Clinical Study of Neflamapimod in Patients With Dementia With Lewy Bodies
Study Details
Study Description
Brief Summary
The purpose of this study is to determine whether neflamapimod can improve learning skills, problem solving skills, and memory loss in people diagnosed with DLB. More specifically, improvement in verbal learning, memory, and attention, as well as cognitive and functional performance will be measured.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 2 |
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Neflamapimod Neflamapimod will be administered with food for 16 weeks in subjects with DLB. Subjects will receive 3 capsules per day (TID) with food (i.e., with the morning, mid-day and evening meals). |
Drug: Neflamapimod
Neflamapimod is a highly specific inhibitor of the intra-cellular enzyme mitogen-activated protein kinase14 (p38α) provided in 40mg capsules
Other Names:
|
| Placebo Comparator: Placebo Placebo will be administered with food for 16 weeks in subjects with DLB. Subjects will receive 3 capsules per day (TID) with food (i.e., with the morning, mid-day and evening meals). |
Drug: Placebo
Placebo is a capsule that looks just like neflamapimod but without the active ingredients
|
Outcome Measures
Primary Outcome Measures
- Change in Clinical Dementia Rating Scale - Sum of Boxes (CDR-SB) in neflamapimod-treated subjects compared to placebo recipients. [16 weeks]
The primary objective is to demonstrate the efficacy of neflamapimod, compared to placebo, as a treatment for DLB, as assessed by the CDR-SB scale. CDR-SB scores range from 0 to 18 with a higher score indicating worsening of cognitive impairment.
Secondary Outcome Measures
- Change in Timed Up and Go Test (TUG) in neflamapimod-treated subjects compared to placebo recipients. [16 weeks]
Demonstrate that neflamapimod improves motor function in patients with DLB, compared to placebo, as assessed by the TUG test. TUG scores typically range from 6 to 20 seconds with a higher score indicating worse mobility. A score of >15 indicates an increased risk of falls.
- Change in the composite score of the Neuropsychological Test Battery (NTB), including tests of attention, executive function, and visual learning in neflamapimod-treated subjects compared to placebo recipients. [16 weeks]
Demonstrate that neflamapimod improves cognition, compared to placebo, as assessed by a DLB-specific NTB in patients with DLB. NTB includes Cogstate Detection test (DET), Cogstate Identification test (IDN), Cogstate One Card Learning test (OCL), Cogstate One Back test (ONB), Letter Fluency Test (LFT). Each score on the individual tests is converted to a z-score, and then a total z-score for the composite is calculated, in which each test is weighted equally. As the analysis is based on z-scores, there is no minimum or maximum value. A z-score of 0 is equal to the mean with negative numbers indicating values lower than the mean and positive values higher. A positive change in z-score indicates an improvement in cognition and a negative change in z-score indicates a worsening in cognition.
- Alzheimer's Disease Cooperative Study - Clinical Global Impression of Change (ADCS-GCIC) score at Week 16 in neflamapimod-treated subjects compared to placebo recipients. [16 weeks]
Demonstrate that neflamapimod improves global (cognition, function and behavior) disease status evaluated by a clinician with caregiver input, compared to placebo, in patients with DLB, as assessed ADCS-CGIC score. ADCS-CGIC scores range from 1 to 7, where 1 = marked improvement, 2= moderate improvement, 3 = minimal improvement, 4 = no change, 5 = minimal worsening, 6 = moderate worsening, and 7 = marked worsening.
Other Outcome Measures
- Exploratory outcome - Dementia Cognitive Fluctuations Scale (DCFS) [16 weeks]
Change in DCFS score in neflamapimod-treated subjects compared to placebo recipients. DCFS scores range from 4 to 20 where a higher score indicates more severe cognitive fluctuations and disease worsening.
- Exploratory outcome - 12-item Neuropsychiatric Inventory (NPI-12) [16 weeks]
Change in neflamapimod-treated subjects compared to placebo recipients in the following: Select domains of the NPI-12, including depression (dysphoria), apathy, hallucinations, and agitation/aggression. Change in hallucinations frequency x severity score within the NPI-12 in subjects who report hallucinations at baseline. Change in sleep and night-time behavior change within the NPI-12. NPI-12 scores range from 0 to 12 for each individual domain and 0 to 144 total score, where a higher score indicates worsening of neuropsychiatric symptoms.
- Exploratory outcome - Movement Disorder Society - Unified Parkinson's Disease Rating Scale - Part III (MSD-UPDRS3) motor examination (Part III) [16 weeks]
Change in MDS-UPDRS3 score in neflamapimod-treated subjects compared to placebo recipients.. MDS-UPDRS 3 scores range from 0 to 108 where a higher score indicates more severe motor symptoms.
