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Dapagliflozin In Alzheimer's Disease

Primary Purpose

Alzheimer Disease

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Dapagliflozin
Placebo
Sponsored by
Jeff Burns, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alzheimer Disease

Eligibility Criteria

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

Inclusion Criteria:

  1. Provision of informed consent prior to any study specific procedures.
  2. Have a diagnosis of probable AD per McKhann et al. criteria
  3. Have a body mass index (BMI) ≥23
  4. Age 50-85
  5. Have a Mini Mental Status Exam (MMSE) score of 15-26 (inclusive) at screening visit
  6. Have a reliable and competent study partner who is willing to accompany the participant to all study visits, monitor compliance of study medication administration, and observe/report any changes in the participant's health throughout the study duration
  7. Are on stable doses of concurrent medications for at least 4 weeks prior to the screening visit
  8. Speaks English as his/her primary language.
  9. Females of child-bearing potential (i.e., pre-menopausal) must have a negative urine pregnancy test at the screening visit and must agree to use of contraception throughout the trial and for 30 days after the last dose of study medication. The approved methods of contraception are abstinence, the consistent use of an approved oral contraceptive (birth control pill or "the pill"), an intrauterine device (IUD), hormonal implants, contraceptive injection, double barrier method (diaphragm with spermicidal gel or condom with contraceptive foam).

Exclusion Criteria:

  1. Received an investigational product in another clinical study during the last 4 weeks prior to screening
  2. Diagnosis of Type 1 diabetes
  3. Diagnosis of Type 2 diabetes treated with insulin, sulfonylureas, glucagon like peptide1 receptor agonists (GLP-1), thiazolidinedione (TZD) or SGLT2 inhibitors (metformin monotherapy is allowed).
  4. Estimated Glomerular Filtration Rate (eGFR; MDRD) <45 mL/min at screening or unstable renal disease.
  5. Any condition when MRI is contraindicated such as, but not limited to, having a pacemaker or claustrophobia.
  6. Severe hepatic injury and/or significant abnormal liver function defined as aspartate aminotransferase (AST) >3x upper limit of normal (ULN) and/or alanine aminotransferase (ALT) >3x ULN. Total bilirubin >2.0 mg/dL (34.2 μmol/L)
  7. Intolerance or allergy to dapaglifozin or any other SGLT2 inhibitor or any other substance in the tablets.
  8. Dementia due to causes other than AD
  9. History of recurrent urinary tract infection
  10. Active mycotic genital infection
  11. History of bladder cancer
  12. History of diabetic ketoacidosis
  13. Potentially confounding, serious, or unstable medical conditions such as:

    1. cancer within the past 3 years (except basal cell, squamous cell, or localized prostate cancer)
    2. a recent cardiac event (i.e. heart attack, angioplasty, etc. within the 3 months prior to screening visit)
    3. other conditions that pose a potential safety risk or confounding factor in the investigator's opinion
  14. Any abnormal physical examination assessment or vital sign assessment at the screening visit that is deemed to be clinically significant by the principal investigator.
  15. Any abnormal clinical laboratory test result at the screening visit that is deemed to be clinically significant by the principal investigator.

Sites / Locations

  • University of Kansas Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Dapagliflozin

Matching placebo

Arm Description

10 mg dapagliflozin oral tablet taken once daily for 12 weeks

Placebo oral tablet taken once daily for 12 weeks

Outcomes

Primary Outcome Measures

Cerebral N Acetyl-Aspartate (NAA)
Cerebral NAA concentration via Magnetic Resonance Spectroscopy (MRS)

Secondary Outcome Measures

Full Information

First Posted
December 21, 2018
Last Updated
May 10, 2023
Sponsor
Jeff Burns, MD
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1. Study Identification

Unique Protocol Identification Number
NCT03801642
Brief Title
Dapagliflozin In Alzheimer's Disease
Official Title
Randomized Controlled Pilot Trial Of Dapagliflozin In Alzheimer's Disease
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Completed
Study Start Date
January 29, 2019 (Actual)
Primary Completion Date
July 7, 2022 (Actual)
Study Completion Date
July 7, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Jeff Burns, MD

