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Effects of Dopaminergic Therapy in Patients With Alzheimer's Disease (DOPAD)

Primary Purpose

Alzheimer Disease

Status
Completed
Phase
Phase 2
Locations
Italy
Study Type
Interventional
Intervention
Rotigotine transdermal patch
Placebo
Sponsored by
I.R.C.C.S. Fondazione Santa Lucia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alzheimer Disease focused on measuring Rotigotine, Dopamine

Eligibility Criteria

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

Inclusion Criteria:

  1. The patient (or if applicable the legally acceptable representative if different from the responsible caregiver) and the responsible caregiver have signed the Informed Consent Form.
  2. The patient has probable AD, diagnosed according to National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria.
  3. The patient is a man or woman, aged ≤ 85 years.
  4. The patient has a Clinical Dementia Rating (CDR) total score of 0.5 or 1 (mild) and MMSE score of 20-26 (inclusive) at Screening.
  5. Has at least one identified adult caregiver who is able to provide meaningful assessment of changes in subject behavior and function over time and provide information on safety and tolerability, and is able to verify daily compliance with study drug
  6. The patient has been treated with acetylcholinesterase inhibitor (AChEI), i.e., donepezil, galantamine, or rivastigmine, at the time of Screening

    • For at least 3 months
    • The current dosage regimen and must have remained stable for ≥ 8 weeks
    • It must be planned that the dosage regimen will remain stable throughout participation in the study

Exclusion Criteria:

  1. Significant neurodegenerative disorder of the central nervous system other than Alzheimer's disease, e.g., Lewy body dementia, Parkinson's disease, multiple sclerosis, progressive supranuclear palsy, hydrocephalus, Huntington's disease, any condition directly or indirectly caused by Transmissible Spongiform Encephalopathy (TSE), Creutzfeldt-Jakob Disease (CJD), variant Creutzfeldt-Jakob Disease (vCJD), or new variant Creutzfeldt-Jakob Disease (nvCJD)
  2. The patients has history of seizure (with the exception of febrile seizures in childhood)
  3. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition - Text Revision (DSM IV-TR) criteria met for any of the following within specified period:

    • Major depressive disorder (current)
    • Schizophrenia (lifetime)
    • Other psychotic disorders, bipolar disorder, or substance (including alcohol) related disorders (within the past 5 years)
  4. Metal implants in the head (except dental), pacemaker, cochlear implants, or any other non-removable items that are contraindications to MR imaging.
  5. Evidence of clinically significant disease including but not limited to pulmonary, gastrointestinal, renal, hepatic, endocrine, cardiovascular or metabolic disorder (Patients with controlled diabetes, or hypertension, or complete/partial right bundle branch block may be included in the study).
  6. Treatment currently or within 6 months before Baseline with any of the following medications:

    • Typical and atypical antipsychotics (i.e. Clozapine, Olanzapine)
    • Antiparkinson agents (e.g., levodopa, dopamine agonists, COMT inhibitors, amantadine, monoamine oxidase B inhibitors, anticholinergics etc)
    • Carbamazepine, Primidone, Pregabalin, Gabapentin
    • Memantine

Sites / Locations

  • Santa Lucia Foundation

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Rotigotine 4 mg

Placebo

Arm Description

Rotigotine transdermal patches 4 mg

Placebo transdermal patches

Outcomes

Primary Outcome Measures

Global cognition
Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-Cog)

Secondary Outcome Measures

Frontal cognitive functions
Frontal assessment battery (FAB)
Activities of daily living
Alzheimer's disease Cooperative Study - Activities of Daily Living (ADCS-ADL)
Neurophysiological markers of cortical activity
TEP amplitude over the PFC
Neuropsychiatric evaluation
Neuropsychiatric Inventory (NPI)

Full Information

First Posted
August 11, 2017
Last Updated
December 14, 2018
Sponsor
I.R.C.C.S. Fondazione Santa Lucia
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1. Study Identification

Unique Protocol Identification Number
NCT03250741
Brief Title
Effects of Dopaminergic Therapy in Patients With Alzheimer's Disease
Acronym
DOPAD
Official Title
Effects of Dopaminergic Therapy in Patients With Alzheimer's Disease: a Phase II 24-week, Randomized, Double-blind Placebo Controlled Study.
Study Type
Interventional

2. Study Status

Record Verification Date
December 2018
Overall Recruitment Status
Completed
Study Start Date
June 2016 (Actual)
Primary Completion Date
November 2018 (Actual)
Study Completion Date
November 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
I.R.C.C.S. Fondazione Santa Lucia

