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A Safety, Tolerability, Pharmacokinetics, Pharmacodynamics and Preliminary Efficacy Study of TPI-287 in Alzheimer's Disease

Primary Purpose

Alzheimer's Disease

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
TPI-287 2 mg/m2
TPI-287 6.3 mg/m2
TPI-287 20 mg/m2
Placebo
Sponsored by
University of California, San Francisco
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Alzheimer's Disease focused on measuring Alzheimer's disease, mild to moderate

Eligibility Criteria

50 Years - 82 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria (all must be met):

  1. Between 50 and 82 years of age (inclusive)
  2. Meets National Institute on Aging-Alzheimer's Association Workgroups criteria for probable AD dementia (McKhann et al. 2011)
  3. MRI at Screening is consistent with AD (≤ 4 microhemorrhages, and no large strokes or severe white matter disease)
  4. MHIS at Screening is ≤ 4
  5. MMSE at Screening is between 14 and 26 (inclusive)
  6. FDA-approved AD medications are allowed as long as the dose is stable for 2 months prior to Screening. Other medications (except those listed under exclusion criteria) are allowed as long as the dose is stable for 30 days prior to Screening
  7. Has a reliable study partner who agrees to accompany the subject to visits, and spends at least 5 hours per week with the subject
  8. Agrees to 2 lumbar punctures
  9. Signed and dated written informed consent obtained from the subject and the subject's caregiver in accordance with local IRB regulations
  10. Males and all WCBP agree to abstain from sex or use an adequate method of contraception for the duration of the study and for 30 days after the last dose of study drug.

Exclusion Criteria (any one of the following will exclude a subject from being enrolled into the study):

  1. Any medical condition other than AD that could account for cognitive deficits (e.g., active seizure disorder, stroke, vascular dementia)
  2. History of significant cardiovascular, hematologic, renal, or hepatic disease (or laboratory evidence thereof)
  3. History of significant peripheral neuropathy
  4. History of major psychiatric illness or untreated depression
  5. Neutrophil count <1,500/mm3, platelets <100,000/mm3, serum creatinine >1.5 x upper limit of normal (ULN), total bilirubin >1.5 x ULN, alanine aminotransferase (ALT) >3 x ULN, aspartate aminotransferase (AST) >3 x ULN, or INR >1.2 at Screening or baseline evaluations
  6. Evidence of any clinically significant findings on Screening or baseline evaluations which, in the opinion of the Investigator would pose a safety risk or interfere with appropriate interpretation of study data
  7. Current or recent history (within four weeks prior to Screening) of a clinically significant bacterial, fungal, or mycobacterial infection
  8. Current clinically significant viral infection
  9. Major surgery within four weeks prior to Screening
  10. Unable to tolerate MRI scan at Screening
  11. Any contraindication to or unable to tolerate lumbar puncture at Screening, including use of anti-coagulant medications such as warfarin. Daily administration of 81 mg aspirin will be allowed as long as the dose is stable for 30 days prior to Screening
  12. Subjects who, in the opinion of the Investigator, are unable or unlikely to comply with the dosing schedule or study evaluations
  13. Any previous exposure to microtubule inhibitors (including TPI 287) within 5 years of Screening. Treatment with microtubule inhibitors other than TPI287 while on study will not be allowed
  14. Participation in another AD clinical trial within 3 months of Screening
  15. Treatment with another investigational drug within 30 days of Screening. Treatment with investigational drugs other than TPI 287 while on study will not be allowed
  16. Known hypersensitivity to the inactive ingredients in the study drug
  17. Pregnant or lactating
  18. Positive pregnancy test at Screening or Baseline (Day 1)
  19. Cancer within 5 years of Screening, except for non-metastatic skin cancer.

