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Trial registered on ANZCTR
Registration number
ACTRN12617000214336
Ethics application status
Approved
Date submitted
2/02/2017
Date registered
9/02/2017
Date last updated
24/11/2017
Type of registration
Retrospectively registered
Titles & IDs
Public title
Effects of statins on cognition in older adults with dementia
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Scientific title
A pilot study of N-of-1 trials to determine the effects of deprescribing statins on short-term cognition in older adults with dementia
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Secondary ID [1]
290386
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None
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Universal Trial Number (UTN)
U1111-1189-0576
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Dementia
300702
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Cognitive impairment
300703
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Condition category
Condition code
Neurological
300548
300548
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0
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Dementias
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Neurological
300549
300549
0
0
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Neurodegenerative diseases
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Patients will be randomly assigned to one of two treatment arms: Arm 1, Placebo-Statin-Placebo; or Arm 2, Statin-Placebo-Statin.
Patients will be on each period of either 'statin' or 'placebo' for 5 weeks with no washout, resulting in a total trial period of 15 weeks.
Patients will be taking their normal statin treatment during their 'statin' period(s), with a placebo replacement during 'placebo' period(s).
Adherence will be tested by using a pill count at the end of each intervention period.
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Intervention code [1]
296214
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Treatment: Drugs
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Comparator / control treatment
Patients will be compared between having a placebo, and when on their normal statin treatment - which will act as a control period.
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Control group
Active
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Outcomes
Primary outcome [1]
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Mean change in Alzheimer's Disease Assessment Scale - Cognitive Portion (ADAS-CoG) score
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Assessment method [1]
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Timepoint [1]
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Baseline, and at 5, 10 and 15-weeks after enrolment in the trial.
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Secondary outcome [1]
328712
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Mean change in Quality of Life in Alzheimer's Disease (QoL-AD) score
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Assessment method [1]
328712
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Timepoint [1]
328712
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Baseline, and at 5, 10 and 15-weeks after enrolment in the trial.
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Secondary outcome [2]
328713
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Mean change in Short Performance Physical Battery score
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Assessment method [2]
328713
0
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Timepoint [2]
328713
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Baseline, and at 5, 10 and 15-weeks after enrolment in the trial
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Secondary outcome [3]
328714
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Mean change in Cambridge Behavioural Inventory score
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Assessment method [3]
328714
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Timepoint [3]
328714
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Baseline, and at 5, 10 and 15-weeks after enrolment in the trial
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Eligibility
Key inclusion criteria
Mini-Mental State Examination (MMSE) score of between 10 and 23 and/or clinical diagnosis of dementia; currently taking any statin for at least 6 months
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Minimum age
80
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Too unwell to participate, or in the terminal stage of any illness; active cancer diagnosis; taking a combination statin;
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Randomised by a third-party (Clinical Trials Pharmacy at the Royal North Shore Hospital, St Leonards, Sydney) upon patient enrolment into the study.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Random number generator on Microsoft Excelt
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Other
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Other design features
Multiple N-of-1 trials with participants randomised to either Treatment Arm 1 (Placebo-Statin-Placebo) or Treatment Arm 2 (Statin-Placebo-Statin)
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Phase
Phase 4
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
This is a pilot study so no formal power calculation was used. We aim to recruit 30 participants for this study which can then inform future trials.
Data analysis will be conducted within each N-of-1 trial and results combined across them. We will follow the intention-to-treat principal of analyses. The difference in mean ADAS-CoG scores between statin therapy and placebo is the pre-specified primary outcome, with a difference of 4 to be considered clinically significant.
