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A Phase III Trial of Nilvadipine to Treat Alzheimer's Disease (NILVAD)

Primary Purpose

Alzheimer's Disease

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Nilvadipine
Placebo
Sponsored by
Prof Brian Lawlor
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alzheimer's Disease focused on measuring Alzheimer's Disease, Investigator-driven clinical trial, Nilvadipine, Calcium Channel blocker, Elderly, Therapeutic Intervention

Eligibility Criteria

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

Inclusion Criteria:

  1. Age range: Adult subjects, males and females over age 50 years.
  2. Prior diagnosis of mild to moderate probable AD based on NINCDS-ADRDA criteria (see Appendix B) and
  3. Standardised Mini-Mental State Examination (SMMSE) score > 12 on stable dose (>3 months of cholinesterase inhibitor and or memantine). Subjects who are not on cholinesterase inhibitors or memantine due to poor tolerability and/or who will not require treatment with these medications during the course of the study can be included.
  4. Collateral informants such as a spouse, family member, close friend. The informant must have close contact with the subject and agree to monitor/manage study drug adherence, observe for possible adverse events, assist with psychometric measures requiring informant information, and accompany the subject to all evaluation visits.
  5. Fluency in relevant language sufficient to reliably complete all study assessments.
  6. Systolic BP > 100 mmHg but ≤ 159 mmHg, and diastolic BP > 65 mmHg but ≤ 99 mmHg on resting office based BP measurements, or a Systolic BP > 105 mmHg but ≤ 140 mmHg, and diastolic BP > 70 mmHg but ≤ 90 mmHg on ABPM measurement

Exclusion Criteria:

  1. Subjects with co-morbid dementia due to other neurological disorders such as Parkinson's disease, vascular dementia, Huntington's disease, Pick's disease, Creutzfeldt-Jakob disease, normal pressure hydrocephalus, brain tumor, progressive supranuclear palsy, seizure disorder, subdural hematoma, or multiple sclerosis, as well as subjects with HIV disease, neurosyphilis, history of significant head trauma with loss of consciousness followed by persistent neurological deficits, known structural brain abnormalities, or any other condition known to interfere with cognitive function.
  2. Subjects currently taking any calcium channel blocker or Beta-blocker
  3. Subjects who in the opinion of the investigator, have a medical condition that would preclude them from participating in the study (e.g.hemodynamically significant coronary artery disease., chronic heart failure, syncope within the past year, significant valvular heart disease i.e. severe aortic and mitral stenosis.. symptomatic orthostatic hypotension within the last year, subjects requiring more than one agent to control BP.), or subjects who in the opinion of the investigator are unlikely to complete per protocol due to care issues etc:
  4. Current Axis I diagnosis of schizophrenia, bipolar disorder, major depression. Subjects who are currently or who have within the past year met criteria for drug or alcohol abuse or dependence.
  5. Pregnant women or women who may possibly become pregnant.
  6. Subjects with a history of hypersensitivity to nilvadipine (Nivadil).
  7. Subjects who have taken an investigational or other unapproved drug during the 30 days or five half-lives, whichever is longer, prior to baseline.
  8. Subjects who are participating in other research studies.
  9. Patients with a SBP of ≤ 100 mmHg and/or a DBP of ≤ 65 mmHg on office based BP measurements, or a SBP ≤ 105 mmHg and/or a DBP of ≤ 70 mmHg on ABPM will not be included in the study.

Sites / Locations

  • Centre Hospitalier Universitaire d'Amiens (CHU Amiens)
  • Centre Hospitalier Universitaire de Bethune (CH Bethune)
  • Centre Hospitalier Universitaire de Caen (CHU Caen)
  • Centre Hospitalier Universitaire de Calais (CHU Calais)
  • Centre Hospitalier Universitaire de Lens (CHU Lens)
  • Centre Hospitalier Regional et Universitaire de Lille (CHRU Lille)
  • Centre Hospitalier Universitaire de Saint Philibert (GHICL)
  • University of Ulm
  • "G. Papanicolaou" Hospital
  • "G.Papageorgiou" Hospital
  • AXEPA Hospital
  • Szeged University
  • University College Cork
  • St James Hospital
  • Hospital of Brescia
  • Hospital Castellanza
  • Hospital of Genoa
  • Hospital of Milan
  • Hospital of Arnhem
  • Hospital of Maastricht
  • Hospital of Nijmegen
  • Gothenburg Univeristy
  • Kings College London

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Active Comparator

Arm Label

Placebo

Nilvadipine

Arm Description

250 patients will receive the placebo

250 patient will receive the active drug Nilvadipine 8mg

Outcomes

Primary Outcome Measures

Alzheimer's Disease Assessment Scale (ADAS) Cog
The Alzheimer's Disease Assessment Scale (Cognitive) (Mohs et al. 1983) ADAS-cog 12 is a primary efficacy outcome measure, and includes 12 items of cognitive evaluation, namely immediate word recall, naming objects and fingers, commands, constructional praxis, ideational praxis, orientation, word recognition, remembering test instructions, spoken language ability, word-finding difficulty in spontaneous speech, comprehension & delayed recall. A higher ADAS-cog score indicates a poorer cognitive function.

