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Safety, and Efficacy of a New Buccal Film of Montelukast in Patients With Mild to Moderate Alzheimer's Disease (BUENA)

Primary Purpose

Alzheimer Disease

Status
Active
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
Montelukast buccal film
Placebo buccal film
Sponsored by
IntelGenx Corp.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alzheimer Disease

Eligibility Criteria

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

Inclusion Criteria:

  • Mild to moderate Alzheimer's Disease.
  • MMSE score of 14 - 22
  • CT or MRI within 18 months prior to screening indicating clinical phenotype of Alzheimer's Disease
  • Treated daily with donepezil, rivastigmine or galantamine for ≥ 3 months
  • All other medications for chronic conditions should have been at a stable dose for at least 2 weeks prior to first dose.
  • No clinically meaningful abnormalities on electrocardiogram (ECG), physical examination and clinical laboratory tests

Exclusion Criteria:

  • Taken memantine within 2 months prior to screening.
  • Current diagnosis of any psychiatric disorder, depression that is not well-controlled, clinically significant or unstable systemic disease, or severe medical procedures
  • Clinically relevant abnormal laboratory values suggesting an unknown disease and requiring further clinical evaluation.
  • Patients at imminent risk of self-harm, based on clinical interview and response on S-STS
  • History of malignancy occurring within 5 years immediately prior to screening, except for a subject who has been adequately treated for (1) basal cell or squamous cell skin cancer, (2) in situ cervical cancer, (3) localized prostate carcinoma, or (4) who has undergone potentially curative therapy with no evidence of recurrence for more than 3 years post-therapy, and who is deemed at low risk for recurrence by her/his treating physician
  • History of any of the following cardiovascular conditions that an unstable:

    • Hypotension
    • Hypertension
    • Active cardiovascular disease
  • Evidence of cerebrovascular disease
  • Have used or plan to use the following medications from 30 days prior to Visit 1 through the end of the study:

    • Narcotic analgesics more frequently than on three days per week as needed for pain;
    • Daily antipsychotic (except for risperidone, quetiapine and aripiprazole, and only if at a stable and controlled dose)
    • Daily anxiolytic use; however, occasional use as needed for acute agitation or to be used as a rescue anxiolytic (i.e., lorazepam and oxazepam) is acceptable as long as not used within 24 hours of a clinic visit window;
    • Daily antidepressants (except for citalopram, escitalopram, venlafaxine, trazodone, sertraline, and mirtazapine, and only if at a stable and controlled dose);
    • Low potency antipsychotic agents (eg chlorpromazine) - not permitted at any time during the study;
    • Anti-parkinson's disease medications (selegiline, levodopa, amantadine) for the treatment of Parkinson's Syndrome Complex;
    • Lithium;
    • Clozapine;
  • Previously treated with or currently using montelukast

Sites / Locations

  • Vancouver Island Health Authority
  • Centricity Research (formerly True North Clinical Research)
  • Centricity Research (formerly True North Clinical Research)
  • Bruyère Research Institute
  • Recherches Neuro-Hippocampe
  • Kawartha Centre - Redefining Healthy Aging
  • Gerontion Research Inc.
  • Baycrest
  • Recherche Neuro-Hippocampe
  • Centre hospitalier universitaire de Québec -Université Laval
  • Centre de recherche sur le vieillissement, CIUSSS de l'Estrie-CHUS
  • Diex Recherche Sherbrooke Inc.

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Group A

Group B

Arm Description

Montelukast buccal film, administered 10-mg once or 30-mg twice daily (once in the morning and once in the evening) for 26 weeks.

Placebo buccal film, administered once or twice daily (once in the morning and once in the evening) for 26 weeks.

