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A Study of Crenezumab Versus Placebo in Preclinical Presenilin1 (PSEN1) E280A Mutation Carriers to Evaluate Efficacy and Safety in the Treatment of Autosomal-Dominant Alzheimer's Disease (AD), Including a Placebo-Treated Non-Carrier Cohort

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ClinicalTrials.gov Identifier: NCT01998841
Recruitment Status : Active, not recruiting
First Posted : December 2, 2013
Last Update Posted : December 28, 2017
Sponsor:
Collaborators:
Information provided by (Responsible Party):

Study Description
Brief Summary:
This randomized, double-blind, placebo-controlled, parallel group, adaptive study will evaluate the efficacy and safety of crenezumab versus placebo in individuals who carry the PSEN1 E280A autosomal-dominant mutation and do not meet the criteria for mild cognitive impairment due to AD or dementia due to AD and are, thus, in a preclinical phase of AD. Participants will be randomized in a 1:1 ratio to receive either crenezumab or placebo subcutaneously (every 2 weeks) or intravenously (every 4 weeks) for at least 260 weeks. The switch to the intravenous (IV) dose will be optional (as per participant decision). The study will also include a cohort of PSEN1 E280A mutation non-carriers who will be dosed with placebo only.

Condition or disease Intervention/treatment Phase
Alzheimer's Disease Drug: Crenezumab Drug: Placebo Phase 2

Study Design

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 252 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: A Double-Blind, Placebo-Controlled Parallel-Group Study in Preclinical PSEN1 E280A Mutation Carriers Randomized to Crenezumab or Placebo, and in Non-Randomized, Placebo-Treated Non-Carriers From the Same Kindred, to Evaluate the Efficacy and Safety of Crenezumab in the Treatment of Autosomal-Dominant Alzheimer's Disease
Actual Study Start Date : December 20, 2013
Estimated Primary Completion Date : February 25, 2022
Estimated Study Completion Date : February 25, 2022

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arms and Interventions

Arm Intervention/treatment
Experimental: Mutation Carriers: Crenezumab
Participants will receive crenezumab subcutaneously (every 2 weeks) or intravenously (every 4 weeks) for at least 260 weeks.
Drug: Crenezumab
Crenezumab will be administered subcutaneously (every 2 weeks) or intravenously (every 4 weeks) for at least 260 weeks.
Other Name: MABT5102A
Placebo Comparator: Mutation Carriers: Placebo
Participants will receive placebo subcutaneously (every 2 weeks) or intravenously (every 4 weeks) for at least 260 weeks.
Drug: Placebo
Placebo matched to crenezumab will be administered subcutaneously (every 2 weeks) or intravenously (every 4 weeks) for at least 260 weeks.
Placebo Comparator: Non-carriers of Mutation: Placebo
Participants will receive placebo subcutaneously (every 2 weeks) or intravenously (every 4 weeks) for at least 260 weeks.
Drug: Placebo
Placebo matched to crenezumab will be administered subcutaneously (every 2 weeks) or intravenously (every 4 weeks) for at least 260 weeks.


Outcome Measures

Primary Outcome Measures :
  1. Change From Baseline in Alzheimer's Prevention Initiative Autosomal-Dominant Alzheimer's Disease (API ADAD) Composite Cognitive Test Total Score at Week 260 [ Time Frame: Baseline and Week 260 ]

Secondary Outcome Measures :
  1. Time to Progression to Mild Cognitive Impairment (MCI) due to AD or to Dementia due to AD [ Time Frame: Baseline up to 260 weeks ]
  2. Time to Clinical Dementia Rating (CDR) Scale Global Score of Greater Than (>) Zero [ Time Frame: Baseline up to 260 weeks ]
  3. Change From Baseline in CDR Scale - Sum of Boxes at Week 260 [ Time Frame: Baseline and Week 260 ]
  4. Change From Baseline in Episodic Memory Measure: Free and Cued Selective Reminding Task (FCSRT) at Week 260 [ Time Frame: Baseline and Week 260 ]
  5. Change From Baseline in Measure of Overall Neurocognitive Functioning: Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) at Week 260 [ Time Frame: Baseline and Week 260 ]
  6. Change From Baseline in Mean Cerebral Fibrillar Amyloid Accumulation Standard Uptake Value Ratio (SUVR) as Assessed by Positron Emission Tomography (PET) at Week 260 [ Time Frame: Baseline and Week 260 ]
  7. Change From Baseline in Regional Cerebral Metabolic Rate of Glucose (CMRgI) Using Fluorine-18-Labeled 2-Deoxyglucose (FDG)-PET at Week 260 [ Time Frame: Baseline and Week 260 ]
  8. Change From Baseline in Brain Atrophy Measured by Volumetric Measurements Using Magnetic Resonance Imaging (MRI) at Week 260 [ Time Frame: Baseline and Week 260 ]
  9. Change From Baseline in a tau-Based Cerebral Spinal Fluid (CSF) Biomarker at Week 260 [ Time Frame: Baseline and Week 260 ]
  10. Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs) [ Time Frame: Day 1 up to 16 weeks following the last administration of study drug or study discontinuation/termination, whichever is later (up to approximately 432 weeks) ]
  11. Number of Participants With Anti-Crenezumab Antibodies [ Time Frame: Day 1 up to 16 weeks following the last administration of study drug or study discontinuation/termination, whichever is later (up to approximately 432 weeks) ]
  12. CSF Crenezumab Concentration [ Time Frame: Baseline (at least 72 hours prior to the first study drug administration); Weeks 104 and 260; at study completion/early discontinuation (up to approximately 416 weeks) ]
  13. Serum Crenezumab Concentration [ Time Frame: Predose (Hour 0) at Baseline, Weeks 4, 12, 16, 24, 36, 52, 76, 104, 128, 156, 180, 208, 232, 260, 284, 312, 336, 364, 388, 416, and 16 weeks after last dose/early discontinuation (up to approximately 432 weeks) ]

Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:   30 Years to 60 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Membership in PSEN1 E280A mutation carrier kindred
  • Agrees to conditions of, and is willing to undergo, genetic testing (for example [e.g.], apolipoprotein E [APOE], PSEN1 E280A, and other genetic testing)
  • PSEN1 E280A mutation carrier or non-carrier status has been confirmed prior to or during the screening period
  • Mini-Mental Stage Examination (MMSE) greater than or equal to (>=) 24 for participants with less than (<) 9 years of education or MMSE >=26 for participants with 9 or more years of education
  • Does not meet criteria for dementia due to AD per the National Institute on Aging and the Alzheimer's Association Workgroup (McKhann et al. 2011) criteria
  • Does not meet criteria for mild cognitive impairment (MCI) due to AD per the National Institute on Aging and the Alzheimer's Association Workgroup (Albert et al. 2011) criteria
  • Adequate vision and hearing in the investigator's judgment to be able to complete testing
  • If female, and not documented (by medical records or physician's note) to be surgically sterile (absence of ovaries and/or uterus) or postmenopausal, willing to undergo pregnancy tests at protocol-specific timepoints
  • For women who are not documented (by medical records or physician's note) to be surgically sterile (absence of ovaries and/or uterus) or postmenopausal, agreement to remain abstinent or use two adequate methods of contraception, including at least one method with a failure rate of <1 percent (%) per year (e.g., hormonal implants, combined oral contraceptives, vasectomized partner, tubal ligation) during the treatment period and for at least 16 weeks after the last dose of study drug
  • For men with partners of childbearing potential (that is [i.e.], women who are not surgically sterile and are not postmenopausal), agreement to remain abstinent or use a condom as a method of contraception during the treatment period and for at least 8 weeks after the last dose of study drug
  • Study partner who agrees to participate in the study and is capable of and willing to: accompany the participant to all required visits; provide information for required telephone assessments; spend sufficient time with the participant to be familiar with his/her overall function and behavior and be able to provide adequate information about the participant including knowledge about domestic activities, hobbies, routines, social skills and basic activities of daily life; work and educational history; cognitive performance including memory abilities, language abilities, temporal and spatial orientation, judgment and problem solving; emotional and psychological state; and general health status
  • Participant and study partner have evidence of adequate premorbid functioning (e.g., intellectual, visual, and auditory) and are fluent in, and able to read, the language in which study assessments are administered
  • Willing and able to undergo neuroimaging (PET and MRI)
  • Serum thyroid stimulating hormone (TSH) and B12 levels within normal or expected ranges for the testing laboratory or if TSH and B12 values are out of range they are judged by the investigator not to be clinically significant. If participant is undergoing thyroid replacement therapy, TSH levels must be within normal or expected ranges for the testing laboratory or, if TSH values are out of range, they do not require any therapeutic actions (treatment or surveillance). If participant is receiving vitamin B12 injections or oral vitamin B12 therapy, B12 levels must be at or above the lower limit of normal for the testing laboratory or, if B12 values are out of range, they do not require any therapeutic actions (treatment or surveillance)
  • In good general health with no known co-morbidities expected to interfere with participation in the study

Exclusion Criteria:

  • Significant medical, psychiatric, or neurological condition or disorder documented by history, physical, neurological, laboratory, or electrocardiogram (ECG) examination that would place the participant at undue risk in the investigator's judgment or impact the interpretation of efficacy
  • History of stroke. Participants with a history of transient ischemic attack may be enrolled if the event occurred >=2 years prior to screening
  • History of severe, clinically significant (persistent neurological deficit or structural brain damage) central nervous system trauma (e.g. cerebral contusion)
  • Body weight <45 or >120 kilograms (kg)
  • History or presence of atrial fibrillation that poses a risk for future stroke in the investigator's judgment
  • Clinically significant laboratory or ECG abnormalities (e.g., abnormally prolonged or shortened QTc interval) in the investigator's judgment
  • Current presence of bipolar disorder or other clinically significant major psychiatric disorder according to Diagnostic and Statistical Manual of Mental Disorders 4th Edition Text Revision (DSM-IV-TR) or symptom (e.g., hallucinations, agitation, paranoia) that could affect the participant's ability to complete evaluations
  • Clinically significant depression, based in part by a Geriatric Depression Scale (short form) (15-point scale) score >9 at screening
  • History of seizures (excluding febrile seizures of childhood, or other isolated seizure episodes that were not due to epilepsy in the judgment of the investigator, and required at most time-limited anticonvulsant treatment, and which occurred more than 7 years prior to the screening visit)
  • Myocardial infarction within 2 years, congestive heart failure, atrial fibrillation, or uncontrolled hypertension
  • Pregnant or nursing women, or women who intend to become pregnant or to nurse infants during the conduct of this trial
  • Clinically significant infection within the last 30 days prior to screening
  • Positive urine test for drugs of abuse at screening
  • History of alcohol or substance dependence within the previous two years
  • Use of any other medications with the potential to significantly affect cognition; intermittent or short-term use of these medications may be allowed if deemed medically necessary for the treatment of a non-excluded medical condition with approval from the Medical Monitor. In addition, use of tricyclic antidepressants or benzodiazepines will be permitted if used in stable, low doses for the treatment of a non-excluded medical condition with approval from the Medical Monitor
  • Use of typical anti-psychotics or barbiturates
  • Use of non-anti-cholinergic antidepressant medications or atypical anti-psychotics unless maintained on a stable dose regimen for at least 6 weeks prior to screening
  • Use of any Food and Drug Administration (FDA)/Instituto Nacional de Vigilancia de Medicamentos y Alimentos (INVIMA)-approved medications for treatment of late onset Alzheimer's disease (LOAD) at screening/baseline. Cholinesterase inhibitors and/or memantine are prohibited during the study except in participants enrolled in the study that develop AD dementia
  • Use of anti-coagulant medication (heparinoids, heparin, warfarin, thrombin inhibitors, Factor Xa inhibitors), or known coagulopathy or platelet count <100,000 cells/microliter, within 4 weeks of the screening visit; Anti-platelet medications (e.g., aspirin, clopidigrel, dipyridamole) are permitted if on a stable dose for 4 or more weeks prior to screening. Short-term, peri-operative use of anti-coagulants may not result in discontinuation from the study; however, any such use must be discussed with the Medical Monitor
  • Treatment with any biologic therapy within five half-lives or 3 months prior to screening, whichever is longer, with the exception of routinely recommended vaccinations, which are allowed
  • Use of anti-seizure medication (except in childhood for febrile seizures or if used for non-seizure indications), anti-parkinsonian, or stimulant (e.g., methylphenidate) medications
  • Use of investigational drug, device, or experimental medication within 60 days (or five half-lives, whichever is longer) of the screening visit
  • Previous treatment with crenezumab or any other therapeutic that targets A-beta
  • History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric, human, or humanized antibodies or fusion proteins
  • Contraindication to MRI scan procedures or clinically significant claustrophobia that would contraindicate a brain MRI scan
  • Contraindication to PET scan procedures
Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01998841


Locations
Colombia
Fundacion Cardiomet
Armenia, Colombia
Clínica de Marly
Bogota, Colombia
Grupo Neurociencias de Antioquia
Medellin, Colombia
Hospital San Juan de Dios
Yarumal, Colombia
Sponsors and Collaborators
Genentech, Inc.
Banner Alzheimer's Institute
National Institute on Aging (NIA)
Investigators
Study Director: Clinical Trials Hoffmann-La Roche
More Information

Responsible Party: Genentech, Inc.
ClinicalTrials.gov Identifier: NCT01998841     History of Changes
Other Study ID Numbers: GN28352
First Posted: December 2, 2013    Key Record Dates
Last Update Posted: December 28, 2017
Last Verified: December 2017

Additional relevant MeSH terms:
Alzheimer Disease
Dementia
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Tauopathies
Neurodegenerative Diseases
Neurocognitive Disorders
Mental Disorders