The primary objective is to:* Evaluate the efficacy, safety, and tolerability of AVP-786 compared to placebo for thetreatment of agitation in patients with dementia of the Alzheimer*s typeThe secondary objectives are to:* Evaluate the effects of AVP…
ID
Source
Brief title
Condition
- Mental impairment disorders
- Dementia and amnestic conditions
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Primary Efficacy Measure: Cohen-Mansfield Agitation Inventory (CMAI)
Secondary outcome
Key Secondary Efficacy Measure: Clinical Global Impression of Severity of
Illness for Agitation (CGIS-Agitation)
Other efficacy measures include:
* Change from baseline to each study visit in efficacy period in CMAI Total
score
* Change from baseline to each study visit in efficacy period in CGISAgitation
score
* CGIC-Agitation score at each study visit in the efficacy period
* Change from baseline to each study visit in efficacy period in NPI-AA score
* Change from baseline to each study visit in efficacy period in NPI total score
* CMAI Response Rate at each study visit in efficacy period, where response is
defined as >= 30% reduction in CMAI Total Score from baseline
* CMAI Response Rate at each study visit in efficacy period, where response is
defined as >= 50% reduction in CMAI Total Score from baseline
* Change from baseline to each study visit in efficacy period in the EQ- 5D-5L
total score
* Change from baseline to each study visit in efficacy period in the RUDLite
Safety: Safety and tolerability of AVP-786 will be assessed by reported adverse
events (AEs), physical and neurological examinations, vital signs, clinical
laboratory assessments, resting 12-lead electrocardiograms (ECGs), MMSE, the
Epworth Sleepiness Scale (ESS), and the Sheehan Suicidality Tracking Scale
(S-STS).
Background summary
Agitation is widely recognized by clinicians as a common and important clinical
feature of Alzheimer*s disease and other forms of dementia. Agitation,
aggression, depression, hallucinations, and delusions are estimated to affect
up to approximately 90% of patients with Alzheimer*s disease with an increase
in prevalence as the disease progresses. In a meta analyses of data from 55
studies, overall prevalence of agitation ranged from 5% to 88% across all
studies, with 23 studies reporting the prevalence of at least one
neuropsychiatric syndrome with a range of 40% to 100%. Agitation in patients
with dementia is associated with increased functional disability, worse quality
of life, earlier institutionalization, increased caregiver burden, increased
healthcare costs, shorter time to severe dementia and accelerated mortality.
Currently, there is no approved treatment in the US to manage agitation in
patients with Alzheimer*s disease. Pharmacologic treatments for patients with
agitation in Alzheimer*s disease include off-label use of atypical
antipsychotics, selective serotonin reuptake inhibitors, benzodiazepines, and
anticonvulsants; however, these treatments provide only modest efficacy that is
offset by relatively poor adherence, safety, and tolerability. It is widely
recognized that a safe and effective treatment for patients with agitation in
Alzheimer*s disease represents a significant unmet need. Such a treatment could
profoundly impact patient care, potentially reduce caregiver burden, and
improve overall disease prognosis. AVP-786 is a combination product of
deudextromethorphan hydrobromide (d6-DM), a central nervous system (CNS)-active
agent, and quinidine sulfate (Q), used as an inhibitor of d6-DM metabolism via
the cytochrome P450 (CYP) liver isoenzyme 2D6 (CYP2D6). AVP-786 is being
developed by Otsuka Pharmaceutical Development & Commercialization, Inc. for
the treatment of neuropsychiatric conditions.
The demonstrated receptor pharmacology of d6-DM supports a potential clinical
benefit for agitation in patients with dementia of the Alzheimer*s type.
Study objective
The primary objective is to:
* Evaluate the efficacy, safety, and tolerability of AVP-786 compared to
placebo for the
treatment of agitation in patients with dementia of the Alzheimer*s type
The secondary objectives are to:
* Evaluate the effects of AVP-786 compared to placebo on global assessments of
severity and
improvement of agitation
* Evaluate the effects of AVP-786 compared to placebo on neuropsychiatric
symptoms
* Evaluate the effects of AVP-786 compared to placebo on measures of quality of
life and
resource utilization
Study design
Phase 3, multicenter, randomized, double-blind, placebo-controlled study
Intervention
AVP-786 capsule will be administered orally BID up to a maximum dose of d6-DM
42.63 mg and Q 4.9 mg and matching placebo capsule (identical appearance to
AVP-786 capsule) will be administered orally BID.
Study burden and risks
For this study the patients will need to visit hospital 10 times in 20 weeks. A
visit lasts 1-2 hours.
they will have to undergo/complete the following:
- Physical exam and neurological exam, 2 times
- Measurement of blood pressure, body temperature, breathing rate, and
heart rate, 9 times
- ECG, 5 times
- Questionnaires: NPI (9 times), MMSE (3 times), ESS (2 times), S-STS (3
times), RUD-Lite (2 times), EQ-5D-5L (2 times)
- Blood (total 262.5 ml ) and urine tests, 4 and 1 times respectively
- Pregnancy tests in women of childbearing potential, 3 times
- Female patients: no breastfeeding allowed. Effective methods of birth control
must be used from the time of signing the ICF, throughout the entire study and
for 30 days following the last dose of the study drug.
