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Impact of Nilotinib on Safety, Biomarkers and Clinical Outcomes in Mild to Moderate Alzheimer's Disease (AD)

Primary Purpose

Alzheimer's Disease

Status
Unknown status
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Placebo Capsule(s) Once a Day by Mouth
Nilotinib Capsule(s) Once a Day by Mouth
Sponsored by
Georgetown University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alzheimer's Disease focused on measuring Nilotinib in Alzheimer's disease

Eligibility Criteria

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

Inclusion Criteria:

  1. Age ≥ 50
  2. Fluent in English
  3. Biomarker confirmed AD with CSF level of Abeta42 <600ng/mL
  4. Able to ingest oral medications
  5. Diagnosis of mild to moderate AD according to dementia criteria outlined by McKhann et al.
  6. Neuroimaging (MRI or CT) consistent with the diagnosis of AD within the past year
  7. MMSE between 17 and 24 (inclusive) at screening
  8. Modified Hachinski score ≤ 4
  9. QTc interval 350-460ms, inclusive
  10. Caregiver/study partner to accompany participant to all visits and have direct contact with the participant > 2 days/week
  11. Written informed consent
  12. Capability and willingness to comply with all study criteria
  13. Supervision available for study medication
  14. Stable medical conditions for 3 months prior to screening visit
  15. Stable medications for 4 weeks prior to screening visit
  16. Able to complete baseline assessments
  17. Minimum of 6 years of education, or work history sufficient to exclude mental retardation
  18. Stable use of cholinesterase inhibitors and memantine (U.S. FDA-approved medications for patients with probable AD), vitamin E (up to 400 IU daily), estrogens, aspirin (81-300 mg daily), and cholesterol-lowering agents for 3 months prior to screening is allowed.
  19. Clinical laboratory values within normal limits or, if abnormal, must be judged to be clinically insignificant by the investigator

Exclusion Criteria:

  1. Non-AD dementia, probable AD with Down syndrome, APP, PS-1, or PS-2 mutations (known familial AD), LBD and Fronto-temporal dementia (FTD)
  2. History of clinically significant stroke
  3. Current evidence or history in past two years of epilepsy, focal brain lesion, head injury with loss of consciousness or DSM-IV criteria for any major psychiatric disorder including psychosis, major depression, bipolar disorder, alcohol or substance abuse
  4. Sensory impairment that would preclude participation/cooperation with the protocol
  5. Patients with hypokalemia, hypomagnesaemia, or long QTc syndrome.
  6. Concomitant drugs known to prolong the QTc interval (>461ms) and history of cardiovascular disease, including myocardial infarction or cardiac failure, angina, arrhythmia
  7. Prescribed strong CYP3A4 inhibitors or a medical history of liver or pancreatic disease
  8. Evidence of any significant clinical disorder or laboratory finding that renders the participant unsuitable for receiving an investigational drug including clinically significant or unstable hematologic, hepatic, cardiovascular, pulmonary, gastrointestinal, endocrine, metabolic, renal or other systemic disease or laboratory abnormality
  9. Active neoplastic disease, history of cancer five years prior to screening, including breast cancer (history of treated basal or squamous skin cancer, or stable prostate cancer are not exclusionary)
  10. Pregnancy or possible pregnancy
  11. Contraindications to LP: prior lumbosacral spine surgery, severe degenerative joint disease or deformity of the spine, platelets < 100,000, use of Coumadin/warfarin, or history of a bleeding disorder
  12. Contraindication to MRI
  13. Evidence of more than 4 micro hemorrhages and/or hemosiderosis by a recent (12 months) and/or the screening MRI.
  14. A low B12 is exclusionary, unless follow-up labs (homocysteine (HC) and methylmalonic acid (MMA)) indicate that it is not physiologically significant.
  15. Enrolled in another active trial investigating an experimental drug or therapy for AD
  16. HIV positive

Sites / Locations

  • Georgetown University Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Active Comparator

Arm Label

Group 1 (placebo)

Group 2 (treated)

Arm Description

Out of 42 total participants with mild to moderate AD (MMSE=17-24 inclusive) and their study partners that will be recruited and 1:1 randomized, 21 (twenty-one) will be assigned to group 1 and given 1 capsule of a placebo drug by mouth every day for the first 6 months followed by 2 capsules once daily for the subsequent 6 months, every time taken without a meal, for the total duration of the study for 12 months.

Out of 42 total participants with mild to moderate AD (MMSE=17-24 inclusive) and their study partners that will be recruited and 1:1 randomized, 21 (twenty-one) will be assigned to group 2 treated with 1 capsule (150mg Nilotinib) once a day by mouth for the first 6 months followed by dose escalation to 2 capsules (300mg Nilotinib) once daily by mouth for the subsequent 6 months, every time taken without a meal, for the total study duration of 12 months.

Outcomes

Primary Outcome Measures

Safety will be measured by number of participants experiencing the occurrence of adverse events and/or abnormal laboratory values
Safety will be measured by assessing number of participants with abnormal laboratory values, as well as adverse events (AEs) and serious adverse events (SAEs) deemed to be possibly, probably, or definitely related to the study drug.