Outcomes

Primary Outcome Measures

Global Neuropsychological test battery (NTB) Composite
Evaluate if treatment with montelukast new buccal film is superior to placebo, assessed at Week 26 using the global NTB composite score. The NTB score will be used to assess cognitive and behavioral functions including problem-solving and conceptualization. The composite score will be based on an equally weighted average of standardized change from baseline scores on the following tests: International Shopping List Test (ISLT), ISLT-Delay, One Back Test, One Card Learning Test, Verbal Fluency Test, Category Fluency Test, Identification Test and Detection Test.

Secondary Outcome Measures

Global Neuropsychological test battery (NTB) Composite
Evaluate whether 6 and 12 weeks treatment with montelukast is superior to placebo, assessed using the global NTB composite scores. The NTB score will be used to assess cognitive and behavioral functions including problem-solving and conceptualization. he composite score will be based on an equally weighted average of standardized change from baseline scores on the following tests: International Shopping List Test (ISLT), ISLT-Delay, One Back Test, One Card Learning Test, Verbal Fluency Test, Category Fluency Test, Identification Test and Detection Test
Mini Mental State Examination (MMSE)
Evaluate whether 26 weeks of treatment with montelukast improved scores using the MMSE. The MMSE will be used to assess the subject's mental status in terms of cognitive function and level of dementia. The MMSE test will consist of an 11-question measure that will test five areas of cognitive function: orientation, registration, attention and calculation, recall, and language. The maximum score is 30.
Alzheimer's Disease Cooperative Study - Clinical Global Impression of Change (ADCS-CGIC)
Evaluate whether 26 weeks of treatment with montelukast improved scores using the ADCS-CGIC. ADCS-CGIC assessment and rating will be based on investigator's observation of changes in the subject's cognitive, functional, and behavioral performance since the beginning of a clinical trial (baseline) until end of treatment (Week 8).
Alzheimer's Disease Cooperative Study - Activities of Daily Living, 23-items scale (ADCS-ADL23)
Evaluate whether 26 weeks of treatment with montelukast improved scores using the ADCS-ADL23. The ADCS-ADL23 outcome measurement along with the assistance of the caregiver, will measure and evaluate the change from baseline and at Week 8, in the competence and performance of the subject in conducting their basic tasks and instrumental activities of daily living.
Neuropsychiatric Inventory (NPI)
Evaluate whether 26 weeks of treatment with montelukast improves the behavioral disturbance in patients, measured by the neuropsychiatric inventory (NPI), compared to placebo. NPI is an assessment of the frequency and severity of behavioral disturbances in dementia. The inventory comprises 10 behavioural areas: delusions, hallucinations, agitation/aggression, depression, anxiety, elation/euphoria, apathy/indifference, disinhibition, irritability/lability, aberrant motor behaviour; and 2 neurovegetative areas. Each area has a screening question between 7 and 9 follow-up questions relating to symptoms, asked if the answer to the screening question was 'yes'. Ratings will be based on frequency, severity and distress on identified behaviours. The change from Baseline and at 26 week treatment will be measured.
Sheehan Suicide Tracking Scale (S-STS)
Evaluate whether 26 weeks of treatment with montelukast affected suicidal risk, measured by the S-STS.
Incontinency Frequency Rating
Evaluate whether 26 weeks of treatment with montelukast improved bladder incontinence in patients who reported this problem, measured by recording events and observations in the incontinency frequency rating.
Incidence of Treatment-Emergent Adverse Events
Clinical safety and tolerability of montelukast film will be assessed up to Week 26 by adverse event monitoring (as assessed by CTCAE v5.0).

Full Information

First Posted
January 10, 2018
Last Updated
August 1, 2023
Sponsor
IntelGenx Corp.
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1. Study Identification

Unique Protocol Identification Number
NCT03402503
Brief Title
Safety, and Efficacy of a New Buccal Film of Montelukast in Patients With Mild to Moderate Alzheimer's Disease
Acronym
BUENA
Official Title
A Randomized Phase IIa, Multi-center, Double-blind, Placebo-controlled Study to Assess the Safety, Feasibility, Tolerability, and Efficacy of a New Buccal Film of Montelukast in Patients With Mild to Moderate Alzheimer's Disease
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
November 26, 2018 (Actual)
Primary Completion Date
February 29, 2024 (Anticipated)
Study Completion Date
May 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
IntelGenx Corp.

