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Trial of CORT108297 to Attenuate the Effects of Acute Stress in the Allocortex (CORT-X) (CORT-X)

Primary Purpose

Mild Cognitive Impairment, Alzheimer Disease, Memory Impairment

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
CORT108297
Placebo
Sponsored by
Johns Hopkins University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Mild Cognitive Impairment focused on measuring Stress, Memory loss, Dementia, Alzheimer's disease, Cognitive, Impairment

Eligibility Criteria

55 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Individuals must meet criteria for mild cognitive impairment due to Alzheimer's disease according to National Institute on Aging (NIA)/Alzheimer's Association recommendations OR be cognitively normal based on clinical and cognitive assessment in the Enrollment Visit and have at least one of the following risk factors for AD:

  • Known to have at least 1 apolipoprotein E (APOE) ε4 allele;
  • Subjective cognitive concerns with a T score < 40 on the Multifactorial Memory Questionnaire Satisfaction Scale23;
  • A first-degree relative with dementia.

Inclusion Criteria for all subjects:

  • At least 55 years of age;
  • Body mass index >17 and <30;
  • Post-menopausal (if female)
  • Non-smoker;
  • Availability of a study partner who has frequent contact with the subject (10+ hours/week in person and by telephone), and is able to provide an independent evaluation of functioning;
  • Native English speaker;
  • Good general health with no disease expected to interfere with the study;
  • Willing and able to participate for the duration of the study.

Exclusion Criteria for all subjects:

  • Participation in a therapeutic clinical trial at any time during the study;
  • Abnormal corrected QT interval using Bazett's formula (QTcB; defined as > 450 ms for men and > 470 ms for women) as determined on ECG;
  • Any significant neurologic disease other than suspected incipient Alzheimer's disease, such as Parkinson's disease, multi-infarct dementia, Huntington's disease, normal pressure hydrocephalus, brain tumor, progressive supranuclear palsy, seizure disorder, subdural hematoma, multiple sclerosis, or history of significant head trauma followed by persistent neurologic deficits or known structural brain abnormalities, including lacunes in critical memory structures including the hippocampus and parahippocampal cortex;
  • Major depression, bipolar disorder within the past 1 year;
  • History of alcohol or drug dependence;
  • Any significant systemic illness or unstable medical condition, which could lead to difficulty complying with the protocol;
  • General surgery within the last 3 months;
  • Sensory impairment (poor vision or hearing) significant enough to interfere with ability to provide valid cognitive test data;
  • Treatment within the last six months with antidepressants, neuroleptics, sedative hypnotics, or glucocorticoids;
  • Treatment within the last six months with medications metabolized by the CYP2C9 or CYP2C19 enzymes, most notably clopidogrel and proton pump inhibitors;
  • Concurrent use of a CYP3A inhibitor, including grapefruit juice, and St. John's Wort;
  • Exceptions to these guidelines may be considered on a case-by-case basis at the discretion of the PI.

Sites / Locations

  • Johns Hopkins School of MedicineRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

Other

Arm Label

MCI

Cognitively Normal

Arm Description

Individuals with mild cognitive impairment due to Alzheimer's disease

Individuals who are cognitively normal but who are at risk for Alzheimer's disease

Outcomes

Primary Outcome Measures

Memory as assessed by pattern separation task performance after 2 weeks of treatment with CORT108297
Percent of correct responses to the "lure" items on the pattern separation task, with 100% indicating a perfect score
Memory as assessed by the Hopkins Verbal Learning Test-Revised Edition (HVLT-R) after 2 weeks of treatment with CORT108297
Total number of words recalled in trials 1, 2, 3, and the delayed recall trial of the HVLT-R, with scores ranging from 0 (no words recalled) to 48 (all 12 words recalled after each of the trials)
Executive functioning as assessed by the Trail Making Test (TMT), part B after 2 weeks of treatment with CORT108297
Number of seconds required to complete part B of the TMT, with lower scores indicating better performance
Executive functioning as assessed by the Digit Span Task (digit span backwards) after 2 weeks of treatment with CORT108297
Total number of correct responses on the backwards trials of the Digit Span Task, with scores ranging from 0 (no trials correct) to 14 (perfect score)

Secondary Outcome Measures

Full Information

First Posted
October 19, 2020
Last Updated
July 6, 2023
Sponsor
Johns Hopkins University
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1. Study Identification

Unique Protocol Identification Number
NCT04601038
Brief Title
Trial of CORT108297 to Attenuate the Effects of Acute Stress in the Allocortex (CORT-X)
Acronym
CORT-X
Official Title
Phase II Trial of CORT108297 to Attenuate the Effects of Acute Stress in the Allocortex (CORT-X)
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 28, 2021 (Actual)
Primary Completion Date
June 30, 2025 (Anticipated)
Study Completion Date
January 1, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Johns Hopkins University

