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Effect of Neflamapimod on Brain Inflammation in Alzheimer's Disease Patients (VIP)

Primary Purpose

Alzheimer Disease

Status
Completed
Phase
Phase 2
Locations
France
Study Type
Interventional
Intervention
VX-745
placebo
Sponsored by
University Hospital, Toulouse
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alzheimer Disease

Eligibility Criteria

18 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • A group of 40 AD patients at an early stage (prodromal) will be recruited. Patient's recruitment will follow the most recent research criteria for AD in its "typical form" (Dubois, Feldman et al. 2014):

    • Age 50 - 90 (inclusive)
    • Willing and able to provide informed consent
    • Objective memory impairment corroborated by level of performance on a standardized memory test (Free and Cued Selective Reminding test, (Grober, Hall et al. 2008)) < -1.5 DS according to established norms and
    • Documented cerebral amyloidopathy using CSF analysis or PET amyloid imaging and
    • Early stage of the disease (Mini Mental State Examination > 20) (Folstein, Robins et al. 1983).

Exclusion Criteria:

  • • Evidence of neurodegenerative disease other than AD

    • Inability for any reason to undergo MRI scans (e.g. pacemaker). Patients who require sedation for screening procedures such as MRI may receive a short-acting sedative.
    • Psychiatric disorder that would compromise ability to comply with study requirements
    • History of cancer within the last 5 years, except basal cell carcinoma, non-squamous skin carcinoma, prostate cancer or carcinoma in situ with no significant progression over the past 2 years
    • Significant cardiovascular, pulmonary, renal, liver, infectious disease, immune disorder or metabolic/endocrine disorders or other disease that would preclude treatment with p38 MAP kinase inhibitor and/or assessment of drug safety and efficacy
    • Recent (<60 days) changes to AD medications prescribed for cognitive reasons or with the potential to impact cognition
    • Psychotropic drugs taken within 1 month. Anticoagulant drugs taken within 1 week.
    • Participation in a study of an investigational drug less than 6 months or 5 half-lives of the investigational drug, whichever is longer, before enrollment in the study
    • Male subjects with female partner of child-bearing potential who are unwilling or unable to adhere to contraception requirements
    • Female subjects who have not reached menopause or have not had a hysterectomy or bilateral oophorectomy/salpingoophorectomy
    • Positive urine or serum pregnancy test or plans desires to become pregnant during the course of the trial
    • History of alcohol and/or illicit drug abuse within 6 months.
    • Infection with hepatitis A, B or C or HIV.
    • Any factor deemed by the investigator to be likely to interfere with study conduction

Sites / Locations

  • CHU Toulouse

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

VX-745

placebo

Arm Description

In the present study, VX-745 will be given at the dosage of 40 mg twice a day (1 tab. of 40 mg, twice), orally for 12 weeks

In the present study, placebo will be given twice a day (1 tab. , twice), orally for 12 weeks

Outcomes

Primary Outcome Measures

brain inflammation assessed by [18F]-DPA714, Standard Uptake Value (SUV)
To track the impact of this drug in patients, investigators will use an innovative radiotracer, [18F]DPA-714, as a promising ligand of microglial activation targeting the translocator protein (TSPO), specific of microglial activation. The use of [18F]DPA-714 will allow us to monitor the evolution of neuroinflammation in patients as a function of treatment. the main objective will be to compare the level of inflammation using the [18F]DPA-714 in neflamapimod and placebo. Regional cortical DPA-714 mean SUV will be measured in each subject using a Matlab (The MathWorks®) script. Mean global SUVs will be calculated
brain inflammation assessed by [18F]-DPA714, Standard Uptake Value (SUV) 2
SUVs in the five lobes will be calculated.
brain inflammation assessed by [18F]-DPA714, Standard Uptake Value (SUV)3
SUVs in specific regions of interest (ROIs: orbitofrontal, anterior cingulate, posterior cingulate and precuneus) will be calculated.

