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A Pilot Trial of Lithium in Subjects With Progressive Supranuclear Palsy or Corticobasal Degeneration

Primary Purpose

Progressive Supranuclear Palsy, Corticobasal Degeneration

Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
Lithium
Sponsored by
Westat
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Progressive Supranuclear Palsy focused on measuring progressive supranuclear palsy, corticobasal degeneration, PSP, CBD, lithium, tau

Eligibility Criteria

40 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Able to give informed consent
  2. Able to comply with the study protocol, including ability to attend follow-up study visits for the duration of the study
  3. Diagnosis of PSP or CBD based on the following criteria:

    1. Probable PSP:

      • Gradually progressive akinetic disorder
      • Unequivocal and prominent slowing of vertical saccades or vertical supranuclear gaze palsy
      • Early prominent postural instability or early falls
      • Poor or absent response to levodopa
    2. Probable CBD:

      • Chronic progressive course
      • Asymmetric onset
      • Presence of higher cortical dysfunction (apraxia, apraxia of speech, non-fluent aphasia, cortical sensory loss, or alien limb)
      • Movement disorder: rigid/akinetic syndrome resistant to levodopa and either dystonic limb posturing or focal myoclonus in limb (spontaneous or stimulus sensitive)
  4. If psychotropic or anti-parkinsonian medications are taken (e.g., anxiolytics, hypnotics, benzodiazepines, antidepressants, levodopa, amantadine), the dosage must be stable for 28 days prior to the screening visit and should be maintained at constant dosages throughout the study, as possible
  5. If NSAIDs, ACE-Is, ARBs, thiazide diuretics, COX-2 inhibitors or theophylline are taken by the subject, the dosage must be stable for 28 days prior to the screening visit and should be maintained at constant dosages throughout the study, as possible.
  6. Creatinine clearance > 50 ml/min
  7. Able to take oral medication
  8. Women must not be able to become pregnant (e.g., post menopausal, surgically sterile or using adequate birth control methods for the duration of the study.)
  9. Able to identify a study partner

Exclusion Criteria:

  1. Evidence of other diseases that could explain the clinical presentation
  2. History of known sensitivity or intolerability to lithium or to other known ingredients in the study drug
  3. Exposure to any investigational agent within 28 days of the screening visit
  4. Clinically significant cardiac disease or EKG findings
  5. Other serious illness, including psychiatric illness ("serious illness" is defined as an illness that is unstable enough that it might jeopardize the subject's ability to complete the study)
  6. Moderate to severe ongoing depression
  7. Family history of "PSP" or "CBS"
  8. Clinically significant abnormalities on the screening visit laboratory results
  9. Any AE ≥ Grade 3 as listed on the CTCAE, version 3.0
  10. Women who are pregnant or breastfeeding
  11. History of brain surgery
  12. Use of other potential GSK-3β inhibitors (e.g., valproic acid)
  13. Use of iodide salts [e.g., calcium iodide, hydrogen iodide (hydriodic acid), iodide, iodinated glycerol (Organidin), iodine, potassium iodide (SSKI), and sodium iodide]
  14. Previous use of lithium
  15. Use of Coenzyme Q10 at a dosage greater than 600 mg a day or NanoQuinon at a dosage greater than 150mg a day or 2.5 mg/kg a day
  16. Active psoriasis

Sites / Locations

  • Northwestern University
  • Rush University Medical Center
  • University of Louisville
  • University of Maryland
  • UMDNJ Robert Wood Johnson Medical School
  • Beth Israel Medical Center
  • Oregon Health & Science University
  • Medical University of South Carolina
  • Newcastle University

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

1

Arm Description

All participants will receive lithium. The dosage will be titrated over a 5-week period. Participants will then be followed prospectively for 6 months. Participants will be evaluated at the screening visit, baseline visit, and weeks 2 and 5 during the titration phase. Clinic study visits will then occur on alternate months through week 28. Telephone visits will occur between clinic study visits.

Outcomes

Primary Outcome Measures

Ability to Tolerate Lithium Carbonate
The ability to complete the study period on lithium at a serum concentration of at least 0.4 mEq/L.

