Alzheimer's Disease
Conditions
Brief summary
AZD0530 is an inhibitor of Src and Abl family kinases1. It has been developed as treatment for malignancies because these kinases play a role in tumor invasion and proliferation. However, the Src family kinases (SFKs) are highly expressed in brain and have major effects on synaptic plasticity2. Moreover, the investigators have recently shown that a specific SFK, namely Fyn, is aberrantly activated by specific conformations of the Amyloid Beta (Aß) peptide from Alzheimer's disease (AD). Genetic deletion of Fyn rescues AD deficits in preclinical models. This clinical trial will test the potential benefit of AZD0530 for Alzheimer's disease modification.
Interventions
DRUGAZD0530 100mg daily
All patients in experimental group (50%) will be started on 100mg AZD0530 daily
DRUGAZD0530 125mg daily
Patients with plasma drug level \<100ng/ml after 2 weeks of 100mg AZD0530 daily will receive 125mg daily of AZD0530.
DRUGPlacebo
50% of patients will receive placebo treatment for the duration of the study.
Sponsors
Alzheimer's Therapeutic Research Institute
Yale University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
55 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
1. NIA-Alzheimer's Association core clinical criteria for probable AD 2. 18F-Florbetapir scan with evidence of elevated Aβ (based on central review) 3. Age between 55-85 (inclusive) 4. MMSE score between 18 and 26 (inclusive) 5. Stability of permitted medications for 4 weeks. In particular: * Stable doses of antidepressants lacking significant anticholinergic side effects (if they are not currently depressed and do not have a history of major depression within the past 1 year) * Cholinesterase inhibitors and memantine are allowable if stable for 12 weeks prior to screen 6. Geriatric Depression Scale less than 6 \[Note: a score ≥6 on this screening scale may be permissible, if the subject is examined by a site clinician and judged not to be depressed.\] 7. Study partner is available who has frequent contact with the subject (e.g., average of 10 hours per week or more), and can accompany the subject to most visits to answer questions about the subject 8. Visual and auditory acuity adequate for neuropsychological testing 9. Good general health with no disease expected to interfere with the study 10. Subject is not pregnant, lactating, or of childbearing potential (i.e., women must be two years post-menopausal or surgically sterile) 11. Modified Hachinski less than or equal to 4 12. Completed six grades of education or has a good work history 13. Must speak English or Spanish fluently
Exclusion criteria
1. Any significant neurologic disease other than AD, such as Parkinson's disease, multi-infarct dementia, Huntington's disease, normal pressure hydrocephalus, brain tumor, progressive supranuclear palsy, seizure disorder, subdural hematoma, multiple sclerosis, or history of significant head trauma followed by persistent neurologic defaults or known structural brain abnormalities 2. Screening/baseline MRI scan with evidence of infection, infarction, or other focal lesions or multiple lacunes or lacunes in a critical memory structure 3. Subjects that have any contraindications for MRI studies, including claustrophobia, the presence of metal (ferromagnetic) implants, or cardiac pacemaker 4. Major depression, bipolar disorder as described in DSM-IV within the past 1 year or psychotic features, agitation or behavioral problems within 3 months, which could lead to difficulty complying with the protocol 5. History of schizophrenia (DSM V criteria) 6. History of alcohol or substance abuse or dependence within the past 2 years (DSM V criteria) 7. Clinically significant or unstable medical condition, including uncontrolled hypertension, uncontrolled diabetes, or significant cardiac, pulmonary, renal, hepatic, endocrine, or other systemic disease in the opinion of the Investigator, may either put the subject at risk because of participation in the study, or influence the results, or the subject's ability to participate in the study. 