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SNIFF - 3-Week Aptar CPS Device

Primary Purpose

Mild Cognitive Impairment, Cognitive Impairment, Alzheimer Disease, Early Onset

Status
Not yet recruiting
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Insulin (Humulin® R U-100)
Placebo
Aptar Pharma CPS Intranasal Delivery Device
Sponsored by
Wake Forest University Health Sciences
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Mild Cognitive Impairment focused on measuring Intranasal Delivery of Insulin, Cognitive Testing, Nasal Insulin

Eligibility Criteria

55 Years - 85 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Age 55 to 85 (inclusive)
  2. Fluent in English
  3. Cognitively normal or diagnosis of amnestic mild cognitive impairment (aMCI) or mild Alzheimer's disease (AD)
  4. Amyloid positive by positron emission tomography (PET) or cerebrospinal fluid (CSF) criteria
  5. Stable medical condition for 3 months prior to screening visit
  6. Stable medications for 4 weeks prior to the screening and study visits (exceptions may be made on a case by case basis by the study physician)
  7. Clinical laboratory values must be within normal limits or, if abnormal, must be judged to be clinically insignificant by the study physician

Exclusion Criteria:

  1. A diagnosis of dementia other than Alzheimer's disease (AD)
  2. History of a clinically significant stroke
  3. Current evidence or history in past two years of epilepsy, head injury with loss of consciousness, any major psychiatric disorder including psychosis, major depression, bipolar disorder
  4. Diabetes (type I or type II) insulin-dependent and non-insulin-dependent diabetes mellitus
  5. Current or past regular use of insulin or any other anti-diabetic medication within 2 months of screening visit
  6. History of seizure within past five years
  7. Pregnancy or possible pregnancy
  8. Use of anticoagulants
  9. Residence in a skilled nursing facility at screening
  10. Use of an investigational agent within two months of screening visit
  11. Regular use of alcohol, narcotics, anticonvulsants, anti-parkinsonian medications, or any other exclusionary medications (exceptions may be made on a case by case basis by the study physician)

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Placebo Comparator

    Arm Label

    Humulin® R U-100

    Placebo

    Arm Description

    Twenty randomly assigned participants with Alzheimer's disease or mild cognitive impairment will receive intranasal administrations of Humulin® R U-100 (40 IU) four times daily for 3 weeks.

    Twenty randomly assigned participants with Alzheimer's disease or mild cognitive impairment will receive intranasal administrations of placebo (insulin diluent) four times daily for 3 weeks.

    Outcomes

    Primary Outcome Measures

    Percentage of Prescribed Dose Taken
    Participant self-reported medication adherence information will be calculated by study staff on a 0%-100% scale. A score below 80% indicates low medication adherence and a score of 80% or higher indicates high medication adherence.