Sites / Locations

  • UCSF Memory and Aging Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Placebo Comparator

Arm Label

TPI-287 low dose

TPI-287 moderate dose

TPI-287 high dose

Placebo

Arm Description

2 mg/m2 of TPI-287 administered as a 1-hour intravenous infusion once every 3 weeks for 9 weeks (for a total of 4 infusions)

6.3 mg/m2 of TPI-287 administered as a 1-hour intravenous infusion once every 3 weeks for 9 weeks (for a total of 4 infusions)

20 mg/m2 of TPI-287 administered as a 1-hour intravenous infusion once every 3 weeks for 9 weeks (for a total of 4 infusions)

Outcomes

Primary Outcome Measures

Maximum tolerated dose of TPI-287
Planned dose range of intravenous infusions of TPI-287 administered once every 3 weeks for 9 weeks. The dose will be escalated in 3 sequential cohorts and participants will be monitored for adverse events to determine safety and tolerability.

Secondary Outcome Measures

TPI-287 levels in blood plasma and cerebrospinal fluid
Blood plasma will be collected at specified time-points before and following the first infusion of study drug (TPI-287 or placebo) to measure TPI-287 levels. Steady-state levels of TPI-287 will be estimated from cerebrospinal fluid collected at end-point visit of placebo-controlled phase. These levels will be used to estimate the pharmacokinetic properties of TPI-287.

Full Information

First Posted
October 14, 2013
Last Updated
April 13, 2020
Sponsor
University of California, San Francisco
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1. Study Identification

Unique Protocol Identification Number
NCT01966666
Brief Title
A Safety, Tolerability, Pharmacokinetics, Pharmacodynamics and Preliminary Efficacy Study of TPI-287 in Alzheimer's Disease
Official Title
A Phase 1, Randomized, Double-Blind, Placebo-Controlled, Sequential Cohort, Dose-Ranging Study of the Safety, Tolerability, Pharmacokinetics, Pharmacodynamics, and Preliminary Efficacy of TPI-287 in Patients With Mild to Moderate Alzheimer's Disease
Study Type
Interventional

2. Study Status

Record Verification Date
April 2020
Overall Recruitment Status
Completed
Study Start Date
November 2013 (undefined)
Primary Completion Date
September 2019 (Actual)
Study Completion Date
September 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of California, San Francisco

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of the study is to determine the highest dose of TPI-287 that is safe and tolerable when administered as an intravenous infusion to participants with mild to moderate Alzheimer's disease (AD), to measure pharmacokinetic properties of the drug as well as to gauge preliminary efficacy of TPI-287 on disease progression.
Detailed Description
The maximum tolerated dose of TPI-287 will be determined through a planned dose escalation over 3 sequential cohorts, each comprising of 11 participants randomized to either TPI-287 or placebo. TPI-287 or placebo will be administered as an intravenous infusion once every 3 weeks for 9 weeks, for a total of 4 infusions. Participants who successfully complete this phase will have the option of entering into the open label extension phase during which TPI-287 will be administered once every 3 weeks for an additional 6 weeks, for a total of 3 extra infusions. Pre-medication of diphenhyramine 25 mg (Benadryl) will be given IV within 30 to 60 minutes prior to each study infusion in the study. Safety and tolerability will be assessed through reporting of adverse events, physical and neurological testing, ECGs, as well as blood and urine analyses. Baseline and end-point measures of cognition and function, MRI brain scans, and cerebrospinal fluid (CSF) biomarker analyses will be used to determine preliminary efficacy of TPI-287 in mild-moderate AD. Pharmacokinetic and pharmacodynamic properties of TPI-287 will be calculated from blood plasma collected after the first infusion, and from CSF collected on the last visit of the placebo-controlled phase.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alzheimer's Disease
Keywords
Alzheimer's disease, mild to moderate

