A Novel Therapeutic Target for Alzheimer's Disease in Men and Women 50-85 Years of Age.
Primary Purpose
Mild Cognitive Impairment, Mild Alzheimer's Disease
Status
Unknown status
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
Dabigatran
Placebo - Cap
Sponsored by
About this trial
This is an interventional treatment trial for Mild Cognitive Impairment focused on measuring MCI, Mild AD, Dabigatran
Eligibility Criteria
Inclusion Criteria:
- Diagnosis of MCI likely due to AD or mild AD based on IWG-2 criteria for typical AD (A plus B at any stage) 2011 revised criteria
- English speaking men & woman age 50 -85 years (inclusive)
- Ability to provide informed consent
- MMSE score >20 at screening
- Informant or caregiver (e.g. family member, friend) willing to participate in semi-structured interviews
- CSF Aβ positive (MCI and AD) or a positive amyloid positron emission tomography (PET) scan within 6-months prior to screening using IWG-2 criteria.
- CDR Scale Global Score between 0.5 and 1
- Stable dosing (prior 3-months) of standard AD medications are allowed
- Demonstrated willingness to comply with study visit schedule, laboratory studies, and other study procedures
Exclusion Criteria:
- Pre-menopausal women (last menstruation < 1 year prior to screening) who are not surgically sterile.
- Creatinine clearance < 50mL/min
- Current psychiatric or neurological disorder that would contribute to cognitive impairment (focal neurological features early extrapyramidal signs, early hallucinations, cognitive fluctuations, non-AD dementia, major depression)
- Cerebrovascular disease
- Toxic, inflammatory, and metabolic disorders, all of which may require specific investigations
- MRI Flair or T2 signal changes in the medial temporal lobe that are consistent with infectious or vascular insults
- Sudden onset or early occurrence of the following symptoms: gait disturbances, seizures, major and prevalent behavioral changes
- Inability to swallow pills
- Current anticoagulant therapy
- Conditions associated with an increased risk of bleeding (e.g. major surgery within 30-days of baseline, planned surgery or intervention during treatment period)
- History of intracranial, intraocular, spinal, retroperitoneal or atraumatic intra-articular bleeding
- Gastrointestinal hemorrhage within the past year
- Symptomatic or endoscopically documented gastroduodenal ulcer disease in the previous 30-days; hemorrhagic disorder or bleeding diathesis
- Need for anticoagulant treatment of disorders, fibrinolytic agents within 48-hours of study baseline, uncontrolled hypertension (systolic blood pressure greater than 180mm Hg and/or diastolic blood pressure greater than 100 mm Hg)
- Recent malignancy or radiation therapy (within 6-months) and a survival rate of 3-years,
- Active infective endocarditis
- Active liver disease (including but not limited to persistent ALT, AST, Alk Phos greater than twice the upper limit of the normal range; active hepatitis C (positive HCV RNA)
- Active hepatitis B (HBs antigen +, anti HBc IgM +), active hepatitis A
- HIV/AIDS diagnosis
MRI exclusionary criteria
- Brain Aneurysm Clip
- Implanted neural stimulator
- Implanted cardiac pacemaker or defibrillator
- Cochlear implant
- Ocular foreign body (e.g. metal shavings)
- Other implanted medical devices: (e.g. Swan Ganz catheter, mechanical prosthetic heart)
- Insulin pump
- Metal shrapnel or bullet
Additional concomitant drug exclusionary criteria will be applied by investigator.
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Active Comparator
Placebo Comparator
Active Comparator
Arm Label
Dabigatran
Placebo
Open Label
Arm Description
Participants will receive 150mg dabigatran daily for a total of 9-months.
Participants will receive placebo daily for a total of 9-months.
All study participants are assigned to receive 150mg dabigatran daily for a total of 12 months (study month 9 through month 21)
Outcomes
Primary Outcome Measures
Evaluate dabigatran efficacy in MCI and mild AD population using changes in targeted plasma and CSF biomarker levels at 9 and 21 months
Evaluate effectiveness of dabigatran (150mg daily) on disease modification measured by changes in targeted plasma and CSF biomarkers associated with the early stages of Alzheimer's disease
Secondary Outcome Measures
Demonstrate a reduction in decline of cognitive function related to physical functioning in placebo arm after crossing over to 12-months of active treatment
Demonstrate an observed benefit of cognitive performance/function using the ADCS ADL MCI
Changes in cognitive performance in placebo arm after cross-over to open-label treatment phase
Evaluate effectiveness of dabigatran (150mg daily) using the CDR-SB
Safety and tolerability of dabigatran in experimental population (MCI and mild AD populations) based on reported serious and adverse events
Determine the safety and tolerability of dabigatran in MCI probably due to AD and mild AD population using physician and patient reported adverse events.
