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    Clinical Trial Results:
    Randomised, double-blind, parallel-group, placebo-controlled, fixed-dose study of Lu AE58054 in patients with mild-moderate Alzheimer’s disease treated with donepezil

    Summary
    EudraCT number
    2012-004764-22
    Trial protocol
    GB   EE   IT   LT   PT   FI   IE   HU   HR   CZ  
    Global end of trial date
    19 Dec 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    04 Jan 2018
    First version publication date
    04 Jan 2018
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    14862A STARBEAM
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02006641
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    H. Lundbeck A/S
    Sponsor organisation address
    Ottiliavej 9, Valby, Denmark, 2500
    Public contact
    lundbeckclinicaltrials@lundbeck.com, H. Lundbeck A/S, lundbeckclinicaltrials@lundbeck.com
    Scientific contact
    lundbeckclinicaltrials@lundbeck.com, H. Lundbeck A/S, lundbeckclinicaltrials@lundbeck.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    19 Dec 2016
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    19 Dec 2016
    Global end of trial reached?
    Yes
    Global end of trial date
    19 Dec 2016
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To establish the efficacy of idalopirdine as adjunctive therapy to donepezil for symptomatic treatment of patients with mild-moderate Alzheimer’s disease (AD).
    Protection of trial subjects
    The trial was conducted in accordance with the Declaration of Helsinki (2013) and ICH Good Clinical Practice (1996)
    Background therapy
    The study consisted of a screening period (up to 2-week period from screening to randomization), a 24-week double-blind treatment period with placebo or idalopirdine 10 mg/day or 30 mg/day as adjunctive therapy to donepezil 10 mg/day, and a 4-week safety follow-up period following study completion or withdrawal from treatment.
    Evidence for comparator
    -
    Actual start date of recruitment
    14 Jan 2014
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 88
    Country: Number of subjects enrolled
    Portugal: 15
    Country: Number of subjects enrolled
    United Kingdom: 83
    Country: Number of subjects enrolled
    Croatia: 16
    Country: Number of subjects enrolled
    Czech Republic: 48
    Country: Number of subjects enrolled
    Estonia: 51
    Country: Number of subjects enrolled
    Finland: 13
    Country: Number of subjects enrolled
    France: 37
    Country: Number of subjects enrolled
    Hungary: 15
    Country: Number of subjects enrolled
    Italy: 66
    Country: Number of subjects enrolled
    Lithuania: 45
    Country: Number of subjects enrolled
    Argentina: 74
    Country: Number of subjects enrolled
    United States: 165
    Country: Number of subjects enrolled
    Canada: 30
    Country: Number of subjects enrolled
    Korea, Republic of: 46
    Country: Number of subjects enrolled
    Taiwan: 19
    Country: Number of subjects enrolled
    Brazil: 38
    Country: Number of subjects enrolled
    Israel: 9
    Worldwide total number of subjects
    858
    EEA total number of subjects
    477
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    109
    From 65 to 84 years
    673
    85 years and over
    76

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Subjects who met each of the inclusion and none of the exclusion criteria were eligible to participate in the study

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Placebo
    Arm description
    Placebo adjunct to 10 mg Donepezil Placebo: Once daily, matching placebo capsules, orally
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Matching placebo capsules once daily

    Arm title
    Idalopirdine 10 mg
    Arm description
    Idalopirdine adjunct to 10 mg Donepezil Idalopirdine: Once daily, encapsulated tablets, orally
    Arm type
    Experimental

    Investigational medicinal product name
    Idalopirdine 10 mg
    Investigational medicinal product code
    Other name
    Lu AE58054
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Encapsulated tablets 10 mg, once daily

    Arm title
    Idalopirdine 30 mg
    Arm description
    Idalopirdine adjunct to 10 mg Donepezil Idalopirdine: Once daily, encapsulated tablets, orally
    Arm type
    Experimental