    Secondary Outcome Measures

    Change in the Preclinical Alzheimer Cognitive Composite 5 (PACC5) Z-Score
    Cognition will be measured using the PACC5 scale, which includes the free/cued selective reminding test, delayed paragraph recall, digit-symbol substitution, mini mental state score, and the category fluency task. The PACC5 is a composite score comprised of measures of global cognition, memory, and executive function. The score reflects an averaged z-score, with higher scores indicating better cognitive performance.
    Change in the 14-item Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog 14) Score
    A psychometric instrument that evaluates memory, attention, reasoning, language, orientation, and praxis. A higher score indicates more impairment. Scores from the original portion of the test range from 0 (best) to 65 (worse), and are added to the mean of the words not immediately recalled (max of 10) and the number of items not recalled after a delay (ranging from 0-10) all total the maximum score of 85. A positive change indicates cognitive worsening.
    Change in Cerebrospinal Fluid (CSF) Insulin Levels
    Measurement of the levels of insulin in cerebrospinal fluid (CSF) after being delivered with the intranasal delivery device. This will help to determine the ability of the intranasal delivery device to increase levels of insulin in CSF.
    Change in amyloid β-peptide (Aβ) 40 (Aβ40) in Cerebrospinal Fluid (CSF)
    Cerebrospinal fluid (CSF) samples will be used to measure the levels of amyloid β-peptide (Aβ) 40. CSF Aβ40 is a key Alzheimer's disease (AD) biomarker that reflects pathological aggregation of amyloid in the brain.
    Change in amyloid β-peptide (Aβ) 42 (Aβ42) in Cerebrospinal Fluid (CSF)
    Cerebrospinal fluid (CSF) samples will be used to measure the levels of amyloid β-peptide (Aβ) 42. CSF Aβ42 is a key Alzheimer's disease (AD) biomarker that reflects pathological aggregation of amyloid in the brain.
    Change in Cerebrospinal Fluid (CSF) Levels of Total Tau
    Cerebrospinal fluid (CSF) samples will be used to measure the levels of total tau protein in the brain to assess impact on brain tau as a relevant Alzheimer's Disease (AD) biomarker.
    Change in Cerebrospinal Fluid (CSF) Levels of Phospho-Tau 181
    Cerebrospinal fluid (CSF) samples will be used to measure the levels of phospho-tau 181 protein in the brain to assess impact on brain tau as a relevant Alzheimer's Disease (AD) biomarker.
    Change in Cerebrospinal Fluid (CSF) Levels of Phospho-Tau 217
    Cerebrospinal fluid (CSF) samples will be used to measure the levels of phospho-tau 217 protein in the brain to assess impact on brain tau as a relevant Alzheimer's Disease (AD) biomarker.

    Full Information

    First Posted
    July 27, 2021
    Last Updated
    May 4, 2023
    Sponsor
    Wake Forest University Health Sciences
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05006599
    Brief Title
    SNIFF - 3-Week Aptar CPS Device
    Official Title
    Study of Nasal Insulin to Fight Forgetfulness (SNIFF) - 3-Week Aptar CPS Device
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    May 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    May 2025 (Anticipated)
    Primary Completion Date
    May 2029 (Anticipated)
    Study Completion Date
    May 2031 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Wake Forest University Health Sciences

    4. Oversight

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

    5. Study Description

    Brief Summary
    The SNIFF 3-Week Aptar Device study will involve using a device to administer insulin or placebo through each participant's nose or intra-nasally. Insulin is a hormone that is produced in the body. It works by lowering levels of glucose (sugar) in the blood. This study is measuring how much insulin the device delivers. In addition, this study will look at the effects of insulin or placebo administered intra-nasally using an intranasal delivery device on memory, blood, and cerebrospinal fluid (CSF).
    Detailed Description
    The proposed study will examine whether an intranasal delivery device can be used by adults with preclinical Alzheimer's disease (cognitively normal but with abnormal brain levels of the hallmark peptide Aβ) to reliably deliver insulin or placebo four times daily over a 4 week period. We will also examine effects of treatment on cognition, CSF biomarkers, and cerebral perfusion. If successful, information gained from the study will inform the design of future Phase III trials of intranasal insulin.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Mild Cognitive Impairment, Cognitive Impairment, Alzheimer Disease, Early Onset
    Keywords
    Intranasal Delivery of Insulin, Cognitive Testing, Nasal Insulin