4. Oversight

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

5. Study Description

Brief Summary
The aim of this study is to evaluate the safety, feasibility, tolerability and efficacy of a new buccal film of montelukast in patients with mild to moderate Alzheimer's disease.
Detailed Description
This is a randomized Phase IIa, multi-center, double-blind, placebo-controlled study of a new buccal film of montelukast in patients with mild to moderate Alzheimer's Disease. Study drug (montelukast or matching placebo) will be administered once or twice daily for 26 weeks, and treatment effect will be assessed primarily using the global NTB composite score at Week 26. Patients who consent to participate will undergo screening assessments to determine eligibility. This study will enroll patients who are ≥50 years of age with mild to moderate Alzheimer's Disease and on a stable treatment of donepezil, rivastigmine or galantamine for ≥3 months. Patients will be randomized (using a balanced block randomization schedule) to one of two treatment groups: Group A: Montelukast buccal film Group B: Matching placebo buccal film In addition to the global NTB composite, patients will also be evaluated using the MMSE, ADCS-CGIC, ADCS-ADL23, NPI and S-STS. Patients will be followed for any safety concerns throughout the study and for 4 weeks following the last study visit.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
54 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Group A
Arm Type
Experimental
Arm Description
Montelukast buccal film, administered 10-mg once or 30-mg twice daily (once in the morning and once in the evening) for 26 weeks.
Arm Title
Group B
Arm Type
Placebo Comparator
Arm Description
Placebo buccal film, administered once or twice daily (once in the morning and once in the evening) for 26 weeks.
Intervention Type
Drug
Intervention Name(s)
Montelukast buccal film
Intervention Description
Film with active investigational product (montelukast) inserted and applied on inner cheek
Intervention Type
Other
Intervention Name(s)
Placebo buccal film
Intervention Description
Film with placebo (no active drug) inserted and applied on inner cheek
Primary Outcome Measure Information:
Title
Global Neuropsychological test battery (NTB) Composite
Description
Evaluate if treatment with montelukast new buccal film is superior to placebo, assessed at Week 26 using the global NTB composite score. The NTB score will be used to assess cognitive and behavioral functions including problem-solving and conceptualization. The composite score will be based on an equally weighted average of standardized change from baseline scores on the following tests: International Shopping List Test (ISLT), ISLT-Delay, One Back Test, One Card Learning Test, Verbal Fluency Test, Category Fluency Test, Identification Test and Detection Test.
Time Frame
To be conducted at Visit 2 (Baseline), Visit 4 (Week 6), Visit 6 (Week 12) and Visit 8 (Week 26)
Secondary Outcome Measure Information:
Title
Global Neuropsychological test battery (NTB) Composite
Description
Evaluate whether 6 and 12 weeks treatment with montelukast is superior to placebo, assessed using the global NTB composite scores. The NTB score will be used to assess cognitive and behavioral functions including problem-solving and conceptualization. he composite score will be based on an equally weighted average of standardized change from baseline scores on the following tests: International Shopping List Test (ISLT), ISLT-Delay, One Back Test, One Card Learning Test, Verbal Fluency Test, Category Fluency Test, Identification Test and Detection Test
Time Frame
To be conducted at Visit 4 (Week 6) and Visit 6 (Week 12)
Title
Mini Mental State Examination (MMSE)
Description
Evaluate whether 26 weeks of treatment with montelukast improved scores using the MMSE. The MMSE will be used to assess the subject's mental status in terms of cognitive function and level of dementia. The MMSE test will consist of an 11-question measure that will test five areas of cognitive function: orientation, registration, attention and calculation, recall, and language. The maximum score is 30.