Evaluation of cognitive performance in placebo arm after cross-over to open-label treatment phase
Evaluate effectiveness of dabigatran (150mg daily) using the MoCA
Full Information
NCT ID
NCT03752294
First Posted
May 15, 2018
Last Updated
November 20, 2018
Sponsor
University of Rhode Island
Collaborators
Alzheimer's Drug Discovery Foundation, Boehringer Ingelheim
1. Study Identification
Unique Protocol Identification Number
NCT03752294
Brief Title
A Novel Therapeutic Target for Alzheimer's Disease in Men and Women 50-85 Years of Age.
Official Title
A 24-month, Randomized-control, Double-blind, Multi-center, Delayed-start, Pilot Study Evaluating Thrombin Inhibitions Alzheimer's Disease Using 150mg Dabigatran Daily: A Novel Therapeutic Target for Alzheimer's Disease
Study Type
Interventional
2. Study Status
Record Verification Date
November 2018
Overall Recruitment Status
Unknown status
Study Start Date
November 2018 (Anticipated)
Primary Completion Date
November 2021 (Anticipated)
Study Completion Date
December 2021 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Rhode Island
Collaborators
Alzheimer's Drug Discovery Foundation, Boehringer Ingelheim
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
A randomized-control, double-blind, multi-center, delayed-start, pilot trial evaluating the disease modifying effects of a 150mg once-a-day dose vs. placebo of dabigatran in men and women, between the ages of 50-85 years, confirmed with MCI probably due to AD and mild Alzheimer's Disease.
Detailed Description
The study will be conducted in 2-phases. The Phase I double-blind portion of the study consists of 40-60 active participants with MCI probably due to AD and mild AD randomized to 150mg once-a-day dose of dabigatran or placebo. A futility analysis will be conducted based on month 3 plasma biomarker changes from baseline. Excluding futility, at the end of Phase I, the study continues onto the open-label phase of the study where the placebo arm will be treated with 150mg once-a-day with dabigatran from months 10-21. The active treatment arm will continue on dabigatran through month-21. For final analysis, a difference in intercept of a generalized growth model between randomization groups during Phase 2 in the Cognitive Dementia Rating Scale-Sum of Boxes (CDR-SB) will be taken as evidence of effectiveness and justify further study. All patients will discontinue dabigatran after month 21 and a 3-month follow-up period will confirm whether or not the proposed cognitive effects can be sustained in the absence of treatment. The relationships between changes in levels of plasma biomarkers over time will be tested with regards to each other and relative to MRI and cognitive testing performed at scheduled intervals.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Mild Cognitive Impairment, Mild Alzheimer's Disease
Keywords
MCI, Mild AD, Dabigatran
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Crossover Assignment
Model Description
Randomized-control, Double-blind, Multicenter, Delayed-start, Pilot
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
The first phase of the study is 9-month, double-blind, randomized-control treatment. All participants participants will cross-over to phase II (open label) for an additional 12 months of treatment with a 3-month non-treatment follow-up
Allocation
Randomized
Enrollment
40 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Dabigatran
Arm Type
Active Comparator
Arm Description
Participants will receive 150mg dabigatran daily for a total of 9-months.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Participants will receive placebo daily for a total of 9-months.
Arm Title
Open Label
Arm Type
Active Comparator
Arm Description
All study participants are assigned to receive 150mg dabigatran daily for a total of 12 months (study month 9 through month 21)
Intervention Type
Drug
Intervention Name(s)
Dabigatran
Other Intervention Name(s)
Pradaxa
Intervention Description
At the end of a 9-month randomized-control, double-blind treatment all study participants will cross-over to the 12-month open-label phase with a 3-month non-treatment follow-up.
