search
Back to results

Study of APH-1105 in Patients With Mild to Moderate Alzheimer's Disease

Primary Purpose

Dementia, Alzheimer Disease 1, Alzheimer Disease 2

Status
Not yet recruiting
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
APH-1105
Placebo
Sponsored by
Aphios
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Dementia focused on measuring Alzheimer's Disease, Dementia

Eligibility Criteria

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

Inclusion Criteria

  • Males and Females ages > 50 years of age at screening visit
  • Probable Alzheimer's Disease according to National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association(NINCDS-ADRDA) and Diagnostic Statistical Manual (DSM) IV-V criteria
  • Clinical Dementia Rating Scale (CDR) global score > 1.0 at the time of screening
  • Mini-Mental Status Examination score of 22-30 at screening visit CT or MRI of brain, within 12 months prior to randomization, compatible with a diagnosis of Probable Alzheimer's Disease
  • Physical examination, laboratory data and electrocardiogram results from screening visit must be normal or abnormal findings must be judged not to be clinically significant
  • Ability to walk, at least with an assistive device
  • Vision and hearing sufficient to comply with testing
  • Informed consent from patient, or legal guardian (if applicable) and a caregiver
  • Living outside an institutional facility
  • Must have at least 1 informant/study partner

Exclusion Criteria

  • Clinically significant and active pulmonary, gastrointestinal, renal, hepatic, endocrine or cardiovascular system diseases
  • Other neurological disorders, including but not limited to stroke, Parkinson's Disease, seizure disorder, or head injury with loss of consciousness within the past 5 years
  • DSM-IV Axis I disorder other than Alzheimer's Disease, including amnesic disorders, schizophrenia or schizoaffective disorder, bipolar disorder, current major depressive episode, psychosis, panic, or post-traumatic stress disorder
  • CT scan or MRI evidence of hydrocephalus, stroke, a space-occupying lesion, cerebral infection, or any other clinically significant central nervous system disease
  • Dementia complicated by another organic disease
  • Dementia complicated by the presence of predominant delusions
  • Patients with a hematological malignancy or solid tumor who are undergoing treatment, who have completed treatment within the past 6 months, or who still have evidence of active disease
  • Current drug or alcohol dependency including nicotine addiction (smokers)
  • Subjects receiving immune-suppressants tricyclic antidepressants anticoagulants or chemotherapeutic agents
  • Hypertension that is poorly controlled or managed
  • Any medical or neurological/neurodegenerative condition (other than AD) that, in the opinion of the Investigator, might be a contributing cause to the participant's cognitive impairment or could lead to discontinuation, lack of compliance, interference with study assessments, or safety concerns
  • Clinically significant, unstable psychiatric illness
  • Have had a stroke or Transient Ischemic Attack (TIA) or unexplained loss of consciousness in the past 1 year
  • Relevant brain hemorrhage, bleeding disorder and cerebrovascular abnormalities
  • History of unstable angina, myocardial infarction, chronic heart failure or clinically significant conduction abnormalities within 1 year prior to Screening Visit 1
  • Indication of impaired renal or liver function
  • Clinically significant systemic illness or serious infection within 30 days prior to or during the screening period
  • Use of allowed medications for chronic conditions at doses that have not been stable for at least 4 weeks prior to Screening Visit 1, or use of AD medications at doses that have not been stable for at least 8 weeks prior to Screening Visit 1
  • Use of any medications that, in the opinion of the Investigator, may contribute to cognitive impairment, put the participants at higher risk for adverse events (AEs), or impair the participant's ability to perform cognitive testing or complete study procedures.
  • Contraindications to study procedures

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm 4

    Arm Type

    Experimental

    Experimental

    Experimental

    Placebo Comparator

    Arm Label

    0.5 µg

    1.0 µg

    2.0 µg

    Placebo

    Arm Description

    Intranasal (IN) nanoparticles - 0.5 micrograms. The study is planned to include 1 dose of APH 1105 / 0.5 µg, administered twice a week for 12 weeks, for a total of 24 doses.

