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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/ct2/show/NCT02245737
Registration number
NCT02245737
Ethics application status
Date submitted
18/09/2014
Date registered
22/09/2014
Date last updated
3/12/2019
Titles & IDs
Public title
An Efficacy and Safety Study of Lanabecestat (LY3314814) in Early Alzheimer's Disease
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Scientific title
A 24-month, Multicenter, Randomized, Double-blind, Placebo-controlled, Parallel-group, Efficacy, Safety, Tolerability, Biomarker, and Pharmacokinetic Study of AZD3293 in Early Alzheimer's Disease (The AMARANTH Study)
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Secondary ID [1]
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I8D-MC-AZES
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Secondary ID [2]
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16023
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Universal Trial Number (UTN)
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Trial acronym
AMARANTH
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Alzheimer´s Disease
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Condition category
Condition code
Neurological
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Alzheimer's disease
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Neurological
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Dementias
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Lanabecestat
Treatment: Drugs - Placebo
Experimental: Lanabecestat 20 milligrams (mg) - Lanabecestat 20 mg given orally once daily for 104 weeks.
Experimental: Lanabecestat 50 mg - Lanabecestat 50 mg given orally once daily for 104 weeks.
Placebo Comparator: Placebo - Placebo given orally once daily for 104 weeks.
Treatment: Drugs: Lanabecestat
Administered orally
Treatment: Drugs: Placebo
Administered orally
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Change From Baseline on the 13-item Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-Cog13)
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Assessment method [1]
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ADAS-Cog13 (13-item version of ADAS-Cog) is a psychometric instrument that evaluates word recall, ability to follow commands, constructional praxis, naming, ideational praxis, orientation, word recognition, memory, comprehension of spoken language, word-finding, and language ability, with a measure of delayed word recall and concentration/ distractibility. The total score of the 13-item scale ranges from 0 to 85, with an increase in score indicating cognitive worsening. Least Squares (LS) mean was determined by mixed-model repeated measures (MMRM) model with factors for treatment, visit, treatment-by-visit interaction, disease status at baseline, apolipoprotein E4 (APOE4) status, acetylcholinesterase inhibitor (AChEI) use at baseline, pooled country, and covariates for baseline ADAS-Cog13 total score, age at baseline, and baseline ADAS-Cog13 total score-by-visit interaction.
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Timepoint [1]
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Baseline, Week 104
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Secondary outcome [1]
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Change From Baseline on the Alzheimer´s Disease Cooperative Study Activities of Daily Living Inventory Instrumental Items (ADCS-iADL)
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Assessment method [1]
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The ADCS-ADL is a 23-item inventory developed as a rater-administered questionnaire answered by the participant's caregiver. The ADCS-ADL measures both basic and instrumental activities of daily living by participants. The range for the ADCS-iADL is 0-59 with higher scores reflecting better performance. LS Mean was determined by MMRM model with factors for treatment, visit, treatment-by-visit interaction, disease status at baseline, APOE4 status, AChEI use at baseline, pooled country, and covariates for baseline for baseline iADL score, age at baseline, and baseline iADL score-by-visit interaction.
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Timepoint [1]
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Baseline, Week 104
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Secondary outcome [2]
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Change From Baseline on the Functional Activities Questionnaire (FAQ) Score
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Assessment method [2]
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FAQ is a 10-item, caregiver-based questionnaire and was administered to the study partner who was asked to rate the participant's ability to perform a variety of activities ranging from writing checks, assembling tax records, shopping, playing games, food preparation, traveling, keeping appointments, traveling out of neighborhood, keeping track of current events and understanding media. FAQ total score was calculated by adding the scores from each of the 10 items. Each activity is rated on a scale from 0 to 3 (Never did and would have difficulty now = 1; Never did [the activity] but could do now = 0; Normal = 0; Has difficulty but does by self = 1; Requires assistance = 2; Dependent = 3). FAQ scale is 0 to 30, with higher scores indicating greater impairment. LS Mean was calculated by MMRM with factors for treatment, visit, treatment-by-visit interaction, disease status at baseline, APOE4 status, AChEI use at baseline and pooled country.
