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Trial record 8 of 333 for:    DABIGATRAN

A Novel Therapeutic Target for Alzheimer's Disease in Men and Women 50-85 Years of Age.

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ClinicalTrials.gov Identifier: NCT03752294
Recruitment Status : Not yet recruiting
First Posted : November 23, 2018
Last Update Posted : November 23, 2018
Sponsor:
Collaborators:
Alzheimer’s Drug Discovery Foundation
Boehringer Ingelheim
Information provided by (Responsible Party):
University of Rhode Island

Brief Summary:
A randomized-control, double-blind, multi-center, delayed-start, pilot trial evaluating the disease modifying effects of a 150mg once-a-day dose vs. placebo of dabigatran in men and women, between the ages of 50-85 years, confirmed with MCI probably due to AD and mild Alzheimer's Disease.

Condition or disease Intervention/treatment Phase
Mild Cognitive Impairment Mild Alzheimer's Disease Drug: Dabigatran Drug: Placebo - Cap Phase 1

Detailed Description:
The study will be conducted in 2-phases. The Phase I double-blind portion of the study consists of 40-60 active participants with MCI probably due to AD and mild AD randomized to 150mg once-a-day dose of dabigatran or placebo. A futility analysis will be conducted based on month 3 plasma biomarker changes from baseline. Excluding futility, at the end of Phase I, the study continues onto the open-label phase of the study where the placebo arm will be treated with 150mg once-a-day with dabigatran from months 10-21. The active treatment arm will continue on dabigatran through month-21. For final analysis, a difference in intercept of a generalized growth model between randomization groups during Phase 2 in the Cognitive Dementia Rating Scale-Sum of Boxes (CDR-SB) will be taken as evidence of effectiveness and justify further study. All patients will discontinue dabigatran after month 21 and a 3-month follow-up period will confirm whether or not the proposed cognitive effects can be sustained in the absence of treatment. The relationships between changes in levels of plasma biomarkers over time will be tested with regards to each other and relative to MRI and cognitive testing performed at scheduled intervals.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Intervention Model Description: Randomized-control, Double-blind, Multicenter, Delayed-start, Pilot
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description: The first phase of the study is 9-month, double-blind, randomized-control treatment. All participants participants will cross-over to phase II (open label) for an additional 12 months of treatment with a 3-month non-treatment follow-up
Primary Purpose: Treatment
Official Title: A 24-month, Randomized-control, Double-blind, Multi-center, Delayed-start, Pilot Study Evaluating Thrombin Inhibitions Alzheimer's Disease Using 150mg Dabigatran Daily: A Novel Therapeutic Target for Alzheimer's Disease
Estimated Study Start Date : November 2018
Estimated Primary Completion Date : November 2021
Estimated Study Completion Date : December 2021


Arm Intervention/treatment
Active Comparator: Dabigatran
Participants will receive 150mg dabigatran daily for a total of 9-months.
Drug: Dabigatran
At the end of a 9-month randomized-control, double-blind treatment all study participants will cross-over to the 12-month open-label phase with a 3-month non-treatment follow-up.
Other Name: Pradaxa

Placebo Comparator: Placebo
Participants will receive placebo daily for a total of 9-months.
Drug: Placebo - Cap
At the end of a 9-month randomized-control, double-blind treatment all study participants will cross-over to the 12-month open-label phase with a 3-month non-treatment follow-up
Other Name: Study Drug

Active Comparator: Open Label
All study participants are assigned to receive 150mg dabigatran daily for a total of 12 months (study month 9 through month 21)
Drug: Dabigatran
At the end of a 9-month randomized-control, double-blind treatment all study participants will cross-over to the 12-month open-label phase with a 3-month non-treatment follow-up.
Other Name: Pradaxa




Primary Outcome Measures :
  1. Evaluate dabigatran efficacy in MCI and mild AD population using changes in targeted plasma and CSF biomarker levels at 9 and 21 months [ Time Frame: 9 and 21-months ]
    Evaluate effectiveness of dabigatran (150mg daily) on disease modification measured by changes in targeted plasma and CSF biomarkers associated with the early stages of Alzheimer's disease


Secondary Outcome Measures :
  1. Demonstrate a reduction in decline of cognitive function related to physical functioning in placebo arm after crossing over to 12-months of active treatment [ Time Frame: 12 - 24 months ]
    Demonstrate an observed benefit of cognitive performance/function using the ADCS ADL MCI

  2. Changes in cognitive performance in placebo arm after cross-over to open-label treatment phase [ Time Frame: 24-months ]
    Evaluate effectiveness of dabigatran (150mg daily) using the CDR-SB

  3. Safety and tolerability of dabigatran in experimental population (MCI and mild AD populations) based on reported serious and adverse events [ Time Frame: 21-months ]
    Determine the safety and tolerability of dabigatran in MCI probably due to AD and mild AD population using physician and patient reported adverse events.

