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Posiphen® Dose-Finding, Biomarker Study in Early Alzheimer's and Parkinson's Patients

Primary Purpose

Alzheimer Disease, Parkinson Disease

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Posiphen
Placebo
Sponsored by
Annovis Bio Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alzheimer Disease focused on measuring Safety, Tolerability, Pharmacokinetics, Pharmacodynamics, Neurotoxic proteins, Neurotransmitters, Amyloid Precursor Proteins, Inflammatory factors, Synaptic factors, CSF

Eligibility Criteria

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

Inclusion Criteria

Subjects must meet the following criteria:

  1. Male or female aged 45 years and over.
  2. Female participants must be of non-childbearing potential or post-menopausal for at least 2 consecutive years or surgically sterile (bilateral tubal ligation, hysterectomy or bilateral oophorectomy) for at least 6 months prior to screening.
  3. Female participants will be given a urine pregnancy test at the screening visit for which they should test negative.
  4. A) AD - CDR = 0.5 or 1. B) PD - Hoehn & Yahr ≤ 4; PD criteria by MDS-UPDRS.
  5. A) AD MMSE score between the range of 18 to 28. B) PD MMSE score between the range of 18 to 30.
  6. General cognition and functional performance sufficiently preserved that the subject can provide written informed consent.
  7. No evidence of current suicidal ideation or previous suicide attempt in the past month as evaluated in the Columbia Suicide Severity Rating Scale.
  8. MRI scan within the 12 months prior to screening without evidence of infection, infarction, or other focal lesions and without clinical symptoms suggestive of intervening neurological disease. Lacunes that are not believed to contribute to the subject's cognitive impairment are permissible. If there is no MRI available within a 12-month timeframe, then an MRI must be performed as part of the screening procedures for eligibility.
  9. Stability of permitted medications prior to screening.

    1. Stable for at least 12 weeks: Cholinesterase inhibitors and/or memantine medication
    2. Stable for at least 4 weeks:

    i. Anti-parkinsonian medication ii. Anticonvulsant medications used for epilepsy or mood stabilization; neuropathic pain indications iii. Mood-stabilizing psychotropic agents, including, but not limited to, lithium.

  10. Adequate visual and hearing ability (physical ability to perform all the study assessments).
  11. Good general health with no disease expected to interfere with the study.
  12. Subjects previously exposed to Posiphen may be included in the study.

Exclusion Criteria

Subjects meeting any of the following criteria must not be included in the study:

  1. Has a history of a psychiatric disorder such as schizophrenia, bipolar disorder or major depression according to the criteria of the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Mild depression or history of depression that is stable on treatment with a SSRI or SNRI medication at a stable dose is acceptable.
  2. History of a seizure disorder.
  3. Has a history or current evidence of long QT syndrome, Fridericia's formula corrected QT (QTcF) interval ≥ 450ms, or torsades de pointes.
  4. Has bradycardia (<50 bpm) or tachycardia (>100 bpm) on the ECG at screening.
  5. Has uncontrolled Type-1 or Type-2 diabetes . A Subject with HbA1c levels up to 7.5% can be enrolled if the investigator believes the subject's diabetes is under control.
  6. Has clinically significant renal or hepatic impairment.
  7. Has any clinically significant abnormal laboratory values. Subjects with liver function tests (aspartate aminotransferase [AST] or alanine aminotransferase [ALT]) greater than twice the upper limit of normal will be excluded.
  8. Is at imminent risk of self-harm, based on clinical interview and responses on the C SSRS, or of harm to others in the opinion of the Investigators. Subjects must be excluded if they report suicidal ideation with intent, with or without a plan or method (e.g. positive response to Items 4 or 5 in assessment of suicidal ideation on the C SSRS) in the past 2 months, or suicidal behavior in the past 6 months.
  9. Has four or more signal hypointensities on T2*-weighted gradient recalled echo magnetic resonance sequences that are thought to represent hemosiderin deposits including microhemorrhages and superficial siderosis or evidence of acute or sub-acute micro or microhemorrhage as noted on the MRI scan.
  10. Has cancer or has had a malignant tumor within the past year, except patients who underwent potentially curative therapy with no evidence of recurrence. (Patients with stable untreated prostate cancer or skin cancers are not excluded).
  11. Alcohol / Substance use disorder, moderate to severe, in the last 5 years according to the most current version DSM.
  12. Participation in another clinical trial with an investigational agent and have taken at least one dose of study medication, unless unblinded on placebo, within 60 days prior to the start of screening. (The end of a previous investigational trial is the date the last dose of an investigational agent was taken), or five half-lives of the investigational drug, whichever is greater.
  13. Subjects with infection or inflammation of the skin or skin disease at or in proximity to the lumbar puncture site.
  14. History of lumbar spine surgery or chronic low back pain (CLBP).
  15. Subjects with learning disability or developmental delay.
  16. Subjects whom the site PI deems to be otherwise ineligible.

