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Safety, Tolerability and Immunogenicity of ACI-24 Vaccine in Adults With Down Syndrome (3-Star)

Primary Purpose

Down Syndrome

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
ACI-24 low dose
ACI-24 high dose
Placebo
Sponsored by
AC Immune SA
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Down Syndrome focused on measuring cognitive decline

Eligibility Criteria

25 Years - 45 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Males or females with Down Syndrome aged ≥25 to ≤45 years, with a cytogenetic diagnosis being either Trisomy 21 or Complete Unbalanced Translocation of the Chromosome 21.
  • Subjects and their study partner/legal representative in the opinion of the investigator able to understand and to provide written informed consent.
  • Written informed consent obtained from subjects and their study partner/legal representative before any trial-related activities.
  • In the opinion of the investigator able to fully participate in the trial and sufficiently proficient in English to be capable of reliably completing study assessments.
  • Subjects have a study partner/legal representative who have direct contact with the subjects at least 10 hours per week and who can be asked questions about the subjects.

Exclusion Criteria:

  • Subjects weighing less than 40 kg.
  • IQ less than 40 (as assessed by Kaufman Brief Intelligence Test, Second Edition (KBIT-2).
  • In the investigators opinion, any clinically significant current psychiatric or neurologic illness, including a past illness with a risk of recurrence, other than Down syndrome.
  • Any medical condition likely to significantly hamper the evaluation of safety of the study drug.
  • DSM-IV criteria for drug or alcohol abuse or dependence currently met within the past five years.
  • History or presence of uncontrolled seizures. If history of seizures, they must be well controlled with no occurrence of seizures in the past 2 years prior to study screening. The use of anti-epileptic medications is permitted.
  • History of meningitis or meningoencephalitis.
  • History of malignant neoplasms within 3 years prior to study screening or where there is current evidence of recurrent or metastatic disease.
  • History of persistent cognitive deficits immediately following head trauma.
  • History of inflammatory neurology disorders.
  • History of autoimmune disease with potential for CNS involvement.
  • MRI scan at screening showing a single area of cerebral vasogenic edema, superficial siderosis, or evidence of a prior macrohemorrhage, or showing more than four cerebral microhemorrhages (regardless of their anatomical location or diagnostic characterization as "possible" or "definite").
  • MRI examination cannot be done for any reason, including metal implants contraindicated for MRI studies and/or severe claustrophobia.
  • Significant hearing or visual impairment or other issues judged relevant by the investigator preventing to comply with the protocol and to perform the outcome measures.
  • Severe infections or a major surgical operation within 3 months prior to screening.
  • History of chronic or recurrent infections judged to be clinically significant by the investigator.
  • History or presence of immunological or inflammatory conditions which are judged to be clinically significant by the investigator.
  • Celiac disease not on a gluten free diet for at least 3 months prior to study screening.
  • Chronic benign skin pathologies, unless viewed as clinically insignificant in the investigator's opinion.
  • Any vaccine received within the past 2 months before baseline, except influenza vaccine which if indicated must be given at least 2 weeks prior to baseline.
  • Clinically significant arrhythmias or other abnormalities on ECG at screening. (Minor abnormalities documented as clinically insignificant by the investigator will be allowed.)
  • Clinically significant abnormal vital signs including sustained sitting blood pressure greater than 160/90 mmHg.
  • In the opinion of the site investigator, deviations from normal values for hematologic parameters, liver function tests, and other biochemical measures, that are judged to be clinically significant.
  • Subjects with treated hypothyroidism not on a stable dose of medication for at least 3 months prior to screening and having clinically significant abnormal serum T-4 and TSH at screening.
  • Subjects with diabetes mellitus with an HbA1c of ≥ 8.0%.
  • Subjects who have been receiving any experimental drug for Down Syndrome with a washout less than 30 days or less than five halflives of the drug, whichever is longer.
  • Female subjects being pregnant as confirmed by serum testing at screening or planning to be pregnant or lactating.
  • Female subjects not using a reliable method of contraception (unless abstaining).
  • Patient receiving any anticoagulant drug, or aspirin at doses greater than 100 mg daily in the 7 days prior to lumbar puncture (in order to avoid risk of bleeding during scheduled or unscheduled lumbar puncture)
  • Use of antidepressants other than SSRI/SNRIs at stable dose, antipsychotics (typical or atypical), GABA agonists (e.g. gabapentin), or stimulants (e.g. methylphenidate, modafinil). In exceptional cases, low doses of atypical antipsychotics (e.g. risperidone up to 0.5 mg/day or quetiapine up to 50 mg/day) or benzodiazepines are only allowed after review by the site principal investigator, in consultation with the project director and/or medical monitors.
  • Current use of immunosuppressant or immunomodulating drugs or their use within the past 6 months prior to study screening. Current use of steroids or their use within the past 3 months prior to study screening.
  • Use of Cholinesterase Inhibitor or use of Glutamatergic drugs (Topiramate, Memantine, Lamotrigine) if not on stable dose for at least 3 months prior to screening.
  • Subjects who have donated blood or blood products during the 30 days prior to screening who plan to donate blood while participating in the study or within four weeks after completion of the study.

