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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
University of Rhode Island
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Mild Cognitive Impairment focused on measuring MCI, Mild AD, Dabigatran

Eligibility Criteria

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

Inclusion Criteria:

  1. 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
  2. English speaking men & woman age 50 -85 years (inclusive)
  3. Ability to provide informed consent
  4. MMSE score >20 at screening
  5. Informant or caregiver (e.g. family member, friend) willing to participate in semi-structured interviews
  6. 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.
  7. CDR Scale Global Score between 0.5 and 1
  8. Stable dosing (prior 3-months) of standard AD medications are allowed
  9. Demonstrated willingness to comply with study visit schedule, laboratory studies, and other study procedures

Exclusion Criteria:

  1. Pre-menopausal women (last menstruation < 1 year prior to screening) who are not surgically sterile.
  2. Creatinine clearance < 50mL/min
  3. 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)
  4. Cerebrovascular disease
  5. Toxic, inflammatory, and metabolic disorders, all of which may require specific investigations
  6. MRI Flair or T2 signal changes in the medial temporal lobe that are consistent with infectious or vascular insults
  7. Sudden onset or early occurrence of the following symptoms: gait disturbances, seizures, major and prevalent behavioral changes
  8. Inability to swallow pills
  9. Current anticoagulant therapy
  10. Conditions associated with an increased risk of bleeding (e.g. major surgery within 30-days of baseline, planned surgery or intervention during treatment period)
  11. History of intracranial, intraocular, spinal, retroperitoneal or atraumatic intra-articular bleeding
  12. Gastrointestinal hemorrhage within the past year
  13. Symptomatic or endoscopically documented gastroduodenal ulcer disease in the previous 30-days; hemorrhagic disorder or bleeding diathesis
  14. 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)
  15. Recent malignancy or radiation therapy (within 6-months) and a survival rate of 3-years,
  16. Active infective endocarditis
  17. 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)
  18. Active hepatitis B (HBs antigen +, anti HBc IgM +), active hepatitis A
  19. HIV/AIDS diagnosis

MRI exclusionary criteria

  1. Brain Aneurysm Clip
  2. Implanted neural stimulator
  3. Implanted cardiac pacemaker or defibrillator
  4. Cochlear implant
  5. Ocular foreign body (e.g. metal shavings)
  6. Other implanted medical devices: (e.g. Swan Ganz catheter, mechanical prosthetic heart)
  7. Insulin pump
  8. 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

    First Posted
    May 15, 2018
    Last Updated
    November 20, 2018
    Sponsor
    University of Rhode Island
    Collaborators
    Alzheimer's Drug Discovery Foundation, Boehringer Ingelheim
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    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

    Learn more about this trial

    A Novel Therapeutic Target for Alzheimer's Disease in Men and Women 50-85 Years of Age.

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