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Timepoint [2]
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Baseline, Week 104
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Secondary outcome [3]
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Change From Baseline on the Integrated Alzheimer's Disease Rating Scale (iADRS) Score
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Assessment method [3]
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The iADRS is a composite that measures both cognition and function. The iADRS comprises scores form the ADAS- Cog and the ADCS-iADL. The iADRS is calculated as a linear combination of the total scores of the ADAS-Cog13 (score range 0 to 85 with higher scores reflecting worse performance) and the ADCS-iADL (score range from 0-59 with higher scores reflecting better performance). The iADRS score ranges from 0 to 144 with higher scores indicating greater impairment. LS Mean was determined by MMRM methodology with factors for treatment, visit, treatment-by- visit interaction, disease status at baseline, APOE4 status, AChEI use at baseline, pooled country, and covariates for baseline iADRS13 total score, age at baseline, and baseline iADRS13 total score-by-visit interaction.
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Timepoint [3]
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Baseline, Week 104
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Secondary outcome [4]
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Change From Baseline on the Clinical Dementia Rating - Sum of Boxes (CDR-SB) Score
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Assessment method [4]
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The CDR-SB is a rater administered scale and impairment is scored in of the following categories: memory, orientation, judgment and problem solving, community affairs, home and hobbies and personal care. Impairment is scored on a scale in which no dementia = 0, questionable dementia = 0.5, mild dementia = 1, moderate dementia = 2 and severe dementia = 3. The 6 individual category ratings, or "box scores", were added together to give the CDR-Sum of Boxes which ranges from 0-18, with higher scores indicating greater impairment. LS Mean was determined by MMRM methodology with factors for treatment, visit, treatment-by-visit interaction, disease status at baseline, APOE4 status, AChEI use at baseline, pooled country, and covariates for baseline CDR-SB score, age at baseline, and baseline CDR-SB score-by-visit interaction.
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Timepoint [4]
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Baseline, Week 104
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Secondary outcome [5]
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Time to Progression as Measured by Loss of Clinical Dementia Rating (CDR) Global Score Stage
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Assessment method [5]
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The CDR global score is a composite score calculated using the Washington University CDR-assignment algorithm applied to the 6 individual domain box scores (Morris 1993). The memory domain is considered the primary category that drives the CDR global outcome, and all other domains are secondary. The CDR global score ranges from 0 to 3 (0 = no dementia, 0.5 = questionable dementia, 1 = mild dementia, 2 = moderate dementia, 3 = severe dementia).
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Timepoint [5]
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Baseline through Loss of 1 Global Stage or Week 104
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Secondary outcome [6]
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Change From Baseline in Neuropsychiatric Inventory (NPI) Score
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Assessment method [6]
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The NPI is a questionnaire administered to caregivers that quantifies behavioral changes. Each of the 12 behavioral domains the caregiver reports as present are scored for Frequency, scale: 1 (Occasionally) to 4 (Very Frequently), and Severity, scale: 1 (Mild) to 3 (Severe). If the domain is reported by the caregiver as 'Not Affected,' that domain is scored as 0. The individual domain scores are calculated by multiplying the frequency times the severity for each domain. NPI Total Score is calculated by adding the individual domain scores together for all 12 domains, with a scores range from 0 to 144, with higher scores indicating greater severity of neuropsychiatric disturbance. LS Mean was determined by MMRM methodology with factors for treatment, visit, treatment-by-visit interaction, disease status at baseline, APOE4 status, AChEI use at baseline, pooled country, and covariates for baseline NPI score, age at baseline, and baseline NPI score-by-visit interaction.
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Timepoint [6]
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Baseline, Week 104
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Secondary outcome [7]
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Change From Baseline on the Mini-Mental State Examination (MMSE)
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Assessment method [7]
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The MMSE is an instrument used to assess a participant's global cognitive function. The MMSE assesses orientation to time and place, immediate and delayed recall of words, attention and calculation, language (naming, comprehension and repetition), and spatial ability (copying a figure). The range for MMSE total Score is 0 to 30, with a higher score indicating better cognitive performance. LS mean was determined by MMRM methodology with factors for treatment, visit, treatment-by-visit interaction, disease status at baseline, APOE4 status, AChEI use at baseline, pooled country, and covariates for baseline MMSE total score, age at baseline, and baseline MMSE total score-by-visit interaction.