Secondary Outcome Measures

Clinical Dementia Rating Scale Sum of Boxes (CDR-sb)
Clinical Dementia Rating Scale Sum of Boxes (CDR-sb) (Morris et al 1993) is the secondary efficacy outcome measure. This is a semi-structured interview with the caregiver and the patient. The patient's performance in the domains of memory, orientation, judgment, problem solving, community affairs, home and hobbies and personal care are assessed. The CDR-sb is scored from 0-18, with the higher score indicated greater impairment.
Disability Assessment for Dementia (DAD)
Disability Assessment for Dementia (DAD) (Gelinas et al. 1999) is a key secondary efficacy outcome measure and evaluates the basic and instrumental activities in daily activities of elderly people with dementia. This 40-item scale addresses a range of functional domains: eating, meal preparation, telephoning, hygienic, dressing, medication, corresponding, finance, leisure, and housework.

Full Information

First Posted
December 16, 2013
Last Updated
March 3, 2017
Sponsor
Prof Brian Lawlor
Collaborators
University of Dublin, Trinity College, Molecular Medicine Ireland LBG, Alzheimer Europe, Archer Pharmaceuticals, Inc., E-Search Limited, University College Dublin, King's College London, Istituto Di Ricerche Farmacologiche Mario Negri, University Hospital, Lille, University of Ulm, Szeged University, Göteborg University, University College Cork, Aristotle University Of Thessaloniki, Stichting Katholieke Universiteit
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1. Study Identification

Unique Protocol Identification Number
NCT02017340
Brief Title
A Phase III Trial of Nilvadipine to Treat Alzheimer's Disease
Acronym
NILVAD
Official Title
A European Multicentre Double-blind Placebo-controlled Phase III Trial of Nilvadipine in Mild to Moderate Alzheimer's Disease
Study Type
Interventional

2. Study Status

Record Verification Date
March 2017
Overall Recruitment Status
Completed
Study Start Date
April 24, 2013 (Actual)
Primary Completion Date
December 16, 2016 (Actual)
Study Completion Date
December 16, 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Prof Brian Lawlor
Collaborators
University of Dublin, Trinity College, Molecular Medicine Ireland LBG, Alzheimer Europe, Archer Pharmaceuticals, Inc., E-Search Limited, University College Dublin, King's College London, Istituto Di Ricerche Farmacologiche Mario Negri, University Hospital, Lille, University of Ulm, Szeged University, Göteborg University, University College Cork, Aristotle University Of Thessaloniki, Stichting Katholieke Universiteit

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Alzheimer's disease (AD) is an ever-increasing public health concern among the aging population and is the most common form of dementia affecting more than 15 million individuals worldwide and around 5 million Europeans. The direct and indirect costs of AD and other dementias amount to more than €440,000 million each year (www.alz.org, 2010). Even modest therapeutic advances that delay disease onset and progression could significantly reduce the global burden of the disease and the level of care required by patients. While there are symptomatic-based drug therapies available for AD, these medications do not prevent the disease process itself. There is therefore an imperative to develop new treatments for AD that have disease modifying effects. This double-blind placebo controlled study will test the efficacy and safety of nilvadipine in 500 subjects with mild to moderate AD over a treatment period of 18 months. There is a strong scientific rationale for this study: Nilvadipine, a licensed calcium channel enhances Aß clearance from brain and restores cortical perfusion in mouse models of AD. Nilvadipine is safe and well tolerated in AD patients and clinical studies with this medication have shown stabilization of cognitive decline and reduced incidence of AD, pointing to both symptomatic and disease modifying benefits. Male and female patients with mild to moderate AD aged between 50 and 90 with a range of medical morbidities and frailty will be included in the study. If this trial is successful, nilvadipine would represent an advance in the treatment of AD patients and would have a major impact on the health and social care costs incurred in Europe by this neurodegenerative disorder. Furthermore, the creation of the NILVAD network will support future clinical trials and research innovation in AD across Europe.
Detailed Description
Please see 'Brief Summary', above