Secondary Outcome Measures

Study Drug Compliance
Subjects receiving 80% or more of the prescribed doses between study visits were considered compliant.
Changes in Amount of Tau and Phosphorylated Tau in Cerebral Spinal Fluid (CSF)
Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are characterized by hyperphosphorylation of tau. Lithium inhibits one of the kinases (GSK-3 beta) that phosphorylates tau; levels of tau phosphorylation will be measured at baseline and at Week 28.
Change in Brain-Derived Neurotrophic Factor (BDNF) in CSF
With inhibition of Glycogen Synthase Kinase (GSK)-3 beta, levels of BDNF may increase. BDNF levels will be measured at baseline and at Week 28.
Change in Glycogen Synthase Kinase (GSK)-3 Beta Activity
Levels of beta-catenin and the ratio of phosphorylated GSK-3 beta to total GSK-3 beta will be measured at baseline and at Week 28
PSP Rating Scale Score: Change From Baseline
The PSP Rating Scale is a 28-item scale designed to assess the disability associated with PSP. The six functional categories assessed are: daily activities, behavior, bulbar function, oculomotor function, limb motor function, and gait/midline function. Subjects will be assessed at baseline and Weeks 12, 20, and 28.
Unified Parkinson Disease Rating Scale (UPDRS) Motor Subscale Score: Change From Baseline
The UPDRS is a commonly used clinical rating scale to assess motor function in patients with parkinsonism. Subjects will be assessed at baseline and Weeks 5, 12, 20, and 28.
PSP-Quality of Life Scale (QoL):Change From Baseline
The PSP-QoL Scale is an instrument designed to assess mental and physical aspects of quality of life specifically in patients with PSP. Subjects will be assessed at baseline and Weeks 12, 20, and 28.
Frontal Assessment Battery (FAB): Change From Baseline
The FAB is a brief, 6-item instrument designed to assess executive function. Subjects will be assessed at baseline and at Week 28.
Geriatric Depression Scale(GDS)-15:Change From Baseline
The GDS-15 is a 15-item instrument used to screen for depression in the elderly. Subjects will be assessed at the Screening Visit and at Week 28.

Full Information

First Posted
June 20, 2008
Last Updated
June 9, 2015
Sponsor
Westat
Collaborators
National Institute of Neurological Disorders and Stroke (NINDS)
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1. Study Identification

Unique Protocol Identification Number
NCT00703677
Brief Title
A Pilot Trial of Lithium in Subjects With Progressive Supranuclear Palsy or Corticobasal Degeneration
Official Title
A Pilot Trial of Lithium in Subjects With Progressive Supranuclear Palsy or Corticobasal Degeneration
Study Type
Interventional

2. Study Status

Record Verification Date
June 2015
Overall Recruitment Status
Completed
Study Start Date
September 2008 (undefined)
Primary Completion Date
January 2010 (Actual)
Study Completion Date
January 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Westat
Collaborators
National Institute of Neurological Disorders and Stroke (NINDS)

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The goal of this trial is to evaluate the safety and tolerability of lithium in people with progressive supranuclear palsy or corticobasal degeneration.
Detailed Description
Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are progressive, adult-onset neurodegenerative disorders characterized by the accumulation of hyperphosphorylated tau. Symptomatic treatment is of minimal benefit to individuals with PSP or CBD, and there are no effective disease modifying agents. Tau phosphorylation is regulated in part by the enzyme GSK-3β (glycogen synthase kinase-3 beta ). Inhibition of this enzyme may benefit individuals with PSP or CBD by decreasing the levels of phosphorylated tau. Lithium is known to inhibit GSK-3β and, thus, may be a rational therapeutic approach. The primary objective of this study is to determine the safety and tolerability of lithium in people with PSP or CBD. Additionally, this study will evaluate potential biomarkers and clinical outcome measures as well as assess study drug compliance. In this multicenter, open label study, 45 eligible participants with PSP or CBD will receive the study drug, lithium. The dosage of lithium will be titrated over a 5-week period, and participants will then be followed prospectively for 6 months. Participants will be evaluated at the screening visit, baseline visit, and weeks 2 and 5 during the titration phase. Clinic study visits will then occur on alternate months through week 28. Telephone visits will occur between clinic study visits.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Progressive Supranuclear Palsy, Corticobasal Degeneration
Keywords
progressive supranuclear palsy, corticobasal degeneration, PSP, CBD, lithium, tau

