Brunner M, Staffen W, Rainer M, Ondrus M, Ropele S, Smisek M, Sivak R, Winblad B, Novak M. Safety and immunogenicity of the tau vaccine AADvac1 in patients with Alzheimer's disease: a randomised, double-blind, placebo-controlled, phase 1 trial. Lancet Neurol. 2017 Feb;16(2):123-134. doi: 10.1016/S1474-4422(16)30331-3. Epub 2016 Dec 10.
Results Reference
derived
PubMed Identifier
25478017
Citation
Kontsekova E, Zilka N, Kovacech B, Novak P, Novak M. First-in-man tau vaccine targeting structural determinants essential for pathological tau-tau interaction reduces tau oligomerisation and neurofibrillary degeneration in an Alzheimer's disease model. Alzheimers Res Ther. 2014 Aug 1;6(4):44. doi: 10.1186/alzrt278. eCollection 2014.
Results Reference
derived

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Safety Study of AADvac1, a Tau Peptide-KLH-Conjugate Active Vaccine to Treat Alzheimer's Disease

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