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Therapeutic Evaluation of Low-dose IL-2-based Immunomodulatory Approach in Patients With Early AD (IL-2-AD)

Primary Purpose

Alzheimer Disease

Status
Recruiting
Phase
Phase 2
Locations
France
Study Type
Interventional
Intervention
Proleukin
Placebo
Sponsored by
Centre Hospitalier St Anne
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alzheimer Disease focused on measuring Interleukin, Neuroinflammation, Regulatory T cells, Microglia, Synaptic density

Eligibility Criteria

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

Inclusion Criteria:

  • Patients aged > 18
  • Age of disease onset < 70 years
  • Clinical and biological diagnosis of AD based on

    • Progressive amnestic syndrome associated or not with other cognitive impairments
    • Biological criteria: CSF biomarkers suggestive of AD.
  • Brain MRI congruent with the diagnosis, left to the appreciation of the investigator
  • CDR (Clinical Dementia Rating Scale) = 0.5 or 1
  • If patients have an antidepressant or acetylcholinesterase inhibitors treatment, patients must be treated with stable doses of treatment for at least 3 months before inclusion.
  • Have a caregiver who provides a separate written informed consent to participate. If a caregiver/study informant cannot continue, one replacement is allowed.
  • Have adequate vision and hearing for neuropsychological testing in the opinion of the investigator.
  • Have given written informed consent approved by the ethical review board (ERB) governing the site.
  • The patient has to have a French social security number and be fluent and literate in French.

Exclusion Criteria:

  • Subject with a psychiatric evolutionary and/or badly checked.
  • Subject with a grave, severe or unstable pathology (left to the judgement of the investigator) the nature of which can interfere with the variables of evaluation.
  • Epileptic subjects
  • Subject under guardianship or curatorship
  • Subject presenting contraindications to the MRI
  • Known or supposed history (< or = 5 years) of severe alcoholism or misuse of drugs
  • Vascular, inflammatory or expansive, visible lesion in the MRI, which can interfere on the criteria of diagnosis.
  • No health insurance
  • Women of childbearing potential: a woman is considered of childbearing potential (WOCBP), i.e. fertile, following menarche and until becoming post-menopausal unless permanently sterile. Permanent sterilisation methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause.
  • History of auto-immune disease
  • History within the past 10 years of a primary or recurrent malignant disease
  • Diagnosis or history of other possible etiology of dementia, including but not limited to other neurodegenerative disorders (FTD, LBD, VaD, HD, PD, PSP-CBD).
  • Renal dysfunction at inclusion, clearance <30 mL/min
  • Chronic hepatic diseases as indicated by liver function tests abnormalities
  • Abnormal thyroid function
  • Therapeutic trial within 1 year preceding the first study period, or participation in a trial with active or passive immunization against amyloid if patient was assigned to the active treatment arm.
  • Clinically significant evidence of Active viral infection (CMV, EBV, HCV, HBV, TPHA-VDRL, HIV)
  • Current or medical history of severe cardiopathy,
  • - Severe dysfunction in a vital organ
  • Patients with White Blood Count (WBC) < 4.000/mm3; platelets < 100.000/mm3; hematocrit (HCT) < 30%.
  • Patients with serum bilirubin and creatinine outside normal range.
  • Patients with organ allografts.
  • Patients who are likely to require corticosteroids

Sites / Locations

  • GHU Saint AnneRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Treatment

Placebo

Arm Description

Patient will be treated with low dose of Interleukin 2 (PROLEUKIN ®)

Patient will receive sodium chloride solution (NaCl)

Outcomes

Primary Outcome Measures

Change from baseline CDR score at 18 months
The primary endpoint will be evaluated in all patients evaluable for efficacy, i.e. patients who received at least one cure of IL-2 and were evaluated for cognitive and functional status at baseline and 18 months. The response variable will be dichotomized as follows: Responder patient = 1 (end of study CDR score <= baseline CDR score) Non-responder patient = 0 (end of study CDR score > baseline CDR score)