    Investigational medicinal product name
    Idalopirdine 30 mg
    Investigational medicinal product code
    Other name
    Lu AE58054
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Encapsulated tablets 30 mg, once daily

    Number of subjects in period 1
    Placebo Idalopirdine 10 mg Idalopirdine 30 mg
    Started
    284
    290
    284
    Completed
    258
    257
    248
    Not completed
    26
    33
    36
         Caregiver impossibility
    -
    -
    1
         protocol non-compliance
    -
    -
    1
         Patient has moved
    1
    -
    1
         Hospitalisation
    -
    1
    -
         Patient's wife died
    -
    -
    1
         Withdrawal before treatment
    2
    5
    3
         Consent withdrawn by subject
    7
    12
    11
         Adverse event, non-fatal
    15
    11
    15
         Patient did not want to come
    -
    -
    1
         Caregiver in hospital
    -
    1
    -
         Patient did not show up
    1
    -
    -
         Lost to follow-up
    -
    1
    -
         Protocol deviation
    -
    2
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    -

    Reporting group values
    Overall trial Total
    Number of subjects
    858 858
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    109 109
        From 65-84 years
    673 673
        85 years and over
    76 76
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    74.5 ( 81.7 ) -
    Gender categorical
    Units: Subjects
        Female
    527 527
        Male
    331 331
    Race
    Units: Subjects
        Asian
    70 70
        Black or African American
    16 16
        White
    750 750
        Unknown or Not Reported
    22 22

    End points

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    End points reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Placebo adjunct to 10 mg Donepezil Placebo: Once daily, matching placebo capsules, orally

    Reporting group title
    Idalopirdine 10 mg
    Reporting group description
    Idalopirdine adjunct to 10 mg Donepezil Idalopirdine: Once daily, encapsulated tablets, orally

    Reporting group title
    Idalopirdine 30 mg
    Reporting group description
    Idalopirdine adjunct to 10 mg Donepezil Idalopirdine: Once daily, encapsulated tablets, orally

    Primary: Change in Cognition

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    End point title
    Change in Cognition
    End point description
    Change from baseline to Week 24 in Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) total score. The Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-cog) is a 11-item neuropsychological test that assess the severity of cognitive impairment. The items determine the patient's orientation, memory, language, and praxis. Total score of the 11 items range from 0 to 70 (lower score indicates lower cognitive impairment).
    End point type
    Primary
    End point timeframe
    Baseline and Week 24
    End point values
    Placebo Idalopirdine 10 mg Idalopirdine 30 mg
    Number of subjects analysed
    278
    282
    275
    Units: units on a scale
        least squares mean (standard error)
    0.64 ( 0.39 )
    0.55 ( 0.39 )
    1.27 ( 0.39 )
    Statistical analysis title
    Superiority: Placebo vs idalopirdine 10 mg
    Statistical analysis description
    For demonstrating efficacy of a dose, change in cognition (ADAS-cog) and either change in daily functioning (ADCS-ADL23) or change in global clinical impression (ADCS-CGIC) at Week 24 had to show statistically significant favourable differences compared to placebo at Week 24. Overall, type 1 error was controlled at 5% by multiplicity adjustment. Testing of the doses was done in a gated manner, first testing 30 mg at a 5% significance level, and only if found efficacious, then moving on to 10 mg.
    Comparison groups
    Idalopirdine 10 mg v Placebo
    Number of subjects included in analysis
    560
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 1 [1]
    Method
    Mixed models analysis
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.09
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.1
         upper limit
    0.92
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.51
    Notes
    [1] - Corrected for multiplicity according to the multiple testing procedure
    Statistical analysis title
    Superiority Placebo vs idalopirdine 30 mg
    Statistical analysis description
    For demonstrating efficacy of a dose, change in cognition (ADAS-cog) and either change in daily functioning (ADCS-ADL23) or change in global clinical impression (ADCS-CGIC) at Week 24 had to show statistically significant favourable differences compared to placebo at Week 24. Overall, type 1 error was controlled at 5% by multiplicity adjustment. Testing of the doses was done in a gated manner, first testing 30 mg at a 5% significance level, and only if found efficacious, then moving on to 10 mg.
    Comparison groups
    Placebo v Idalopirdine 30 mg
    Number of subjects included in analysis
    553
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.2223 [2]
    Method
    Mixed models analysis
    Parameter type
    Mean difference (final values)
    Point estimate
    0.63
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.38
         upper limit
    1.65
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.52
    Notes
    [2] - Corrected for multiplicity according to the multiple testing procedure