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Timepoint [7]
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Baseline, Week 104
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Secondary outcome [8]
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Pharmacodynamics (PD): Percent Change From Baseline in Concentration of Cerebrospinal Fluid (CSF) Biomarker Amyloid Beta (Aß)1-42
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Assessment method [8]
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Concentration of the peptide Aß 1-42 in plasma measured by validated immunoassay. LS Mean was determined by Analysis of covariance (ANCOVA) with last observation carried forward (LOCF), terms for treatment, baseline biomarker and age at baseline.
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Timepoint [8]
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Baseline, Week 97
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Secondary outcome [9]
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PD: Percent Change From Baseline in Concentration of CSF Biomarker Aß1-40
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Assessment method [9]
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Concentration of the peptide Aß 1-40 in plasma measured by immunoassay. LS Mean was determined by ANCOVA with LOCF (last observation carried forward), terms for treatment, baseline biomarker and age at baseline.
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Timepoint [9]
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Baseline, Week 97
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Secondary outcome [10]
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Change From Baseline in CSF Total Tau
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Assessment method [10]
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Cerebrospinal fluid samples are collected for analysis of concentration total tau. LS Mean was determined by ANCOVA with LOCF and with factors for treatment, disease status at baseline, baseline biomarker and age at baseline.
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Timepoint [10]
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Baseline, Week 97
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Secondary outcome [11]
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Change From Baseline in CSF Phosphorylated Tau
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Assessment method [11]
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Cerebrospinal fluid samples are collected for analysis of concentrations of phosphorylated tau. LS Mean was determined by ANCOVA with LOCF and with factors for treatment, disease status at baseline, baseline biomarker and age at baseline.
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Timepoint [11]
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Baseline, Week 97
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Secondary outcome [12]
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Change From Baseline in Brain Amyloid Burden Using Florbetapir Amyloid Positron Emission Tomography (PET) Scan
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Assessment method [12]
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Amyloid deposition in the brain is one of the defining neuropathologic findings of Alzheimer's disease. Florbetapir exhibits high affinity specific binding to amyloid plaques. The change from baseline was measured as average standard uptake value ratio (SUVr) in prespecified regions of interest (ROI) assessed by florbetapir amyloid PET imaging in a subset of participants. The Centiloid scale standardizes quantitative brain amyloid PET results to allow cross-tracer and cross-methodology comparisons. The Centiloid scale anchor points are 0 and 100, where 0 represents a high-certainty amyloid negative scan and 100 represents the amount of global amyloid deposition found in a typical AD scans. Florbetapir SUVr was converted to the Centiloid scale using the following conversion: Florbetapir Centiloids = 183 x SUVr - 177. LS Mean was determined by ANCOVA methodology with factors for treatment, disease status at baseline, baseline biomarker and age at baseline.
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Timepoint [12]
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Baseline, Week 104
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Secondary outcome [13]
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Change From Baseline in Tau PET ((Flortaucipir F18)
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Assessment method [13]
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Tau PET tracer (flortaucipir F18) longitudinal study measured whether lanabecestat, in participants with mild AD dementia, affected tau density and distribution over time. The outcome reported is the composite summary of the standard uptake value ratio (SUVR) normalized to the signal intensity in white matter. Annualized change is derived as change at LOCF divided by (LOCF date - baseline date) multiplied by 365. LS Mean was determined by ANCOVA methodology with factors for treatment, disease status at baseline, baseline biomarker and age at baseline. Baseline defined to be within 28 days of starting study drug.
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Timepoint [13]
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Baseline, Week 104
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Secondary outcome [14]
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Change From Baseline in Brain Metabolism Using Fluorodeoxyglucose (FDG)
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Assessment method [14]
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Fluorodeoxyglucose (FDG) PET evaluates the regional brain metabolic rates for glucose as a sensitive, in vivo metabolic index of brain function. The outcome reported is the composite summary of the standard uptake value ratio (SUVR) normalized to the pons + vermis assessed with composite meta and composite meta automated anatomical labeling atlas (ALL). Annualized change is derived as change at LOCF divided by (LOCF date - baseline date) multiplied by 365. LS Mean was determined by ANCOVA methodology with factors for treatment, disease status at baseline, baseline biomarker and age at baseline. Baseline defined to be within 28 days of starting study drug.
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Timepoint [14]
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Baseline, Week 104
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Secondary outcome [15]
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Change From Baseline in Whole Brain Volume
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Assessment method [15]
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Magnetic resonance imaging (MRI) was used to evaluate the effect of lanabecestat on whole brain volumes. Annualized change is derived as change at LOCF divided by (LOCF date - baseline date) multiplied by 365. LS Mean was determined by ANCOVA methodology with factors for treatment, baseline vMRI, intracranial volume, disease status at baseline and age at baseline.