    Intranasal (IN) nanoparticles - 1.0 micrograms. The study is planned to include 1 dose of APH 1105 / 1.0 µg, administered twice a week for 12 weeks, for a total of 24 doses.

    Intranasal (IN) nanoparticles - 2.0 micrograms. The study is planned to include 1 dose of APH 1105 / 2.0 µg, administered twice a week for 12 weeks, for a total of 24 doses.

    Intranasal (IN) Placebo nanoparticles. The study is planned to include 1 dose of placebo drug administered twice a week for 12 weeks, for a total of 24 doses.

    Outcomes

    Primary Outcome Measures

    Safety: Incidence of Treatment-emergent Adverse Events
    Number of patients experiencing Adverse (AE) and Serious Adverse (SAE) events during treatment and followup.
    Efficacy: Cognition Change
    Change in Alzheimer's Disease Assessment Scale-Cog (ADAS-COG) total score from baseline to post final treatment dose. The Alzheimer's Disease Assessment Scale-Cognitive Subscale test(ADAS-Cog) measures language and memory and is comprised of 2 parts targeting cognitive and non-cognitive functioning. It consists of 11 items which include (but not all) word recall, naming of objects, word recognition, comprehension and word finding. The ADAS-COG is scored 0-70. The higher the score the greater the impairment.
    Efficacy: Change in Cognitive Functioning
    Change in the Hopkins Verbal Learning Test-Revised from baseline to day 60 post final treatment dose The Hopkins Verbal Learning Test, a three-trial list of 12 words is a learning and free recall task. The Hopkins Verbal Learning Test measures episodic memory. The test is made up of three trials which requires the patient to free-recall words from the 12 word list involving yes/no responses. The score range is from 0-12. Lower scores (numbers) indicate more impairment.

    Secondary Outcome Measures

    Tolerability: [Pharmacokinetics] Cmax
    Characterize pharmacokinetic effects of APH-1105 exposure in patients with Alzheimer's Disease to determine peak plasma concentration (Cmax).
    Tolerability: [Pharmacokinetics] Tmax
    Characterize pharmacokinetic effects of APH-1105 exposure in patients with Alzheimer's Disease to determine peak serum concentration(Tmax).
    Tolerability: [Pharmacokinetics] serum elimination half life
    Characterize pharmacokinetic effects of APH-1105 exposure in patients with Alzheimer's Disease to determine serum elimination half life(1/2).
    Tolerability: [Pharmacodynamics] protein kinase C activity
    Assess the Protein Kinase C Activity in patients treated with multiple doses of APH-1105
    Change in Behavioral Functioning
    Change in the Behavioral Pathology in Alzheimer's Disease Rating Scale -Frequency-Weighted (BEHAVE-AD-FW). The Behavioral Pathology in Alzheimer's Disease Frequency Weighted Severity Scale (BEHAVE-AD-FW) assesses the possible neurological basis of behavioral and psychological symptoms of dementia, the relationships between behavioral functioning and cognitive functioning. The scale consists of seven (7) behavioral categories (paranoid and delusional ideation, hallucinations, activity disturbances, aggressiveness, diurnal rhythm disturbances, affective disturbances, anxieties, and phobias) and consists of twenty-five (25) symptoms grouped into these categories. Items are score on a 4 point severity - higher the score, higher the impairment.
    Change in Behavioral Disturbance
    Change in the Neuropsychiatric Inventory (NPI) The Neuropsychiatric Inventory (12 item) is a caregiver/informant-based interview that assesses 12 neuro-psychiatric symptoms of the participant over the previous month. Responses are rated both in terms of frequency (1=rarely, less than once per week; 2=sometimes, about once per week; 3=often, several times per week; and 4=very often, once or more per day) and severity (1=mild; 2=moderate; 3=severe) with composite scores ranging from 0-144. The higher the score the greater symptom severity.
    Change in Dementia Symptom Severity
    Change in the Clinical Dementia Rating Scale(CDR_SB) The Clinical Dementia Rating or CDR measure the stage severity of dementia. It is a five-point scale in which "0" connotes no cognitive impairment, and then the remaining four points are for various stages of dementia, mild to severe.
    Evaluate the Quality of Life Status
    Change in the Clinical Global Impression of Improvement (CGI-I) and the Caregiver Clinical Global Impression of Improvement (CGI-I) is a 3-item observer-rated scale that measures illness severity, global improvement or change, and therapeutic response. It is rated on a 7-point scale, with the severity of illness scale using a range of responses from 1 (normal) through to 7 (amongst the most severely ill patients). CGI-C scores range from 1 (very much improved) through to 7 (very much worse). Each component of the CGI is rated separately; the instrument does not yield a global score.
    Risk of Suicide
    The Columbia-Suicide Severity Rating Scale (C-SSRS) is an assessment tool that evaluates suicidal ideation and behavior. It is comprised of ten categories, with binary responses (yes/no) to indicate a presence or absence of the behavior. The ten categories included in the C-SSRS are as follows: Category 1 - Wish to be Dead; Category 2 - Non-specific Active Suicidal Thoughts; Category 3 - Active Suicidal Ideation with Any Methods (Not Plan) without Intent to Act; Category 4 - Active Suicidal Ideation with Some Intent to Act, without Specific Plan; Category 5 - Active Suicidal Ideation with Specific Plan and Intent; Category 6 - Preparatory Acts or Behavior; Category 7 - Aborted Attempt; Category 8 - Interrupted Attempt; Category 9 - Actual Attempt (non-fatal); Category 10 - Completed Suicide. A yes/no binary response is also utilized in assessing self-injurious behavior without suicidal intent. The outcome of the C-SSRS is a numerical score obtained from the these categories.