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alzheimer's Disease
Keywords
Alzheimer's Disease, Investigator-driven clinical trial, Nilvadipine, Calcium Channel blocker, Elderly, Therapeutic Intervention

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
511 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
250 patients will receive the placebo
Arm Title
Nilvadipine
Arm Type
Active Comparator
Arm Description
250 patient will receive the active drug Nilvadipine 8mg
Intervention Type
Drug
Intervention Name(s)
Nilvadipine
Other Intervention Name(s)
Also known as Nilvadil (Brand Name)
Intervention Description
8mg of Nilvadipine taken once a day at lunch time for 78 weeks
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
8mg Placebo tablet taken once a day at lunch time for 78 weeks
Primary Outcome Measure Information:
Title
Alzheimer's Disease Assessment Scale (ADAS) Cog
Description
The Alzheimer's Disease Assessment Scale (Cognitive) (Mohs et al. 1983) ADAS-cog 12 is a primary efficacy outcome measure, and includes 12 items of cognitive evaluation, namely immediate word recall, naming objects and fingers, commands, constructional praxis, ideational praxis, orientation, word recognition, remembering test instructions, spoken language ability, word-finding difficulty in spontaneous speech, comprehension & delayed recall. A higher ADAS-cog score indicates a poorer cognitive function.
Time Frame
18 months
Secondary Outcome Measure Information:
Title
Clinical Dementia Rating Scale Sum of Boxes (CDR-sb)
Description
Clinical Dementia Rating Scale Sum of Boxes (CDR-sb) (Morris et al 1993) is the secondary efficacy outcome measure. This is a semi-structured interview with the caregiver and the patient. The patient's performance in the domains of memory, orientation, judgment, problem solving, community affairs, home and hobbies and personal care are assessed. The CDR-sb is scored from 0-18, with the higher score indicated greater impairment.
Time Frame
18 months
Title
Disability Assessment for Dementia (DAD)
Description
Disability Assessment for Dementia (DAD) (Gelinas et al. 1999) is a key secondary efficacy outcome measure and evaluates the basic and instrumental activities in daily activities of elderly people with dementia. This 40-item scale addresses a range of functional domains: eating, meal preparation, telephoning, hygienic, dressing, medication, corresponding, finance, leisure, and housework.
Time Frame
18 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age range: Adult subjects, males and females over age 50 years. Prior diagnosis of mild to moderate probable AD based on NINCDS-ADRDA criteria (see Appendix B) and Standardised Mini-Mental State Examination (SMMSE) score > 12 on stable dose (>3 months of cholinesterase inhibitor and or memantine). Subjects who are not on cholinesterase inhibitors or memantine due to poor tolerability and/or who will not require treatment with these medications during the course of the study can be included. Collateral informants such as a spouse, family member, close friend. The informant must have close contact with the subject and agree to monitor/manage study drug adherence, observe for possible adverse events, assist with psychometric measures requiring informant information, and accompany the subject to all evaluation visits. Fluency in relevant language sufficient to reliably complete all study assessments. Systolic BP > 100 mmHg but ≤ 159 mmHg, and diastolic BP > 65 mmHg but ≤ 99 mmHg on resting office based BP measurements, or a Systolic BP > 105 mmHg but ≤ 140 mmHg, and diastolic BP > 70 mmHg but ≤ 90 mmHg on ABPM measurement Exclusion Criteria: Subjects with co-morbid dementia due to other neurological disorders such as Parkinson's disease, vascular dementia, Huntington's disease, Pick's disease, Creutzfeldt-Jakob disease, normal pressure hydrocephalus, brain tumor, progressive supranuclear palsy, seizure disorder, subdural hematoma, or multiple sclerosis, as well as subjects with HIV disease, neurosyphilis, history of significant head trauma with loss of consciousness followed by persistent neurological deficits, known structural brain abnormalities, or any other condition known to interfere with cognitive function. Subjects currently taking any calcium channel blocker or Beta-blocker Subjects who in the opinion of the investigator, have a medical condition that would preclude them from participating in the study (e.g.hemodynamically significant coronary artery disease., chronic heart failure, syncope within the past year, significant valvular heart disease i.e. severe aortic and mitral stenosis.. symptomatic orthostatic hypotension within the last year, subjects requiring more than one agent to control BP.), or subjects who in the opinion of the investigator are unlikely to complete per protocol due to care issues etc: Current Axis I diagnosis of schizophrenia, bipolar disorder, major depression. Subjects who are currently or who have within the past year met criteria for drug or alcohol abuse or dependence. Pregnant women or women who may possibly become pregnant. Subjects with a history of hypersensitivity to nilvadipine (Nivadil). Subjects who have taken an investigational or other unapproved drug during the 30 days or five half-lives, whichever is longer, prior to baseline. Subjects who are participating in other research studies. Patients with a SBP of ≤ 100 mmHg and/or a DBP of ≤ 65 mmHg on office based BP measurements, or a SBP ≤ 105 mmHg and/or a DBP of ≤ 70 mmHg on ABPM will not be included in the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Brian Lawlor, Prof
Organizational Affiliation
University of Dublin, Trinity College
Official's Role
Principal Investigator
Facility Information:
Facility Name
Centre Hospitalier Universitaire d'Amiens (CHU Amiens)
City
Amiens
Country
France
Facility Name
Centre Hospitalier Universitaire de Bethune (CH Bethune)
City
Bethune
Country
France
Facility Name
Centre Hospitalier Universitaire de Caen (CHU Caen)
City
Caen
Country
France
Facility Name
Centre Hospitalier Universitaire de Calais (CHU Calais)
City
Calais
Country
France
Facility Name
Centre Hospitalier Universitaire de Lens (CHU Lens)
City
Lens
Country
France
Facility Name
Centre Hospitalier Regional et Universitaire de Lille (CHRU Lille)
City
Lille
Country
France
Facility Name
Centre Hospitalier Universitaire de Saint Philibert (GHICL)
City
Lille
Country
France
Facility Name
University of Ulm
City
Ulm
Country
Germany
Facility Name
"G. Papanicolaou" Hospital
City
Athens
Country
Greece
Facility Name
"G.Papageorgiou" Hospital
City
Athens
Country
Greece
Facility Name
AXEPA Hospital
City
Athens
Country
Greece
Facility Name
Szeged University
City
Szeged
Country
Hungary
Facility Name
University College Cork
City
Cork
Country
Ireland
Facility Name
St James Hospital
City
Dublin
Country
Ireland
Facility Name
Hospital of Brescia
City
Brescia
Country
Italy
Facility Name
Hospital Castellanza
City
Castellanza
Country
Italy
Facility Name
Hospital of Genoa
City
Genoa
Country
Italy
Facility Name
Hospital of Milan
City
Milan
Country
Italy
Facility Name
Hospital of Arnhem
City
Arnhem
Country
Netherlands
Facility Name
Hospital of Maastricht
City
Maastricht
Country
Netherlands
Facility Name
Hospital of Nijmegen
City
Nijmegen
Country
Netherlands
Facility Name
Gothenburg Univeristy
City
Gothenburg
Country
Sweden
Facility Name
Kings College London
City
London
Country
United Kingdom