    Secondary: Change in daily functioning

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    End point title
    Change in daily functioning
    End point description
    Change from baseline to Week 24 in Alzheimer's Disease Cooperative Study - Activities of Daily Living Inventory (ADCS-ADL23) total score. The Alzheimer's Disease Cooperative Study - Activities of Daily Living (ADCS-ADL23) is a 23-item clinician-rated inventory to assess activities of daily living (conducted with a caregiver or informant). Each item comprises a series of hierarchical sub-questions, ranging from the highest level of independent performance to a complete loss for each activity. Total score of the 23 items ranges from 0 to 78 (higher score indicates lower disability).
    End point type
    Secondary
    End point timeframe
    Baseline and Week 24
    End point values
    Placebo Idalopirdine 10 mg Idalopirdine 30 mg
    Number of subjects analysed
    278
    282
    275
    Units: units on a scale
        least squares mean (standard error)
    -1.39 ( 0.49 )
    -1.22 ( 0.49 )
    -1.36 ( 0.49 )
    Statistical analysis title
    Superiority: Placebo vs idalopirdine 10 mg
    Statistical analysis description
    For demonstrating efficacy of a dose, change in cognition (ADAS-cog) and either change in daily functioning (ADCS-ADL23) or change in global clinical impression (ADCS-CGIC) at Week 24 had to show statistically significant favourable differences compared to placebo at Week 24. Overall, type 1 error was controlled at 5% by multiplicity adjustment. Testing of the doses was done in a gated manner, first testing 30 mg at a 5% significance level, and only if found efficacious, then moving on to 10 mg.
    Comparison groups
    Placebo v Idalopirdine 10 mg
    Number of subjects included in analysis
    560
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 1 [3]
    Method
    Mixed models analysis
    Parameter type
    Mean difference (net)
    Point estimate
    0.17
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.11
         upper limit
    1.46
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.65
    Notes
    [3] - Corrected for multiplicity according to the multiple testing procedure
    Statistical analysis title
    Superiority: Placebo vs idalopirdine 30 mg
    Statistical analysis description
    For demonstrating efficacy of a dose, change in cognition (ADAS-cog) and either change in daily functioning (ADCS-ADL23) or change in global clinical impression (ADCS-CGIC) at Week 24 had to show statistically significant favourable differences compared to placebo at Week 24. Overall, type 1 error was controlled at 5% by multiplicity adjustment. Testing of the doses was done in a gated manner, first testing 30 mg at a 5% significance level, and only if found efficacious, then moving on to 10 mg.
    Comparison groups
    Placebo v Idalopirdine 30 mg
    Number of subjects included in analysis
    553
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 1 [4]
    Method
    Mixed models analysis
    Parameter type
    Mean difference (final values)
    Point estimate
    0.03
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.27
         upper limit
    1.33
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.66
    Notes
    [4] - Corrected for multiplicity according to the multiple testing procedure