Secondary Outcome Measures

Neuropsychological assessment to assess the following cognitive functions 1:
Memory: Rey Figure
Neuropsychological assessment to assess the following cognitive functions 2:
Memory: DMS 48,
Neuropsychological assessment to assess the following cognitive functions 1.1:
Language: confrontation naming (Gremots),
Neuropsychological assessment to assess the following cognitive functions 2.2:
Language: FAS fluencies,
Neuropsychological assessment to assess the following cognitive functions 3:
o Attention and executive functions: D2
Neuropsychological assessment to assess the following cognitive functions 4:
o Attention and executive functions: TEA
Neuropsychological assessment to assess the following cognitive functions 5:
o Attention and executive functions: SDMT WAIS
Blood and CSF biomarkers of inflammation1
ApoE phenotype
Blood and CSF biomarkers of inflammation 2
TSPO phenotype,
Blood and CSF biomarkers of inflammation 3
TNFa,
Blood and CSF biomarkers of inflammation 4
IL-1b,
Blood and CSF biomarkers of inflammation 5
IFNg
Blood and CSF biomarkers of inflammation 6
IL-12
Blood and CSF biomarkers of inflammation 7
IFNa/b
Blood and CSF biomarkers of inflammation 8
IL-10
Blood and CSF biomarkers of inflammation 9
IL-6
Blood and CSF biomarkers of inflammation 10
IL-8,
Blood and CSF biomarkers of inflammation 11
MCP-1,
Blood and CSF biomarkers of inflammation 12
GM-CSF
Blood and CSF biomarkers of inflammation 13
IL-27
Blood and CSF biomarkers of inflammation 14
chimiokines receptors,
Blood and CSF biomarkers of inflammation 15
PD-1,
Blood and CSF biomarkers of inflammation 16
CD14/16
Blood and CSF biomarkers of inflammation 17
p-tau,
Blood and CSF biomarkers of inflammation 18
abéta42,
Blood and CSF biomarkers of inflammation 19
Abeta40,
Blood and CSF biomarkers of inflammation 20
cells count
Blood and CSF biomarkers of inflammation 21
TNFa
Blood and CSF biomarkers of inflammation 22
IL-1b
Blood and CSF biomarkers of inflammation 23
IL-12
Blood and CSF biomarkers of inflammation 24
MCP-1
Blood and CSF biomarkers of inflammation 25
GM-CSF
Blood and CSF biomarkers of inflammation 26
IL-27,
Blood and CSF biomarkers of inflammation 27
PD-1
Blood and CSF biomarkers of inflammation 28
CD14/16

Full Information

First Posted
December 22, 2017
Last Updated
June 19, 2023
Sponsor
University Hospital, Toulouse
Collaborators
Fondation Plan Alzheimer
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1. Study Identification

Unique Protocol Identification Number
NCT03435861
Brief Title
Effect of Neflamapimod on Brain Inflammation in Alzheimer's Disease Patients
Acronym
VIP
Official Title
Effect of Neflamapimod (VX-745) on Brain Inflammation Using Positron Emission Tomography (PET) Scan in Alzheimer's Disease (AD) Patients
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Completed
Study Start Date
October 8, 2018 (Actual)
Primary Completion Date
April 30, 2021 (Actual)
Study Completion Date
June 30, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University Hospital, Toulouse
Collaborators
Fondation Plan Alzheimer