- Exploratory outcome - EEG [16 weeks]
Change in beta functional connectivity and in alpha reactivity on quantitative EEG in neflamapimod-treated subjects compared to placebo recipients.. Functional connectivity will be analyzed as Amplitude Envelope Correlation (AECc), a measure of interregional communication within the brain. AECcs are computed by correlating the amplitude (energy) envelopes of oscillatory brain signals in two different brain regions. AECc ranges between 0 and 1, with higher AECc values indicating increased functional connectivity. In this study, the primary EEG evaluation will be AECc within the beta band (13-30 Hz), i.e. beta functional connectivity.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Men and women aged ≥55 years.
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Subject or subject's legally authorized representative is willing and able to provide written informed consent.
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Probable DLB by consensus criteria (McKeith et al, 2017), including a positive DaTscan™, who are currently receiving cholinesterase inhibitor therapy. If the DaTscan is negative, but the subject has historical polysomnography (PSG)-verified REM sleep behavioral disorder (RBD), this will also qualify as probable DLB.
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CDR Global Score 0.5 or 1.0 during Screening
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If the patient is currently receiving cholinesterase inhibitor therapy, the patient must have received such therapy for greater than 3 months and on a stable dose for at least 6 weeks at the time of randomization. Except for reducing the dose for tolerability reasons, the dose of cholinesterase inhibitor may not be modified during the study. If the patient is not currently receiving cholinesterase inhibitor therapy, but received such therapy previously, that therapy must have been discontinued at least 3 months prior to randomization. Memantine therapy is allowed, if it had been started at least 3 months prior to randomization and the patient is also receiving cholinesterase inhibitor therapy (memantine monotherapy, i.e., without concomitant cholinesterase inhibitor therapy, is excluded).
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Normal or corrected eyesight and auditory abilities, sufficient to perform all aspects of the cognitive and functional assessments.
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No history of learning difficulties that may interfere with their ability to complete the cognitive tests.
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Received vaccination for SARS-CoV-19 unless medical contraindications prevent being vaccinated.
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Must have reliable informant or caregiver.
Exclusion Criteria:
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Diagnosis of any other ongoing central nervous system (CNS) condition other than DLB, including, but not limited to, post-stroke dementia, vascular dementia, Alzheimer's disease (AD), or Parkinson's disease (PD).
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Plasma ptau181 > 2.4 pg/mL (i.e., above cut-off for pathology associated with Alzheimer's disease) at Screening.
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Suicidality, defined as active suicidal thoughts within 6 months before Screening or at Baseline, defined as answering yes to items 4 or 5 on the C-SSRS, or history of suicide attempt in previous 2 years, or, in the Investigator's opinion, at serious risk of suicide.
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Ongoing major and active psychiatric disorder and/or other concurrent medical condition that, in the opinion of the Investigator, might compromise safety and/or compliance with study requirements.
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Diagnosis of alcohol or drug abuse within the previous 2 years.
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Poorly controlled clinically significant medical illness, such as hypertension (blood pressure >180 mmHg systolic or 100 mmHg diastolic); myocardial infarction within 6 months; uncompensated congestive heart failure or other significant cardiovascular, pulmonary, renal, liver, infectious disease, immune disorder, or metabolic/endocrine disorders or other disease that would interfere with assessment of drug safety.
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Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >2 × the upper limit of normal (ULN), total bilirubin >1.5 × ULN, and/or International Normalized Ratio (INR) >1.5.
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Known human immunodeficiency virus, hepatitis B, or active hepatitis C virus infection.
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Participated in a study of an investigational drug less than six weeks or 5 half-lives of an investigational drug, whichever is longer, before enrollment in this study.
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History of previous neurosurgery to the brain within the past five years.
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If male with female partner(s) of child-bearing potential, unwilling or unable to adhere to contraception requirements specified in the protocol.
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If female who has not has not reached menopause >1 year previously or has not had a hysterectomy or bilateral oophorectomy/salpingo-oophorectomy, has a positive pregnancy test result during Screening and/or is unwilling or unable to adhere to the contraception requirements specified in the protocol.
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Weight less than 60kg.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | JEM Research Institute | Lake Worth | Florida | United States | 33462 |
Sponsors and Collaborators
- EIP Pharma Inc
- National Institute on Aging (NIA)
- Worldwide Clinical Trials
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- EIP21-NFD-504
- R01AG080536
- 2023-504373-20