Intervention Type
Drug
Intervention Name(s)
Placebo - Cap
Other Intervention Name(s)
Study Drug
Intervention Description
At the end of a 9-month randomized-control, double-blind treatment all study participants will cross-over to the 12-month open-label phase with a 3-month non-treatment follow-up
Primary Outcome Measure Information:
Title
Evaluate dabigatran efficacy in MCI and mild AD population using changes in targeted plasma and CSF biomarker levels at 9 and 21 months
Description
Evaluate effectiveness of dabigatran (150mg daily) on disease modification measured by changes in targeted plasma and CSF biomarkers associated with the early stages of Alzheimer's disease
Time Frame
9 and 21-months
Secondary Outcome Measure Information:
Title
Demonstrate a reduction in decline of cognitive function related to physical functioning in placebo arm after crossing over to 12-months of active treatment
Description
Demonstrate an observed benefit of cognitive performance/function using the ADCS ADL MCI
Time Frame
12 - 24 months
Title
Changes in cognitive performance in placebo arm after cross-over to open-label treatment phase
Description
Evaluate effectiveness of dabigatran (150mg daily) using the CDR-SB
Time Frame
24-months
Title
Safety and tolerability of dabigatran in experimental population (MCI and mild AD populations) based on reported serious and adverse events
Description
Determine the safety and tolerability of dabigatran in MCI probably due to AD and mild AD population using physician and patient reported adverse events.
Time Frame
21-months
Title
Evaluation of cognitive performance in placebo arm after cross-over to open-label treatment phase
Description
Evaluate effectiveness of dabigatran (150mg daily) using the MoCA
Time Frame
24-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:
Diagnosis of MCI likely due to AD or mild AD based on IWG-2 criteria for typical AD (A plus B at any stage) 2011 revised criteria
English speaking men & woman age 50 -85 years (inclusive)
Ability to provide informed consent
MMSE score >20 at screening
Informant or caregiver (e.g. family member, friend) willing to participate in semi-structured interviews
CSF Aβ positive (MCI and AD) or a positive amyloid positron emission tomography (PET) scan within 6-months prior to screening using IWG-2 criteria.
CDR Scale Global Score between 0.5 and 1
Stable dosing (prior 3-months) of standard AD medications are allowed
Demonstrated willingness to comply with study visit schedule, laboratory studies, and other study procedures
Exclusion Criteria:
Pre-menopausal women (last menstruation < 1 year prior to screening) who are not surgically sterile.
Creatinine clearance < 50mL/min
Current psychiatric or neurological disorder that would contribute to cognitive impairment (focal neurological features early extrapyramidal signs, early hallucinations, cognitive fluctuations, non-AD dementia, major depression)
Cerebrovascular disease
Toxic, inflammatory, and metabolic disorders, all of which may require specific investigations
MRI Flair or T2 signal changes in the medial temporal lobe that are consistent with infectious or vascular insults
Sudden onset or early occurrence of the following symptoms: gait disturbances, seizures, major and prevalent behavioral changes
Inability to swallow pills
Current anticoagulant therapy
Conditions associated with an increased risk of bleeding (e.g. major surgery within 30-days of baseline, planned surgery or intervention during treatment period)
History of intracranial, intraocular, spinal, retroperitoneal or atraumatic intra-articular bleeding
Gastrointestinal hemorrhage within the past year
Symptomatic or endoscopically documented gastroduodenal ulcer disease in the previous 30-days; hemorrhagic disorder or bleeding diathesis
Need for anticoagulant treatment of disorders, fibrinolytic agents within 48-hours of study baseline, uncontrolled hypertension (systolic blood pressure greater than 180mm Hg and/or diastolic blood pressure greater than 100 mm Hg)
Recent malignancy or radiation therapy (within 6-months) and a survival rate of 3-years,
Active infective endocarditis
Active liver disease (including but not limited to persistent ALT, AST, Alk Phos greater than twice the upper limit of the normal range; active hepatitis C (positive HCV RNA)
Active hepatitis B (HBs antigen +, anti HBc IgM +), active hepatitis A
HIV/AIDS diagnosis
MRI exclusionary criteria
Brain Aneurysm Clip
Implanted neural stimulator
Implanted cardiac pacemaker or defibrillator
Cochlear implant
Ocular foreign body (e.g. metal shavings)
Other implanted medical devices: (e.g. Swan Ganz catheter, mechanical prosthetic heart)
Insulin pump
Metal shrapnel or bullet
Additional concomitant drug exclusionary criteria will be applied by investigator.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Chris Getter
Phone
401-874-2358
Email
cgetter@uri.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Paula Grammas, PhD
Organizational Affiliation
Executive Director of the Ryan Institute for Neuroscience
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
John Stoukides, MD
Organizational Affiliation
Medical Director, Rhode Island Mood & Memory Research Institute
Official's Role
Principal Investigator
12. IPD Sharing Statement
Plan to Share IPD
Undecided
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A Novel Therapeutic Target for Alzheimer's Disease in Men and Women 50-85 Years of Age.
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