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Study of the Efficacy and Safety of Various Anti-inflammatory Agents in Participants With Mild Cognitive Impairment or Mild Alzheimer's Disease

Primary Purpose

Mild Cognitive Impairment, Alzheimer Disease

Status
Active
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Canakinumab
Placebo
Sponsored by
Novartis Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Mild Cognitive Impairment focused on measuring Alzheimer disease, Mild Cognitive Impairment, Elderly adults, Adults, Memory loss, Dementia, Inflammation, ADPT06

Eligibility Criteria

45 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female, age ≥ 45 years and ≤ 90 years at the time of signing the informed consent;
  • Participant has a reliable study partner or caregiver can accompany the participant to all visits;
  • A diagnosis of probable MCI due to AD or mild AD according to the National Institute on Aging and the Alzheimer's Association (NIA-AA) criteria;
  • Confirmed amyloid and tau positivity via CSF sampling performed at screening;
  • Mini-Mental State Examination (MMSE) total score of 20 to 24 (inclusive) at screening; OR, MMSE total score of 25-30 (inclusive) plus a DSST score at least 0.5 standard deviation (SD) below normative data at screening.

Exclusion Criteria:

  • Use of an investigational agent or an approved product with the intent to modulate inflammation or modulate the course of AD (e.g., Tau ASOs, gene therapy, amyloid or tau vaccine):

    • Previous use of small molecules is allowed if discontinued for at least five half-lives, or at least 30 days from when the expected pharmacodynamic effect has returned to baseline prior to screening, whichever is longer
    • Previous use of monoclonal or polyclonal antibodies or other biologics is allowed if discontinued for at least five half-lives prior to screening
  • Current medical or neurological condition that might impact cognition or performance on cognitive assessments, e.g., MCI not due to AD, non-Alzheimer dementia, Huntington's disease, Parkinson's disease, stroke, schizophrenia, bipolar disorder, active major depression, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), active seizure disorder, or history of traumatic brain injury associated with loss of consciousness and ongoing residual transient or permanent neurological signs/symptoms including cognitive deficits, and/or associated with skull fracture;
  • If a historical MRI or CT scan has been performed, signs of major cerebrovascular disease shown on such scans (i.e., presence of infarction in greater than 25% of white matter; more than one lacune within basal ganglia or more than 2 lacunes in white matter);
  • Diagnosis of vascular dementia prior to screening (e.g.., modified Hachinski Ischaemic Scale score > 6 or those who meet the NINDS AIREN criteria for vascular dementia);

Sites / Locations

  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Canakinumab

Placebo

Arm Description

increasing doses of sub-cutaneous injections

Matching placebo sub-cutaneous injections

Outcomes

Primary Outcome Measures

Change from baseline in cognition as measured by the Neuropsychological Test Battery (NTB) total score
Neuropsychological Test Battery (NTB) is a composite of multiple globally-established neuropsychological tests that parovide a thorough assessment of the cognitive domains affect by early Alzheimer's Disease (AD), in particular, memory, executive function, attention and verbal fluency.

Secondary Outcome Measures

Number of participants who experience adverse events and serious adverse events
Clinically significant abnormalities of laboratory values, physical findings, electrocardiogram findings and other safety assessments will be recorded as adverse events if the findings meet the defined criteria for adverse events.
Change from baseline in microglia activation as measured by Positron-Emission Tomography-Translocator Protein 18kDa - microglia activation
Positron-Emission Tomography-Translocator Protein 18kDa-microglia activation (PET TSPO) is considered a marker of central inflammation (a marker for activated microglia and astrocytes) and the signal strength has been shown to correlate with worsening clinical severity in participants with MCI or AD, measures of cognition and various clinical scores.
Change from baseline in neuropsychiatric symptoms as measured by the Neuropsychiatric Inventory (NPI) total score
Neuropsychiatric Inventory (NPI) total score is a globally recognized and the most frequently used assessment of neuropsychiatric symptoms in AD trials that covers twelve neuropsychiatric domains.
Change from baseline in function (activities of daily living) as measured by the Everyday Cognition (eCog) total score
Everyday Cognition (eCog) scale measures cognitively-relevant everyday abilities and is comprised of 39 items covering six cognitively-relevant domains: Everyday Memory, Everyday Language, Everyday Visuospatial Abilities, Everyday Planning, Everyday Organization, and Everyday Divided Attention.
Change from baseline in memory as measured by the total Neuropsychological Test Battery memory composite score and change from baseline in executive function as measured by the total Neuropsychological Test Battery executive function composite score
Total Neuropsychological Test Battery memory composite score is a "memory function" composite score and is obtained by averaging the following z-scores from the NTB: RAVLT immediate and delayed scores. The total Neuropsychological Test Battery executive function composite score is an "executive function" composite score that is obtained by averaging the following three z-scores from the NTB: Wechsler Memory Scale Digit Span, COWAT, and CFT.
Change from baseline in pharmacokinetic concentrations and immunogenetic anti-agent antibody levels in serum and/or plasma and/or cerebrospinal fluid
Pharmacokinetic concentrations and Immunogenic anti-agent antibodies that are measured to assess how the study agent is transported around the body in the blood and CSF and if antibodies are produced by the body in response to the study agent.