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This is phase IIa 24-week, prospective, randomized, double-blind placebo controlled study. The study is designed to evaluate the efficacy, safety, and tolerability of transdermal patch of Rotigotine (RTG) versus placebo (PLC) as add-on therapy with AChEI in patients with mild AD according to the consensus diagnostic criteria and MMSE score of ≥18 and ≤24 at screening. Two groups of patients with mild AD will be involved (50 patients each). One group will be assigned to treatment with RTG 4 mg and the other one to PLC as add on to AChEI therapy (Rivastigmine). Clinical and neurophysiological measurements will be collected before and after drug administration.
Detailed Description
The current study has the ambition to provide first time evidence that dopaminergic stimulation may have a clinical impact in patients with mild AD. Cognitive Assessment: Before and after the 24 weeks of treatment the ADAS-Cog, ADCS-ADL and the Frontal assessment battery (FAB) will be administered. FAB will be performed to measure changes in frontal executive functions (Apollonio et al, 2005) . Neurophysiological investigations will be performed to identify quantifiable biomarkers underlying the effects induced by dopamine agonist on the neurodegenerative brain. The application of recent neurophysiological tools, such as the combined use of transcranial magnetic stimulation (TMS) during electroencephalography (EEG) will allow to measure how dopamine agonists are able to modulate the cortical activity of the prefrontal cortex in AD patients (Kähkönen et al., 2005; Julkunen et al., 2008), likely trough DA terminals originating from the ventral tegmental nucleus, defining the neurophysiological biomarkers of clinical improvement For EEG-TMS recordings, a TMS-compatible EEG equipment will be used for recording EEG activity from the scalp (BrainAmp 32MRplus, BrainProducts). The EEG will be continuously acquired from 64 scalp sites positioned according to the 10-20 International System. To precisely position the coil over the cortical sites across different sessions, a neuronavigation system (Softaxic, E.M.S.) will be used. Neurophysiological changes induced by dopamine-agonist will be indexed by the following measures: corticospinal excitability, cortical reactivity, connectivity and plasticity. Specifically, the cortical reactivity and cortico-cortical connectivity will be evaluated respectively over the prefrontal cortex and between connected areas. We will employ TMS-evoked cortical responses (i.e., TEPs) as a novel probe of dopamine-agonist induced cortical excitability changes (Ilmoniemi et al., 1997; Komssi and Kahkonen, 2006; Julkunen et al., 2008; Miniussi and Thut, 2009; Miniussi et al., 2012; Premoli et al., 2014). To reach this aim, TEPs will serve as markers of left prefrontal cortex (PFC) reactivity whereas the spreading of their cortical activation will serve as an index of connectivity between targeted cortex and functionally connected areas underlying frontal cognitive network.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alzheimer Disease
Keywords
Rotigotine, Dopamine

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Rotigotine 4 mg
Arm Type
Active Comparator
Arm Description
Rotigotine transdermal patches 4 mg
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo transdermal patches
Intervention Type
Drug
Intervention Name(s)
Rotigotine transdermal patch
Other Intervention Name(s)
ROTIGOTINE
Intervention Description
Rotigotine transdermal patches 4mg/24hr
Intervention Type
Other
Intervention Name(s)
Placebo
Other Intervention Name(s)
Placebo transdermal patch
Intervention Description
Placebo transdermal patches of the same size as for Rotigotine transdermal patches
Primary Outcome Measure Information:
Title
Global cognition
Description
Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-Cog)
Time Frame
change from baseline to Week 24
Secondary Outcome Measure Information:
Title
Frontal cognitive functions
Description
Frontal assessment battery (FAB)
Time Frame
change from baseline to Week 24
Title
Activities of daily living
Description
Alzheimer's disease Cooperative Study - Activities of Daily Living (ADCS-ADL)
Time Frame
change from baseline to Week 24
Title
Neurophysiological markers of cortical activity
Description
TEP amplitude over the PFC
Time Frame
change from baseline to Week 24
Title
Neuropsychiatric evaluation
Description
Neuropsychiatric Inventory (NPI)
Time Frame
change from baseline to Week 24