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantCare ProviderInvestigatorOutcomes Assessor
    Masking Description
    Neither participants or site personnel will know which drug intervention (insulin or placebo) is being administered. Exceptions will be the Study Nurse who is directly involved in preparing the insulin or placebo.
    Allocation
    Randomized
    Enrollment
    40 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Humulin® R U-100
    Arm Type
    Experimental
    Arm Description
    Twenty randomly assigned participants with Alzheimer's disease or mild cognitive impairment will receive intranasal administrations of Humulin® R U-100 (40 IU) four times daily for 3 weeks.
    Arm Title
    Placebo
    Arm Type
    Placebo Comparator
    Arm Description
    Twenty randomly assigned participants with Alzheimer's disease or mild cognitive impairment will receive intranasal administrations of placebo (insulin diluent) four times daily for 3 weeks.
    Intervention Type
    Drug
    Intervention Name(s)
    Insulin (Humulin® R U-100)
    Intervention Description
    Participants will administer 40 IU of Humulin® U-100 insulin four times per day with an intranasal delivery device.
    Intervention Type
    Drug
    Intervention Name(s)
    Placebo
    Other Intervention Name(s)
    Insulin Diluent
    Intervention Description
    Participants will administer placebo (insulin diluent) four times per day with an intranasal delivery device.
    Intervention Type
    Device
    Intervention Name(s)
    Aptar Pharma CPS Intranasal Delivery Device
    Intervention Description
    Participants will be assigned to receive Humulin® insulin or placebo administered through the Aptar Pharma CPS intranasal delivery device.
    Primary Outcome Measure Information:
    Title
    Percentage of Prescribed Dose Taken
    Description
    Participant self-reported medication adherence information will be calculated by study staff on a 0%-100% scale. A score below 80% indicates low medication adherence and a score of 80% or higher indicates high medication adherence.
    Time Frame
    Week 4
    Secondary Outcome Measure Information:
    Title
    Change in the Preclinical Alzheimer Cognitive Composite 5 (PACC5) Z-Score
    Description
    Cognition will be measured using the PACC5 scale, which includes the free/cued selective reminding test, delayed paragraph recall, digit-symbol substitution, mini mental state score, and the category fluency task. The PACC5 is a composite score comprised of measures of global cognition, memory, and executive function. The score reflects an averaged z-score, with higher scores indicating better cognitive performance.
    Time Frame
    Baseline to Week 8
    Title
    Change in the 14-item Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog 14) Score
    Description
    A psychometric instrument that evaluates memory, attention, reasoning, language, orientation, and praxis. A higher score indicates more impairment. Scores from the original portion of the test range from 0 (best) to 65 (worse), and are added to the mean of the words not immediately recalled (max of 10) and the number of items not recalled after a delay (ranging from 0-10) all total the maximum score of 85. A positive change indicates cognitive worsening.
    Time Frame
    Baseline to Week 8
    Title
    Change in Cerebrospinal Fluid (CSF) Insulin Levels
    Description
    Measurement of the levels of insulin in cerebrospinal fluid (CSF) after being delivered with the intranasal delivery device. This will help to determine the ability of the intranasal delivery device to increase levels of insulin in CSF.
    Time Frame
    Baseline to Week 8
    Title
    Change in amyloid β-peptide (Aβ) 40 (Aβ40) in Cerebrospinal Fluid (CSF)
    Description
    Cerebrospinal fluid (CSF) samples will be used to measure the levels of amyloid β-peptide (Aβ) 40. CSF Aβ40 is a key Alzheimer's disease (AD) biomarker that reflects pathological aggregation of amyloid in the brain.
    Time Frame
    Baseline to Week 8
    Title
    Change in amyloid β-peptide (Aβ) 42 (Aβ42) in Cerebrospinal Fluid (CSF)
    Description
    Cerebrospinal fluid (CSF) samples will be used to measure the levels of amyloid β-peptide (Aβ) 42. CSF Aβ42 is a key Alzheimer's disease (AD) biomarker that reflects pathological aggregation of amyloid in the brain.
    Time Frame
    Baseline to Week 8
    Title
    Change in Cerebrospinal Fluid (CSF) Levels of Total Tau
    Description
    Cerebrospinal fluid (CSF) samples will be used to measure the levels of total tau protein in the brain to assess impact on brain tau as a relevant Alzheimer's Disease (AD) biomarker.
    Time Frame
    Baseline to Week 8
    Title
    Change in Cerebrospinal Fluid (CSF) Levels of Phospho-Tau 181
    Description
    Cerebrospinal fluid (CSF) samples will be used to measure the levels of phospho-tau 181 protein in the brain to assess impact on brain tau as a relevant Alzheimer's Disease (AD) biomarker.
    Time Frame
    Baseline to Week 8
    Title
    Change in Cerebrospinal Fluid (CSF) Levels of Phospho-Tau 217
    Description
    Cerebrospinal fluid (CSF) samples will be used to measure the levels of phospho-tau 217 protein in the brain to assess impact on brain tau as a relevant Alzheimer's Disease (AD) biomarker.
    Time Frame
    Baseline to Week 8
    Other Pre-specified Outcome Measures:
    Title
    Change in Quick Dementia Rating Scale (QDRS) Score
    Description
    The QDRS (Galvin, 2015) is a clinical scale that rates the severity of dementia as absent, questionable, mild, moderate, or severe (Clinical Dementia Rating score of 0, 0.5, 1, 2, or 3, respectively). The score assesses six domains: memory, orientation, judgment and problem solving, community affairs, home and hobbies, and personal care. At Screening the QDRS global score will be used for eligibility purposes. For all other administrations, the 6 domain scores will be summed to get the QDRS Sum of Boxes (SB) score. Sum of boxes score ranges from 0-100 with a high score meaning more severe dementia.
    Time Frame
    Baseline to Week 8
    Title
    Change in Patient Health Questionnaire (PHQ-9) Score
    Description
    The Patient Health Questionnaire (PHQ-9) is a 9-item, validated measure of depression severity. Respondents indicate how bothered by problems they are on a scale from 0 (not at all) to 3 (nearly every day). Total scores range from 0 to 27, where higher scores indicate more severe depression.
    Time Frame
    Baseline to Week 8
    Title
    Change in Generalized Anxiety Disorder scale-7 (GAD-7) Score
    Description
    Changes in anxiety will be measured using the Generalized Anxiety Disorder Scale (GAD-7), which contains 7 items with total scores ranging from 0 to 21. Scores of 5, 10, and 15 are cut-offs for mild, moderate, and severe anxiety, respectively.
    Time Frame
    Baseline to Week 8
    Title
    Change in PROMIS Sleep Disturbance Questionnaire Score
    Description
    A questionnaire to assess self-reported quality of general sleep and sleep disturbance. Each item on the form is rated on a 5-point scale (1=never; 2=rarely; 3=sometimes; 4=often; and 5=always) with a range in score from 8 to 40 with higher scores indicating greater severity of sleep disturbance.
    Time Frame
    Baseline to Week 8
    Title
    Change in the Alzheimer's Disease Cooperative Study Activities of Daily Living Scale for Mild Cognitive Impairment (ADCS-ADL-MCI)
    Description
    An interview-based assessment of information provided by the study partner (informant). The total scores based on 18 items on the scale range from 0 to 53 with lower scores representing greater impairment.
    Time Frame
    Baseline to Week 8