Secondary Outcome Measures

Effects of Nilotinib treatment on measurement of Nilotinib in the CSF
The investigators will determine the effects of Nilotinib treatment on Abl inhibition to demonstrate CNS target engagement

Full Information

First Posted
October 21, 2016
Last Updated
March 12, 2019
Sponsor
Georgetown University
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1. Study Identification

Unique Protocol Identification Number
NCT02947893
Brief Title
Impact of Nilotinib on Safety, Biomarkers and Clinical Outcomes in Mild to Moderate Alzheimer's Disease
Acronym
AD
Official Title
A Randomized, Double Blind, Placebo-controlled Study to Evaluate the Impact of Low Doses of Nilotinib (Tasigna®) on Safety, Biomarkers and Clinical Outcomes in Subjects With Mild to Moderate Alzheimer's Disease
Study Type
Interventional

2. Study Status

Record Verification Date
March 2019
Overall Recruitment Status
Unknown status
Study Start Date
January 2017 (Actual)
Primary Completion Date
December 2019 (Anticipated)
Study Completion Date
February 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Georgetown University

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The investigators hypothesize that Nilotinib will be safe in individuals with mild to moderate AD. Specifically, investigators hypothesize that low daily oral doses of Nilotinib will lead to CSF penetration, CNS Abl inhibition, and stabilization of CSF total Tau and p-Tau231/181 and Abeta42/40 levels. The investigators hypothesize that Nilotinib will decrease brain load of amyloid using amyloid positron emission tomography (PET). The investigators also predict that Nilotinib will reduce CSF markers of cell death, including neuron specific enolase (NSE) and S100B.
Detailed Description
The investigators propose a novel treatment strategy that involves Abl inhibition to alter Abeta40/42, total Tau and p-Tau231/181 in subjects with mild to moderate dementia due to AD. The investigators pre-clinical studies show that Nilotinib inhibits brain Abl, decreases Abeta and p-Tau, modulates brain and peripheral immune profiles and reverses cognitive decline in AD models. Taken together, these data support the hypothesis that Nilotinib is a viable therapeutic candidate - via Abl inhibition - in subjects with AD. Based on strong pre-clinical evidence about the effects of Nilotinib on neurodegenerative pathologies, including autophagic clearance of neurotoxic proteins, immunity and behavior, the investigators conducted an open label pilot clinical trial in advanced (stage 3-5) PD with dementia (PDD) and Lewy Body Dementia (LBD) patients. Participants (N=12) were randomized 1:1 to once daily oral dose of 150mg and 300mg Nilotinib for 6 months. The investigators showed that Nilotinib penetrates the blood brain barrier (BBB), in agreement with pre-clinical data. Several studies show that Abeta42 is decreased and CSF total Tau and p-Tau are increased in PD and LBD. Investigators data show that Nilotinib reverses loss of CSF Abeta40/42 and significantly reduces (N=5, P<0.05) CSF total Tau and p-Tau between baseline and 6 months treatment. These biomarker changes are consistent with cognitive improvement (3.5-3.85 points) using Mini-Mental Status Exam (MMSE) and the Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA-Cog) between baseline and 6 months. These data are very compelling to evaluate the effects of Nilotinib in a phase II, randomized, double-blind, placebo-controlled trial in patients with mild to moderate AD.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alzheimer's Disease
Keywords
Nilotinib in 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
42 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Group 1 (placebo)
Arm Type
Placebo Comparator
Arm Description
Out of 42 total participants with mild to moderate AD (MMSE=17-24 inclusive) and their study partners that will be recruited and 1:1 randomized, 21 (twenty-one) will be assigned to group 1 and given 1 capsule of a placebo drug by mouth every day for the first 6 months followed by 2 capsules once daily for the subsequent 6 months, every time taken without a meal, for the total duration of the study for 12 months.
Arm Title
Group 2 (treated)
Arm Type
Active Comparator
Arm Description
Out of 42 total participants with mild to moderate AD (MMSE=17-24 inclusive) and their study partners that will be recruited and 1:1 randomized, 21 (twenty-one) will be assigned to group 2 treated with 1 capsule (150mg Nilotinib) once a day by mouth for the first 6 months followed by dose escalation to 2 capsules (300mg Nilotinib) once daily by mouth for the subsequent 6 months, every time taken without a meal, for the total study duration of 12 months.
Intervention Type
Drug
Intervention Name(s)
Placebo Capsule(s) Once a Day by Mouth
Other Intervention Name(s)
Nilotinib in Alzheimer's Disease
Intervention Description
1 capsule of Placebo once a day for 6 months followed by 2 capsules of Placebo for another 6 months
Intervention Type
Drug
Intervention Name(s)
Nilotinib Capsule(s) Once a Day by Mouth
Other Intervention Name(s)
Nilotinib in Alzheimer's Disease
Intervention Description
1 capsule of Nilotinib 150 mg once a day for 6 months followed by 2 capsules of Nilotinib (150 mg each capsule = 300 mb total) for the subsequent 6 months
Primary Outcome Measure Information:
Title
Safety will be measured by number of participants experiencing the occurrence of adverse events and/or abnormal laboratory values
Description
Safety will be measured by assessing number of participants with abnormal laboratory values, as well as adverse events (AEs) and serious adverse events (SAEs) deemed to be possibly, probably, or definitely related to the study drug.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Effects of Nilotinib treatment on measurement of Nilotinib in the CSF
Description
The investigators will determine the effects of Nilotinib treatment on Abl inhibition to demonstrate CNS target engagement
Time Frame
12 months