Secondary Outcome Measures

Rate of cognitive decline between placebo and treatment groups as assessed by changes in MMSE scores at baseline, 6, 12, and 18 months
MMSE total score out of 30
Rate of cognitive decline between placebo and treatment groups as assessed by changes in ADAS-Cog 13 items scores at baseline, 6, 12, and 18 months
ADAS-Cog total score out of 85
Rate of functional decline between placebo and treatment groups as assessed by changes in ADCS-ADL MCI scores at baseline, 6, 12, and 18 months
ADSC-ADL MCI total score out of 53
Rate of functional decline between placebo and treatment groups as assessed by changes in CDR (sum of boxes) scores at baseline, 6, 12, and 18 months
CDR sum of the boxes (CDR-SOB) total score out of 18
Change in neuroimmune reaction as assessed by [18F]-DPA-714 PET global cortical index and regional cortical binding at baseline and 18 months between placebo and treated groups
Global and regional cortical [18F]-DPA-714 PET uptake ratio
Change in peripheral frequency of Treg and other immune effectors at 18 months compared to baseline between placebo and treated groups
Tregs frequency, total lymphocytes as a biomarker of target engagement
Change in hippocampal atrophy at 18 month compared to baseline between placebo and treated groups
Volume of hippocampus measured in T1 MRI
Number of patients with treatment related adverse events as assessed by clinical safety panel
Clinical safety will be assessed via the following assessments: Vital signs (including blood pressure, weight, BPM, temperature) - each visit ECG - at inclusion and at V22 (M18) Check-list questionnaire to assess clinical adverse events - each visit
Number of patients with treatment related adverse events as assessed by blood laboratory safety panel
Biological safety will be evaluated and controlled through blood laboratory safety tests which include the following: Thyroid function: T4 and TSH - at inclusion, at V21 Haematology (RBC, WBC, leukocyte formula, platelets) and C reactive protein (CRP) - at inclusion, 8 days before the randomization, each day of the induction phase (day 1 to day 5), before each injection of the maintenance phase until V7, then every fortnight until the last injection of the maintenance phase, and then at M6, M12 and M18. Biochemistry (electrolytes, proteins, albumin, urea, creatinine, glucose, AST, ALT, GGT, bilirubin) and Coagulation tests - at inclusion, 8 days before the randomization, every 2 months for 6 months (V9 and V17), and at M6, M12 and M18

Full Information

First Posted
December 21, 2020
Last Updated
January 11, 2023
Sponsor
Centre Hospitalier St Anne
Collaborators
For Drug Consulting
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1. Study Identification

Unique Protocol Identification Number
NCT05468073
Brief Title
Therapeutic Evaluation of Low-dose IL-2-based Immunomodulatory Approach in Patients With Early AD
Acronym
IL-2-AD
Official Title
Therapeutic Evaluation of Low-dose IL-2-based Immunomodulatory Approach in Patients With Early AD
Study Type
Interventional

2. Study Status

Record Verification Date
October 2022
Overall Recruitment Status
Recruiting
Study Start Date
October 11, 2022 (Actual)
Primary Completion Date
September 1, 2025 (Anticipated)
Study Completion Date
September 1, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Centre Hospitalier St Anne
Collaborators
For Drug Consulting

4. Oversight

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

5. Study Description

Brief Summary
Study aims at evaluating the therapeutic efficacy and safety of low-dose IL-2 immunomodulatory treatment in patients with early AD, in a phase II, randomized, double blind, placebo-controlled phase II clinical trial. Patients with AD at early stage will be recruited and randomized (2:1) in each treatment group. The primary endpoint is the rate of decline assessed through CDR change at 18 months between the placebo group and the treated patients.
Detailed Description
This study aims to investigate the immunomodulatory therapeutic potential and safety of low-dose (ld) IL-2 in a randomized, double blind, and placebo-controlled phase II clinical trial. Conservative diagnosis criteria based on clinical and CSF biomarkers have been established to avoid risks of misdiagnosis. The treatment consist of 21 cures of subcutaneous injections of either placebo or low-dose (1MIU/day) IL-2 (PROLEUKIN ®). Patients will receive 5 consecutive injections during the induction phase which will be followed by a week break. During the maintenance phase a total of 16 injections will be administered weekly. Total duration of treatment for each patient is anticipated to be 18 weeks. Patients will be followed-up for 18 months after the first injection. At inclusion, in addition to the clinical evaluation, a hybrid PET/MRI (using [18F]-DPA-714) scan will be performed. After randomized patients successfully complete the treatment phases, they will be followed-up through 3 clinical and 1 neuroimaging visits to assess cogitive and functional decline. Clinical visits are scheduled at 6, 12, and 18 months after treatment induction. Another hybrid PET/MRI (using [18F]-DPA-714) scan will be performed at 19 months following induction.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alzheimer Disease
Keywords
Interleukin, Neuroinflammation, Regulatory T cells, Microglia, Synaptic density