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
TPI-287 low dose
Arm Type
Experimental
Arm Description
2 mg/m2 of TPI-287 administered as a 1-hour intravenous infusion once every 3 weeks for 9 weeks (for a total of 4 infusions)
Arm Title
TPI-287 moderate dose
Arm Type
Experimental
Arm Description
6.3 mg/m2 of TPI-287 administered as a 1-hour intravenous infusion once every 3 weeks for 9 weeks (for a total of 4 infusions)
Arm Title
TPI-287 high dose
Arm Type
Experimental
Arm Description
20 mg/m2 of TPI-287 administered as a 1-hour intravenous infusion once every 3 weeks for 9 weeks (for a total of 4 infusions)
Arm Title
Placebo
Arm Type
Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
TPI-287 2 mg/m2
Intervention Description
2 mg/m2 of TPI-287 diluted with 500mL 0.9% sodium chloride. TPI-287 is a microtubule inhibitor belonging to the taxane diterpenoid (taxoid) family, and specifically to the abeotaxane class.
Intervention Type
Drug
Intervention Name(s)
TPI-287 6.3 mg/m2
Intervention Description
6.3 mg/m2 of TPI-287 diluted with 500mL 0.9% sodium chloride. TPI-287 is a microtubule inhibitor belonging to the taxane diterpenoid (taxoid) family, and specifically to the abeotaxane class.
Intervention Type
Drug
Intervention Name(s)
TPI-287 20 mg/m2
Intervention Description
20 mg/m2 of TPI-287 diluted with 500mL 0.9% sodium chloride. TPI-287 is a microtubule inhibitor belonging to the taxane diterpenoid (taxoid) family, and specifically to the abeotaxane class.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
500mL 0.9% sodium chloride.
Primary Outcome Measure Information:
Title
Maximum tolerated dose of TPI-287
Description
Planned dose range of intravenous infusions of TPI-287 administered once every 3 weeks for 9 weeks. The dose will be escalated in 3 sequential cohorts and participants will be monitored for adverse events to determine safety and tolerability.
Time Frame
up to 13 weeks post initial dosing
Secondary Outcome Measure Information:
Title
TPI-287 levels in blood plasma and cerebrospinal fluid
Description
Blood plasma will be collected at specified time-points before and following the first infusion of study drug (TPI-287 or placebo) to measure TPI-287 levels. Steady-state levels of TPI-287 will be estimated from cerebrospinal fluid collected at end-point visit of placebo-controlled phase. These levels will be used to estimate the pharmacokinetic properties of TPI-287.
Time Frame
Screening and Week 10
Other Pre-specified Outcome Measures:
Title
CSF biomarkers of Alzheimer's disease
Description
A lumbar puncture will be performed at the screening and final visits to obtain cerebrospinal fluid (CSF). CSF will be analyzed for changes to concentration of biomarkers of Alzheimer's disease - beta amyloid (1-42), total tau, phosphorylated tau, tau isoforms and fragments, and tau phosphopeptides.
Time Frame
Screening and Week 10
Title
Brain MRI scan
Description
Brain MRI scans will be performed to explore effects of changes in brain network functional and structural connectivity as well as perfusion after administration of study drug.
Time Frame
Screening and Week 11
Title
Cognition
Description
The Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog) and Mini Mental State Examination (MMSE) will be conducted to determine effect and preliminary efficacy of the drug on cognition.
Time Frame
Screening and Week 11
Title
Degree of disability
Description
The Alzheimer's Disease Cooperative Study - Activities of Daily Living (ADCS-ADL) will be conducted to determine effect and preliminary efficacy of the drug on degree of disability.
Time Frame
Screening and Week 11
Title
Behavior
Description
The Geriatric Depression Scale (GDS) will be conducted to determine effect and preliminary efficacy of the drug on behavior.
Time Frame
Screening and Week 11
Title
Number of participants with adverse events as a measure of safety and tolerability of extended administration of TPI-287
Description
Participants who successfully complete the placebo controlled phase will be offered the option to enter an open label extension phase comprising of 3 additional infusions of TPI-287, administered once every 3 weeks for 6 weeks. Participants will be monitored for adverse events to determine drug safety and tolerability.
Time Frame
up to 20 weeks post initial dosing