    Secondary: Change in global impression

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    End point title
    Change in global impression
    End point description
    Alzheimer's Disease Cooperative Study - Clinical Global Impression of Change (ADCS-CGIC) score at Week 24. The Alzheimer's Disease Cooperative Study - Clinical Global Impression of Change is a semi-structured interview to assess clinically relevant changes in patients with AD. The items determine cognition, behavior, social and daily functioning. Severity at baseline is rated on a 7-point scale from 1 (normal, not ill at all) to 7 (among the most extremely ill patients). The clinically relevant change from baseline is rated on a 7-point scale from 1 (marked improvement) to 7 (marked worsening).
    End point type
    Secondary
    End point timeframe
    Baseline and Week 24
    End point values
    Placebo Idalopirdine 10 mg Idalopirdine 30 mg
    Number of subjects analysed
    277
    282
    275
    Units: units on a scale
        least squares mean (standard error)
    4.30 ( 0.06 )
    4.24 ( 0.06 )
    4.35 ( 0.06 )
    Statistical analysis title
    Superiority: Placebo vs idalopirdine 10 mg
    Statistical analysis description
    For demonstrating efficacy of a dose, change in cognition (ADAS-cog) and either change in daily functioning (ADCS-ADL23) or change in global clinical impression (ADCS-CGIC) at Week 24 had to show statistically significant favourable differences compared to placebo at Week 24. Overall, type 1 error was controlled at 5% by multiplicity adjustment. Testing of the doses was done in a gated manner, first testing 30 mg at a 5% significance level, and only if found efficacious, then moving on to 10 mg.
    Comparison groups
    Placebo v Idalopirdine 10 mg
    Number of subjects included in analysis
    559
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 1 [5]
    Method
    Mixed models analysis
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.07
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.23
         upper limit
    0.1
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.08
    Notes
    [5] - Corrected for multiplicity according to the multiple testing procedure
    Statistical analysis title
    Superiority: Placebo vs idalopirdine 30 mg
    Statistical analysis description
    For demonstrating efficacy of a dose, change in cognition (ADAS-cog) and either change in daily functioning (ADCS-ADL23) or change in global clinical impression (ADCS-CGIC) at Week 24 had to show statistically significant favourable differences compared to placebo at Week 24. Overall, type 1 error was controlled at 5% by multiplicity adjustment. Testing of the doses was done in a gated manner, first testing 30 mg at a 5% significance level, and only if found efficacious, then moving on to 10 mg.
    Comparison groups
    Placebo v Idalopirdine 30 mg
    Number of subjects included in analysis
    552
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 1 [6]
    Method
    Mixed models analysis
    Parameter type
    Mean difference (final values)
    Point estimate
    0.05
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.12
         upper limit
    0.21
    Variability estimate
    Standard error of the mean
    Dispersion value
    0.09
    Notes
    [6] - Corrected for multiplicity according to the multiple testing procedure

    Secondary: Change in behavioural disturbance

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    End point title
    Change in behavioural disturbance
    End point description
    Change from baseline to Week 24 in Neuropsychiatric Inventory (NPI) total score. The Neuropsychiatric Inventory is a 12-item structured interview with a caregiver to assess behavioural disturbances. The NPI comprises 10 behavioural and 2 neurovegetative items. Each item consists of a screening question and several sub-questions that are rated no (not present) or yes (present). Each item is rated for frequency (a 4-point scale from 1 [occasionally] to 4 [very frequent]) and severity (a 3-point scale from 1 [mild] to 3 [marked]). The total NPI score is the frequency ratings multiplied by the severity ratings and ranges from 0 to 144 (higher score indicates worse outcome).
    End point type
    Secondary
    End point timeframe
    Baseline and Week 24
    End point values
    Placebo Idalopirdine 10 mg Idalopirdine 30 mg
    Number of subjects analysed
    278
    282
    275
    Units: units on a scale
        least squares mean (standard error)
    -0.31 ( 0.59 )
    -0.94 ( 0.59 )
    -0.54 ( 0.60 )
    No statistical analyses for this end point