Full Information

First Posted
March 10, 2021
Last Updated
October 2, 2023
Sponsor
Novartis Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT04795466
Brief Title
Study of the Efficacy and Safety of Various Anti-inflammatory Agents in Participants With Mild Cognitive Impairment or Mild Alzheimer's Disease
Official Title
Exploratory PLatform Trial on Anti-Inflammatory Agents in Alzheimer's Disease (EXPLAIN-AD): A Randomized, Placebo-controlled, Multicenter Platform Study to Evaluate the Efficacy, Safety, Tolerability and Pharmacokinetics of Various Anti-inflammatory Agents in Patients With Mild Cognitive Impairment Due to Alzheimer's Disease and Mild Alzheimer's Disease
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
October 28, 2021 (Actual)
Primary Completion Date
March 13, 2024 (Anticipated)
Study Completion Date
March 13, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Novartis Pharmaceuticals

4. Oversight

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

5. Study Description

Brief Summary
The purpose of this platform study is to evaluate the effect of anti-inflammatory agents on cognition in early Alzheimer's disease. Additionally, the safety and tolerability of these anti-inflammatory agents and the effects on central and peripheral inflammation will be evaluated.
Detailed Description
This is a randomized, placebo-controlled, participant- and investigator-blinded study in participants with either mild cognitive impairment or mild Alzheimer's disease with evidence of peripheral inflammation. This study is using a platform design to be able to investigate different agents (therapies) in a perpetual manner. Each unique investigational agent will have a unique cohort of participants assigned. New cohorts of participants may be enrolled to investigate additional agents at unspecified timepoints throughout the study. There are three periods in the study: screening period of 60 days that includes a baseline period of 7 days, a treatment period (20 weeks) and a follow-up period (28 days) and an additional follow-up visit for therapies with a longer washout.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Mild Cognitive Impairment, Alzheimer Disease
Keywords
Alzheimer disease, Mild Cognitive Impairment, Elderly adults, Adults, Memory loss, Dementia, Inflammation, ADPT06