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
CORT-X will examine if mitigation of stress-mediated pathogenesis of Alzheimer's disease (AD) is a feasible target for intervention in individuals at risk for this disease. This single-site (Baltimore, Maryland) phase II clinical trial is a 2-week, randomized, placebo-controlled crossover study of the effects of the selective glucocorticoid receptor antagonist, CORT108297, on cognitive test performance in 26 individuals with mild cognitive impairment (MCI) due to AD and in 26 cognitively normal individuals with an increased risk for AD due to family history, genetics, and/or subjective memory complaints. All subjects will participate in a brief stressor (public speaking and mental arithmetic) and provide saliva samples so investigators can measure stress hormone response. Then, following 2 weeks of treatment with placebo or CORT108297, in counterbalanced order, participants will complete cognitive tests assessing memory and executive function. All study participants will receive CORT108297 and placebo over the course of this 10-week trial that requires 6 in-person study visits. The primary aims will compare the effects of CORT108297 to placebo on cognitive test performance in individuals with MCI due to AD and in individuals at risk for AD, and describe the side effects of CORT108297 in study participants. Secondary aims will identify subject characteristics that predict positive response to study drug.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Mild Cognitive Impairment, Alzheimer Disease, Memory Impairment
Keywords
Stress, Memory loss, Dementia, Alzheimer's disease, Cognitive, Impairment

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
52 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
MCI
Arm Type
Other
Arm Description
Individuals with mild cognitive impairment due to Alzheimer's disease
Arm Title
Cognitively Normal
Arm Type
Other
Arm Description
Individuals who are cognitively normal but who are at risk for Alzheimer's disease
Intervention Type
Drug
Intervention Name(s)
CORT108297
Intervention Description
120mg of a selective glucocorticoid receptor antagonist, taken as 2 tablets daily for 2 weeks
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo taken as 2 tablets daily for 2 weeks
Primary Outcome Measure Information:
Title
Memory as assessed by pattern separation task performance after 2 weeks of treatment with CORT108297
Description
Percent of correct responses to the "lure" items on the pattern separation task, with 100% indicating a perfect score
Time Frame
After 2 weeks of treatment
Title
Memory as assessed by the Hopkins Verbal Learning Test-Revised Edition (HVLT-R) after 2 weeks of treatment with CORT108297
Description
Total number of words recalled in trials 1, 2, 3, and the delayed recall trial of the HVLT-R, with scores ranging from 0 (no words recalled) to 48 (all 12 words recalled after each of the trials)
Time Frame
After 2 weeks of treatment
Title
Executive functioning as assessed by the Trail Making Test (TMT), part B after 2 weeks of treatment with CORT108297
Description
Number of seconds required to complete part B of the TMT, with lower scores indicating better performance
Time Frame
After 2 weeks of treatment
Title
Executive functioning as assessed by the Digit Span Task (digit span backwards) after 2 weeks of treatment with CORT108297
Description
Total number of correct responses on the backwards trials of the Digit Span Task, with scores ranging from 0 (no trials correct) to 14 (perfect score)
Time Frame
After 2 weeks of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Individuals must meet criteria for mild cognitive impairment due to Alzheimer's disease according to National Institute on Aging (NIA)/Alzheimer's Association recommendations OR be cognitively normal based on clinical and cognitive assessment in the Enrollment Visit and have at least one of the following risk factors for AD: Known to have at least 1 apolipoprotein E (APOE) ε4 allele; Subjective cognitive concerns with a T score < 40 on the Multifactorial Memory Questionnaire Satisfaction Scale23; A first-degree relative with dementia. Inclusion Criteria for all subjects: At least 55 years of age; Body mass index >17 and <30; Post-menopausal (if female) Non-smoker; Availability of a study partner who has frequent contact with the subject (10+ hours/week in person and by telephone), and is able to provide an independent evaluation of functioning; Native English speaker; Good general health with no disease expected to interfere with the study; Willing and able to participate for the duration of the study. Exclusion Criteria for all subjects: Participation in a therapeutic clinical trial at any time during the study; Abnormal corrected QT interval using Bazett's formula (QTcB; defined as > 450 ms for men and > 470 ms for women) as determined on ECG; Any significant neurologic disease other than suspected incipient Alzheimer's disease, such as Parkinson's disease, multi-infarct dementia, Huntington's disease, normal pressure hydrocephalus, brain tumor, progressive supranuclear palsy, seizure disorder, subdural hematoma, multiple sclerosis, or history of significant head trauma followed by persistent neurologic deficits or known structural brain abnormalities, including lacunes in critical memory structures including the hippocampus and parahippocampal cortex; Major depression, bipolar disorder within the past 1 year; History of alcohol or drug dependence; Any significant systemic illness or unstable medical condition, which could lead to difficulty complying with the protocol; General surgery within the last 3 months; Sensory impairment (poor vision or hearing) significant enough to interfere with ability to provide valid cognitive test data; Treatment within the last six months with antidepressants, neuroleptics, sedative hypnotics, or glucocorticoids; Treatment within the last six months with medications metabolized by the CYP2C9 or CYP2C19 enzymes, most notably clopidogrel and proton pump inhibitors; Concurrent use of a CYP3A inhibitor, including grapefruit juice, and St. John's Wort; Exceptions to these guidelines may be considered on a case-by-case basis at the discretion of the PI.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Nicholas Bienko, MS
Phone
410-550-2036
Email
nbienko1@jhmi.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Cynthia A Munro, PhD
Phone
410-550-6271
Email
cmunro@jhmi.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Cynthia A Munro, PhD
Organizational Affiliation
Johns Hopkins School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Johns Hopkins School of Medicine
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21224
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nick Bienko, MA
Phone
410-550-2036
Email
nbienko1@jhmi.edu

12. IPD Sharing Statement

Learn more about this trial

Trial of CORT108297 to Attenuate the Effects of Acute Stress in the Allocortex (CORT-X)

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