Sites / Locations

  • St. Joseph's Hospital and Medical Center - Barrow Neurology Clinics
  • UCSD Adult Down Syndrome Program
  • Johns Hopkins University
  • Massachusetts General Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Active Comparator

Placebo Comparator

Arm Label

ACI-24 low dose

ACI-24 high dose

Placebo

Arm Description

Vaccine formulation will be administrated s.c. 7 times.

Vaccine formulation will be administrated s.c. 7 times.

The placebo is ready-to-use solution for injection, administrated s.c. 7 times.

Outcomes

Primary Outcome Measures

Antibody Titer (Serum Anti-Aβ1-42 Free IgG) - Mean Absolute Value
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. The measure is expressed in Arbitrary Units per mL (AU/mL). AU/mL in a sample is obtained by back-calculation towards the standard curve.

Secondary Outcome Measures

Amyloid Beta 1-40 in Blood - Mean Absolute Value
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered.
CANTAB - MOT Latency Score
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Cambridge Neuropsychological Test Automated Battery (CANTAB), Motor Screening Task (MOT) is a cognitive scale to be completed by the subject. Range score from 0 to ∞, lower score means a better outcome
CANTAB - PAL First Attempt Memory Score
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Cambridge Neuropsychological Test Automated Battery (CANTAB), Paired Associate Learning (PAL) is a cognitive scale to be completed by the subject. Range score from 0 to 20, higher score means a better outcome
Brief Praxis Test (BPT) - Total Score
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Brief Praxis Test (BPT) is a cognitive scale to be completed by the subject. Range score from 0 to 80, higher score means better outcome
Vineland II - Communication Domain Standard Score
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Vineland II is a behavioral questionnaire to be completed by the study partner of the subject. Range score from 0 to 113, higher score means a better outcome
Vineland II - Daily Living Skill - Domain Standard Score
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Vineland II is a behavioral questionnaire to be completed by the study partner of the subject. Range score from 0 to 114, higher score means a better outcome
Vineland II - Socialisation - Domain Standard Score
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Vineland II is a behavioral questionnaire to be completed by the study partner of the subject. Range score from 0 to 115, higher score means a better outcome
NPI - Total Score
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Neuropsychiatric Inventory (NPI) is a behavioral questionnaire to be completed by the study partner of the subject. Range score from 0 to 144, higher score means a worse outcome
Clinical Global Impression of Change (CGIC) - Change From Baseline at Week 50
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Clinical Global Impression of Change (CGIC) is a global assessment to be completed by the investigator.