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: The patient (or if applicable the legally acceptable representative if different from the responsible caregiver) and the responsible caregiver have signed the Informed Consent Form. The patient has probable AD, diagnosed according to National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria. The patient is a man or woman, aged ≤ 85 years. The patient has a Clinical Dementia Rating (CDR) total score of 0.5 or 1 (mild) and MMSE score of 20-26 (inclusive) at Screening. Has at least one identified adult caregiver who is able to provide meaningful assessment of changes in subject behavior and function over time and provide information on safety and tolerability, and is able to verify daily compliance with study drug The patient has been treated with acetylcholinesterase inhibitor (AChEI), i.e., donepezil, galantamine, or rivastigmine, at the time of Screening For at least 3 months The current dosage regimen and must have remained stable for ≥ 8 weeks It must be planned that the dosage regimen will remain stable throughout participation in the study Exclusion Criteria: Significant neurodegenerative disorder of the central nervous system other than Alzheimer's disease, e.g., Lewy body dementia, Parkinson's disease, multiple sclerosis, progressive supranuclear palsy, hydrocephalus, Huntington's disease, any condition directly or indirectly caused by Transmissible Spongiform Encephalopathy (TSE), Creutzfeldt-Jakob Disease (CJD), variant Creutzfeldt-Jakob Disease (vCJD), or new variant Creutzfeldt-Jakob Disease (nvCJD) The patients has history of seizure (with the exception of febrile seizures in childhood) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition - Text Revision (DSM IV-TR) criteria met for any of the following within specified period: Major depressive disorder (current) Schizophrenia (lifetime) Other psychotic disorders, bipolar disorder, or substance (including alcohol) related disorders (within the past 5 years) Metal implants in the head (except dental), pacemaker, cochlear implants, or any other non-removable items that are contraindications to MR imaging. Evidence of clinically significant disease including but not limited to pulmonary, gastrointestinal, renal, hepatic, endocrine, cardiovascular or metabolic disorder (Patients with controlled diabetes, or hypertension, or complete/partial right bundle branch block may be included in the study). Treatment currently or within 6 months before Baseline with any of the following medications: Typical and atypical antipsychotics (i.e. Clozapine, Olanzapine) Antiparkinson agents (e.g., levodopa, dopamine agonists, COMT inhibitors, amantadine, monoamine oxidase B inhibitors, anticholinergics etc) Carbamazepine, Primidone, Pregabalin, Gabapentin Memantine
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alessandro Martorana, MD, PhD
Organizational Affiliation
University of Rome Tor Vergata
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Giacomo Koch, MD, PhD
Organizational Affiliation
Santa Lucia Foundation IRCCS
Official's Role
Principal Investigator
Facility Information:
Facility Name
Santa Lucia Foundation
City
Rome
ZIP/Postal Code
00179
Country
Italy

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
22863599
Citation
Martorana A, Di Lorenzo F, Esposito Z, Lo Giudice T, Bernardi G, Caltagirone C, Koch G. Dopamine D(2)-agonist rotigotine effects on cortical excitability and central cholinergic transmission in Alzheimer's disease patients. Neuropharmacology. 2013 Jan;64:108-13. doi: 10.1016/j.neuropharm.2012.07.015. Epub 2012 Aug 1.
Results Reference
background
PubMed Identifier
25309431
Citation
Martorana A, Koch G. "Is dopamine involved in Alzheimer's disease?". Front Aging Neurosci. 2014 Sep 25;6:252. doi: 10.3389/fnagi.2014.00252. eCollection 2014.
Results Reference
result
PubMed Identifier
24859851
Citation
Koch G, Di Lorenzo F, Bonni S, Giacobbe V, Bozzali M, Caltagirone C, Martorana A. Dopaminergic modulation of cortical plasticity in Alzheimer's disease patients. Neuropsychopharmacology. 2014 Oct;39(11):2654-61. doi: 10.1038/npp.2014.119. Epub 2014 May 26.
Results Reference
result
PubMed Identifier
32667654
Citation
Koch G, Motta C, Bonni S, Pellicciari MC, Picazio S, Casula EP, Maiella M, Di Lorenzo F, Ponzo V, Ferrari C, Scaricamazza E, Caltagirone C, Martorana A. Effect of Rotigotine vs Placebo on Cognitive Functions Among Patients With Mild to Moderate Alzheimer Disease: A Randomized Clinical Trial. JAMA Netw Open. 2020 Jul 1;3(7):e2010372. doi: 10.1001/jamanetworkopen.2020.10372. Erratum In: JAMA Netw Open. 2020 Aug 3;3(8):e2019190.
Results Reference
derived

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Effects of Dopaminergic Therapy in Patients With Alzheimer's Disease

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