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
17 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1
Arm Type
Other
Arm Description
All participants will receive lithium. The dosage will be titrated over a 5-week period. Participants will then be followed prospectively for 6 months. Participants will be evaluated at the screening visit, baseline visit, and weeks 2 and 5 during the titration phase. Clinic study visits will then occur on alternate months through week 28. Telephone visits will occur between clinic study visits.
Intervention Type
Drug
Intervention Name(s)
Lithium
Intervention Description
All participants will receive lithium. The dosage will be titrated over a 5-week period and then continued for an additional 6 months.
Primary Outcome Measure Information:
Title
Ability to Tolerate Lithium Carbonate
Description
The ability to complete the study period on lithium at a serum concentration of at least 0.4 mEq/L.
Time Frame
28 weeks
Secondary Outcome Measure Information:
Title
Study Drug Compliance
Description
Subjects receiving 80% or more of the prescribed doses between study visits were considered compliant.
Time Frame
28 weeks
Title
Changes in Amount of Tau and Phosphorylated Tau in Cerebral Spinal Fluid (CSF)
Description
Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are characterized by hyperphosphorylation of tau. Lithium inhibits one of the kinases (GSK-3 beta) that phosphorylates tau; levels of tau phosphorylation will be measured at baseline and at Week 28.
Time Frame
28 weeks
Title
Change in Brain-Derived Neurotrophic Factor (BDNF) in CSF
Description
With inhibition of Glycogen Synthase Kinase (GSK)-3 beta, levels of BDNF may increase. BDNF levels will be measured at baseline and at Week 28.
Time Frame
28 weeks
Title
Change in Glycogen Synthase Kinase (GSK)-3 Beta Activity
Description
Levels of beta-catenin and the ratio of phosphorylated GSK-3 beta to total GSK-3 beta will be measured at baseline and at Week 28
Time Frame
28 weeks
Title
PSP Rating Scale Score: Change From Baseline
Description
The PSP Rating Scale is a 28-item scale designed to assess the disability associated with PSP. The six functional categories assessed are: daily activities, behavior, bulbar function, oculomotor function, limb motor function, and gait/midline function. Subjects will be assessed at baseline and Weeks 12, 20, and 28.
Time Frame
28 weeks
Title
Unified Parkinson Disease Rating Scale (UPDRS) Motor Subscale Score: Change From Baseline
Description
The UPDRS is a commonly used clinical rating scale to assess motor function in patients with parkinsonism. Subjects will be assessed at baseline and Weeks 5, 12, 20, and 28.
Time Frame
28 weeks
Title
PSP-Quality of Life Scale (QoL):Change From Baseline
Description
The PSP-QoL Scale is an instrument designed to assess mental and physical aspects of quality of life specifically in patients with PSP. Subjects will be assessed at baseline and Weeks 12, 20, and 28.
Time Frame
28 weeks
Title
Frontal Assessment Battery (FAB): Change From Baseline
Description
The FAB is a brief, 6-item instrument designed to assess executive function. Subjects will be assessed at baseline and at Week 28.
Time Frame
28 weeks
Title
Geriatric Depression Scale(GDS)-15:Change From Baseline
Description
The GDS-15 is a 15-item instrument used to screen for depression in the elderly. Subjects will be assessed at the Screening Visit and at Week 28.
Time Frame
28 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Able to give informed consent Able to comply with the study protocol, including ability to attend follow-up study visits for the duration of the study Diagnosis of PSP or CBD based on the following criteria: Probable PSP: Gradually progressive akinetic disorder Unequivocal and prominent slowing of vertical saccades or vertical supranuclear gaze palsy Early prominent postural instability or early falls Poor or absent response to levodopa Probable CBD: Chronic progressive course Asymmetric onset Presence of higher cortical dysfunction (apraxia, apraxia of speech, non-fluent aphasia, cortical sensory loss, or alien limb) Movement disorder: rigid/akinetic syndrome resistant to levodopa and either dystonic limb posturing or focal myoclonus in limb (spontaneous or stimulus sensitive) If psychotropic or anti-parkinsonian medications are taken (e.g., anxiolytics, hypnotics, benzodiazepines, antidepressants, levodopa, amantadine), the dosage must be stable for 28 days prior to the screening visit and should be maintained at constant dosages throughout the study, as possible If NSAIDs, ACE-Is, ARBs, thiazide diuretics, COX-2 inhibitors or theophylline are taken by the subject, the dosage must be stable for 28 days prior to the screening visit and should be maintained at constant dosages throughout the study, as possible. Creatinine clearance > 50 ml/min Able to take oral medication Women must not be able to become pregnant (e.g., post menopausal, surgically sterile or using adequate birth control methods for the duration of the study.) Able to identify a study partner Exclusion Criteria: Evidence of other diseases that could explain the clinical presentation History of known sensitivity or intolerability to lithium or to other known ingredients in the study drug Exposure to any investigational agent within 28 days of the screening visit Clinically significant cardiac disease or EKG findings Other serious illness, including psychiatric illness ("serious illness" is defined as an illness that is unstable enough that it might jeopardize the subject's ability to complete the study) Moderate to severe ongoing depression Family history of "PSP" or "CBS" Clinically significant abnormalities on the screening visit laboratory results Any AE ≥ Grade 3 as listed on the CTCAE, version 3.0 Women who are pregnant or breastfeeding History of brain surgery Use of other potential GSK-3β inhibitors (e.g., valproic acid) Use of iodide salts [e.g., calcium iodide, hydrogen iodide (hydriodic acid), iodide, iodinated glycerol (Organidin), iodine, potassium iodide (SSKI), and sodium iodide] Previous use of lithium Use of Coenzyme Q10 at a dosage greater than 600 mg a day or NanoQuinon at a dosage greater than 150mg a day or 2.5 mg/kg a day Active psoriasis
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Renè Gonin, PhD
Organizational Affiliation
(Math. Stats.), Westat
Official's Role
Principal Investigator
Facility Information:
Facility Name
Northwestern University
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
Rush University Medical Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
Facility Name
University of Louisville
City
Louisville
State/Province
Kentucky
ZIP/Postal Code
40202
Country
United States
Facility Name
University of Maryland
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21201
Country
United States
Facility Name
UMDNJ Robert Wood Johnson Medical School
City
New Brunswick
State/Province
New Jersey
ZIP/Postal Code
08901
Country
United States
Facility Name
Beth Israel Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10003
Country
United States
Facility Name
Oregon Health & Science University
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239-3098
Country
United States
Facility Name
Medical University of South Carolina
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29401
Country
United States
Facility Name
Newcastle University
City
Newcastle upon Tyne
ZIP/Postal Code
NE4 5PL
Country
United Kingdom

12. IPD Sharing Statement

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A Pilot Trial of Lithium in Subjects With Progressive Supranuclear Palsy or Corticobasal Degeneration

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