Time Frame
To be conducted at Visit 1 (Screening), Visit 2 (Baseline), Visit 4 (Week 6), Visit 6 (Week 12), Visit 8 (Week 26)
Title
Alzheimer's Disease Cooperative Study - Clinical Global Impression of Change (ADCS-CGIC)
Description
Evaluate whether 26 weeks of treatment with montelukast improved scores using the ADCS-CGIC. ADCS-CGIC assessment and rating will be based on investigator's observation of changes in the subject's cognitive, functional, and behavioral performance since the beginning of a clinical trial (baseline) until end of treatment (Week 8).
Time Frame
To be conducted at Visit 2 (Baseline) and Visit 8 (Week 26)
Title
Alzheimer's Disease Cooperative Study - Activities of Daily Living, 23-items scale (ADCS-ADL23)
Description
Evaluate whether 26 weeks of treatment with montelukast improved scores using the ADCS-ADL23. The ADCS-ADL23 outcome measurement along with the assistance of the caregiver, will measure and evaluate the change from baseline and at Week 8, in the competence and performance of the subject in conducting their basic tasks and instrumental activities of daily living.
Time Frame
To be conducted at Visit 2 (Baseline) and Visit 8 (Week 26)
Title
Neuropsychiatric Inventory (NPI)
Description
Evaluate whether 26 weeks of treatment with montelukast improves the behavioral disturbance in patients, measured by the neuropsychiatric inventory (NPI), compared to placebo. NPI is an assessment of the frequency and severity of behavioral disturbances in dementia. The inventory comprises 10 behavioural areas: delusions, hallucinations, agitation/aggression, depression, anxiety, elation/euphoria, apathy/indifference, disinhibition, irritability/lability, aberrant motor behaviour; and 2 neurovegetative areas. Each area has a screening question between 7 and 9 follow-up questions relating to symptoms, asked if the answer to the screening question was 'yes'. Ratings will be based on frequency, severity and distress on identified behaviours. The change from Baseline and at 26 week treatment will be measured.
Time Frame
To be conducted at Visit 2 (Baseline) and Visit 8 (Week 26)
Title
Sheehan Suicide Tracking Scale (S-STS)
Description
Evaluate whether 26 weeks of treatment with montelukast affected suicidal risk, measured by the S-STS.
Time Frame
To be conducted at all visits i.e., Visit 1 (Screening), Visit 2 (Baseline), Visit 3 (Week 3), Visit 4 (Week 6),Visit 5 (Week 9), Visit 6 (Week 12), Visit 7 (Week 18), and Visit 8 (Week 26)
Title
Incontinency Frequency Rating
Description
Evaluate whether 26 weeks of treatment with montelukast improved bladder incontinence in patients who reported this problem, measured by recording events and observations in the incontinency frequency rating.
Time Frame
If there is a known history of incontinence, ratings to be conducted at all visits i.e., Visit 1 (Screening), Visit 2 (Baseline), Visit 3 (Week 3), Visit 4 (Week 6),Visit 5 (Week 9), Visit 6 (Week 12), Visit 7 (Week 18), and Visit 8 (Week 26)
Title
Incidence of Treatment-Emergent Adverse Events
Description
Clinical safety and tolerability of montelukast film will be assessed up to Week 26 by adverse event monitoring (as assessed by CTCAE v5.0).
Time Frame