    Full Information

    First Posted
    January 4, 2019
    Last Updated
    July 26, 2021
    Sponsor
    Aphios
    search

    1. Study Identification

    Unique Protocol Identification Number
    NCT03806478
    Brief Title
    Study of APH-1105 in Patients With Mild to Moderate Alzheimer's Disease
    Official Title
    Safety, Tolerability and Efficacy Assessment of Intranasal Nanoparticles of APH-1105, A Novel Alpha Secretase Modulator For Mild to Moderate Cognitive Impairment Due to Alzheimer's Disease(AD)
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2021
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    June 2023 (Anticipated)
    Primary Completion Date
    September 2024 (Anticipated)
    Study Completion Date
    December 2024 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Aphios

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Product Manufactured in and Exported from the U.S.
    Yes
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    This is a Phase 2 study assessing the safety, tolerability and efficacy of intranasal delivery of APH-1105 for the treatment of mild to moderate Alzheimer's in adult.
    Detailed Description
    This study is a multi-center, randomized, triple blind placebo-control with parallel groups. Patients diagnosed with mild to moderate AD will be enrolled and randomly assigned in a blinded fashion to receive study drug APH-1105. Groups will receive either 0.5 µg (15 active, 5 placebo), 1.0 µg (15 active, 5 placebo), or 2.0 µg (15 active, 5 placebo). A full assessment will be made of all relevant tolerability and safety data. Patients will be administered the study drug outside of the clinic setting by a study partner twice a week. The initial dose of APH-1105 will take place in a clinic setting for the purpose of collecting initial Pharmacokinetic data. The total duration for patient participation will be approximately 18 weeks which includes 1 week for screening, 12 weeks of treatment and followup 4 weeks post final dose. Study visits will occur during screening, baseline, weeks 1, 2, 4, 8, 12 and 16 for a total of 7 visits. Week 16 represents the followup visit after the final dose of study medication. Cognitive assessments will be performed at screening, and will repeat at weeks 4, 12 and 16. Behavioral Functioning and Quality of Life measures will be done at weeks 2,4,8,12 and 16. Blood samples will collected though out the study for Pharmacokinetic analyses.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Dementia, Alzheimer Disease 1, Alzheimer Disease 2, Alzheimer Disease 3
    Keywords
    Alzheimer's Disease, Dementia