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
34 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Canakinumab
Arm Type
Experimental
Arm Description
increasing doses of sub-cutaneous injections
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Matching placebo sub-cutaneous injections
Intervention Type
Biological
Intervention Name(s)
Canakinumab
Other Intervention Name(s)
ACZ885
Intervention Description
Biological sub-cutaneous injection
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Matching placebo subcutaneous injection
Primary Outcome Measure Information:
Title
Change from baseline in cognition as measured by the Neuropsychological Test Battery (NTB) total score
Description
Neuropsychological Test Battery (NTB) is a composite of multiple globally-established neuropsychological tests that parovide a thorough assessment of the cognitive domains affect by early Alzheimer's Disease (AD), in particular, memory, executive function, attention and verbal fluency.
Time Frame
Baseline and at 24 weeks
Secondary Outcome Measure Information:
Title
Number of participants who experience adverse events and serious adverse events
Description
Clinically significant abnormalities of laboratory values, physical findings, electrocardiogram findings and other safety assessments will be recorded as adverse events if the findings meet the defined criteria for adverse events.
Time Frame
Baseline up to 30 days post last dose
Title
Change from baseline in microglia activation as measured by Positron-Emission Tomography-Translocator Protein 18kDa - microglia activation
Description
Positron-Emission Tomography-Translocator Protein 18kDa-microglia activation (PET TSPO) is considered a marker of central inflammation (a marker for activated microglia and astrocytes) and the signal strength has been shown to correlate with worsening clinical severity in participants with MCI or AD, measures of cognition and various clinical scores.
Time Frame
Baseline and at 12 weeks
Title
Change from baseline in neuropsychiatric symptoms as measured by the Neuropsychiatric Inventory (NPI) total score
Description
Neuropsychiatric Inventory (NPI) total score is a globally recognized and the most frequently used assessment of neuropsychiatric symptoms in AD trials that covers twelve neuropsychiatric domains.
Time Frame
Baseline and at 24 weeks
Title
Change from baseline in function (activities of daily living) as measured by the Everyday Cognition (eCog) total score
Description
Everyday Cognition (eCog) scale measures cognitively-relevant everyday abilities and is comprised of 39 items covering six cognitively-relevant domains: Everyday Memory, Everyday Language, Everyday Visuospatial Abilities, Everyday Planning, Everyday Organization, and Everyday Divided Attention.
Time Frame
Baseline and at 24 weeks
Title
Change from baseline in memory as measured by the total Neuropsychological Test Battery memory composite score and change from baseline in executive function as measured by the total Neuropsychological Test Battery executive function composite score
Description
Total Neuropsychological Test Battery memory composite score is a "memory function" composite score and is obtained by averaging the following z-scores from the NTB: RAVLT immediate and delayed scores. The total Neuropsychological Test Battery executive function composite score is an "executive function" composite score that is obtained by averaging the following three z-scores from the NTB: Wechsler Memory Scale Digit Span, COWAT, and CFT.
Time Frame
Baseline and at 24 weeks
Title
Change from baseline in pharmacokinetic concentrations and immunogenetic anti-agent antibody levels in serum and/or plasma and/or cerebrospinal fluid
Description
Pharmacokinetic concentrations and Immunogenic anti-agent antibodies that are measured to assess how the study agent is transported around the body in the blood and CSF and if antibodies are produced by the body in response to the study agent.
Time Frame
Baseline through to 24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
45 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female, age ≥ 45 years and ≤ 90 years at the time of signing the informed consent; Participant has a reliable study partner or caregiver can accompany the participant to all visits; A diagnosis of probable MCI due to AD or mild AD according to the National Institute on Aging and the Alzheimer's Association (NIA-AA) criteria; Confirmed amyloid and tau positivity via CSF sampling performed at screening; Mini-Mental State Examination (MMSE) total score of 20 to 24 (inclusive) at screening; OR, MMSE total score of 25-30 (inclusive) plus a DSST score at least 0.5 standard deviation (SD) below normative data at screening. Exclusion Criteria: Use of an investigational agent or an approved product with the intent to modulate inflammation or modulate the course of AD (e.g., Tau ASOs, gene therapy, amyloid or tau vaccine): Previous use of small molecules is allowed if discontinued for at least five half-lives, or at least 30 days from when the expected pharmacodynamic effect has returned to baseline prior to screening, whichever is longer Previous use of monoclonal or polyclonal antibodies or other biologics is allowed if discontinued for at least five half-lives prior to screening Current medical or neurological condition that might impact cognition or performance on cognitive assessments, e.g., MCI not due to AD, non-Alzheimer dementia, Huntington's disease, Parkinson's disease, stroke, schizophrenia, bipolar disorder, active major depression, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), active seizure disorder, or history of traumatic brain injury associated with loss of consciousness and ongoing residual transient or permanent neurological signs/symptoms including cognitive deficits, and/or associated with skull fracture; If a historical MRI or CT scan has been performed, signs of major cerebrovascular disease shown on such scans (i.e., presence of infarction in greater than 25% of white matter; more than one lacune within basal ganglia or more than 2 lacunes in white matter); Diagnosis of vascular dementia prior to screening (e.g.., modified Hachinski Ischaemic Scale score > 6 or those who meet the NINDS AIREN criteria for vascular dementia);
Facility Information:
Facility Name
Novartis Investigative Site
City
Charlestown
State/Province
Massachusetts
ZIP/Postal Code
02129
Country
United States
Facility Name
Novartis Investigative Site
City
Stony Brook
State/Province
New York
ZIP/Postal Code
11794-8161
Country
United States
Facility Name
Novartis Investigative Site
City
Kuopio
ZIP/Postal Code
70210
Country
Finland
Facility Name
Novartis Investigative Site
City
Turku
ZIP/Postal Code
20520
Country
Finland
Facility Name
Novartis Investigative Site
City
Reykjavik
ZIP/Postal Code
101
Country
Iceland
Facility Name
Novartis Investigative Site
City
Plymouth
State/Province
Devon
ZIP/Postal Code
PL6 8BT
Country
United Kingdom
Facility Name
Novartis Investigative Site
City
Guildford
State/Province
Surrey
ZIP/Postal Code
GU27YD
Country
United Kingdom
Facility Name
Novartis Investigative Site
City
London
ZIP/Postal Code
W1G 9JF
Country
United Kingdom
Facility Name
Novartis Investigative Site
City
Motherwell
ZIP/Postal Code
ML1 4UF
Country
United Kingdom
Facility Name
Novartis Investigative Site
City
Southampton
ZIP/Postal Code
SO30 3JB
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations. This trial data availability is according to the criteria and process described on https://www.clinicalstudydatarequest.com/

Learn more about this trial

Study of the Efficacy and Safety of Various Anti-inflammatory Agents in Participants With Mild Cognitive Impairment or Mild Alzheimer's Disease

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