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    Summary
    EudraCT Number:2012-002843-11
    Sponsor's Protocol Code Number:BAN2401-G000-201
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Temporarily Halted
    Date on which this record was first entered in the EudraCT database:2013-03-06
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2012-002843-11
    A.3Full title of the trial
    A Placebo-controlled, Double-blind, Parallel-group, Bayesian Adaptive Randomization Design and Dose Regimen-finding Study to Evaluate Safety, Tolerability and Efficacy of BAN2401 in Subjects With Early Alzheimer’s Disease
    Studio controllato con placebo, in doppio cieco, a gruppi paralleli, con disegno randomizzato adattivo Bayesiano, di determinazione del regime posologico, condotto per valutare la sicurezza, la tollerabilità e l'efficacia di BAN2401 in soggetti affetti da malattia di Alzheimer a esordio precoce
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase 2 clinical study to investigate the effects of BAN2401 in patients with early Alzheimer's Disease
    Studio clinico di fase 2 per valutare gli effetti di BAN2401 in pazienti con malattia di Alzheimer a esordio precoce.
    A.3.2Name or abbreviated title of the trial where available
    Athena AD
    Athena AD
    A.4.1Sponsor's protocol code numberBAN2401-G000-201
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorEisai Limited
    B.1.3.4CountryUnited Kingdom
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportEisai Limited
    B.4.2CountryUnited Kingdom
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationEisai Limited
    B.5.2Functional name of contact pointMedical Information
    B.5.3 Address:
    B.5.3.1Street AddressMosquito Way
    B.5.3.2Town/ cityHatfield
    B.5.3.3Post codeAL10 9SN
    B.5.3.4CountryUnited Kingdom
    B.5.4Telephone number+44 0845 676 1400
    B.5.5Fax number+44 0845 676 1486
    B.5.6E-mailLMedInfo@eisai.net
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameBAN2401
    D.3.2Product code BAN2401
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPNot mentioned (Noncurrent)
    Intravenous use
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product Yes
    D.3.11.13.1Other medicinal product typeMonoclonal Antibody.
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboSolution for injection
    D.8.4Route of administration of the placeboIntravenous use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Mild cognitive impairment due to Alzheimer's disease or mild Alzheimer's dementia
    lieve deficit cognitivo causato da malattia di Alzheimer o demenza di Alzheimer lieve.
    E.1.1.1Medical condition in easily understood language
    Mild cognitive impairment or mild dementia caused by Alzheimer's disease which results in progressive memory loss, reasoning, language and other mental abilities.
    lieve deficit cognitivo o demenza lieve causata dal morbo di Alzheimer che porta a progressiva perdita di memoria, capacità di ragionamento, linguaggio e altre abilità mentali.
    E.1.1.2Therapeutic area Diseases [C] - Nervous System Diseases [C10]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 14.1
    E.1.2Level HLT
    E.1.2Classification code 10001897
    E.1.2Term Alzheimer's disease (incl subtypes)
    E.1.2System Organ Class 100000004852
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    1. To evaluate the efficacy of BAN2401 compared to placebo by establishing the ED90 (as defined in the protocol) for BAN2401 on the derived Composite Clinical Score at 12 months of treatment in subjects with Early Alzheimer’s Disease (EAD), defined as mild cognitive impairment (MCI) due to Alzheimer’s disease (AD) – intermediate likelihood or mild Alzheimer’s dementia.
    2. To assess the safety and tolerability of 3 doses and 2 dose regimens of BAN2401 in subjects with EAD.
    1.Valutare l'efficacia di BAN2401 rispetto al placebo stabilendo il valore ED90 (definito nel protocollo) per BAN2401 sul punteggio clinico composito ottenuto a 12 mesi di trattamento in soggetti affetti da malattia di Alzheimer a esordio precoce (Early Alzheimer’s Disease, EAD), definita come deterioramento cognitivo lieve (mild cognitive impairment, MCI) causato dalla malattia di Alzheimer (Alzheimer’s disease, AD) – potenzialmente di grado intermedio - demenza di Alzheimer di grado lieve.
    2.Valutare la sicurezza e la tollerabilità di 3 dosi e 2 regimi posologici di BAN2401 in soggetti affetti da EAD.
    E.2.2Secondary objectives of the trial
    1. To evaluate the effect of BAN2401 compared to placebo on the derived Composite Clinical Score following 18 months of treatment in subjects with EAD.