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Parallel Assignment
    Model Description
    Exploratory Phase 2 Trial
    Masking
    ParticipantCare ProviderOutcomes Assessor
    Masking Description
    Triple Blind
    Allocation
    Randomized
    Enrollment
    60 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    0.5 µg
    Arm Type
    Experimental
    Arm Description
    Intranasal (IN) nanoparticles - 0.5 micrograms. The study is planned to include 1 dose of APH 1105 / 0.5 µg, administered twice a week for 12 weeks, for a total of 24 doses.
    Arm Title
    1.0 µg
    Arm Type
    Experimental
    Arm Description
    Intranasal (IN) nanoparticles - 1.0 micrograms. The study is planned to include 1 dose of APH 1105 / 1.0 µg, administered twice a week for 12 weeks, for a total of 24 doses.
    Arm Title
    2.0 µg
    Arm Type
    Experimental
    Arm Description
    Intranasal (IN) nanoparticles - 2.0 micrograms. The study is planned to include 1 dose of APH 1105 / 2.0 µg, administered twice a week for 12 weeks, for a total of 24 doses.
    Arm Title
    Placebo
    Arm Type
    Placebo Comparator
    Arm Description
    Intranasal (IN) Placebo nanoparticles. The study is planned to include 1 dose of placebo drug administered twice a week for 12 weeks, for a total of 24 doses.
    Intervention Type
    Drug
    Intervention Name(s)
    APH-1105
    Intervention Description
    The investigational drug product, APH-1105 is a sterile, pyrogen-free lyophilized powder intended for intranasal administration.
    Intervention Type
    Other
    Intervention Name(s)
    Placebo
    Intervention Description
    The placebo is a sterile, pyrogen free lyophilized powder identical in appearance to the experimental drug
    Primary Outcome Measure Information:
    Title
    Safety: Incidence of Treatment-emergent Adverse Events
    Description
    Number of patients experiencing Adverse (AE) and Serious Adverse (SAE) events during treatment and followup.
    Time Frame
    Baseline through 30 days post final treatment dose up to day 60
    Title
    Efficacy: Cognition Change
    Description
    Change in Alzheimer's Disease Assessment Scale-Cog (ADAS-COG) total score from baseline to post final treatment dose. The Alzheimer's Disease Assessment Scale-Cognitive Subscale test(ADAS-Cog) measures language and memory and is comprised of 2 parts targeting cognitive and non-cognitive functioning. It consists of 11 items which include (but not all) word recall, naming of objects, word recognition, comprehension and word finding. The ADAS-COG is scored 0-70. The higher the score the greater the impairment.
    Time Frame
    Baseline - day 60
    Title
    Efficacy: Change in Cognitive Functioning
    Description
    Change in the Hopkins Verbal Learning Test-Revised from baseline to day 60 post final treatment dose The Hopkins Verbal Learning Test, a three-trial list of 12 words is a learning and free recall task. The Hopkins Verbal Learning Test measures episodic memory. The test is made up of three trials which requires the patient to free-recall words from the 12 word list involving yes/no responses. The score range is from 0-12. Lower scores (numbers) indicate more impairment.
    Time Frame
    Baseline - day 60
    Secondary Outcome Measure Information:
    Title
    Tolerability: [Pharmacokinetics] Cmax
    Description
    Characterize pharmacokinetic effects of APH-1105 exposure in patients with Alzheimer's Disease to determine peak plasma concentration (Cmax).
    Time Frame
    Blood draws at baseline and 15 minutes, 30minutes, 60minutes, 2 hours, 6hours, 12hours, 24hours, 48hours and 72hours post first administered dose
    Title
    Tolerability: [Pharmacokinetics] Tmax
    Description
    Characterize pharmacokinetic effects of APH-1105 exposure in patients with Alzheimer's Disease to determine peak serum concentration(Tmax).
    Time Frame
    Blood draws at baseline and 15 minutes, 30minutes, 60minutes, 2 hours, 6hours, 12hours, 24hours, 48hours and 72hours post first administered dose
    Title
    Tolerability: [Pharmacokinetics] serum elimination half life
    Description
    Characterize pharmacokinetic effects of APH-1105 exposure in patients with Alzheimer's Disease to determine serum elimination half life(1/2).
    Time Frame