Sites / Locations

  • New England Institute for Clinical Research
  • DeLand Clinical Research Unit
  • MD Clinical
  • Homestead Associates in Research
  • Ezy Medical Research Co.
  • Conquest Research LLC
  • iResearch Atlanta, LLC
  • Hawaii Pacific Neuroscience
  • Quest Research Institute
  • North Suffolk Neurology, PC
  • Penn Medicine, Department of Neurology, U of PA
  • University of Texas Health Science Center
  • Aspen Clinical Research LLC

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm 8

Arm Type

Active Comparator

Active Comparator

Active Comparator

Active Comparator

Active Comparator

Placebo Comparator

Placebo Comparator

Active Comparator

Arm Label

Posiphen, 80mg (Parkinson's Participants)

Posiphen, 40mg (Parkinson's Participants)

Posiphen, 20mg (Parkinson's Participants)

Posiphen, 10mg (Parkinson's Participants)

Posiphen, 5mg (Parkinson's Participants)

Placebo (Parkinson's Participants)

Placebo (Alzheimer's Participants)

Posiphen, 80mg (Alzheimer's Participants)

Arm Description

Posiphen Oral Capsule, 80mg, taken once per day for 25±2 days.

Posiphen Oral Capsule, 40mg, taken once per day for 25±2 days.

Posiphen Oral Capsule, 20mg, taken once per day for 25±2 days.

Posiphen Oral Capsule, 10mg, taken once per day for 25±2 days.

Posiphen Oral Capsule, 5mg, taken once per day for 25±2 days.

Placebo Oral Capsule, taken once per day for 25±2 days.

Placebo Oral Capsule, taken once per day for 25±2 days.

Posiphen Oral Capsule, 80mg, taken once per day for 25±2 days.

Outcomes

Primary Outcome Measures

Percentage of Participants With Treatment-Emergent Adverse Events
Percent of patients with AEs in the Posiphen treatment arms compared to the Placebo group

Secondary Outcome Measures

Concentration of Posiphen in Plasma
Maximum Plasma Concentration (Cmax) of Posiphen reported as ng/mL.

Full Information

First Posted
August 11, 2020
Last Updated
February 6, 2023
Sponsor
Annovis Bio Inc.
Collaborators
Parexel
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1. Study Identification

Unique Protocol Identification Number
NCT04524351
Brief Title
Posiphen® Dose-Finding, Biomarker Study in Early Alzheimer's and Parkinson's Patients
Official Title
A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Dose-Finding Study to Evaluate the Safety, Tolerability, Pharmacokinetic and Pharmacodynamic Effects of Posiphen® in Subjects With Early Alzheimer's Disease (AD) or Early Parkinson's Disease (PD)
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Completed
Study Start Date
August 14, 2020 (Actual)
Primary Completion Date
August 16, 2021 (Actual)
Study Completion Date
January 31, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Annovis Bio Inc.
Collaborators
Parexel