    2. To evaluate the potential disease-modifying effects of BAN2401 compared to placebo on total hippocampal atrophy at 6, 12, and 18 months of treatment in subjects with EAD as measured by total hippocampal volume using volumetric magnetic resonance imaging (vMRI).
    3. To evaluate the potential disease-modifying effects of BAN2401 compared to placebo on brain amyloid levels at 12 and 18 months of treatment in subjects with EAD as measured by amyloid positron emission tomography (PET).
    1.Valutare gli effetti di BAN2401 rispetto al placebo sul Punteggio clinico composito derivato a 18 mesi di trattamento in soggetti affetti da EAD.
    2.Valutare i potenziali effetti modificanti la malattia di BAN2401 rispetto al placebo sull'atrofia ippocampale totale a 6, 12 e 18 mesi di trattamento in soggetti affetti da EAD, tramite misurazione del volume ippocampale totale per mezzo di risonanza magnetica volumetrica (RMv).
    3.Valutare i potenziali effetti modificanti la malattia di BAN2401 rispetto al placebo sui livelli cerebrali di amiloide a 12 e 18 mesi di trattamento in soggetti affetti da EAD, rilevati tramite tomografia a emissione di positroni (positron emission tomography, PET).
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Mild Cognitive Impairment due to Alzheimer’s Disease – Intermediate Likelihood:
    1. Subjects who meet the National Institute of Aging – Alzheimer’s Association (NIA-AA) core clinical criteria for mild cognitive impairment due to Alzheimer’s disease
    2. Subjects who have a CDR score of 0.5 and a Memory Box score of 0.5 or greater at Screening and Baseline
    3. Subjects who report a history of subjective memory decline with gradual onset and slow progression over the last one year before Screening; MUST be corroborated by an informant
    4. Subjects with objective impairment in episodic memory as indicated by 1-1.5 standard deviations below age-adjusted mean in the WMS-IV LMII, as follows:
    a) 11-15 for age 50 to 64 years
    b) 9-12 for age 65 to 69 years
    c) 8-11 for age 70 to 74 years
    d) 6-9 for age 75 to 79 years
    e) 4-7 for age 80 to 90 years
    Mild Alzheimer’s Dementia:
    5. Subjects who meet the NIA-AA core clinical criteria for probable Alzheimer’s dementia
    6. Subjects who have a CDR score of 0.5-1.0 and a Memory Box score of 0.5 or greater at Screening and Baseline
    Key Inclusion Criteria that must be met by ALL Subjects:
    7. Positive amyloid load as indicated by PET assessment of imaging agent uptake into brain
    8. Male or female subjects aged between 50 and 90 years, inclusive
    9. MMSE score equal to or greater than 22, and equal to or less than 30, at Screening and Baseline
    10. Body Mass Index (BMI) < 35 at Screening
    11. Females must not be lactating or pregnant at Screening or Baseline (as documented by a negative beta-human chorionic gonadotropin assay [ß-hCG]. A separate baseline assessment is required if a negative screening pregnancy test was obtained more than 72 hours before the first dose of study drug.
    12. All females will be considered to be of childbearing potential unless they are postmenopausal (amenorrheic for at least 12 consecutive months, in the appropriate age group, and without other known or suspected cause) or have been sterilized surgically (i.e., bilateral tubal ligation, total hysterectomy, or bilateral
    oophorectomy, all with surgery at least 1 month before dosing).
    13. Females of childbearing potential must not have had unprotected sexual intercourse within 30 days before study entry and must agree to use a highly effective method of contraception (e.g., total abstinence, an intrauterine device, a double-barrier method [such as condom plus diaphragm with spermicide], a contraceptive implant, an oral contraceptive, or have a vasectomized partner with confirmed azoospermia) throughout the entire study period and for 35 days after study drug discontinuation. If currently abstinent, the subject must agree to use a double-barrier method as described above if she becomes sexually active during the study period and for 35 days after study drug discontinuation. Females who are using hormonal
    contraceptives must have been on a stable dose of the same hormonal contraceptive product for at least 4 weeks before dosing and must continue to use the same contraceptive during the study and for 35 days after study drug discontinuation.