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Timepoint [15]
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Baseline, Week 104
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Secondary outcome [16]
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Pharmacokinetics (PK): Plasma Concentration of Lanabecestat
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Assessment method [16]
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Timepoint [16]
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Week 4, post dose prior to departure from the clinic
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Eligibility
Key inclusion criteria
- Gradual and progressive change in the participant's memory function over more than 6
months, reported by participant and study partner
- Mini-Mental State Examination score of 20-30 inclusive at screening
- Objective impairment in memory as evaluated by memory test performed at screening
- For a diagnosis of mild Alzheimer's Disease (AD), participant meets the National
Institute on Aging and the Alzheimer's Association (NIA-AA) criteria for probable AD
- For a diagnosis of MCI due to AD, participant meets NIA-AA criteria for MCI due to AD
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Minimum age
55
Years
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Maximum age
85
Years
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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
- Significant neurological disease affecting the central nervous system, other than AD,
that may affect cognition or ability to complete the study, including but not limited
to, other dementias, serious infection of the brain, Parkinson´s disease, or epilepsy
or recurrent seizures
- History of clinically evident stroke, or multiple strokes based on history or imaging
results
- History of clinically important carotid or vertebrobasilar stenosis or plaque
- History of multiple concussions with sustained cognitive complaints or objective
change in neuropsychological function in the last 5 years
- Participants with a current Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition diagnosis of Major Depressive Disorder or any current primary
psychiatric diagnosis other than AD if, in the judgment of the investigator, the
psychiatric disorder or symptom is likely to confound interpretation of drug effect,
affect cognitive assessments, or affect the participant´s ability to complete the
study
- History of alcohol or drug abuse or dependence (except nicotine dependence) within 2
years before the screening
- Within 1 year before the screening or between screening and baseline, any of the
following: myocardial infarction; moderate or severe congestive heart failure, New
York Heart Association class III or IV; hospitalization for, or symptom of, unstable
angina; syncope due to orthostatic hypotension or unexplained syncope; known
significant structural heart disease (eg, significant valvular disease, hypertrophic
cardiomyopathy), or hospitalization for arrhythmia
- Congenital QT prolongation
- History of cancer within the last 5 years, with the exception of non-metastatic basal
and/or squamous cell carcinoma of the skin, in situ cervical cancer, non-progressive
prostate cancer or other cancers with low-risk of recurrence or spread
- Current serious or unstable clinically important systemic illness that, in the
judgment of the investigator, is likely to affect cognitive assessment, deteriorate,
or affect the participant's safety or ability to complete the study, including
hepatic, renal, gastroenterologic, respiratory, cardiovascular, endocrinologic,
immunologic, or hematologic disorders
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Study design
Purpose of the study
Treatment
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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)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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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 analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 2/Phase 3
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Terminated
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
30/09/2014
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
4/10/2018
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Sample size
Target
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Accrual to date
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Final
2218
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Recruitment in Australia
Recruitment state(s)
NSW,QLD,SA,VIC,WA
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Recruitment hospital [1]
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Southern Neurology - Kogarah
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Recruitment hospital [2]
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Griffith University - Gold Coast
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Royal Adelaide Hospital - Adelaide
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Recruitment hospital [4]
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Box Hill Hospital - Box Hill
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Recruitment hospital [5]
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Delmont Private Hospital - Glen Iris
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Recruitment hospital [6]
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Heidelberg Repatriation Hospital - Heidelberg
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Recruitment hospital [7]
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The Florey Institute of Neuroscience and Mental Health - Parkville
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Recruitment hospital [8]
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Australian Alzheimer's Research Foundation - Nedlands
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Recruitment hospital [9]
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Neuro Trials Victoria Pty Ltd - Noble Park
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Recruitment postcode(s) [1]
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2217 - Kogarah
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Recruitment postcode(s) [2]
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4222 - Gold Coast
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Recruitment postcode(s) [3]
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5000 - Adelaide
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Recruitment postcode(s) [4]
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3128 - Box Hill
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Recruitment postcode(s) [5]
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3146 - Glen Iris
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3081 - Heidelberg
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Recruitment postcode(s) [7]
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3052 - Parkville
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Recruitment postcode(s) [8]
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6009 - Nedlands
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Recruitment postcode(s) [9]
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3174 - Noble Park
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Recruitment outside Australia
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United States of America
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Arizona
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California
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Colorado
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Connecticut
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District of Columbia
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Florida
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Georgia
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Illinois
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Indiana
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Massachusetts
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Mississippi
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Edegem
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Canada
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Nova Scotia
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Canada
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Ontario
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Canada
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Qubec
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Cedex 9
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Nantes
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Toulouse
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Villeurbanne
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Bayern
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Niedersachsen
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Germany
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Germany
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Sachsen
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Germany
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Thüringen
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Germany
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Berlin
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Hungary
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Baranya
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Hungary
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Budapest
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Hungary
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Debrecen
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Hungary
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Szeged
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Italy