Full Information

First Posted
April 1, 2016
Last Updated
September 21, 2021
Sponsor
AC Immune SA
Collaborators
National Institute on Aging (NIA), Alzheimer's Disease Cooperative Study (ADCS), LuMind IDSC Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT02738450
Brief Title
Safety, Tolerability and Immunogenicity of ACI-24 Vaccine in Adults With Down Syndrome
Acronym
3-Star
Official Title
A Phase Ib Multi-Center, Double-Blind, Randomized, Placebo-Controlled Dose Escalation Study of the Safety, Tolerability and Immunogenicity of ACI-24 in Adults With Down Syndrome
Study Type
Interventional

2. Study Status

Record Verification Date
September 2021
Overall Recruitment Status
Completed
Study Start Date
March 2016 (Actual)
Primary Completion Date
June 2020 (Actual)
Study Completion Date
June 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
AC Immune SA
Collaborators
National Institute on Aging (NIA), Alzheimer's Disease Cooperative Study (ADCS), LuMind IDSC Foundation

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to test in adults with Down Syndrome the safety, tolerability and immunogenicity of a vaccine, ACI-24.
Detailed Description
This is a prospective multi-center, placebo controlled, double-blind and randomized dose escalation study of 2 doses of ACI-24 versus Placebo over 24 months with a total of 21 visits. All subjects will receive the study medication (ACI-24 or Placebo) 7 times via s.c. injection (12 months) and will be followed up for 12 months after the last dose with a final safety and efficacy assessment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Down Syndrome
Keywords
cognitive decline

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
ACI-24 low dose
Arm Type
Active Comparator
Arm Description
Vaccine formulation will be administrated s.c. 7 times.
Arm Title
ACI-24 high dose
Arm Type
Active Comparator
Arm Description
Vaccine formulation will be administrated s.c. 7 times.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
The placebo is ready-to-use solution for injection, administrated s.c. 7 times.
Intervention Type
Biological
Intervention Name(s)
ACI-24 low dose
Intervention Description
ACI-24 administered as a sterile suspension in PBS via s.c. injection.
Intervention Type
Biological
Intervention Name(s)
ACI-24 high dose
Intervention Description
ACI-24 administered as a sterile suspension in PBS via s.c. injection.
Intervention Type
Biological
Intervention Name(s)
Placebo
Other Intervention Name(s)
PBS
Intervention Description
Placebo is a standard PBS sterile solution administrated via s.c. injection.
Primary Outcome Measure Information:
Title
Antibody Titer (Serum Anti-Aβ1-42 Free IgG) - Mean Absolute Value
Description
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. The measure is expressed in Arbitrary Units per mL (AU/mL). AU/mL in a sample is obtained by back-calculation towards the standard curve.
Time Frame
Values at baseline (week 0) and week 50 are reported
Secondary Outcome Measure Information:
Title
Amyloid Beta 1-40 in Blood - Mean Absolute Value
Description
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered.
Time Frame
Values at baseline (week 0) and week 50 are reported
Title
CANTAB - MOT Latency Score
Description
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Cambridge Neuropsychological Test Automated Battery (CANTAB), Motor Screening Task (MOT) is a cognitive scale to be completed by the subject. Range score from 0 to ∞, lower score means a better outcome
Time Frame
Values at baseline (week 0) and week 50 are reported
Title
CANTAB - PAL First Attempt Memory Score
Description
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Cambridge Neuropsychological Test Automated Battery (CANTAB), Paired Associate Learning (PAL) is a cognitive scale to be completed by the subject. Range score from 0 to 20, higher score means a better outcome
Time Frame
Values at baseline (week 0) and week 50 are reported
Title
Brief Praxis Test (BPT) - Total Score
Description
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Brief Praxis Test (BPT) is a cognitive scale to be completed by the subject. Range score from 0 to 80, higher score means better outcome
Time Frame
Values at baseline (week 0) and week 50 are reported
Title
Vineland II - Communication Domain Standard Score
Description
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Vineland II is a behavioral questionnaire to be completed by the study partner of the subject. Range score from 0 to 113, higher score means a better outcome
Time Frame
Values at baseline (week 0) and week 50 are reported
Title
Vineland II - Daily Living Skill - Domain Standard Score
Description
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Vineland II is a behavioral questionnaire to be completed by the study partner of the subject. Range score from 0 to 114, higher score means a better outcome
Time Frame
Values at baseline (week 0) and week 50 are reported
Title
Vineland II - Socialisation - Domain Standard Score
Description
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Vineland II is a behavioral questionnaire to be completed by the study partner of the subject. Range score from 0 to 115, higher score means a better outcome
Time Frame
Values at baseline (week 0) and week 50 are reported
Title
NPI - Total Score
Description
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Neuropsychiatric Inventory (NPI) is a behavioral questionnaire to be completed by the study partner of the subject. Range score from 0 to 144, higher score means a worse outcome
Time Frame
Values at baseline (week 0) and week 50 are reported.
Title
Clinical Global Impression of Change (CGIC) - Change From Baseline at Week 50
Description
All subjects who received at least 1 dose of the study treatment of either ACI-24 300 μg, ACI-24 1000 μg or placebo are considered. Clinical Global Impression of Change (CGIC) is a global assessment to be completed by the investigator.
Time Frame
Values at baseline (week 0) and week 50 are reported