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: Age ≥ 50 Fluent in English Biomarker confirmed AD with CSF level of Abeta42 <600ng/mL Able to ingest oral medications Diagnosis of mild to moderate AD according to dementia criteria outlined by McKhann et al. Neuroimaging (MRI or CT) consistent with the diagnosis of AD within the past year MMSE between 17 and 24 (inclusive) at screening Modified Hachinski score ≤ 4 QTc interval 350-460ms, inclusive Caregiver/study partner to accompany participant to all visits and have direct contact with the participant > 2 days/week Written informed consent Capability and willingness to comply with all study criteria Supervision available for study medication Stable medical conditions for 3 months prior to screening visit Stable medications for 4 weeks prior to screening visit Able to complete baseline assessments Minimum of 6 years of education, or work history sufficient to exclude mental retardation Stable use of cholinesterase inhibitors and memantine (U.S. FDA-approved medications for patients with probable AD), vitamin E (up to 400 IU daily), estrogens, aspirin (81-300 mg daily), and cholesterol-lowering agents for 3 months prior to screening is allowed. Clinical laboratory values within normal limits or, if abnormal, must be judged to be clinically insignificant by the investigator Exclusion Criteria: Non-AD dementia, probable AD with Down syndrome, APP, PS-1, or PS-2 mutations (known familial AD), LBD and Fronto-temporal dementia (FTD) History of clinically significant stroke Current evidence or history in past two years of epilepsy, focal brain lesion, head injury with loss of consciousness or DSM-IV criteria for any major psychiatric disorder including psychosis, major depression, bipolar disorder, alcohol or substance abuse Sensory impairment that would preclude participation/cooperation with the protocol Patients with hypokalemia, hypomagnesaemia, or long QTc syndrome. Concomitant drugs known to prolong the QTc interval (>461ms) and history of cardiovascular disease, including myocardial infarction or cardiac failure, angina, arrhythmia Prescribed strong CYP3A4 inhibitors or a medical history of liver or pancreatic disease Evidence of any significant clinical disorder or laboratory finding that renders the participant unsuitable for receiving an investigational drug including clinically significant or unstable hematologic, hepatic, cardiovascular, pulmonary, gastrointestinal, endocrine, metabolic, renal or other systemic disease or laboratory abnormality Active neoplastic disease, history of cancer five years prior to screening, including breast cancer (history of treated basal or squamous skin cancer, or stable prostate cancer are not exclusionary) Pregnancy or possible pregnancy Contraindications to LP: prior lumbosacral spine surgery, severe degenerative joint disease or deformity of the spine, platelets < 100,000, use of Coumadin/warfarin, or history of a bleeding disorder Contraindication to MRI Evidence of more than 4 micro hemorrhages and/or hemosiderosis by a recent (12 months) and/or the screening MRI. A low B12 is exclusionary, unless follow-up labs (homocysteine (HC) and methylmalonic acid (MMA)) indicate that it is not physiologically significant. Enrolled in another active trial investigating an experimental drug or therapy for AD HIV positive
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Raymond S. Turner, MD, PhD
Organizational Affiliation
Georgetown University
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Charbel E Moussa, MD, PhD
Organizational Affiliation
Georgetown University
Official's Role
Study Director
Facility Information:
Facility Name
Georgetown University Medical Center
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20007
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
27434297
Citation
Pagan F, Hebron M, Valadez EH, Torres-Yaghi Y, Huang X, Mills RR, Wilmarth BM, Howard H, Dunn C, Carlson A, Lawler A, Rogers SL, Falconer RA, Ahn J, Li Z, Moussa C. Nilotinib Effects in Parkinson's disease and Dementia with Lewy bodies. J Parkinsons Dis. 2016 Jul 11;6(3):503-17. doi: 10.3233/JPD-160867.
Results Reference
result
Links:
URL
https://neurology.georgetown.edu/translational_neurotherapeutics
Description
TRANSLATIONAL NEUROTHERAPEUTICS PROGRAM Georgetown University Medical Center & Medstar Georgetown University Hospital
URL
https://sites.google.com/a/georgetown.edu/moussa-lab/nilotinib---when-the-hope-outweighs-the-hype
Description
Nilotinib - When the Hope outweighs the Hype
URL
https://sites.google.com/a/georgetown.edu/moussa-lab/home
Description
The Laboratory for Dementia and Parkinsonism Georgetown University Medical Center

Learn more about this trial

Impact of Nilotinib on Safety, Biomarkers and Clinical Outcomes in Mild to Moderate Alzheimer's Disease

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