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Biella
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Italy
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Milano
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Italy
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Palermo
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Italy
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PI
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Italy
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Ancona
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Italy
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Brescia
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Italy
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Chieti
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Italy
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Genova
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Italy
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Modena
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Italy
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Roma
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Italy
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Torino
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Japan
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Aichi
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Japan
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Chiba
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Japan
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Hokkaido
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Japan
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Ibaraki
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Japan
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Iwate
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Japan
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Kanagawa
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Japan
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Kyoto
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Japan
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Nagano
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Japan
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Okayama
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Japan
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Okinawa
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Japan
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Osaka
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Japan
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Saitama
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Japan
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Tokyo
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Japan
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Toyama
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Japan
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Fukuoka
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Korea, Republic of
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Busan
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Korea, Republic of
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Geonggi-do
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Korea, Republic of
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Gyeonggi-do
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Korea, Republic of
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Gyeonggido
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Korea, Republic of
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Incheon
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Korea, Republic of
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Seoul
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Poland
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Dolnoslaskie
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Lódzkie
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Podlaskie
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Poland
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Bydgoszcz
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Poland
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Katowice
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Poland
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Kielce
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Poland
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Krakow
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Poland
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Lublin
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Poland
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Siemianowice Slaskie
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Poland
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Warszawa
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Puerto Rico
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Bayamon
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Carolina
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San Juan
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Romania
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Bucuresti
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Romania
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Timisoara
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Spain
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Alicante
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Spain
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Barcelona
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Spain
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Caceres
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Getafe
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Spain
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Madrid
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Spain
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Vizcaya
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Spain
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Cordoba
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Spain
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Palma de Mallorca
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Spain
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Reus
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Spain
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San Sebastian
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Spain
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Valencia
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United Kingdom
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Devon
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United Kingdom
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East Sussex
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United Kingdom
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Hampshire
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United Kingdom
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Lancs
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United Kingdom
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Leeds
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United Kingdom
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Staffordshire
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United Kingdom
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Brentford
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United Kingdom
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Glasgow
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United Kingdom
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London
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United Kingdom
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Manchester
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Funding & Sponsors
Primary sponsor type
Commercial sector/Industry
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Name
AstraZeneca
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Other collaborator category [1]
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Commercial sector/Industry
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Eli Lilly and Company
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Ethics approval
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Summary
Brief summary
The purpose of this study is to assess the efficacy and safety of lanabecestat compared with
placebo administered for 104 weeks in the treatment of early Alzheimer´s disease. The study
will test the hypothesis that lanabecestat is a disease-modifying treatment for participants
with early Alzheimer´s disease, defined as the continuum of participants with mild cognitive
impairment (MCI) due to Alzheimer´s disease and participants diagnosed with mild dementia of
the Alzheimer´s type, as measured by change from baseline on the 13-item Alzheimer's Disease
Assessment Scale - Cognitive Subscale (ADAS-Cog13) score at week 104 in each of the 2
lanabecestat treatment groups compared with placebo.
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Trial website
https://clinicaltrials.gov/ct2/show/NCT02245737
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Public notes
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Contacts
Principal investigator
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Call 1-877-CTLILLY (1-877-285-4559) or 1-317-615-4559 Mon- Fri 9 AM - 5 PM Eastern time (UTC/GMT - 5 hours, EST)
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Eli Lilly and Company
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Summary Results
For IPD and results data, please see
https://clinicaltrials.gov/ct2/show/NCT02245737
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