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
45 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment
Arm Type
Experimental
Arm Description
Patient will be treated with low dose of Interleukin 2 (PROLEUKIN ®)
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Patient will receive sodium chloride solution (NaCl)
Intervention Type
Drug
Intervention Name(s)
Proleukin
Other Intervention Name(s)
Interleukin 2
Intervention Description
Sub-cutaneous injections of Interleukin-2 (PROLEUKIN ®) Induction phase: 5 consecutive days. A week break. Maintenance phase: once a week during 16 weeks
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
Sodium chloride solution
Intervention Description
Sub-cutaneous injections of placebo (NaCl) Induction phase: 5 consecutive days. A week break. Maintenance phase: once a week during 16 weeks.
Primary Outcome Measure Information:
Title
Change from baseline CDR score at 18 months
Description
The primary endpoint will be evaluated in all patients evaluable for efficacy, i.e. patients who received at least one cure of IL-2 and were evaluated for cognitive and functional status at baseline and 18 months. The response variable will be dichotomized as follows: Responder patient = 1 (end of study CDR score <= baseline CDR score) Non-responder patient = 0 (end of study CDR score > baseline CDR score)
Time Frame
18 months
Secondary Outcome Measure Information:
Title
Rate of cognitive decline between placebo and treatment groups as assessed by changes in MMSE scores at baseline, 6, 12, and 18 months
Description
MMSE total score out of 30
Time Frame
6, 12 and 18 months
Title
Rate of cognitive decline between placebo and treatment groups as assessed by changes in ADAS-Cog 13 items scores at baseline, 6, 12, and 18 months
Description
ADAS-Cog total score out of 85
Time Frame
6, 12 and 18 months
Title
Rate of functional decline between placebo and treatment groups as assessed by changes in ADCS-ADL MCI scores at baseline, 6, 12, and 18 months
Description
ADSC-ADL MCI total score out of 53
Time Frame
6, 12 and 18 months
Title
Rate of functional decline between placebo and treatment groups as assessed by changes in CDR (sum of boxes) scores at baseline, 6, 12, and 18 months
Description
CDR sum of the boxes (CDR-SOB) total score out of 18
Time Frame
6, 12 and 18 months
Title
Change in neuroimmune reaction as assessed by [18F]-DPA-714 PET global cortical index and regional cortical binding at baseline and 18 months between placebo and treated groups
Description
Global and regional cortical [18F]-DPA-714 PET uptake ratio
Time Frame
18 months
Title
Change in peripheral frequency of Treg and other immune effectors at 18 months compared to baseline between placebo and treated groups
Description
Tregs frequency, total lymphocytes as a biomarker of target engagement
Time Frame
6, 12 and 18 month
Title
Change in hippocampal atrophy at 18 month compared to baseline between placebo and treated groups
Description
Volume of hippocampus measured in T1 MRI
Time Frame
18 months
Title
Number of patients with treatment related adverse events as assessed by clinical safety panel
Description
Clinical safety will be assessed via the following assessments: Vital signs (including blood pressure, weight, BPM, temperature) - each visit ECG - at inclusion and at V22 (M18) Check-list questionnaire to assess clinical adverse events - each visit
Time Frame
18 months
Title
Number of patients with treatment related adverse events as assessed by blood laboratory safety panel
Description
Biological safety will be evaluated and controlled through blood laboratory safety tests which include the following: Thyroid function: T4 and TSH - at inclusion, at V21 Haematology (RBC, WBC, leukocyte formula, platelets) and C reactive protein (CRP) - at inclusion, 8 days before the randomization, each day of the induction phase (day 1 to day 5), before each injection of the maintenance phase until V7, then every fortnight until the last injection of the maintenance phase, and then at M6, M12 and M18. Biochemistry (electrolytes, proteins, albumin, urea, creatinine, glucose, AST, ALT, GGT, bilirubin) and Coagulation tests - at inclusion, 8 days before the randomization, every 2 months for 6 months (V9 and V17), and at M6, M12 and M18