    Secondary: Change in Individual Behavioural Disturbance Items

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    End point title
    Change in Individual Behavioural Disturbance Items
    End point description
    Change in single NPI item scores at Week 24. The Neuropsychiatric Inventory is a 12-item structured interview with a caregiver to assess behavioural disturbances. The NPI comprises 10 behavioural and 2 neurovegetative items. Each item consists of a screening question and several sub-questions that are rated no (not present) or yes (present). Each item is then rated for frequency (a 4-point scale from 1 [occasionally] to 4 [very frequent]) and severity (a 3-point scale from 1 [mild] to 3 [marked]). Total score for each single NPI item ranges from 0-12 (frequency multiplied by severity), where higher scores represent worse outcome.
    End point type
    Secondary
    End point timeframe
    Baseline and Week 24
    End point values
    Placebo Idalopirdine 10 mg Idalopirdine 30 mg
    Number of subjects analysed
    278
    282
    275
    Units: units on a scale
    least squares mean (standard error)
        Delusions
    0.01 ( 0.08 )
    -0.18 ( 0.08 )
    0.00 ( 0.08 )
        Hallucinations
    0.00 ( 0.04 )
    -0.06 ( 0.04 )
    -0.03 ( 0.04 )
        Agitation/aggression
    0.02 ( 0.11 )
    -0.06 ( 0.11 )
    -0.06 ( 0.11 )
        Depression/dysphoria
    -0.20 ( 0.10 )
    -0.08 ( 0.10 )
    -0.14 ( 0.10 )
        Anxiety
    -0.05 ( 0.11 )
    -0.06 ( 0.11 )
    -0.02 ( 0.11 )
        Elation/euphoria
    0.01 ( 0.04 )
    -0.05 ( 0.04 )
    -0.02 ( 0.04 )
        Apathy/indifference
    0.00 ( 0.17 )
    -0.19 ( 0.17 )
    -0.24 ( 0.17 )
        Disinhibition
    0.08 ( 0.09 )
    0.04 ( 0.09 )
    0.02 ( 0.09 )
        Irritability/lability
    0.03 ( 0.12 )
    -0.05 ( 0.12 )
    -0.17 ( 0.12 )
        Aberrant motor behaviour
    -0.03 ( 0.14 )
    0.06 ( 0.14 )
    0.12 ( 0.14 )
        Sleep
    -0.04 ( 0.12 )
    -0.07 ( 0.12 )
    0.12 ( 0.12 )
        Appetite/eating disorder
    -0.14 ( 0.14 )
    -0.30 ( 0.14 )
    -0.07 ( 0.14 )
    No statistical analyses for this end point

    Secondary: Change in NPI anxiety item score in patients with an NPI anxiety item score of at least 2 at baseline

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    End point title
    Change in NPI anxiety item score in patients with an NPI anxiety item score of at least 2 at baseline
    End point description
    Change from baseline to Week 24 in NPI anxiety item score in patients with an NPI anxiety item score of at least 2 at baseline The Neuropsychiatric Inventory is a 12-item structured interview with a caregiver to assess behavioural disturbances. The NPI comprises 10 behavioural and 2 neurovegetative items. Each item consists of a screening question and several sub-questions that are rated no (not present) or yes (present). Each item is then rated for frequency (a 4-point scale from 1 [occasionally] to 4 [very frequent]) and severity (a 3-point scale from 1 [mild] to 3 [marked]). The total score for the NPI anxiety item ranges from 0-12 (frequency multiplied by severity), where a higher score represents a worse outcome.
    End point type
    Secondary
    End point timeframe
    Baseline and Week 24
    End point values
    Placebo Idalopirdine 10 mg Idalopirdine 30 mg
    Number of subjects analysed
    71
    56
    61
    Units: units on a scale
        least squares mean (standard error)
    -1.48 ( 0.38 )
    -1.82 ( 0.40 )
    -1.69 ( 0.40 )
    No statistical analyses for this end point

    Secondary: Clinical Improvement

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    End point title
    Clinical Improvement
    End point description
    Clinical response at Week 24 (based on pre-specified ADAS-cog, ADCS-ADL23, and ADCS-CGIC changes [change in ADAS-cog below or equal to -4, change in ADCS-ADL23 at least 0, and ADCS-CGIC below or equal to 4])
    End point type
    Secondary
    End point timeframe
    Week 24
    End point values
    Placebo Idalopirdine 10 mg Idalopirdine 30 mg
    Number of subjects analysed
    255
    257
    249
    Units: Count of participants
        number (not applicable)
    20
    33
    22
    No statistical analyses for this end point