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Maximum Age & Unit of Time
82 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria (all must be met): Between 50 and 82 years of age (inclusive) Meets National Institute on Aging-Alzheimer's Association Workgroups criteria for probable AD dementia (McKhann et al. 2011) MRI at Screening is consistent with AD (≤ 4 microhemorrhages, and no large strokes or severe white matter disease) MHIS at Screening is ≤ 4 MMSE at Screening is between 14 and 26 (inclusive) FDA-approved AD medications are allowed as long as the dose is stable for 2 months prior to Screening. Other medications (except those listed under exclusion criteria) are allowed as long as the dose is stable for 30 days prior to Screening Has a reliable study partner who agrees to accompany the subject to visits, and spends at least 5 hours per week with the subject Agrees to 2 lumbar punctures Signed and dated written informed consent obtained from the subject and the subject's caregiver in accordance with local IRB regulations Males and all WCBP agree to abstain from sex or use an adequate method of contraception for the duration of the study and for 30 days after the last dose of study drug. Exclusion Criteria (any one of the following will exclude a subject from being enrolled into the study): Any medical condition other than AD that could account for cognitive deficits (e.g., active seizure disorder, stroke, vascular dementia) History of significant cardiovascular, hematologic, renal, or hepatic disease (or laboratory evidence thereof) History of significant peripheral neuropathy History of major psychiatric illness or untreated depression Neutrophil count <1,500/mm3, platelets <100,000/mm3, serum creatinine >1.5 x upper limit of normal (ULN), total bilirubin >1.5 x ULN, alanine aminotransferase (ALT) >3 x ULN, aspartate aminotransferase (AST) >3 x ULN, or INR >1.2 at Screening or baseline evaluations Evidence of any clinically significant findings on Screening or baseline evaluations which, in the opinion of the Investigator would pose a safety risk or interfere with appropriate interpretation of study data Current or recent history (within four weeks prior to Screening) of a clinically significant bacterial, fungal, or mycobacterial infection Current clinically significant viral infection Major surgery within four weeks prior to Screening Unable to tolerate MRI scan at Screening Any contraindication to or unable to tolerate lumbar puncture at Screening, including use of anti-coagulant medications such as warfarin. Daily administration of 81 mg aspirin will be allowed as long as the dose is stable for 30 days prior to Screening Subjects who, in the opinion of the Investigator, are unable or unlikely to comply with the dosing schedule or study evaluations Any previous exposure to microtubule inhibitors (including TPI 287) within 5 years of Screening. Treatment with microtubule inhibitors other than TPI287 while on study will not be allowed Participation in another AD clinical trial within 3 months of Screening Treatment with another investigational drug within 30 days of Screening. Treatment with investigational drugs other than TPI 287 while on study will not be allowed Known hypersensitivity to the inactive ingredients in the study drug Pregnant or lactating Positive pregnancy test at Screening or Baseline (Day 1) Cancer within 5 years of Screening, except for non-metastatic skin cancer.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Adam L Boxer, M.D., Ph.D.
Organizational Affiliation
University of California, San Francisco
Official's Role
Principal Investigator
Facility Information:
Facility Name
UCSF Memory and Aging Center
City
San Francisco
State/Province
California
ZIP/Postal Code
94158
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
31710340
Citation
Tsai RM, Miller Z, Koestler M, Rojas JC, Ljubenkov PA, Rosen HJ, Rabinovici GD, Fagan AM, Cobigo Y, Brown JA, Jung JI, Hare E, Geldmacher DS, Natelson-Love M, McKinley EC, Luong PN, Chuu EL, Powers R, Mumford P, Wolf A, Wang P, Shamloo M, Miller BL, Roberson ED, Boxer AL. Reactions to Multiple Ascending Doses of the Microtubule Stabilizer TPI-287 in Patients With Alzheimer Disease, Progressive Supranuclear Palsy, and Corticobasal Syndrome: A Randomized Clinical Trial. JAMA Neurol. 2020 Feb 1;77(2):215-224. doi: 10.1001/jamaneurol.2019.3812.
Results Reference
derived

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A Safety, Tolerability, Pharmacokinetics, Pharmacodynamics and Preliminary Efficacy Study of TPI-287 in Alzheimer's Disease

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