- Male patients: due to the potential risk of the effect on the sperm
appropriate method of contraception must be used starting at screening and
continuing for at least 30 days following the last dose of study drug.
- Diary for the caregiver to complete
The patient must appoint someone such as a family member or professional
caregiver who knows them well enough to provide information about the patient
to the study doctor and staff during the study. This person must attend all
study visits with them and will be required to sign the caregiver informed
consent form.
Common risks: (occurred in equal to or greater than 1% and less than 10% of
participants)
• Abdominal discomfort
• Anxiety
• Fall
• Somnolence (sleepiness)
• Dizziness
• Upper Respiratory Tract Infection
• Dry Mouth
• Headache
• Contusion (bruise)
• Nasopharyngitis (common cold)
• Nausea
• Vomiting
• Hyperhidrosis (excessive sweating)
• Hypertension (high blood pressure)
• Skin abrasion (scrape)
• Arthralgia (joint pain)
• Electrocardiogram Qt Prolonged (a measurement related to the heart rhythm)
• Laceration (cut)
• Dehydration
• Pneumonia (chest infection)
• Sinus bradycardia (slow heartbeat)
• Syncope (passing out; brief loss of consciousness caused by insufficient
blood flow to the brain and a fall in blood pressure)
• Increase in Blood Creatine Phosphokinase (a protein found in your heart,
brain, and skeletal muscles)
Rare Serious Side Effects Reported from Quinidine, a Component of AVP-786:
• Decrease of platelets in the blood (increases risk of bleeding)
• Vasculitis (inflammation of blood vessels)
• Lupus-like syndrome (a disorder of the immune system presenting with a rash)
• Swelling and inflammation of the liver (symptoms include jaundice [yellowing
color of the eyes or skin], nausea, loss of appetite)
• Changes to your heart rate
Severe side effects that have been reported from dextromethorphan overdose may
include:
• Respiratory depression (decrease in respiratory function)
• Seizures (convulsions)
• Coma
The studies conducted to date showed a favorable safety and tolerability
profile for AVP-786. The plasma concentrations of d6-DM (and metabolites)
observed in these studies were shown to be generally well tolerated. The
combined safety data from the AVP-786 clinical studies, in
addition to risk minimization measures taken in the clinical studies, support
further development of AVP-786.
2440 Research Blvd 2440
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Rockville MD 20850
US
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Age
Inclusion criteria
1. Males and females 50 to 90 years of age (inclusive) at the time of informed
consent.
2. Diagnosis of probable Alzheimer*s disease according to the 2011 NIA-AA
working groups criteria. Either outpatients or residents of an assisted living
facility, a skilled nursing home, a dementia unit, or any other type of
facility providing long-term care.
3. MMSE score between 8 and 24 (inclusive) at Screening and Baseline.
4. Patient has clinically significant, moderate-to-severe agitation for at
least 2 weeks prior to Screening that interferes with daily routine per the
Investigator*s judgment.
5. Patients who require pharmacotherapy for the treatment of agitation per the
Investigator*s judgment, after:
* An evaluation of reversible factors (eg, pain, infection, or polypharmacy),
and
* A course of nonpharmacological interventions (eg, redirecting behavior, group
activities, music therapy).
6. Diagnosis of agitation must meet the International Psychogeriatric
Association (IPA) provisional definition of agitation.
7. NPI-AA total score (frequency × severity) must be >= 4 at Screening and
Baseline.
8. Patient must meet an additional predetermined blinded eligibility criterion.
9. Patient has stable cardiac, pulmonary, hepatic, and renal function per the
Investigator*s judgment.
10. No clinically significant findings on the Screening ECGs based on central
review and on the Baseline predose ECG based on the machine read and
Investigator*s evaluation.
11. Women who are of childbearing potential and are sexually active must use an
effective method of birth control for at least 1 month prior to the Baseline,
during participation in the study, and for at least 30 days after the last dose
of study drug. The following requirements must be met:
* Women who are of childbearing potential must use 2 of the following
precautions in order to minimize the risk of failure of 1 method of birth
control: vasectomy, tubal ligation, vaginal diaphragm, intrauterine device,
birth control pills, birth control depot injection, birth control implant, or
condom with spermicide or sponge with spermicide. Periodic abstinence (eg,
calendar, ovulation, symptothermal, post-ovulation methods), declaration of
abstinence for the duration of exposure to study drug, or withdrawal are not
acceptable methods of contraception.
* Women who are sterile (ie, had an oophorectomy and/or hysterectomy),
postmenopausal (defined as 12 consecutive months with no menses without an
alternative medical cause), or practice true abstinence (when this method is in
line with the preferred and usual lifestyle of the patient) are exempt from
this requirement.