10. Eligibility

Sex
All
Minimum Age & Unit of Time
25 Years
Maximum Age & Unit of Time
45 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Males or females with Down Syndrome aged ≥25 to ≤45 years, with a cytogenetic diagnosis being either Trisomy 21 or Complete Unbalanced Translocation of the Chromosome 21. Subjects and their study partner/legal representative in the opinion of the investigator able to understand and to provide written informed consent. Written informed consent obtained from subjects and their study partner/legal representative before any trial-related activities. In the opinion of the investigator able to fully participate in the trial and sufficiently proficient in English to be capable of reliably completing study assessments. Subjects have a study partner/legal representative who have direct contact with the subjects at least 10 hours per week and who can be asked questions about the subjects. Exclusion Criteria: Subjects weighing less than 40 kg. IQ less than 40 (as assessed by Kaufman Brief Intelligence Test, Second Edition (KBIT-2). In the investigators opinion, any clinically significant current psychiatric or neurologic illness, including a past illness with a risk of recurrence, other than Down syndrome. Any medical condition likely to significantly hamper the evaluation of safety of the study drug. DSM-IV criteria for drug or alcohol abuse or dependence currently met within the past five years. History or presence of uncontrolled seizures. If history of seizures, they must be well controlled with no occurrence of seizures in the past 2 years prior to study screening. The use of anti-epileptic medications is permitted. History of meningitis or meningoencephalitis. History of malignant neoplasms within 3 years prior to study screening or where there is current evidence of recurrent or metastatic disease. History of persistent cognitive deficits immediately following head trauma. History of inflammatory neurology disorders. History of autoimmune disease with potential for CNS involvement. MRI scan at screening showing a single area of cerebral vasogenic edema, superficial siderosis, or evidence of a prior macrohemorrhage, or showing more than four cerebral microhemorrhages (regardless of their anatomical location or diagnostic characterization as "possible" or "definite"). MRI examination cannot be done for any reason, including metal implants contraindicated for MRI studies and/or severe claustrophobia. Significant hearing or visual impairment or other issues judged relevant by the investigator preventing to comply with the protocol and to perform the outcome measures. Severe infections or a major surgical operation within 3 months prior to screening. History of chronic or recurrent infections judged to be clinically significant by the investigator. History or presence of immunological or inflammatory conditions which are judged to be clinically significant by the investigator. Celiac disease not on a gluten free diet for at least 3 months prior to study screening. Chronic benign skin pathologies, unless viewed as clinically insignificant in the investigator's opinion. Any vaccine received within the past 2 months before baseline, except influenza vaccine which if indicated must be given at least 2 weeks prior to baseline. Clinically significant arrhythmias or other abnormalities on ECG at screening. (Minor abnormalities documented as clinically insignificant by the investigator will be allowed.) Clinically significant abnormal vital signs including sustained sitting blood pressure greater than 160/90 mmHg. In the opinion of the site investigator, deviations from normal values for hematologic parameters, liver function tests, and other biochemical measures, that are judged to be clinically significant. Subjects with treated hypothyroidism not