8. Has had a history within the last 5 years of a primary or recurrent malignant disease with the exception of non-melanoma skin cancers, resected cutaneous squamous cell carcinoma in situ, basal cell carcinoma, cervical carcinoma in situ, or in situ prostate cancer with normal prostate-specific antigen post-treatment 9. Clinically significant abnormalities in B12 or TFTs that might interfere with the study. A low B12 is exclusionary, unless follow-up labs (homocysteine (HC) and methylmalonic acid (MMA)) indicate that it is not physiologically significant. 10. Residence in skilled nursing facility. 11. Use of any excluded medication as described in study protocol 12. Current or recent participation in any procedures involving radioactive agents, including current, past, or anticipated exposure to radiation in the workplace, such that the total radiation dose exposure to the subject in a given year would exceed the limits of annual and total dose commitment set forth in the US Code of Federal Regulations (CFR) Title 21 Section 361.1. This guideline is an effective dose of 5 rem received per year. 13. Neutropenia defined as absolute neutrophils count of \<1,800/microliter 14. Thrombocytopenia defined as platelet count \<120x103/microliter 15. For CSF sub-study participants, a current blood clotting or bleeding disorder, or significantly abnormal PT or PTT at screening 16. Clinically significant abnormalities in screening laboratories, including: * Aspartate aminotransferase (AST) \>1.5 times ULN * Alanine aminotransferase (ALT) \> 1.5 times ULN * Total bilirubin \>1.5 times ULN * Serum creatinine \>2.0 times ULN 17. History of interstitial lung disease 18. Patients whom the PI deems to be otherwise ineligible
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Brain Glucose Uptake Measured Using 18F-FDG PET Imaging | 12 months | Composite measure of brain glucose uptake using F18-FDG PET in a pre-defined set of brain regions, between baseline and 12 months. |
| Number of Participants With One or More Serious/Other Adverse Events Subjects With Mild AD as Assessed by Analysis of Adverse Events, Including Symptoms, and Abnormal Findings on Physical and Neurological Examinations, and Standard Labs. | 12 months | Assessment of any adverse effects between drug and placebo-treated subjects |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The Effect of Treatment With AZD0530 on Cognitive and Behavioral Function | 12 months | The change in cognitive function between baseline and 12 months will be measured by the following tests: 1. Alzheimer Disease Assessment Scale - Cognitive 11 (ADAS-cog11). Measures: Cognitive function Maximum score: 70; Minimum score: 0. Higher score equals worse cognitive function 2. Mini-Mental State Examination (MMSE) Measures: Cognitive Function Maximum score: 30; Minimum score: 0. Higher score equal better cognitive function 3. Alzheimer Disease Cooperative Study - Activities of Daily Living Inventory (ADCS-ADL) Measures: Ability to perform routine daily activities Maximum score: 78; Minimum score: 0. Higher score equals better ability to perform activities of daily living 4. Clinical Dementia Rating Sum of Boxes (CDR-SO) Measures: Dementia severity Maximum score: 18; Minimum score: 0. Higher score equals more severe dementia. |
| Percent Change in Brain Volume Before and After Treatment | 12 months | Change in volume of pre-defined brain regions between baseline and 12 months of treatment. |
| Cerebrospinal Fluid Levels of Total Tau, Phospho-tau (p-Tau), and Amyloid-beta 1-42 (Abeta 1-42) | 12 months | Measure concentration of Tau and Amyloid-beta 1-42 biomarkers in the cerebrospinal fluid between baseline and 12 months of treatment |
| Change in Brain Glucose Uptake Measured Using 18F-FDG PET Imaging | 12 months | The results from the primary outcome with brain FDG-PET imaging was analyzed by ApoE genotype. Composite measure of brain glucose uptake using F18-FDG PET in a pre-defined set of brain regions, between baseline and 12 months. |
Countries
Canada, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| AZD0530 100mg Daily Patients in the experimental group (50%) will be started on this dose. After 2 weeks, patients with a plasma drug level of \<100ng/ml will receive 125mg AZD0530 daily and remain in the same experimental group as patient receiving 100mg daily.