4. Oversight

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

5. Study Description

Brief Summary
Annovis is conducting a clinical study to investigate Posiphen in patients with Early Alzheimer's Disease (AD) and Early Parkinson's Disease (PD). Investigators are looking to recruit 68 patients in two parts of the study. In Part one of the study Investigators will recruit 14 AD and 14 PD patients who will either receive placebo (an inert pill which looks like the study drug) or the study drug Posiphen, both taken daily. In Part two of the study Investigators will recruit 40 PD patients who will receive different strengths of the study drug Posiphen taken daily. Patients will be required to come to the site for 3 face to face visits and have 4 phone calls, tests include but are not limited to, blood and CSF (spinal fluid) sampling, cognitive assessments, clinical examinations and laboratory safety tests. Primarily the Investigators are looking for the safety and tolerability of Posiphen, although Investigators will also evaluate the activity of Posiphen by a number of different biomarkers measuring pathway and target engagements.
Detailed Description
Part 1 is a study with 14 Early AD and 14 Early PD patients who are randomized to 80 mg of Posiphen or placebo. Participants will undergo a Screening Visit, provide informed consent and be evaluated for eligibility per the inclusion and exclusion criteria. If enrolled, participants will proceed to the randomized treatment portions of the study. Period 1 consists of first-time dosing in clinic with administration of 80 mg of Posiphen or Placebo. Period 2 consists of an at home dosing period of 25±2 days, with daily administration of 80 mg of Posiphen or Placebo. Period 3 will be comprised of a stay at the clinical research unit where the subject will undergo study procedures that include safety assessments (AE and concomitant medication monitoring, 12-lead ECGs, clinical laboratory testing, vital signs assessments, and physical examinations), the last dose of Posiphen or Placebo, and 6 hours of blood and CSF sampling. At the end of blood/CSF sampling, the subjects will need to stay for a minimum of 1 hour of observation but may stay if necessary for observation until the following day (e.g., if the subject has blood/CSF sampling on Day 25, he/she may stay for observation until Day 26). After all end-of-study procedures are complete, the subject will be discharged to home. A 24-hour follow-up call will occur to assess the participants current condition and if there are any additional adverse events to report. After completion of Part 1 of the study, the plasma and CSF samples will be analyzed for the biomarkers to determine if changes are needed to the biomarkers to be measured in Part 2. Since the conduct of the study in Part 2 will be identical to the conduct of the study in Part 1, recruitment will continue uninterrupted. The only potential change between Part 1 and Part 2 are the biomarkers to be measured. Part 2 is a study with 40 Early PD patients, 10 patients each who are randomized to one of 4 treatment conditions of Posiphen (5 mg, 10 mg, 20 mg, or 40 mg). Participants will undergo a Screening Visit, provide informed consent and be evaluated for eligibility per the inclusion and exclusion criteria. If enrolled, participants will proceed to the randomized treatment portions of the study. Period 1 consists of first-time dosing in clinic with administration of 5, 10, 20, or 40mg of Posiphen. Period 2 consists of an at home dosing period of 25±2 days, with daily administration of 5, 10, 20, or 40mg of Posiphen. Period 3 will be comprised of a stay at the clinical research unit where the subject will undergo study procedures that include safety assessments (AE and concomitant medication monitoring, 12-lead ECGs, clinical laboratory testing, vital signs assessments, and physical examinations), the last dose of Posiphen or Placebo, and 6 hours of blood and CSF sampling. At the end of blood/CSF sampling, the subject will need to stay for a minimum of 1 hour of observation but may stay if necessary for observation until the following day (e.g., if the subject has blood/CSF sampling on Day 25, he/she may stay for observation until Day 26). After all end-of-study procedures are complete, the subject will be discharged to home. A 24-hour follow-up call will occur to assess the participant's current condition and if there are any additional adverse events to report.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alzheimer Disease, Parkinson Disease
Keywords
Safety, Tolerability, Pharmacokinetics, Pharmacodynamics, Neurotoxic proteins, Neurotransmitters, Amyloid Precursor Proteins, Inflammatory factors, Synaptic factors, CSF