    Secondary: Clinical Worsening

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    End point title
    Clinical Worsening
    End point description
    Clinical worsening at Week 24 (Based on pre-specified ADAS-cog, ADCS-ADL23, and ADCS-CGIC changes [change in ADAS-cog above or equal to 4, change in ADCS-ADL23 below 0, and ADCS-CGIC above 4])
    End point type
    Secondary
    End point timeframe
    Week 24
    End point values
    Placebo Idalopirdine 10 mg Idalopirdine 30 mg
    Number of subjects analysed
    255
    257
    249
    Units: Count of participants
    27
    28
    27
    No statistical analyses for this end point

    Secondary: Change in cognitive aspects of mental function

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    End point title
    Change in cognitive aspects of mental function
    End point description
    Change from baseline to Week 24 in Mini Mental State Examination (MMSE). The Mini Mental State Examination (MMSE) is an 11-item test to assess the cognitive aspects of mental function. The subtests assess orientation, memory, attention, language, and visual construction. The scores for each item is dichotomous (1 = response is correct, 0 = response is incorrect). Total score of the 11 items ranges from 0 to 30 (higher score indicates lower deficit).
    End point type
    Secondary
    End point timeframe
    Baseline and Week 24
    End point values
    Placebo Idalopirdine 10 mg Idalopirdine 30 mg
    Number of subjects analysed
    258
    257
    248
    Units: Units on a scale
        least squares mean (standard error)
    -0.24 ( 0.21 )
    -0.45 ( 0.21 )
    -0.34 ( 0.21 )
    No statistical analyses for this end point

    Secondary: Change in health-related quality of life (EQ-5D) utility score

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    End point title
    Change in health-related quality of life (EQ-5D) utility score
    End point description
    Change from baseline to Week 24 in EuroQol 5-dimensional (EQ-5D) utility score The EQ-5D is a patient-reported assessment that measures the patient's well-being. It consists of an utility score based on 5 descriptive items (mobility, self-care, usual activities, pain/discomfort, and depression/anxiety) and a Visual Analogue Scale (VAS). Each descriptive item is rated on a 3-point index ranging from 1 (no problems) to 3 (extreme problems) that is used for calculating a single summary index (from 0 to 1). A higher EQ-5D score indicates a worse outcome.
    End point type
    Secondary
    End point timeframe
    Baseline and Week 24
    End point values
    Placebo Idalopirdine 10 mg Idalopirdine 30 mg
    Number of subjects analysed
    274
    275
    266
    Units: units on a scale
        least squares mean (standard error)
    0.03 ( 0.01 )
    0.02 ( 0.01 )
    0.01 ( 0.01 )
    No statistical analyses for this end point

    Secondary: Change in health-related quality of life (EQ-5D VAS)

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    End point title
    Change in health-related quality of life (EQ-5D VAS)
    End point description
    Change from baseline to Week 24 in EQ-5D Visual Analogue Scale (EQ-5D VAS). The EQ-5D is a patient-reported assessment that measures the patient's well-being. It consists of an utility score based on 5 descriptive items (mobility, self-care, usual activities, pain/discomfort, and depression/anxiety) and a Visual Analogue Scale (VAS). The VAS ranges from 0 (worst imaginable health state) to 100 (best imaginable health state).
    End point type
    Secondary
    End point timeframe
    Baseline and Week 24
    End point values
    Placebo Idalopirdine 10 mg Idalopirdine 30 mg
    Number of subjects analysed
    274
    274
    266
    Units: Units on a scale
        least squares mean (standard error)
    1.35 ( 0.99 )
    1.87 ( 0.99 )
    1.00 ( 1.01 )
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    First dose to end of study (week 28)
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.0
    Reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Placebo adjunct to 10 mg Donepezil