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PubMed Identifier
31088188
Citation
de Heus RAA, Donders R, Santoso AMM, Olde Rikkert MGM, Lawlor BA, Claassen JAHR; Nilvad Study Group. Blood Pressure Lowering With Nilvadipine in Patients With Mild-to-Moderate Alzheimer Disease Does Not Increase the Prevalence of Orthostatic Hypotension. J Am Heart Assoc. 2019 May 21;8(10):e011938. doi: 10.1161/JAHA.119.011938.
Results Reference
derived
PubMed Identifier
30248105
Citation
Lawlor B, Segurado R, Kennelly S, Olde Rikkert MGM, Howard R, Pasquier F, Borjesson-Hanson A, Tsolaki M, Lucca U, Molloy DW, Coen R, Riepe MW, Kalman J, Kenny RA, Cregg F, O'Dwyer S, Walsh C, Adams J, Banzi R, Breuilh L, Daly L, Hendrix S, Aisen P, Gaynor S, Sheikhi A, Taekema DG, Verhey FR, Nemni R, Nobili F, Franceschi M, Frisoni G, Zanetti O, Konsta A, Anastasios O, Nenopoulou S, Tsolaki-Tagaraki F, Pakaski M, Dereeper O, de la Sayette V, Senechal O, Lavenu I, Devendeville A, Calais G, Crawford F, Mullan M; NILVAD Study Group. Nilvadipine in mild to moderate Alzheimer disease: A randomised controlled trial. PLoS Med. 2018 Sep 24;15(9):e1002660. doi: 10.1371/journal.pmed.1002660. eCollection 2018 Sep.
Results Reference
derived
Links:
URL
http://www.nilvad.eu/
Description
NILVAD project website

Learn more about this trial

A Phase III Trial of Nilvadipine to Treat Alzheimer's Disease

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