AZD0530 100mg daily: All patients in experimental group (50%) will be started on 100mg AZD0530 daily
AZD0530 125mg daily: Patients with plasma drug level \<100ng/ml after 2 weeks of 100mg AZD0530 daily will receive 125mg daily of AZD0530. | 79 |
| AZD0530 Placebo 50% of patients will receive placebo treatment for the duration of the study,
Placebo: 50% of patients will receive placebo treatment for the duration of the study. | 80 |
| Total | 159 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 13 | 6 |
| Overall Study | non-compliance | 3 | 0 |
| Overall Study | Study partner unable to participate | 1 | 0 |
| Overall Study | Withdrawal by Subject | 4 | 4 |
Baseline characteristics
| Characteristic | AZD0530 100mg Daily | AZD0530 Placebo | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 56 Participants | 63 Participants | 119 Participants |
| Age, Categorical Between 18 and 65 years | 23 Participants | 17 Participants | 40 Participants |
| Race/Ethnicity, Customized American Indian or Alaskan Native | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Black or African American | 4 Participants | 3 Participants | 7 Participants |
| Race/Ethnicity, Customized Hispanic or Latino | 1 Participants | 6 Participants | 7 Participants |
| Race/Ethnicity, Customized More than one race | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Unknown or Not Reported | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized White (not Hispanic) | 74 Participants | 68 Participants | 142 Participants |
| Region of Enrollment Canada | 3 participants | 4 participants | 7 participants |
| Region of Enrollment United States | 76 participants | 76 participants | 152 participants |
| Sex: Female, Male Female | 41 Participants | 31 Participants | 72 Participants |
| Sex: Female, Male Male | 38 Participants | 49 Participants | 87 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 1 / 79 | 0 / 80 |
| other Total, other adverse events | 73 / 79 | 65 / 80 |
| serious Total, serious adverse events | 12 / 79 | 7 / 80 |
Outcome results
Primary
Change in Brain Glucose Uptake Measured Using 18F-FDG PET Imaging
Composite measure of brain glucose uptake using F18-FDG PET in a pre-defined set of brain regions, between baseline and 12 months.
Time frame: 12 months
Population: Number of participants is lower than total randomized participants due to a modified intent-to-treat analysis where only randomized participants who also underwent a post-baseline F18-FDG PET brain scan are included.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| AZD0530 100mg/125mg Daily | Change in Brain Glucose Uptake Measured Using 18F-FDG PET Imaging | -0.06 umol/100g/min (change) | Standard Deviation 0.03 |
| AZD0530 Placebo | Change in Brain Glucose Uptake Measured Using 18F-FDG PET Imaging | -0.05 umol/100g/min (change) | Standard Deviation 0.03 |
Primary
Number of Participants With One or More Serious/Other Adverse Events Subjects With Mild AD as Assessed by Analysis of Adverse Events, Including Symptoms, and Abnormal Findings on Physical and Neurological Examinations, and Standard Labs.