    14. Subjects who are receiving an anticholinesterase inhibitor and/or memantine for AD must be on a stable dose for at least 12 weeks prior to Baseline. Treatment-naïve subjects for AD can be entered into the study. Unless otherwise stated, subjects must have been on stable doses of all other permitted concomitant medications (i.e., non-AD related) for at least 4 weeks prior to Screening.
    15. Must have an identified caregiver/informants (defined as an informant or person able to support the subject for the duration of the study and who spends at least 8 hours per week with the subject). In addition this person must be willing and able to provide follow-up information on the subject throughout the course of the study. This person must, in the opinion of the investigator, spend sufficient time with the study subject on a regular basis such that the caregiver/informant can reliably fulfill the study requirements. A permanent caregiver/informant need not be living in the same residence with the subject. For such a caregiver/informant not residing with the subject, the investigator has to be satisfied that the subject can contact the caregiver/informant readily during the times when the caregiver/informant is not with the subject. If in doubt about whether a subject's care arrangements are suitable for inclusion, the investigator should discuss this with the medical monitor. Caregivers/informants need only to be present at visits where clinical assessment of CDR and FAQ takes place.
    16. Provide written informed consent
    17. Willing and able to comply with all aspects of the protocol
    Diagnosi
    Deterioramento cognitivo lieve causato da malattia di Alzheimer – potenzialmente di grado intermedio:
    1.Soggetti che soddisfano i criteri clinici fondamentali del National Institute of Aging - Alzheimer’s Association (NIA-AA) per deterioramento cognitivo lieve causato da malattia di Alzheimer – potenzialmente di grado intermedio.
    2.Soggetti che presentano un punteggio CDR di 0,5 e un punteggio nella casella mnemonica di 0,5 o superiore allo screening e al basale.
    3.Soggetti che riferiscono un'anamnesi di declino soggettivo della memoria a insorgenza graduale e con lenta progressione nell'arco dell'ultimo anno precedente lo screening. DEVE essere confermata da un informatore.
    4.Soggetti con deterioramento oggettivo della memoria episodica, indicata da deviazioni standard sotto la media adattata all'età di 1-1,5 sulla WMS-IV LMII:
    a)11-15 per un'età compresa tra 50 e 64 anni
    b)9-12 per un'età compresa tra 65 e 69 anni
    c)8-11 per un'età compresa tra 70 e 74 anni
    d)6-9 per un'età compresa tra 75 e 79 anni
    e)4-7 per un'età compresa tra 80 e 90 anni
    Demenza di Alzheimer di grado lieve:
    5.Soggetti che soddisfano i criteri clinici fondamentali NIA-AA per probabile AD.
    6.Soggetti che presentano un punteggio CDR di 0,5 - 1,0 e un punteggio nella casella mnemonica di 0,5 o superiore allo screening e al basale.
    Criteri di inclusione chiave che devono essere soddisfatti da TUTTI i soggetti:
    7.Carico di amiloide positivo, indicato dall'assorbimento dell'agente diagnostico per immagini nel cervello, valutato tramite PET.
    8.Soggetti di sesso maschile o femminile di età compresa tra 50 e 90 anni compresi.
    9.Punteggio MMSE pari o superiore a 22 e pari o inferiore a 30, allo screening e al basale.
    10.Indice di massa corporea (IMC) < 35 allo screening.
    11.Le donne non devono essere in allattamento o in stato di gravidanza allo screening o al basale (stato documentato da un'analisi della gonadotropina β-corionica umana [ß-hCG] negativa). Se è stato ottenuto un test di gravidanza negativo allo screening oltre 72 ore prima dell'assunzione della prima dose del farmaco in studio, è necessaria una valutazione basale separata.
    12.Tutte le donne saranno considerate fertili salvo che siano in postmenopausa (amenorreiche da almeno 12 mesi consecutivi, nella fascia di età appropriata, e in assenza di altra causa nota o sospetta) o siano state sterilizzate chirurgicamente (ad es. sottoposte a legatura bilaterale delle tube, isterectomia totale od ovariectomia bilaterale, tutte con intervento chirurgico avvenuto almeno 1 mese prima della somministrazione).