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
75 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Posiphen, 80mg (Parkinson's Participants)
Arm Type
Active Comparator
Arm Description
Posiphen Oral Capsule, 80mg, taken once per day for 25±2 days.
Arm Title
Posiphen, 40mg (Parkinson's Participants)
Arm Type
Active Comparator
Arm Description
Posiphen Oral Capsule, 40mg, taken once per day for 25±2 days.
Arm Title
Posiphen, 20mg (Parkinson's Participants)
Arm Type
Active Comparator
Arm Description
Posiphen Oral Capsule, 20mg, taken once per day for 25±2 days.
Arm Title
Posiphen, 10mg (Parkinson's Participants)
Arm Type
Active Comparator
Arm Description
Posiphen Oral Capsule, 10mg, taken once per day for 25±2 days.
Arm Title
Posiphen, 5mg (Parkinson's Participants)
Arm Type
Active Comparator
Arm Description
Posiphen Oral Capsule, 5mg, taken once per day for 25±2 days.
Arm Title
Placebo (Parkinson's Participants)
Arm Type
Placebo Comparator
Arm Description
Placebo Oral Capsule, taken once per day for 25±2 days.
Arm Title
Placebo (Alzheimer's Participants)
Arm Type
Placebo Comparator
Arm Description
Placebo Oral Capsule, taken once per day for 25±2 days.
Arm Title
Posiphen, 80mg (Alzheimer's Participants)
Arm Type
Active Comparator
Arm Description
Posiphen Oral Capsule, 80mg, taken once per day for 25±2 days.
Intervention Type
Drug
Intervention Name(s)
Posiphen
Intervention Description
Solid oral dosage form, capsule
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Solid oral dosage form, capsule
Primary Outcome Measure Information:
Title
Percentage of Participants With Treatment-Emergent Adverse Events
Description
Percent of patients with AEs in the Posiphen treatment arms compared to the Placebo group
Time Frame
25±2 days
Secondary Outcome Measure Information:
Title
Concentration of Posiphen in Plasma
Description
Maximum Plasma Concentration (Cmax) of Posiphen reported as ng/mL.
Time Frame
Samples collected over a 6 hour timeframe
Other Pre-specified Outcome Measures:
Title
Change in Abeta42/Abeta40 Ratio
Description
Biomarker related to neurotoxic protein cascade measured in patient sample
Time Frame
Baseline to 25±2 days
Title
Changes in Functional Impairment
Description
Functional impairment will be evaluated using the Clinical Dementia Rating (CDR) scale (Berg1988) for AD.
Time Frame
Baseline to 25±2 days
Title
Changes in Functional Impairment
Description
Functional impairment will be evaluated using the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) scale (Goetz 2008) for those with PD.
Time Frame
Baseline to 25±2 days
Title
Changes in Cognition
Description
For both populations, the Mini-Mental State Examination (MMSE) scale (Folstein 1975) will be administered as a global measure of cognition.
Time Frame
Baseline to 25±2 days
Title
Changes in Cognition
Description
For both populations, the Coding subtest from the Weschler Adult Intelligence Scales, 4th edition (WAIS-IV) will serve as a sensitive measure of CNS dysfunction.
Time Frame
Baseline to 25±2 days
Title
Changes in Cognition
Description
The subjects with AD will also be administered the The Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) Subscale (Schafer 2012).
Time Frame
Baseline to 25±2 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
45 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria Subjects must meet the following criteria: Male or female aged 45 years and over. Female participants must be of non-childbearing potential or post-menopausal for at least 2 consecutive years or surgically sterile (bilateral tubal ligation, hysterectomy or bilateral oophorectomy) for at least 6 months prior to screening. Female participants will be given a urine pregnancy test at the screening visit for which they should test negative. A) AD - CDR = 0.5 or 1. B) PD - Hoehn & Yahr ≤ 4; PD criteria by MDS-UPDRS. A) AD MMSE score between the range of 18 to 28. B) PD MMSE score between the range of 18 to 30. General cognition and functional performance sufficiently preserved that the subject can provide written informed consent. No evidence of current suicidal ideation or previous suicide attempt in the past month as evaluated in the Columbia Suicide Severity Rating Scale. MRI scan within the 12 months prior to screening without evidence of infection, infarction, or other focal lesions and without clinical symptoms suggestive of intervening neurological disease. Lacunes that are not believed to contribute to the subject's cognitive impairment are permissible. If there is no MRI available within a 12-month timeframe, then an MRI must be performed as part of the screening procedures for eligibility. Stability of permitted medications prior to screening. Stable for at least 12 weeks: Cholinesterase inhibitors and/or memantine medication Stable for at least 4 weeks: i. Anti-parkinsonian medication ii. Anticonvulsant medications used for epilepsy or mood stabilization; neuropathic pain indications iii. Mood-stabilizing psychotropic agents, including, but