Assessment of any adverse effects between drug and placebo-treated subjects
Time frame: 12 months
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| AZD0530 100mg/125mg Daily | Number of Participants With One or More Serious/Other Adverse Events Subjects With Mild AD as Assessed by Analysis of Adverse Events, Including Symptoms, and Abnormal Findings on Physical and Neurological Examinations, and Standard Labs. | Subjects with one or more adverse events | 73 Participants |
| AZD0530 100mg/125mg Daily | Number of Participants With One or More Serious/Other Adverse Events Subjects With Mild AD as Assessed by Analysis of Adverse Events, Including Symptoms, and Abnormal Findings on Physical and Neurological Examinations, and Standard Labs. | Subjects with one or more serious adverse events | 12 Participants |
| AZD0530 Placebo | Number of Participants With One or More Serious/Other Adverse Events Subjects With Mild AD as Assessed by Analysis of Adverse Events, Including Symptoms, and Abnormal Findings on Physical and Neurological Examinations, and Standard Labs. | Subjects with one or more adverse events | 68 Participants |
| AZD0530 Placebo | Number of Participants With One or More Serious/Other Adverse Events Subjects With Mild AD as Assessed by Analysis of Adverse Events, Including Symptoms, and Abnormal Findings on Physical and Neurological Examinations, and Standard Labs. | Subjects with one or more serious adverse events | 7 Participants |
Secondary
Cerebrospinal Fluid Levels of Total Tau, Phospho-tau (p-Tau), and Amyloid-beta 1-42 (Abeta 1-42)
Measure concentration of Tau and Amyloid-beta 1-42 biomarkers in the cerebrospinal fluid between baseline and 12 months of treatment
Time frame: 12 months
Population: Number of participants is lower than total randomized participants due to a modified intent-to-treat analysis where only randomized participants who also underwent a post-baseline cerebrospinal fluid analysis were included.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| AZD0530 100mg/125mg Daily | Cerebrospinal Fluid Levels of Total Tau, Phospho-tau (p-Tau), and Amyloid-beta 1-42 (Abeta 1-42) | CSF Total tau | 91.7448 pg/ml | Standard Deviation 212.7244 |
| AZD0530 100mg/125mg Daily | Cerebrospinal Fluid Levels of Total Tau, Phospho-tau (p-Tau), and Amyloid-beta 1-42 (Abeta 1-42) | CSF p-Tau | 1.5837 pg/ml | Standard Deviation 17.7504 |
| AZD0530 100mg/125mg Daily | Cerebrospinal Fluid Levels of Total Tau, Phospho-tau (p-Tau), and Amyloid-beta 1-42 (Abeta 1-42) | CSF Abeta 1-42 | -1.3383 pg/ml | Standard Deviation 47.3549 |
| AZD0530 Placebo | Cerebrospinal Fluid Levels of Total Tau, Phospho-tau (p-Tau), and Amyloid-beta 1-42 (Abeta 1-42) | CSF p-Tau | -1.9986 pg/ml | Standard Deviation 13.7311 |
| AZD0530 Placebo | Cerebrospinal Fluid Levels of Total Tau, Phospho-tau (p-Tau), and Amyloid-beta 1-42 (Abeta 1-42) | CSF Total tau | 1.2091 pg/ml | Standard Deviation 131.2533 |
| AZD0530 Placebo | Cerebrospinal Fluid Levels of Total Tau, Phospho-tau (p-Tau), and Amyloid-beta 1-42 (Abeta 1-42) | CSF Abeta 1-42 | -1.3758 pg/ml | Standard Deviation 43.3233 |
Secondary
Change in Brain Glucose Uptake Measured Using 18F-FDG PET Imaging
The results from the primary outcome with brain FDG-PET imaging was analyzed by ApoE genotype. Composite measure of brain glucose uptake using F18-FDG PET in a pre-defined set of brain regions, between baseline and 12 months.
Time frame: 12 months
Population: Number of participants is lower than total randomized participants due to a modified intent-to-treat analysis where only randomized participants who also underwent a post-baseline F18-FDG PET brain scan are included.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| AZD0530 100mg/125mg Daily | Change in Brain Glucose Uptake Measured Using 18F-FDG PET Imaging | APOE4 carrier FDG-PET measure from baseline | -0.06 umol/100g/min (change) | Standard Deviation 0.03 |
| AZD0530 100mg/125mg Daily | Change in Brain Glucose Uptake Measured Using 18F-FDG PET Imaging | APOE4 non-carrier FDG-PET measure from baseline | -0.06 umol/100g/min (change) | Standard Deviation 0.03 |
| AZD0530 Placebo | Change in Brain Glucose Uptake Measured Using 18F-FDG PET Imaging | APOE4 carrier FDG-PET measure from baseline | -0.05 umol/100g/min (change) | Standard Deviation 0.03 |
| AZD0530 Placebo | Change in Brain Glucose Uptake Measured Using 18F-FDG PET Imaging | APOE4 non-carrier FDG-PET measure from baseline | -0.05 umol/100g/min (change) | Standard Deviation 0.03 |
Secondary
Percent Change in Brain Volume Before and After Treatment
Change in volume of pre-defined brain regions between baseline and 12 months of treatment.