    13.Le donne fertili non devono aver praticato attività sessuale non protetta nei 30 giorni che precedono l'ingresso nello studio e devono acconsentire ad adottare un metodo contraccettivo altamente efficace (ad es. astinenza totale, un dispositivo intrauterino, un metodo a doppia barriera [quale profilattico più diaframma con spermicida], un impianto contraccettivo, un contraccettivo orale, o che abbiano un compagno sottoposto a vasectomia con azoospermia confermata) per l'intera durata dello studio e per 35 giorni dopo l'interruzione del farmaco in studio. Qualora attualmente si astenga da rapporti sessuali, il soggetto deve acconsentire all'uso di un metodo a doppia barriera, tra quelli descritti sopra, nel caso divenisse sessualmente attivo durante il periodo dello studio e per 35 giorni dopo la sospensione del farmaco in studio. Le donne che utilizzano contraccettivi ormonali devono aver assunto una dose stabile del medesimo contraccettivo orale per almeno 4 settimane prima della somministrazione e continuarne l'utilizzo durante lo studio e per 35 giorni dopo l'interruzione del farmaco in studio.
    14.I soggetti che ricevono inibitori dell'anticolinesterasi e/o memantina per l'AD devono assumerne una dose stabile per almeno 12 settimane prima del basale. I soggetti naïve al trattamento dell'AD possono essere arruolati nello studio. Salvo ove diversamente indicato, i soggetti devono aver assunto dosi stabili di tutti gli altri farmaci concomitanti consentiti (ad es. non correlati all'AD) per almeno 4 settimane prima dello screening.
    E.4Principal exclusion criteria
    1. Any neurological condition that may be contributing to cognitive impairment above and beyond that caused by the subject’s AD
    2. History of transient ischemic attacks, stroke, or seizures within 12 months of Screening
    3. Any psychiatric diagnosis or symptoms, (e.g., hallucinations, major depression, or delusions) that could interfere with study procedures in the subject
    4. GDS score ≥ 8 at Screening
    5. Evidence of other clinically significant lesions that could indicate a dementia diagnosis other than AD on brain MRI at Screening. All MRIs will be acquired using a standardized procedure that will be outlined in the Imaging Charter and Imaging Acquisition Guidelines (IAG) and will be read by an approved centralized reader.
    6. Other significant pathological findings on brain MRI at Screening, including but not limited to: more than 4 micro-hemorrhages (defined as 10 mm or less at the greatest diameter); a single macro-hemorrhage greater than 10 mm at greatest diameter; an area of superficial siderosis; evidence of vasogenic edema; evidence of cerebral contusion, encephalomalacia, aneurysms, vascular malformations, infective lesions, evidence of multiple lacunar infarcts or stroke involving a major vascular territory, severe small vessel, or white matter disease or space occupying lesions (e.g., arachnoid cysts) or brain tumors (e.g., meningioma)
    7. Hypersensitivity to BAN2401 or any of the excipients, or to any monoclonal antibody treatment
    8. Any immunological disease which is not adequately controlled, or which requires treatment with biologic drugs during the study
    9. Subjects with a bleeding disorder that is not under adequate control (including a platelet count <50,000 or INR >1.5)
    10. For subjects not taking thyroid hormone, free triiodothyronine (T3), free thyroxine (T4), or thyroid stimulating hormone (TSH) outside the normal range. For subjects taking thyroid hormone, free T3 or free T4 outside the normal range, or TSH above the upper limit of normal (ULN) at Screening
    11. Abnormally low serum Vitamin B12 levels for the testing laboratory (if subject is taking Vitamin B12 injections, level should be at or above the lower limit of normal [LLN] for the testing laboratory).
    12. A prolonged QT/QTc interval (QTc > 450 ms) as demonstrated by a repeated electrocardiogram (ECG)
    13. Known to be human immunodeficiency virus (HIV) positive
    14. Any other clinically significant abnormalities in physical examination, vital signs, laboratory tests or ECG at Screening or Baseline which in the opinion of the principal investigator (PI), require further investigation or treatment or which may interfere with study procedures or safety
    15. Uncontrolled Type 1 or Type 2 diabetes mellitus. Evidence of uncontrolled diabetes mellitus includes hemoglobin A1c (HbA1c) > 9%.
    16. Uncontrolled hypertension with a history of blood pressure consistently above 165/100 mm Hg at Screening
    17. History of uncontrolled cardiovascular disease within 6 months of Screening, including acute coronary syndrome, clinically significant valvular heart disease, uncompensated heart failure (New York Heart Association [NYHA] Class III and Class IV), or uncontrolled arrhythmia
    18. Subjects with malignant neoplasms within 3 years of Screening (except for basal or squamous cell carcinoma in situ of the skin, or localized prostate cancer in male subjects). Subjects who had malignant neoplasms but who have had at least 3 years of documented uninterrupted remission before Screening need
    not be excluded.