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
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
This is a pilot randomized controlled trial in individuals with probable Alzheimer's disease testing the effects of 10 mg dapagliflozin, taken daily for 12 weeks, on cerebral n-acetyl aspartate (NAA) levels using magnetic resonance spectroscopy (MRS). The investigators will also examine the safety and tolerability of dapagliflozin and explore the effects on systemic NAA levels in blood and urine, cerebral metabolism (fluorodeoxyglucose [FDG] PET), systemic metabolic biomarkers that indicate and quantify secondary metabolic effects, and cognitive performance.
Detailed Description
This is a double-blind, randomized, placebo-controlled, parallel group, 12-week study performed at a single site (University of Kansas Alzheimer's Disease Center) to investigate the effect of dapagliflozin in participants with probable AD (MMSE 15-26 inclusive). A total of 48 participants will be enrolled with 2:1 randomization to 10mg dapagliflozin once daily (n=32) for 12 weeks vs matching placebo (n=16). The primary objective of the study is to assess the effect of 12 weeks of 10mg dapagliflozin once daily on cerebral NAA (a proxy measure of mitochondrial mass) in participants with AD. Procedures will include phlebotomy, urine collection, MRI/MRS, FDG-PET, cognitive testing, DEXA scanning, and indirect calorimetry at baseline and 12 weeks to assess these outcomes: N Acetyl-Aspartate (NAA): Cerebral NAA (as measured by MRS) and Systemic NAA levels (in blood and urine) Cerebral metabolism (by FDG PET) Systemic metabolic effects: Lipids (total cholesterol, LDL, HDL), Plasma beta-hydroxybutyrate, Insulin resistance (Hemoglobin A1c, glucose and insulin during tolerance testing), Catabolic/Anabolic state [activated AKT and MTOR], Mitochondrial function measures [platelet cytochrome oxidase and citrate synthase], Inflammatory mechanisms [MCP-1, eotaxin, TNF alpha, CRP], Body composition (DEXA scanning for fat and lean mass), Resting metabolic rate (indirect calorimetry), Cognitive effects will be assessed at baseline and week 12 using the Alzheimer's Disease Assessment Scale-Cognitive Subscale 14 (ADAS-Cog14) and individual tests of Logical Memory I and II, Trailmaking A and B, and Stroop Word Color Test. 12 participants will be enrolled in an optional MRI/MRS sub-study with repeat MRI/MRS prior to randomization to assess scan-rescan reliability of the NAA measure. Safety and tolerability of dapagliflozin (10mg daily) will be monitored throughout the study and formally at every study visit to assess the incidence and severity of AEs and the rate of discontinuations due to AEs. Safety assessments will include measuring vital signs and body weight, safety labs (including a comprehensive metabolic panel [CMP] and complete blood count [CBC] with differential) and physical and neurological examinations at screening and at end of treatment (EOT).

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 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
48 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Dapagliflozin
Arm Type
Experimental
Arm Description
10 mg dapagliflozin oral tablet taken once daily for 12 weeks
Arm Title
Matching placebo
Arm Type
Placebo Comparator
Arm Description
Placebo oral tablet taken once daily for 12 weeks
Intervention Type
Drug
Intervention Name(s)
Dapagliflozin
Other Intervention Name(s)
Farxiga
Intervention Description
10 mg oral tablets taken once daily for 12 weeks
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Placebo tablet (matched in size and color to active tablet) taken once daily for 12 weeks
Primary Outcome Measure Information:
Title
Cerebral N Acetyl-Aspartate (NAA)
Description
Cerebral NAA concentration via Magnetic Resonance Spectroscopy (MRS)
Time Frame
12 weeks
Other Pre-specified Outcome Measures:
Title
Systemic NAA levels
Description
NAA concentration levels in blood and urine using UPLC-MS/MS method
Time Frame
12 weeks
Title
FDG PET Metabolism (Standard Uptake Value Ratio)
Description
FDG PET measures reflecting cerebral metabolism standardized to the uptake value of the cerebellum and standardized uptake value ratios (SUVR) will be calculated from native-space ROIs.
Time Frame
12 weeks
Title
Total Cholesterol
Description
Total cholesterol level
Time Frame
12 weeks
Title
LDL Cholesterol
Description
LDL cholesterol level
Time Frame
12 weeks
Title
HDL Cholesterol
Description
HDL cholesterol level
Time Frame
12 weeks
Title
Plasma beta-hydroxybutyrate
Description
Plasma beta-hydroxybuteryate levels (ketones)
Time Frame
12 weeks
Title
Hemoglobin A1C
Description
Hemoglobin A1C
Time Frame
12 weeks
Title
Glucose Area Under the Curve
Description
Glucose area under the curve will be calculated based on glucose levels during a 120 minute oral glucose tolerance test.
Time Frame
12 weeks
Title
Insulin Area Under the Curve
Description
Insulin area under the curve will be calculated based on insulin levels during a 120 minute oral glucose tolerance test.
Time Frame
12 weeks
Title
Activated AKT levels
Description
Activated AKT will be measured in lymphocytes immunochemically.
Time Frame
12 weeks
Title
MTOR Phosphorylation
Description
MTOR phosphorylation will be measured in lymphocytes
Time Frame
12 weeks
Title
Platelet Cytochrome Oxidase activity
Description
Cytochrome Oxidase Vmax activity is determined as a pseudo first order-rate constant (sec-1/mg protein) by measuring the oxidation of reduced cytochrome c at 550 nm
Time Frame
12 weeks
Title
Monocyte Chemotactic Protein 1 (MCP-1)
Description
MCP-1, a measure of inflammation, will be measured in platelet free plasma using ELISA.
Time Frame
12 weeks
Title
Eotaxin-1
Description
Eotaxin-1, a measure of inflammation, will be measured in platelet free plasma using ELISA.
Time Frame
12 weeks
Title
Tumor Necrosis Factor (TNF) - alpha
Description
TNF-alpha, a measure of inflammation, will be measured in platelet free plasma using ELISA.
Time Frame
12 weeks
Title
C-Reactive Protein (CRP)
Description
CRP, a measure of inflammation, will be measured in platelet free plasma using ELISA.
Time Frame
12 weeks
Title
Total fat mass
Description
Body composition will be assessed using dual energy x-ray absorptiometry (GE Lunar iDEXA) to determine fat-free mass, fat mass, and percent body fat at baseline, and week 12
Time Frame
12 weeks
Title
Total lean mass
Description
Body composition will be assessed using dual energy x-ray absorptiometry (GE Lunar iDEXA) to determine fat-free mass, fat mass, and percent body fat at baseline, and week 12
Time Frame
12 weeks
Title
Resting Metabolic Rate
Description
Resting metabolic rate will be assessed using indirect calorimetry which measures CO2 production and O2 consumption to calculate total energy produced.
Time Frame
12 weeks
Title
ADAS-Cog 14
Description
Cognitive performance as measured by total score on the ADAS-cog 14.
Time Frame
12 weeks
Title
Trailmaking B
Description
Cognitive performance as measured by Trailmaking B
Time Frame
12 weeks
Title
Stroop Word Color Test
Description
Cognitive performance on the Stroop Word Color test.
Time Frame
12 weeks
Title
Logical Memory II
Description
Memory performance as measured by the Logical Memory II test.
Time Frame
12 weeks
Title
Number of Adverse Events
Description
Total number of adverse events considered related to the study medication
Time Frame
14 weeks
Title
Number of Discontinuations due to Adverse Events
Description
Number of participants who stop taking the study medication due to adverse events
Time Frame
14 weeks