Time frame: 12 months
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| AZD0530 100mg/125mg Daily | Percent Change in Brain Volume Before and After Treatment | Entorhinal volume change | -2.3939 % change in volume | Standard Error 1.8138 |
| AZD0530 100mg/125mg Daily | Percent Change in Brain Volume Before and After Treatment | Whole brain volume change | -1.5993 % change in volume | Standard Error 1.0569 |
| AZD0530 100mg/125mg Daily | Percent Change in Brain Volume Before and After Treatment | Hippocampus volume change | -0.8931 % change in volume | Standard Error 1.8089 |
| AZD0530 Placebo | Percent Change in Brain Volume Before and After Treatment | Entorhinal volume change | -3.1002 % change in volume | Standard Error 1.7446 |
| AZD0530 Placebo | Percent Change in Brain Volume Before and After Treatment | Whole brain volume change | -1.7077 % change in volume | Standard Error 1.0922 |
| AZD0530 Placebo | Percent Change in Brain Volume Before and After Treatment | Hippocampus volume change | -1.542 % change in volume | Standard Error 1.9893 |
Secondary
The Effect of Treatment With AZD0530 on Cognitive and Behavioral Function
The change in cognitive function between baseline and 12 months will be measured by the following tests: 1. Alzheimer Disease Assessment Scale - Cognitive 11 (ADAS-cog11). Measures: Cognitive function Maximum score: 70; Minimum score: 0. Higher score equals worse cognitive function 2. Mini-Mental State Examination (MMSE) Measures: Cognitive Function Maximum score: 30; Minimum score: 0. Higher score equal better cognitive function 3. Alzheimer Disease Cooperative Study - Activities of Daily Living Inventory (ADCS-ADL) Measures: Ability to perform routine daily activities Maximum score: 78; Minimum score: 0. Higher score equals better ability to perform activities of daily living 4. Clinical Dementia Rating Sum of Boxes (CDR-SO) Measures: Dementia severity Maximum score: 18; Minimum score: 0. Higher score equals more severe dementia.
Time frame: 12 months
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| AZD0530 100mg/125mg Daily | The Effect of Treatment With AZD0530 on Cognitive and Behavioral Function | ADAS-Cog score | 7.26 Scores on a scale | Standard Error 0.954 |
| AZD0530 100mg/125mg Daily | The Effect of Treatment With AZD0530 on Cognitive and Behavioral Function | MMSE score | -3.84 Scores on a scale | Standard Error 0.575 |
| AZD0530 100mg/125mg Daily | The Effect of Treatment With AZD0530 on Cognitive and Behavioral Function | ADCS-ADL | -9.49 Scores on a scale | Standard Error 1.263 |
| AZD0530 100mg/125mg Daily | The Effect of Treatment With AZD0530 on Cognitive and Behavioral Function | CDR-SO | 1.946 Scores on a scale | Standard Error 0.292 |
| AZD0530 Placebo | The Effect of Treatment With AZD0530 on Cognitive and Behavioral Function | CDR-SO | 1.468 Scores on a scale | Standard Error 0.274 |
| AZD0530 Placebo | The Effect of Treatment With AZD0530 on Cognitive and Behavioral Function | ADAS-Cog score | 6.14 Scores on a scale | Standard Error 0.903 |
| AZD0530 Placebo | The Effect of Treatment With AZD0530 on Cognitive and Behavioral Function | ADCS-ADL | -7.64 Scores on a scale | Standard Error 1.199 |
| AZD0530 Placebo | The Effect of Treatment With AZD0530 on Cognitive and Behavioral Function | MMSE score | -3.33 Scores on a scale | Standard Error 0.543 |