    19. Has a “yes” answer to Columbia Suicide Severity Rating Scale (C-SSRS) suicidal ideation type 4 or 5, or any suicidal behavior assessment within 6 months before Screening, at Screening, or at the Baseline Visit, or has been hospitalized or treated for suicidal behavior in the past 5 years before Screening
    20. Known or suspected history of drug or alcohol abuse or dependence within 2 years before Screening or a positive urine drug test at Screening. Subjects who test positive for benzodiazepines or opioids in urine drug testing need not be excluded if in the clinical opinion of the investigator, this is due to the subject taking prior/concomitant medications containing benzodiazepines or opioids for a medical condition and
    not due to drug abuse.
    21. Any other medical conditions (e.g., cardiac, respiratory, gastrointestinal, renal disease) which are not stably controlled, or which in the opinion of the investigator(s) could affect the subject’s safety or interfere with the study assessments
    22. Participation in a clinical study involving any therapeutic monoclonal antibody, protein derived from a monoclonal antibody, immunoglobulin therapy, or vaccine within 1 year before Screening
    23. Participation in a clinical study involving any new chemical entities for AD within 6 months prior to Screening unless it can be documented that the subject was in a placebo treatment arm
    1.Qualsiasi condizione neurologica potenzialmente in grado di contribuire al deterioramento cognitivo di cui sopra e altre, causata dall'AD da cui è affetto il soggetto.
    2.Anamnesi di attacchi ischemici transitori (transient ischemic attacks, TIA), ictus o crisi convulsive nei 12 mesi che precedono lo screening.
    3.Eventuali diagnosi o sintomi psichiatrici (ad es. allucinazioni, depressione grave o fissazioni) del soggetto, potenzialmente in grado di interferire con le procedure dello studio.
    4.Punteggio GDS ≥ 8 allo screening
    5.Controindicazioni alla risonanza magnetica, tra cui pacemaker o defibrillatore cardiaco, impianti metallici ferromagnetici, come ad es. dispositivi all'interno del cranio o cardiaci diversi da quelli approvati e considerati sicuri per l'uso all'interno degli scanner per RM.
    6.Presenza di altre lesioni clinicamente significative potenzialmente indicative di una diagnosi di demenza diversa dall'AD evidenziate da RM del cervello allo screening. Tutte le risonanze magnetiche saranno acquisite mediante una procedura standardizzata delineata nell'apposito documento di riferimento e nelle Linee guida per l'acquisizione di immagini (Imaging Acquisition Guideline, IAG) e interpretate da un lettore centralizzato approvato.
    7.Altri referti patologici significativi emersi dalla RM cerebrale allo screening, compresi, ma non in modo esaustivo: oltre 4 microemorragie (ovvero con un diametro massimo pari o inferiore a 10 mm); una singola macroemorragia con un diametro massimo pari o superiore a 10 mm; un'area di siderosi superficiale; evidenza di edema vasogenico, evidenza di contusione cerebrale, encefalomalacia, aneurismi, malformazioni vascolari o lesioni infettive; evidenza di infarti lacunari multipli o ictus che coinvolgono un considerevole territorio vascolare, vasi sanguigni gravemente ristretti o malattia della sostanza bianca; lesioni invasive (ad es. cisti aracnoidee) o tumori cerebrali (ad es. meningioma).
    8.Ipersensibilità a BAN2401 o a uno qualsiasi degli eccipienti o a qualsiasi trattamento a base di anticorpi monoclonali.
    9.Eventuali malattie immunologiche non controllate adeguatamente o che richiedono un trattamento a base di farmaci biologici durante lo studio.
    10.Soggetti affetti da un disturbo emorragico non adeguatamente controllato (compresa una conta piastrinica < 50.000 o INR > 1,5).
    11.Per i soggetti che non assumono ormoni tiroidei, triiodotironina libera (T3), tiroxina libera (T4) o ormone tireostimolante (thyroid stimulating hormone, TSH) al di fuori dell'intervallo normale. Per i soggetti che assumono ormoni tiroidei, T3 o T4 liberi al di fuori dell'intervallo normale o TSH oltre il limite superiore dell'intervallo normale (upper limit of normal, ULN) allo screening.
