Pioglitazone in Alzheimer Disease
Primary Purpose
Alzheimer Disease
Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
pioglitazone
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for Alzheimer Disease focused on measuring PPAR-gamma, inflammation
Eligibility Criteria
Inclusion Criteria:
- CT or MRI since disease onset excluding structural lesions sufficient to account for the participant's dementia
- Mini-Mental State Exam (MMSE) score between 12 and 26, inclusively
- Clinical Dementia Rating (CDR) score of 1 or 2 (mild to moderate AD severity) at both screening and baseline
- Women must be 2-years post-menopausal or surgically sterile.
- Generally healthy and ambulatory or ambulatory-aided (i.e., walker or cane); vision and hearing (hearing aid permissible) sufficient for compliance with testing procedures
- Concomitant medications: Participants may be on stable doses of cholinesterase inhibitors for 90 days prior to screening (may not be started during the trial); antidepressant or antipsychotic medications are acceptable if symptoms are controlled and therapy is at stable dosage for at least 30 days prior to screening; vitamin E at 200 IU daily will be provided to all participants beginning at baseline/randomization (higher doses must be discontinued at the screening visit)
Exclusion Criteria:
- Absence of a reliable caregiver who is willing to participate and comply with protocol responsibilities
- Diabetes mellitus requiring medical therapy (diet-controlled diabetes is acceptable)
- Acute or chronic liver failure, hepatitis within the last two years, or history of drug-induced liver transaminase elevations
- Heart failure meeting New York Heart Association Grade III or IV criteria (i.e., functionally disabling)
- Evidence of active gastrointestinal, renal, pulmonary, endocrine or cardiovascular system disease sufficient to cause cognitive impairment or interfere with past levels of daily function; participants with controlled hypertension (supine diastolic BP < 95mmHg), right bundle branch block (complete or partial) and pacemakers may be included in the study; participants with thyroid disease also may be included in the study, provided they are euthyroid on treatment
- Active treatment for cancer or history of cancer within 3 years of screening (basal cell and squamous cells skin cancers are acceptable; incidental finding of carcinoma cells at transurethral prostate resection without subsequent medical or surgical therapy is acceptable)
- Evidence of other psychiatric/neurologic disorders sufficient to be the primary source of cognitive impairment (i.e., stroke, idiopathic Parkinson's disease, schizophrenia, bipolar or unipolar depression, seizure disorder, head injury with loss of consciousness within the past year) or a modified Hachinski's ischemia score of 5 or greater; delusions, hallucinations or depression not successfully treated or not on stable medical therapy for these conditions 30 days prior to enrollment; known or suspected history (within the past 10 years) of alcoholism or drug misuse
- Participants and/or caregivers who are unwilling or unable to fulfill the requirements of the study
- Any condition which would make the participant or the caregiver, in the opinion of the investigator, unsuitable for the study
Sites / Locations
- University Hospitals of Cleveland
- University of Virginia
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Placebo Comparator
Arm Label
PGZ
Placebo
Arm Description
Outcomes
Primary Outcome Measures
Frequency of adverse events
Secondary Outcome Measures
Laboratory abnormalities
Cognition
Activities of Daily Living (ADL)
Behavior
Global function
Full Information
NCT ID
NCT00982202
First Posted
September 22, 2009
Last Updated
September 22, 2009
Sponsor
National Institute on Aging (NIA)
Collaborators
Takeda Pharmaceuticals North America, Inc.
1. Study Identification
Unique Protocol Identification Number
NCT00982202
Brief Title
Pioglitazone in Alzheimer Disease
Official Title
Pioglitazone in Alzheimer Disease Progression
Study Type
Interventional
2. Study Status
Record Verification Date
September 2009
Overall Recruitment Status
Completed
Study Start Date
January 2002 (undefined)
Primary Completion Date
January 2005 (Actual)
Study Completion Date
January 2005 (Actual)
3. Sponsor/Collaborators
Name of the Sponsor
National Institute on Aging (NIA)
Collaborators
Takeda Pharmaceuticals North America, Inc.
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This study was designed to assess the safety and tolerability of pioglitazone, an approved drug for type 2 diabetes, in non diabetic patients with Alzheimer's disease. It was also designed to generate preliminary information on whether pioglitazone might slow progression of Alzheimer's disease.