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    55 Years
    Maximum Age & Unit of Time
    85 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Age 55 to 85 (inclusive) Fluent in English Cognitively normal or diagnosis of amnestic mild cognitive impairment (aMCI) or mild Alzheimer's disease (AD) Amyloid positive by positron emission tomography (PET) or cerebrospinal fluid (CSF) criteria Stable medical condition for 3 months prior to screening visit Stable medications for 4 weeks prior to the screening and study visits (exceptions may be made on a case by case basis by the study physician) Clinical laboratory values must be within normal limits or, if abnormal, must be judged to be clinically insignificant by the study physician Exclusion Criteria: A diagnosis of dementia other than Alzheimer's disease (AD) History of a clinically significant stroke Current evidence or history in past two years of epilepsy, head injury with loss of consciousness, any major psychiatric disorder including psychosis, major depression, bipolar disorder Diabetes (type I or type II) insulin-dependent and non-insulin-dependent diabetes mellitus Current or past regular use of insulin or any other anti-diabetic medication within 2 months of screening visit History of seizure within past five years Pregnancy or possible pregnancy Use of anticoagulants Residence in a skilled nursing facility at screening Use of an investigational agent within two months of screening visit Regular use of alcohol, narcotics, anticonvulsants, anti-parkinsonian medications, or any other exclusionary medications (exceptions may be made on a case by case basis by the study physician)
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Deborah Dahl, RN
    Phone
    336-713-3432
    Email
    ddahl@wakehealth.edu
    First Name & Middle Initial & Last Name or Official Title & Degree
    Sarah Bohlman, MSL
    Phone
    336-716-7354
    Email
    sarabrow@wakehealth.edu
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Suzanne Craft, PhD
    Organizational Affiliation
    Wake Forest University Health Sciences
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No
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