    Blood draws at baseline and 15 minutes, 30minutes, 60minutes, 2 hours, 6hours, 12hours, 24hours, 48hours and 72hours post first administered dose
    Title
    Tolerability: [Pharmacodynamics] protein kinase C activity
    Description
    Assess the Protein Kinase C Activity in patients treated with multiple doses of APH-1105
    Time Frame
    Blood draws at baseline, 15 minutes, 30minutes, 60minutes, 2hours, 6hours, 12hours, 24hours, 48hours, and 72hours post first administered dose.
    Title
    Change in Behavioral Functioning
    Description
    Change in the Behavioral Pathology in Alzheimer's Disease Rating Scale -Frequency-Weighted (BEHAVE-AD-FW). The Behavioral Pathology in Alzheimer's Disease Frequency Weighted Severity Scale (BEHAVE-AD-FW) assesses the possible neurological basis of behavioral and psychological symptoms of dementia, the relationships between behavioral functioning and cognitive functioning. The scale consists of seven (7) behavioral categories (paranoid and delusional ideation, hallucinations, activity disturbances, aggressiveness, diurnal rhythm disturbances, affective disturbances, anxieties, and phobias) and consists of twenty-five (25) symptoms grouped into these categories. Items are score on a 4 point severity - higher the score, higher the impairment.
    Time Frame
    Baseline, week 4, 8 12 and week 16 post final dose.
    Title
    Change in Behavioral Disturbance
    Description
    Change in the Neuropsychiatric Inventory (NPI) The Neuropsychiatric Inventory (12 item) is a caregiver/informant-based interview that assesses 12 neuro-psychiatric symptoms of the participant over the previous month. Responses are rated both in terms of frequency (1=rarely, less than once per week; 2=sometimes, about once per week; 3=often, several times per week; and 4=very often, once or more per day) and severity (1=mild; 2=moderate; 3=severe) with composite scores ranging from 0-144. The higher the score the greater symptom severity.
    Time Frame
    Baseline, week 4, 8 12 and week 16 post final dose.
    Title
    Change in Dementia Symptom Severity
    Description
    Change in the Clinical Dementia Rating Scale(CDR_SB) The Clinical Dementia Rating or CDR measure the stage severity of dementia. It is a five-point scale in which "0" connotes no cognitive impairment, and then the remaining four points are for various stages of dementia, mild to severe.
    Time Frame
    Baseline, week 4, 8 12 and week 16 post final dose.
    Title
    Evaluate the Quality of Life Status
    Description
    Change in the Clinical Global Impression of Improvement (CGI-I) and the Caregiver Clinical Global Impression of Improvement (CGI-I) is a 3-item observer-rated scale that measures illness severity, global improvement or change, and therapeutic response. It is rated on a 7-point scale, with the severity of illness scale using a range of responses from 1 (normal) through to 7 (amongst the most severely ill patients). CGI-C scores range from 1 (very much improved) through to 7 (very much worse). Each component of the CGI is rated separately; the instrument does not yield a global score.
    Time Frame
    Baseline, week 4, 8, 12 and week 16 post final dose
    Title
    Risk of Suicide
    Description
    The Columbia-Suicide Severity Rating Scale (C-SSRS) is an assessment tool that evaluates suicidal ideation and behavior. It is comprised of ten categories, with binary responses (yes/no) to indicate a presence or absence of the behavior. The ten categories included in the C-SSRS are as follows: Category 1 - Wish to be Dead; Category 2 - Non-specific Active Suicidal Thoughts; Category 3 - Active Suicidal Ideation with Any Methods (Not Plan) without Intent to Act; Category 4 - Active Suicidal Ideation with Some Intent to Act, without Specific Plan; Category 5 - Active Suicidal Ideation with Specific Plan and Intent; Category 6 - Preparatory Acts or Behavior; Category 7 - Aborted Attempt; Category 8 - Interrupted Attempt; Category 9 - Actual Attempt (non-fatal); Category 10 - Completed Suicide. A yes/no binary response is also utilized in assessing self-injurious behavior without suicidal intent. The outcome of the C-SSRS is a numerical score obtained from the these categories.
    Time Frame
    Baseline, week 4, 8, 12 and week 16 post final dose