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
For this project, neflamapimod and placebo will be provided free of charge by the EIP company (www.eippharma.com). Neflamapimod is currently tested in 2 clinical trials in AD, one in Europe (The Netherlands) and one in the USA (clinical trials.gov/VX-745). The company commenced in May 2015 dosing in two phase 2a clinical studies in patients with Early AD: one in the Netherlands that is focused on PET amyloid imaging as the primary biomarker of drug effect, and one in the US (California) that is focused on Cerebrospinal fluid (CSF) evaluation to determine CSF drug concentrations and effects on inflammatory markers and disease biomarkers. Pharmacokinetic evaluation in these patients has demonstrated blood drug concentration levels in the predicted therapeutic range; and importantly, the data from the US study demonstrate that the drug achieves target drug concentrations in CSF, thus confirming the drug robustly enters the brain in humans. The present project offers us a unique chance to test this promising drug in AD patients. The aim of the study is to focus on PET neuroinflammation imaging as the primary biomarker of this drug effect. The chosen biomarker for imaging neuroinflammation in patients is [1 8F]-DPA714.
Detailed Description
The present project is an intervention proof of concept study to test the efficacy of neflamapimod in a population of AD patients at an early stage. To track the impact of this drug in patients, the investigators will use an innovative radiotracer, [18F]DPA-714, as a promising ligand of microglial activation targeting the translocator protein (TSPO), specific of microglial activation. The use of [18F]DPA-714 will allow to monitor the evolution of neuroinflammation in patients as a function of treatment. The main objective will be to compare the level of inflammation using the [18F]DPA-714 in neflamapimod and placebo groups after 12 weeks of treatment. Blood and cerebrospinal fluid (CSF) samples and magnetic resonance imaging (MRI) will also be collected to assess inflammation markers and brain structure respectively in these patients.

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
Model Description
Our mono-centric project will consist in a double-blinded randomized placebo-controlled study, assessing the effect of neflamapimod on brain inflammation in patients suffering of AD by using [18F]-DPA714
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
34 (Actual)

8. Arms, Groups, and Interventions

Arm Title
VX-745
Arm Type
Experimental
Arm Description
In the present study, VX-745 will be given at the dosage of 40 mg twice a day (1 tab. of 40 mg, twice), orally for 12 weeks
Arm Title
placebo
Arm Type
Placebo Comparator
Arm Description
In the present study, placebo will be given twice a day (1 tab. , twice), orally for 12 weeks
Intervention Type
Drug
Intervention Name(s)
VX-745
Other Intervention Name(s)
neflamapimod
Intervention Description
active drug capsules
Intervention Type
Drug
Intervention Name(s)
placebo
Intervention Description
placebo capsules
Primary Outcome Measure Information:
Title
brain inflammation assessed by [18F]-DPA714, Standard Uptake Value (SUV)
Description
To track the impact of this drug in patients, investigators will use an innovative radiotracer, [18F]DPA-714, as a promising ligand of microglial activation targeting the translocator protein (TSPO), specific of microglial activation. The use of [18F]DPA-714 will allow us to monitor the evolution of neuroinflammation in patients as a function of treatment. the main objective will be to compare the level of inflammation using the [18F]DPA-714 in neflamapimod and placebo. Regional cortical DPA-714 mean SUV will be measured in each subject using a Matlab (The MathWorks®) script. Mean global SUVs will be calculated
Time Frame
3 month
Title
brain inflammation assessed by [18F]-DPA714, Standard Uptake Value (SUV) 2
Description
SUVs in the five lobes will be calculated.
Time Frame
3 month
Title
brain inflammation assessed by [18F]-DPA714, Standard Uptake Value (SUV)3
Description
SUVs in specific regions of interest (ROIs: orbitofrontal, anterior cingulate, posterior cingulate and precuneus) will be calculated.
Time Frame
3 month
Secondary Outcome Measure Information:
Title
Neuropsychological assessment to assess the following cognitive functions 1:
Description
Memory: Rey Figure
Time Frame
3 month
Title
Neuropsychological assessment to assess the following cognitive functions 2:
Description
Memory: DMS 48,
Time Frame
3 month
Title
Neuropsychological assessment to assess the following cognitive functions 1.1:
Description
Language: confrontation naming (Gremots),
Time Frame
3 month
Title
Neuropsychological assessment to assess the following cognitive functions 2.2:
Description
Language: FAS fluencies,
Time Frame
3 month
Title
Neuropsychological assessment to assess the following cognitive functions 3:
Description
o Attention and executive functions: D2
Time Frame
3 month
Title
Neuropsychological assessment to assess the following cognitive functions 4:
Description
o Attention and executive functions: TEA
Time Frame
3 month
Title
Neuropsychological assessment to assess the following cognitive functions 5:
Description
o Attention and executive functions: SDMT WAIS
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation1
Description
ApoE phenotype
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 2
Description
TSPO phenotype,
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 3
Description
TNFa,
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 4
Description
IL-1b,
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 5
Description
IFNg
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 6
Description
IL-12
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 7
Description
IFNa/b
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 8
Description
IL-10
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 9
Description
IL-6
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 10
Description
IL-8,
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 11
Description
MCP-1,
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 12
Description
GM-CSF
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 13
Description
IL-27
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 14
Description
chimiokines receptors,
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 15
Description
PD-1,
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 16
Description
CD14/16
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 17
Description
p-tau,
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 18
Description
abéta42,
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 19
Description
Abeta40,
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 20
Description
cells count
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 21
Description
TNFa
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 22
Description
IL-1b
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 23
Description
IL-12
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 24
Description
MCP-1
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 25
Description
GM-CSF
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 26
Description
IL-27,
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 27
Description
PD-1
Time Frame
3 month
Title
Blood and CSF biomarkers of inflammation 28
Description
CD14/16
Time Frame
3 month