    12.Livelli di vitamina B12 nel siero eccessivamente bassi per le analisi di laboratorio (se il soggetto sta assumendo vitamina B12 sotto forma di iniezioni, il livello deve essere pari o superiore al limite inferiore dell'intervallo normale [lower limit of normal, LLN] per le analisi di laboratorio).
    13.Un prolungamento dell'intervallo QT/QTc (QTc > 450 ms), comprovato dalla ripetizione di un elettrocardiogramma (ECG).
    14.Positività nota al virus dell’immunodeficienza umana (HIV).
    15.Qualsiasi altra anomalia clinica significativa emersa in occasione dell'esame obiettivo, nei parametri vitali, nelle analisi di laboratorio o nell'ECG allo screening o al basale che, a parere dello sperimentatore, richieda ulteriori indagini o trattamento, o che potrebbe interferire con le procedure o la sicurezza dello studio.
    16.Diabete mellito di tipo 1 o 2 non controllato. L'evidenza di diabete mellito non controllato comprende un livello di emoglobina A1c (HbA1c) pari a > 9%.
    17.Ipertensione non controllata con anamnesi di pressione arteriosa costantemente superiore a 165/100 mm Hg allo screening.
    18.Anamnesi di malattia cardiovascolare non controllata nei 6 mesi che precedono lo screening, tra cui sindrome coronarica acuta, malattia delle valvole cardiache clinicamente significativa, insufficienza cardiaca scompensata (classe III e IV secondo i criteri della New York Heart Association [NYHA]) o aritmia non controllata.
    19.Soggetti affetti da neoplasie maligne nei 3 anni che precedono lo screening (ad eccezione di carcinoma cutaneo squamocellulare o basocellulare in situ o di carcinoma prostatico localizzato nei soggetti di sesso maschile). I soggetti precedentemente affetti da neoplasie maligne con almeno 3 anni di remissione ininterrotta documentata prima dello screening non devono necessariamente essere esclusi.
    20.Ha risposto con "sì" alla Scala per la valutazione della gravità dell'ideazione suicidaria di tipo 4 o 5 (Columbia Suicide Severity Rating Scale, C-SSRS), o a qualsiasi valutazione del comportamento suicidario nei
    E.5 End points
    E.5.1Primary end point(s)
    • Change from baseline in the derived Composite Clinical Score.
    variazione rispetto al basale del punteggio composito derivato
    E.5.1.1Timepoint(s) of evaluation of this end point
    At 12 months only.
    a 12 mesi di trattamento
    E.5.2Secondary end point(s)
    • Change from baseline in the derived Composite Clinical Score at 18 months.
    • Change from baseline in total hippocampal volume at 6, 12, and 18 months using vMRI.
    • Change from baseline at 12 and 18 months in brain amyloid levels as measured by amyloid PET.
    •Variazione rispetto al basale del Punteggio clinico composito derivato a 18 mesi.
    •Variazione rispetto al basale del volume ippocampale totale a 6, 12 e 18 mesi rilevata
    tramite RMv.
    •Variazione rispetto al basale dei livelli di amiloide nel cervello a 12 e 18 mesi, rilevata tramite PET dell'amiloide.
    E.5.2.1Timepoint(s) of evaluation of this end point
    The Composite Clinical Score at 18 months, vMRI at 6, 12, and 18 months. Amyloid PET at 12 and 18 months.
    • il punteggio clinico composito derivato a 18 mesi
    • RMv a 6, 12 e 18 mesi
    • PET dell'amiloide a 12 e 18 mesi
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Tolerability and Immunogenicity.
    tollerabilità e immunogenicità.
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other Yes
    E.8.1.7.1Other trial design description
    randomizzazione adattiva bayesiana
    Bayesian Adaptive Randomization
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial6
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned7
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA47
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Canada
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months2
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months5
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 300
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 500
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state51
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 300
    F.4.2.2In the whole clinical trial 800
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    Subjects will continue with standard care / treatments for Alzheimer's disease under the care of their own physician, according to applicable local and national clinical guidelines.
    i soggetti continueranno con la terapia standard/trattamento per il morbo di Alzheimer come da indicazione del loro medico curante secondo le linee guida locali.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2013-04-26
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2013-03-19
    P. End of Trial
    P.End of Trial StatusTemporarily Halted
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