Detailed Description
Inflammatory processes are important in the progressive loss of memory and thinking skills in Alzheimer's disease (AD). Laboratory studies show that drugs that bind to a protein known as "Peroxisome Proliferator Activated Receptor-gamma (PPARgamma)" act to reduce inflammatory responses in brain cells known as microglia when they are exposed to amyloid peptide, a major part of AD pathology. Therefore, drugs that activate PPARgamma have great potential for reducing the progression of AD. Pioglitazone (PGZ) activates PPARgamma and has shown favorable clinical experiences and safety profiles in patients with diabetes. This is a pilot study to determine the safety and tolerability of PGZ in patients with AD. Another goal of the study is to assess how clinical measures of cognition, daily function, and behavior might respond to PGZ treatment.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alzheimer Disease
Keywords
PPAR-gamma, inflammation
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
25 (Actual)
8. Arms, Groups, and Interventions
Arm Title
PGZ
Arm Type
Experimental
Arm Title
Placebo
Arm Type
Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
pioglitazone
Other Intervention Name(s)
Actos
Intervention Description
15mg tablet daily, increase by one pill at one-week intervals based on reported tolerability; maintain best tolerated dose (1 to 3 tablets daily) for ~18months
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
1 to 3 tablets daily for ~18 months
Primary Outcome Measure Information:
Title
Frequency of adverse events
Time Frame
baseline, monthly for 1 year, then 15 and 18 months
Secondary Outcome Measure Information:
Title
Laboratory abnormalities
Time Frame
baseline, monthly for 1 year, then 15 and 18 months
Title
Cognition
Time Frame
baseline, 3, 6, 9, 12, 15, and 18 months
Title
Activities of Daily Living (ADL)
Time Frame
baseline, 3, 6, 9, 12, 15, and 18 months
Title
Behavior
Time Frame
baseline, 3, 6, 9, 12, 15, and 18 months
Title
Global function
Time Frame
baseline, 3, 6, 9, 12, 15, and 18 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
CT or MRI since disease onset excluding structural lesions sufficient to account for the participant's dementia
Mini-Mental State Exam (MMSE) score between 12 and 26, inclusively
Clinical Dementia Rating (CDR) score of 1 or 2 (mild to moderate AD severity) at both screening and baseline
Women must be 2-years post-menopausal or surgically sterile.
Generally healthy and ambulatory or ambulatory-aided (i.e., walker or cane); vision and hearing (hearing aid permissible) sufficient for compliance with testing procedures
Concomitant medications: Participants may be on stable doses of cholinesterase inhibitors for 90 days prior to screening (may not be started during the trial); antidepressant or antipsychotic medications are acceptable if symptoms are controlled and therapy is at stable dosage for at least 30 days prior to screening; vitamin E at 200 IU daily will be provided to all participants beginning at baseline/randomization (higher doses must be discontinued at the screening visit)
Exclusion Criteria:
Absence of a reliable caregiver who is willing to participate and comply with protocol responsibilities
Diabetes mellitus requiring medical therapy (diet-controlled diabetes is acceptable)
Acute or chronic liver failure, hepatitis within the last two years, or history of drug-induced liver transaminase elevations
Heart failure meeting New York Heart Association Grade III or IV criteria (i.e., functionally disabling)
Evidence of active gastrointestinal, renal, pulmonary, endocrine or cardiovascular system disease sufficient to cause cognitive impairment or interfere with past levels of daily function; participants with controlled hypertension (supine diastolic BP < 95mmHg), right bundle branch block (complete or partial) and pacemakers may be included in the study; participants with thyroid disease also may be included in the study, provided they are euthyroid on treatment
Active treatment for cancer or history of cancer within 3 years of screening (basal cell and squamous cells skin cancers are acceptable; incidental finding of carcinoma cells at transurethral prostate resection without subsequent medical or surgical therapy is acceptable)
Evidence of other psychiatric/neurologic disorders sufficient to be the primary source of cognitive impairment (i.e., stroke, idiopathic Parkinson's disease, schizophrenia, bipolar or unipolar depression, seizure disorder, head injury with loss of consciousness within the past year) or a modified Hachinski's ischemia score of 5 or greater; delusions, hallucinations or depression not successfully treated or not on stable medical therapy for these conditions 30 days prior to enrollment; known or suspected history (within the past 10 years) of alcoholism or drug misuse
Participants and/or caregivers who are unwilling or unable to fulfill the requirements of the study
Any condition which would make the participant or the caregiver, in the opinion of the investigator, unsuitable for the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Geldmaher, MD
Organizational Affiliation
University of Virginia Health System
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Hospitals of Cleveland
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44120
Country
United States
Facility Name
University of Virginia
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22908
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
15817521
Citation
Heneka MT, Sastre M, Dumitrescu-Ozimek L, Hanke A, Dewachter I, Kuiperi C, O'Banion K, Klockgether T, Van Leuven F, Landreth GE. Acute treatment with the PPARgamma agonist pioglitazone and ibuprofen reduces glial inflammation and Abeta1-42 levels in APPV717I transgenic mice. Brain. 2005 Jun;128(Pt 6):1442-53. doi: 10.1093/brain/awh452. Epub 2005 Apr 7.
Results Reference
background
PubMed Identifier
18072811
Citation
Jiang Q, Heneka M, Landreth GE. The role of peroxisome proliferator-activated receptor-gamma (PPARgamma) in Alzheimer's disease: therapeutic implications. CNS Drugs. 2008;22(1):1-14. doi: 10.2165/00023210-200822010-00001.
Results Reference
background
PubMed Identifier
17848652
Citation
Lincoff AM, Wolski K, Nicholls SJ, Nissen SE. Pioglitazone and risk of cardiovascular events in patients with type 2 diabetes mellitus: a meta-analysis of randomized trials. JAMA. 2007 Sep 12;298(10):1180-8. doi: 10.1001/jama.298.10.1180.
Results Reference
background
PubMed Identifier
20837824
Citation
Geldmacher DS, Fritsch T, McClendon MJ, Landreth G. A randomized pilot clinical trial of the safety of pioglitazone in treatment of patients with Alzheimer disease. Arch Neurol. 2011 Jan;68(1):45-50. doi: 10.1001/archneurol.2010.229. Epub 2010 Sep 13.
Results Reference
derived
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Pioglitazone in Alzheimer Disease
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