Time Frame
18 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients aged > 18 Age of disease onset < 70 years Clinical and biological diagnosis of AD based on Progressive amnestic syndrome associated or not with other cognitive impairments Biological criteria: CSF biomarkers suggestive of AD. Brain MRI congruent with the diagnosis, left to the appreciation of the investigator CDR (Clinical Dementia Rating Scale) = 0.5 or 1 If patients have an antidepressant or acetylcholinesterase inhibitors treatment, patients must be treated with stable doses of treatment for at least 3 months before inclusion. Have a caregiver who provides a separate written informed consent to participate. If a caregiver/study informant cannot continue, one replacement is allowed. Have adequate vision and hearing for neuropsychological testing in the opinion of the investigator. Have given written informed consent approved by the ethical review board (ERB) governing the site. The patient has to have a French social security number and be fluent and literate in French. Exclusion Criteria: Subject with a psychiatric evolutionary and/or badly checked. Subject with a grave, severe or unstable pathology (left to the judgement of the investigator) the nature of which can interfere with the variables of evaluation. Epileptic subjects Subject under guardianship or curatorship Subject presenting contraindications to the MRI Known or supposed history (< or = 5 years) of severe alcoholism or misuse of drugs Vascular, inflammatory or expansive, visible lesion in the MRI, which can interfere on the criteria of diagnosis. No health insurance Women of childbearing potential: a woman is considered of childbearing potential (WOCBP), i.e. fertile, following menarche and until becoming post-menopausal unless permanently sterile. Permanent sterilisation methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause. History of auto-immune disease History within the past 10 years of a primary or recurrent malignant disease Diagnosis or history of other possible etiology of dementia, including but not limited to other neurodegenerative disorders (FTD, LBD, VaD, HD, PD, PSP-CBD). Renal dysfunction at inclusion, clearance <30 mL/min Chronic hepatic diseases as indicated by liver function tests abnormalities Abnormal thyroid function Therapeutic trial within 1 year preceding the first study period, or participation in a trial with active or passive immunization against amyloid if patient was assigned to the active treatment arm. Clinically significant evidence of Active viral infection (CMV, EBV, HCV, HBV, TPHA-VDRL, HIV) Current or medical history of severe cardiopathy, - Severe dysfunction in a vital organ Patients with White Blood Count (WBC) < 4.000/mm3; platelets < 100.000/mm3; hematocrit (HCT) < 30%. Patients with serum bilirubin and creatinine outside normal range. Patients with organ allografts. Patients who are likely to require corticosteroids
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Khaoussou SYLLA, Dr
Phone
01 45 65 76 78
Email
k.sylla@ghu-paris.fr
First Name & Middle Initial & Last Name or Official Title & Degree
Viviane AWASSI
Phone
01 45 65 84 86
Email
v.awassi@ghu-paris.fr
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marie SARAZIN, Prof
Organizational Affiliation
GHU Saint Anne
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Guillaume DOROTHEE, PhD
Organizational Affiliation
INSERM UMRS 938
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Michel BOTTLAENDER, Dr
Organizational Affiliation
Service Hospitalier Frédéric Joliot / CEA
Official's Role
Study Chair
Facility Information:
Facility Name
GHU Saint Anne
City
Paris
ZIP/Postal Code
75674
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Viviane AWASSI
Phone
01 45 65 84 86
Email
v.awassi@ghu-paris.fr
First Name & Middle Initial & Last Name & Degree
Simge OKSUM
Email
simge.oksum@ghu-paris.fr

12. IPD Sharing Statement

Plan to Share IPD
No

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Therapeutic Evaluation of Low-dose IL-2-based Immunomodulatory Approach in Patients With Early AD

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