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: Provision of informed consent prior to any study specific procedures. Have a diagnosis of probable AD per McKhann et al. criteria Have a body mass index (BMI) ≥23 Age 50-85 Have a Mini Mental Status Exam (MMSE) score of 15-26 (inclusive) at screening visit Have a reliable and competent study partner who is willing to accompany the participant to all study visits, monitor compliance of study medication administration, and observe/report any changes in the participant's health throughout the study duration Are on stable doses of concurrent medications for at least 4 weeks prior to the screening visit Speaks English as his/her primary language. Females of child-bearing potential (i.e., pre-menopausal) must have a negative urine pregnancy test at the screening visit and must agree to use of contraception throughout the trial and for 30 days after the last dose of study medication. The approved methods of contraception are abstinence, the consistent use of an approved oral contraceptive (birth control pill or "the pill"), an intrauterine device (IUD), hormonal implants, contraceptive injection, double barrier method (diaphragm with spermicidal gel or condom with contraceptive foam). Exclusion Criteria: Received an investigational product in another clinical study during the last 4 weeks prior to screening Diagnosis of Type 1 diabetes Diagnosis of Type 2 diabetes treated with insulin, sulfonylureas, glucagon like peptide1 receptor agonists (GLP-1), thiazolidinedione (TZD) or SGLT2 inhibitors (metformin monotherapy is allowed). Estimated Glomerular Filtration Rate (eGFR; MDRD) <45 mL/min at screening or unstable renal disease. Any condition when MRI is contraindicated such as, but not limited to, having a pacemaker or claustrophobia. Severe hepatic injury and/or significant abnormal liver function defined as aspartate aminotransferase (AST) >3x upper limit of normal (ULN) and/or alanine aminotransferase (ALT) >3x ULN. Total bilirubin >2.0 mg/dL (34.2 μmol/L) Intolerance or allergy to dapaglifozin or any other SGLT2 inhibitor or any other substance in the tablets. Dementia due to causes other than AD History of recurrent urinary tract infection Active mycotic genital infection History of bladder cancer History of diabetic ketoacidosis Potentially confounding, serious, or unstable medical conditions such as: cancer within the past 3 years (except basal cell, squamous cell, or localized prostate cancer) a recent cardiac event (i.e. heart attack, angioplasty, etc. within the 3 months prior to screening visit) other conditions that pose a potential safety risk or confounding factor in the investigator's opinion Any abnormal physical examination assessment or vital sign assessment at the screening visit that is deemed to be clinically significant by the principal investigator. Any abnormal clinical laboratory test result at the screening visit that is deemed to be clinically significant by the principal investigator.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jeffrey Burns, MD
Organizational Affiliation
University of Kansas Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Kansas Medical Center
City
Kansas City
State/Province
Kansas
ZIP/Postal Code
66160
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Dapagliflozin In Alzheimer's Disease

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