  4. Evaluation of cognitive performance in placebo arm after cross-over to open-label treatment phase [ Time Frame: 24-months ]
    Evaluate effectiveness of dabigatran (150mg daily) using the MoCA



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Ages Eligible for Study:   50 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Diagnosis of MCI likely due to AD or mild AD based on IWG-2 criteria for typical AD (A plus B at any stage) 2011 revised criteria
  2. English speaking men & woman age 50 -85 years (inclusive)
  3. Ability to provide informed consent
  4. MMSE score >20 at screening
  5. Informant or caregiver (e.g. family member, friend) willing to participate in semi-structured interviews
  6. CSF Aβ positive (MCI and AD) or a positive amyloid positron emission tomography (PET) scan within 6-months prior to screening using IWG-2 criteria.
  7. CDR Scale Global Score between 0.5 and 1
  8. Stable dosing (prior 3-months) of standard AD medications are allowed
  9. Demonstrated willingness to comply with study visit schedule, laboratory studies, and other study procedures

Exclusion Criteria:

  1. Pre-menopausal women (last menstruation < 1 year prior to screening) who are not surgically sterile.
  2. Creatinine clearance < 50mL/min
  3. Current psychiatric or neurological disorder that would contribute to cognitive impairment (focal neurological features early extrapyramidal signs, early hallucinations, cognitive fluctuations, non-AD dementia, major depression)
  4. Cerebrovascular disease
  5. Toxic, inflammatory, and metabolic disorders, all of which may require specific investigations
  6. MRI Flair or T2 signal changes in the medial temporal lobe that are consistent with infectious or vascular insults
  7. Sudden onset or early occurrence of the following symptoms: gait disturbances, seizures, major and prevalent behavioral changes
  8. Inability to swallow pills
  9. Current anticoagulant therapy
  10. Conditions associated with an increased risk of bleeding (e.g. major surgery within 30-days of baseline, planned surgery or intervention during treatment period)
  11. History of intracranial, intraocular, spinal, retroperitoneal or atraumatic intra-articular bleeding
  12. Gastrointestinal hemorrhage within the past year
  13. Symptomatic or endoscopically documented gastroduodenal ulcer disease in the previous 30-days; hemorrhagic disorder or bleeding diathesis
  14. Need for anticoagulant treatment of disorders, fibrinolytic agents within 48-hours of study baseline, uncontrolled hypertension (systolic blood pressure greater than 180mm Hg and/or diastolic blood pressure greater than 100 mm Hg)
  15. Recent malignancy or radiation therapy (within 6-months) and a survival rate of 3-years,
  16. Active infective endocarditis
  17. Active liver disease (including but not limited to persistent ALT, AST, Alk Phos greater than twice the upper limit of the normal range; active hepatitis C (positive HCV RNA)
  18. Active hepatitis B (HBs antigen +, anti HBc IgM +), active hepatitis A
  19. HIV/AIDS diagnosis

MRI exclusionary criteria

  1. Brain Aneurysm Clip
  2. Implanted neural stimulator
  3. Implanted cardiac pacemaker or defibrillator
  4. Cochlear implant
  5. Ocular foreign body (e.g. metal shavings)
  6. Other implanted medical devices: (e.g. Swan Ganz catheter, mechanical prosthetic heart)
  7. Insulin pump
  8. Metal shrapnel or bullet

Additional concomitant drug exclusionary criteria will be applied by investigator.


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): NCT03752294


Contacts
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Contact: Chris Getter 401-874-2358 cgetter@uri.edu

Sponsors and Collaborators
University of Rhode Island
Alzheimer’s Drug Discovery Foundation
Boehringer Ingelheim
Investigators
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Study Director: Paula Grammas, PhD Executive Director of the Ryan Institute for Neuroscience
Principal Investigator: John Stoukides, MD Medical Director, Rhode Island Mood & Memory Research Institute

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Responsible Party: University of Rhode Island
ClinicalTrials.gov Identifier: NCT03752294     History of Changes
Other Study ID Numbers: RIN001-001
First Posted: November 23, 2018    Key Record Dates
Last Update Posted: November 23, 2018
Last Verified: November 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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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.: No
Keywords provided by University of Rhode Island:
MCI
Mild AD
Dabigatran
Additional relevant MeSH terms:
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Dabigatran
Alzheimer Disease
Cognitive Dysfunction
Dementia
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Tauopathies
Neurodegenerative Diseases
Neurocognitive Disorders
Mental Disorders
Cognition Disorders
Antithrombins
Serine Proteinase Inhibitors
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Anticoagulants