on a stable dose of medication for at least 3 months prior to screening and having clinically significant abnormal serum T-4 and TSH at screening. Subjects with diabetes mellitus with an HbA1c of ≥ 8.0%. Subjects who have been receiving any experimental drug for Down Syndrome with a washout less than 30 days or less than five halflives of the drug, whichever is longer. Female subjects being pregnant as confirmed by serum testing at screening or planning to be pregnant or lactating. Female subjects not using a reliable method of contraception (unless abstaining). Patient receiving any anticoagulant drug, or aspirin at doses greater than 100 mg daily in the 7 days prior to lumbar puncture (in order to avoid risk of bleeding during scheduled or unscheduled lumbar puncture) Use of antidepressants other than SSRI/SNRIs at stable dose, antipsychotics (typical or atypical), GABA agonists (e.g. gabapentin), or stimulants (e.g. methylphenidate, modafinil). In exceptional cases, low doses of atypical antipsychotics (e.g. risperidone up to 0.5 mg/day or quetiapine up to 50 mg/day) or benzodiazepines are only allowed after review by the site principal investigator, in consultation with the project director and/or medical monitors. Current use of immunosuppressant or immunomodulating drugs or their use within the past 6 months prior to study screening. Current use of steroids or their use within the past 3 months prior to study screening. Use of Cholinesterase Inhibitor or use of Glutamatergic drugs (Topiramate, Memantine, Lamotrigine) if not on stable dose for at least 3 months prior to screening. Subjects who have donated blood or blood products during the 30 days prior to screening who plan to donate blood while participating in the study or within four weeks after completion of the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael S. Rafii, MD, PhD
Organizational Affiliation
USC Keck School of Medicine of the University of Southern California, San Diego
Official's Role
Study Director
Facility Information:
Facility Name
St. Joseph's Hospital and Medical Center - Barrow Neurology Clinics
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85013
Country
United States
Facility Name
UCSD Adult Down Syndrome Program
City
La Jolla
State/Province
California
ZIP/Postal Code
92037-1712
Country
United States
Facility Name
Johns Hopkins University
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21224
Country
United States
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Access to de-identified, individual and trial -level data (analysis datasets), and other information (e.g., protocols) will be provided.
IPD Sharing Access Criteria
These clinical trial data can be requested by any qualified researchers who engage in rigorous independent scientific research and will be provided after review and approval of their research proposal, their Statistical Analysis Plan (SAP) and execution of a Data Use Agreement (DUA). Data sharing shall be in accordance with ADCS' data sharing plan in its grant application and applicable NIH policy in effect at the time of the NIH award.
IPD Sharing URL
https://www.adcs.org/
Citations:
PubMed Identifier
35532913
Citation
Rafii MS, Sol O, Mobley WC, Delpretti S, Skotko BG, Burke AD, Sabbagh MN, Yuan SH, Rissman RA, Pulsifer M, Evans C, Evans AC, Beth G, Fournier N, Gray JA, Dos Santos AM, Hliva V, Vukicevic M, Kosco-Vilbois M, Streffer J, Pfeifer A, Feldman HH. Safety, Tolerability, and Immunogenicity of the ACI-24 Vaccine in Adults With Down Syndrome: A Phase 1b Randomized Clinical Trial. JAMA Neurol. 2022 Jun 1;79(6):565-574. doi: 10.1001/jamaneurol.2022.0983.
Results Reference
derived

Learn more about this trial

Safety, Tolerability and Immunogenicity of ACI-24 Vaccine in Adults With Down Syndrome

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