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    50 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria Males and Females ages > 50 years of age at screening visit Probable Alzheimer's Disease according to National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association(NINCDS-ADRDA) and Diagnostic Statistical Manual (DSM) IV-V criteria Clinical Dementia Rating Scale (CDR) global score > 1.0 at the time of screening Mini-Mental Status Examination score of 22-30 at screening visit CT or MRI of brain, within 12 months prior to randomization, compatible with a diagnosis of Probable Alzheimer's Disease Physical examination, laboratory data and electrocardiogram results from screening visit must be normal or abnormal findings must be judged not to be clinically significant Ability to walk, at least with an assistive device Vision and hearing sufficient to comply with testing Informed consent from patient, or legal guardian (if applicable) and a caregiver Living outside an institutional facility Must have at least 1 informant/study partner Exclusion Criteria Clinically significant and active pulmonary, gastrointestinal, renal, hepatic, endocrine or cardiovascular system diseases Other neurological disorders, including but not limited to stroke, Parkinson's Disease, seizure disorder, or head injury with loss of consciousness within the past 5 years DSM-IV Axis I disorder other than Alzheimer's Disease, including amnesic disorders, schizophrenia or schizoaffective disorder, bipolar disorder, current major depressive episode, psychosis, panic, or post-traumatic stress disorder CT scan or MRI evidence of hydrocephalus, stroke, a space-occupying lesion, cerebral infection, or any other clinically significant central nervous system disease Dementia complicated by another organic disease Dementia complicated by the presence of predominant delusions Patients with a hematological malignancy or solid tumor who are undergoing treatment, who have completed treatment within the past 6 months, or who still have evidence of active disease Current drug or alcohol dependency including nicotine addiction (smokers) Subjects receiving immune-suppressants tricyclic antidepressants anticoagulants or chemotherapeutic agents Hypertension that is poorly controlled or managed Any medical or neurological/neurodegenerative condition (other than AD) that, in the opinion of the Investigator, might be a contributing cause to the participant's cognitive impairment or could lead to discontinuation, lack of compliance, interference with study assessments, or safety concerns Clinically significant, unstable psychiatric illness Have had a stroke or Transient Ischemic Attack (TIA) or unexplained loss of consciousness in the past 1 year Relevant brain hemorrhage, bleeding disorder and cerebrovascular abnormalities History of unstable angina, myocardial infarction, chronic heart failure or clinically significant conduction abnormalities within 1 year prior to Screening Visit 1 Indication of impaired renal or liver function Clinically significant systemic illness or serious infection within 30 days prior to or during the screening period Use of allowed medications for chronic conditions at doses that have not been stable for at least 4 weeks prior to Screening Visit 1, or use of AD medications at doses that have not been stable for at least 8 weeks prior to Screening Visit 1 Use of any medications that, in the opinion of the Investigator, may contribute to cognitive impairment, put the participants at higher risk for adverse events (AEs), or impair the participant's ability to perform cognitive testing or complete study procedures. Contraindications to study procedures
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Trevor P Castor, PhD
    Phone
    781 932 6933
    Email
    tcastor@aphios.com
    First Name & Middle Initial & Last Name or Official Title & Degree
    Judith L Castor, PhD
    Phone
    781 932 6933
    Email
    jlpcastor@aphios.com

    12. IPD Sharing Statement

    Plan to Share IPD
    No

    Learn more about this trial

    Study of APH-1105 in Patients With Mild to Moderate Alzheimer's Disease

    We'll reach out to this number within 24 hrs