* Women who are lactating, pregnant, or plan to become pregnant are not
eligible for participation in the study.
12. For restricted and prohibited concomitant medications, patients willing and
able to meet all protocol requirements for duration of stability or washout
prior to study entry and during the study (see protocol Table 3 Restricted and
Prohibited Concomitant Medications and Appendix 1 Prohibited Concomitant
Medications).
13. Caregiver must be willing and able to comply with all study procedures,
including adherence to administering study drug and not administering any
prohibited medications during the study. The caregiver must spend a minimum of
2 hours with the patient per day for at least 4 days per week to qualify as
caregiver.
14. Patient/caregiver must be willing to sign and receive a copy of
patient/caregiver informed consent form (ICF) after the nature and risks of
study participation have been fully explained. Patients who are not capable of
signing the ICF but are able to provide assent, or the patient*s authorized
representative agrees to participation (for patients unable to provide assent)
are allowed.
Exclusion criteria
1. Caregiver is unwilling or unable, in the opinion of the Investigator, to
comply with study instructions. 2. Patient has dementia predominantly of
non-Alzheimer*s type (eg, vascular dementia, frontotemporal dementia,
Parkinson*s disease, substance-induced dementia). 3. Patients with symptoms of
agitation that are not secondary to Alzheimer*s dementia (eg, secondary to
pain, other psychiatric disorder, or delirium). 4. Patients who have been
diagnosed with an Axis 1 disorder (Diagnostic and Statistical Manual of Mental
Disorders, 5th Edition, Text Revision [DSM-5] criteria) including, but not
limited to: * Schizophrenia, schizoaffective disorder, or other psychotic
disorders not related to dementia * Bipolar I or II disorder, bipolar disorder
not otherwise specified * Current Major Depressive Episode: Patients with a
history of major depressive disorder, that is currently not symptomatic, are
eligible. Patients currently on a stable dose(s) of allowed antidepressant
medication(s) for at least 3 months prior to the Screening visit are eligible.
5. Patients with myasthenia gravis (contraindication for quinidine). 6.
Patients with any personal history of complete heart block, QTc prolongation,
or torsades de pointes. a. Screening and Baseline predose QT interval corrected
for heart rate using the Fridericia*s formula (QTcF) of > 450 msec for males
and > 470 msec for females unless due to ventricular pacing (See Section
8.1.5). Screening ECGs will be based on central review. Baseline predose ECG
will be based on the machine read and Investigator*s evaluation; if the QTcF
result from the machine read is exclusionary, do not administer study drug and
please contact a Medical Monitor. b. Presence of premature ventricular
contractions (PVCs) as evaluated by a central reader and deemed clinically
significant by the Investigator. 7. Patients with any family history of
congenital QT interval prolongation syndrome. 8. Patients with known
hypersensitivity to DM, Q, opiate drugs (codeine, etc), or any other ingredient
of the study drug. 9. Patients who have ever received DM co-administered with Q
or d6-DM co-administered with Q. 10. Patients who would be likely to require a
prohibited concomitant medication during the study (see Table 3, Restricted and
Prohibited Concomitant Medications and Appendix 1 Prohibited Concomitant
Medications). 11. Patients with co-existent clinically significant or unstable
systemic diseases that could confound the interpretation of the safety results
of the study (eg, malignancy [except skin basal cell carcinoma], poorly
controlled diabetes, poorly controlled hypertension, unstable pulmonary, renal
or hepatic disease, unstable ischemic cardiac disease, dilated cardiomyopathy,
or unstable valvular heart disease). Certain other nonmetastatic cancer may be
allowed. Each case is to be evaluated individually with a Medical Monitor. 12.
Patients who are currently participating in or who have participated in other
interventional (drug or device) clinical study, or found to be a *Virtually
Certain* match in Clinical Trial Subject Database (CTSdatabase) with a patient
who has participated in another interventional drug or device study within 30
days of Baseline. 13. Patients with history of postural syncope or any history
of unexplained syncope (evaluated on a case-by-case basis) within 12 months of
Baseline. 14. Patients with a history of substance and/or alcohol abuse within
12 months of Baseline. 15. Patients determined to have a high imminent risk of
falls during the study based on a clinical evaluation by the Investigator. 16.
Patients with evidence of serious risk of suicide at Screening and Baseline
based on the Sheehan Suicidality Tracking Scale (S-STS), ie, a score of 3 or 4
on any one question 2 through 6 or 11, or a score of 2 or higher on any one
questions 1a, 7 through 10, or 12, or who in the opinion of the Investigator
present a serious risk of suicide. 17. Patients who, in the opinion of the
Investigator, Medical Monitor, or sponsor, should not participate in the study.
Design
Recruitment
Medical products/devices used
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
EudraCT | EUCTR2020-000799-39-NL |
ClinicalTrials.gov | NCT04464564 |
CCMO | NL76317.056.21 |