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: A group of 40 AD patients at an early stage (prodromal) will be recruited. Patient's recruitment will follow the most recent research criteria for AD in its "typical form" (Dubois, Feldman et al. 2014): Age 50 - 90 (inclusive) Willing and able to provide informed consent Objective memory impairment corroborated by level of performance on a standardized memory test (Free and Cued Selective Reminding test, (Grober, Hall et al. 2008)) < -1.5 DS according to established norms and Documented cerebral amyloidopathy using CSF analysis or PET amyloid imaging and Early stage of the disease (Mini Mental State Examination > 20) (Folstein, Robins et al. 1983). Exclusion Criteria: • Evidence of neurodegenerative disease other than AD Inability for any reason to undergo MRI scans (e.g. pacemaker). Patients who require sedation for screening procedures such as MRI may receive a short-acting sedative. Psychiatric disorder that would compromise ability to comply with study requirements History of cancer within the last 5 years, except basal cell carcinoma, non-squamous skin carcinoma, prostate cancer or carcinoma in situ with no significant progression over the past 2 years Significant cardiovascular, pulmonary, renal, liver, infectious disease, immune disorder or metabolic/endocrine disorders or other disease that would preclude treatment with p38 MAP kinase inhibitor and/or assessment of drug safety and efficacy Recent (<60 days) changes to AD medications prescribed for cognitive reasons or with the potential to impact cognition Psychotropic drugs taken within 1 month. Anticoagulant drugs taken within 1 week. Participation in a study of an investigational drug less than 6 months or 5 half-lives of the investigational drug, whichever is longer, before enrollment in the study Male subjects with female partner of child-bearing potential who are unwilling or unable to adhere to contraception requirements Female subjects who have not reached menopause or have not had a hysterectomy or bilateral oophorectomy/salpingoophorectomy Positive urine or serum pregnancy test or plans desires to become pregnant during the course of the trial History of alcohol and/or illicit drug abuse within 6 months. Infection with hepatitis A, B or C or HIV. Any factor deemed by the investigator to be likely to interfere with study conduction
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jeremie PARIENTE, MD
Organizational Affiliation
University Hospital, Toulouse
Official's Role
Principal Investigator
Facility Information:
Facility Name
CHU Toulouse
City
Toulouse
ZIP/Postal Code
31000
Country
France

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
33974419
Citation
Tormahlen NM, Martorelli M, Kuhn A, Maier F, Guezguez J, Burnet M, Albrecht W, Laufer SA, Koch P. Design and Synthesis of Highly Selective Brain Penetrant p38alpha Mitogen-Activated Protein Kinase Inhibitors. J Med Chem. 2022 Jan 27;65(2):1225-1242. doi: 10.1021/acs.jmedchem.0c01773. Epub 2021 May 11.
Results Reference
derived

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Effect of Neflamapimod on Brain Inflammation in Alzheimer's Disease Patients

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