26 Weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Mild to moderate Alzheimer's Disease. MMSE score of 14 - 22 CT or MRI within 18 months prior to screening indicating clinical phenotype of Alzheimer's Disease Treated daily with donepezil, rivastigmine or galantamine for ≥ 3 months All other medications for chronic conditions should have been at a stable dose for at least 2 weeks prior to first dose. No clinically meaningful abnormalities on electrocardiogram (ECG), physical examination and clinical laboratory tests Exclusion Criteria: Taken memantine within 2 months prior to screening. Current diagnosis of any psychiatric disorder, depression that is not well-controlled, clinically significant or unstable systemic disease, or severe medical procedures Clinically relevant abnormal laboratory values suggesting an unknown disease and requiring further clinical evaluation. Patients at imminent risk of self-harm, based on clinical interview and response on S-STS History of malignancy occurring within 5 years immediately prior to screening, except for a subject who has been adequately treated for (1) basal cell or squamous cell skin cancer, (2) in situ cervical cancer, (3) localized prostate carcinoma, or (4) who has undergone potentially curative therapy with no evidence of recurrence for more than 3 years post-therapy, and who is deemed at low risk for recurrence by her/his treating physician History of any of the following cardiovascular conditions that an unstable: Hypotension Hypertension Active cardiovascular disease Evidence of cerebrovascular disease Have used or plan to use the following medications from 30 days prior to Visit 1 through the end of the study: Narcotic analgesics more frequently than on three days per week as needed for pain; Daily antipsychotic (except for risperidone, quetiapine and aripiprazole, and only if at a stable and controlled dose) Daily anxiolytic use; however, occasional use as needed for acute agitation or to be used as a rescue anxiolytic (i.e., lorazepam and oxazepam) is acceptable as long as not used within 24 hours of a clinic visit window; Daily antidepressants (except for citalopram, escitalopram, venlafaxine, trazodone, sertraline, and mirtazapine, and only if at a stable and controlled dose); Low potency antipsychotic agents (eg chlorpromazine) - not permitted at any time during the study; Anti-parkinson's disease medications (selegiline, levodopa, amantadine) for the treatment of Parkinson's Syndrome Complex; Lithium; Clozapine; Previously treated with or currently using montelukast
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Frank A Pietrantonio, PhD
Organizational Affiliation
IntelGenx Corp.
Official's Role
Study Director
Facility Information:
Facility Name
Vancouver Island Health Authority
City
Victoria
State/Province
British Columbia
ZIP/Postal Code
V8R 1J8
Country
Canada
Facility Name
Centricity Research (formerly True North Clinical Research)
City
Halifax
State/Province
Nova Scotia
ZIP/Postal Code
B3S 1N2
Country
Canada
Facility Name
Centricity Research (formerly True North Clinical Research)
City
New Minas
State/Province
Nova Scotia
ZIP/Postal Code
B4N 3R7
Country
Canada
Facility Name
Bruyère Research Institute
City
Ottawa
State/Province
Ontario
ZIP/Postal Code
K1N 5C8
Country
Canada
Facility Name
Recherches Neuro-Hippocampe
City
Ottawa
State/Province
Ontario
ZIP/Postal Code
K1Z 1G3
Country
Canada
Facility Name
Kawartha Centre - Redefining Healthy Aging
City
Peterborough
State/Province
Ontario
ZIP/Postal Code
K9H 2P4
Country
Canada
Facility Name
Gerontion Research Inc.
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M4G 3E8
Country
Canada
Facility Name
Baycrest
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M6A 2E1
Country
Canada
Facility Name
Recherche Neuro-Hippocampe
City
Gatineau
State/Province
Quebec
ZIP/Postal Code
J8T 8J1
Country
Canada
Facility Name
Centre hospitalier universitaire de Québec -Université Laval
City
Québec
State/Province
Quebec
ZIP/Postal Code
G1J 1Z4
Country
Canada
Facility Name
Centre de recherche sur le vieillissement, CIUSSS de l'Estrie-CHUS
City
Sherbrooke
State/Province
Quebec
ZIP/Postal Code
J1J 3H5
Country
Canada
Facility Name
Diex Recherche Sherbrooke Inc.
City
Sherbrooke
State/Province
Quebec
ZIP/Postal Code
J1L 0H8
Country
Canada

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Safety, and Efficacy of a New Buccal Film of Montelukast in Patients With Mild to Moderate Alzheimer's Disease

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