not limited to, lithium. Adequate visual and hearing ability (physical ability to perform all the study assessments). Good general health with no disease expected to interfere with the study. Subjects previously exposed to Posiphen may be included in the study. Exclusion Criteria Subjects meeting any of the following criteria must not be included in the study: Has a history of a psychiatric disorder such as schizophrenia, bipolar disorder or major depression according to the criteria of the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Mild depression or history of depression that is stable on treatment with a SSRI or SNRI medication at a stable dose is acceptable. History of a seizure disorder. Has a history or current evidence of long QT syndrome, Fridericia's formula corrected QT (QTcF) interval ≥ 450ms, or torsades de pointes. Has bradycardia (<50 bpm) or tachycardia (>100 bpm) on the ECG at screening. Has uncontrolled Type-1 or Type-2 diabetes . A Subject with HbA1c levels up to 7.5% can be enrolled if the investigator believes the subject's diabetes is under control. Has clinically significant renal or hepatic impairment. Has any clinically significant abnormal laboratory values. Subjects with liver function tests (aspartate aminotransferase [AST] or alanine aminotransferase [ALT]) greater than twice the upper limit of normal will be excluded. Is at imminent risk of self-harm, based on clinical interview and responses on the C SSRS, or of harm to others in the opinion of the Investigators. Subjects must be excluded if they report suicidal ideation with intent, with or without a plan or method (e.g. positive response to Items 4 or 5 in assessment of suicidal ideation on the C SSRS) in the past 2 months, or suicidal behavior in the past 6 months. Has four or more signal hypointensities on T2*-weighted gradient recalled echo magnetic resonance sequences that are thought to represent hemosiderin deposits including microhemorrhages and superficial siderosis or evidence of acute or sub-acute micro or microhemorrhage as noted on the MRI scan. Has cancer or has had a malignant tumor within the past year, except patients who underwent potentially curative therapy with no evidence of recurrence. (Patients with stable untreated prostate cancer or skin cancers are not excluded). Alcohol / Substance use disorder, moderate to severe, in the last 5 years according to the most current version DSM. Participation in another clinical trial with an investigational agent and have taken at least one dose of study medication, unless unblinded on placebo, within 60 days prior to the start of screening. (The end of a previous investigational trial is the date the last dose of an investigational agent was taken), or five half-lives of the investigational drug, whichever is greater. Subjects with infection or inflammation of the skin or skin disease at or in proximity to the lumbar puncture site. History of lumbar spine surgery or chronic low back pain (CLBP). Subjects with learning disability or developmental delay. Subjects whom the site PI deems to be otherwise ineligible.
Facility Information:
Facility Name
New England Institute for Clinical Research
City
Stamford
State/Province
Connecticut
ZIP/Postal Code
06905
Country
United States
Facility Name
DeLand Clinical Research Unit
City
DeLand
State/Province
Florida
ZIP/Postal Code
32720
Country
United States
Facility Name
MD Clinical
City
Hallandale Beach
State/Province
Florida
ZIP/Postal Code
33009
Country
United States
Facility Name
Homestead Associates in Research
City
Miami
State/Province
Florida
ZIP/Postal Code
33032
Country
United States
Facility Name
Ezy Medical Research Co.
City
Miami
State/Province
Florida
ZIP/Postal Code
33175
Country
United States
Facility Name
Conquest Research LLC
City
Winter Park
State/Province
Florida
ZIP/Postal Code
32789
Country
United States
Facility Name
iResearch Atlanta, LLC
City
Decatur
State/Province
Georgia
ZIP/Postal Code
30030
Country
United States
Facility Name
Hawaii Pacific Neuroscience
City
Honolulu
State/Province
Hawaii
ZIP/Postal Code
96817
Country
United States
Facility Name
Quest Research Institute
City
Farmington Hills
State/Province
Michigan
ZIP/Postal Code
48334
Country
United States
Facility Name
North Suffolk Neurology, PC
City
Port Jefferson Station
State/Province
New York
ZIP/Postal Code
11776
Country
United States
Facility Name
Penn Medicine, Department of Neurology, U of PA
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19107
Country
United States
Facility Name
University of Texas Health Science Center
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78229
Country
United States
Facility Name
Aspen Clinical Research LLC
City
Orem
State/Province
Utah
ZIP/Postal Code
84058
Country
United States

12. IPD Sharing Statement

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Posiphen® Dose-Finding, Biomarker Study in Early Alzheimer's and Parkinson's Patients

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