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Recruitment
Recruitment status
Stopped early
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Data analysis
Data analysis is complete
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Reason for early stopping/withdrawal
Participant recruitment difficulties
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Date of first participant enrolment
Anticipated
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Actual
18/01/2017
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Date of last participant enrolment
Anticipated
20/02/2017
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Actual
18/01/2017
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Date of last data collection
Anticipated
11/06/2017
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Actual
18/05/2017
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Sample size
Target
30
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Accrual to date
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Final
1
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment hospital [1]
6862
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Royal North Shore Hospital - St Leonards
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Recruitment postcode(s) [1]
14532
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2065 - St Leonards
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Funding & Sponsors
Funding source category [1]
294779
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University
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Name [1]
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University of Sydney
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Address [1]
294779
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Faculty of Pharmacy
Pharmacy and Bank Building
Science Road
Camperdown
NSW
2006
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Country [1]
294779
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Australia
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Primary sponsor type
University
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Name
University of Sydney
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Address
Faculty of Pharmacy
Pharmacy and Bank Building
Science Road
Camperdown
NSW
2006
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Country
Australia
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Secondary sponsor category [1]
293625
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None
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Name [1]
293625
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Address [1]
293625
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Country [1]
293625
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
296186
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North Sydney Local Health District Human Research Ethics Committee
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Ethics committee address [1]
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Level 13 Kolling Building Royal North Shore Hospital Reserve Road St Leonards NSW 2065
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Ethics committee country [1]
296186
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Australia
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Date submitted for ethics approval [1]
296186
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25/07/2016
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Approval date [1]
296186
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10/10/2016
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Ethics approval number [1]
296186
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HREC/16/HAWKE/286
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Summary
Brief summary
Background: Statins are effective in treating dyslipidaemia in older adults, reducing the cardiovascular related morbidity – however their adverse effects are more common and harmful amongst older adults. Additionally, the impact on cognition is unclear, with previous studies producing mixed results. The N-of-1 method has been demonstrated to be a feasible method of conducting deprescribing trials, generating strong-patient specific evidence as to the effects of discontinuing statin use on cognition. Aims: 1. To determine the effect on cognition of discontinuation and rechallenge with statins. 2. To determine the effects on quality of life and functional status of discontinuation and rechallenge with statins. Methods: A pilot interventional study of 30 older adults 80 years of age or older admitted to Royal North Shore Hospital, Sydney with current dementia diagnosis, and taking statins for at least 6 months will be conducted. Participants will be randomly assigned to statin and placebo treatment pairs with discontinuation and rechallenge of statins over the course of 4-months. At baseline (0-weeks), recruited patients will be subsequently randomised into either continuation of active statin treatment or placebo replacement for a period of 5-weeks. Participants will be followed at 5-weeks (Visit 2), 10-weeks (Visit 3) and 15-weeks (Visit 4). At each visit, patients will be crossed over into opposing intervention, either continuation of active statin or placebo. The primary outcome will be measured using the cognitive portion of the Alzheimer’s Disease Assessment Score (ADAS-CoG), which assesses the level of cognitive impairment on a 30-point scale with a psychometric test. The patients’ general practitioners will be contacted two months after trial completion to ascertain whether patients had discontinued, lowered dose, or continued their statin medication. Hypothesis: We hypothesise that patients will have improved cognition and quality of life when on placebo compared to when on statins.
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Trial website
None
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Trial related presentations / publications
None
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Public notes
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Attachments [1]
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1201
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/AnzctrAttachments/371713-Letter - HREC FINAL approval - HREC Exec meeting 10 October 2016 - RESP 16 191.pdf
(Ethics approval)
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Attachments [2]
1202
1202
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/AnzctrAttachments/371713-PISCF Patient Version 3 26.09.16 Clean.docx
(Participant information/consent)
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Attachments [3]
1203
1203
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/AnzctrAttachments/371713-PISCF Person Responsible Version 3 26.09.16 Clean.docx
(Participant information/consent)
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Contacts
Principal investigator
Name
69910
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Mr Alexander Clough
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Address
69910
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Pharmacy and Bank Building
Science Road
University of Sydney
Camperdown
NSW 2006
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Country
69910
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Australia
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Phone
69910
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+61414161528
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Fax
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Email
69910
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[email protected]
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Contact person for public queries
Name
69911
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Alexander Clough
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Address
69911
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Pharmacy and Bank Building
Science Road
University of Sydney
Camperdown
NSW 2006
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Country
69911
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Australia
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Phone
69911
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+61414161528
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Fax
69911
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Email
69911
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[email protected]
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Contact person for scientific queries
Name
69912
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Alexander Clough
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Address
69912
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Pharmacy and Bank Building
Science Road
University of Sydney
Camperdown
NSW 2006
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Country
69912
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Australia
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Phone
69912
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+61414161528
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Fax
69912
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Email
69912
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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