    Reporting group title
    Idalopirdine 30 mg
    Reporting group description
    Idalopirdine adjunct to 10 mg Donapezile

    Reporting group title
    Idalopirdine 10 mg
    Reporting group description
    Idalopirdine adjunct to 10 mg Donepezile

    Serious adverse events
    Placebo Idalopirdine 30 mg Idalopirdine 10 mg
    Total subjects affected by serious adverse events
         subjects affected / exposed
    12 / 282 (4.26%)
    15 / 281 (5.34%)
    13 / 285 (4.56%)
         number of deaths (all causes)
    1
    1
    0
         number of deaths resulting from adverse events
    1
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Anal cancer
         subjects affected / exposed
    0 / 282 (0.00%)
    0 / 281 (0.00%)
    1 / 285 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bladder transitional cell carcinoma
         subjects affected / exposed
    0 / 282 (0.00%)
    1 / 281 (0.36%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vascular disorders
    Circulatory collapse
         subjects affected / exposed
    0 / 282 (0.00%)
    1 / 281 (0.36%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    General disorders and administration site conditions
    Gait disturbance
         subjects affected / exposed
    0 / 282 (0.00%)
    0 / 281 (0.00%)
    1 / 285 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Benign prostatic hyperplasia
         subjects affected / exposed [1]
    0 / 101 (0.00%)
    1 / 112 (0.89%)
    0 / 113 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Laryngeal haemorrhage
         subjects affected / exposed
    1 / 282 (0.35%)
    0 / 281 (0.00%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Psychiatric disorders
    Aggression
         subjects affected / exposed
    0 / 282 (0.00%)
    1 / 281 (0.36%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Delirium
         subjects affected / exposed
    2 / 282 (0.71%)
    1 / 281 (0.36%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Depressive symptom
         subjects affected / exposed
    1 / 282 (0.35%)
    0 / 281 (0.00%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hallucination
         subjects affected / exposed
    1 / 282 (0.35%)
    0 / 281 (0.00%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hallucinations, mixed
         subjects affected / exposed
    1 / 282 (0.35%)
    0 / 281 (0.00%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Suicidal ideation
         subjects affected / exposed
    1 / 282 (0.35%)
    0 / 281 (0.00%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Cervical vertebral fracture
         subjects affected / exposed
    0 / 282 (0.00%)
    1 / 281 (0.36%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Rib fracture
         subjects affected / exposed
    0 / 282 (0.00%)
    0 / 281 (0.00%)
    1 / 285 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Acute myocardial infarction
         subjects affected / exposed
    0 / 282 (0.00%)
    0 / 281 (0.00%)
    1 / 285 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Angina pectoris
         subjects affected / exposed
    0 / 282 (0.00%)
    1 / 281 (0.36%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Atrioventricular block complete
         subjects affected / exposed
    1 / 282 (0.35%)
    0 / 281 (0.00%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bradycardia
         subjects affected / exposed
    0 / 282 (0.00%)
    1 / 281 (0.36%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac arrest
         subjects affected / exposed
    1 / 282 (0.35%)
    0 / 281 (0.00%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac failure
         subjects affected / exposed
    1 / 282 (0.35%)
    0 / 281 (0.00%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    Myocardial infarction
         subjects affected / exposed
    0 / 282 (0.00%)
    2 / 281 (0.71%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nervous system disorders
    Carotid sinus syndrome
         subjects affected / exposed
    0 / 282 (0.00%)
    1 / 281 (0.36%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cerebrovascular accident
         subjects affected / exposed
    0 / 282 (0.00%)
    0 / 281 (0.00%)
    2 / 285 (0.70%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Dementia
         subjects affected / exposed
    1 / 282 (0.35%)
    0 / 281 (0.00%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Embolic stroke
         subjects affected / exposed
    0 / 282 (0.00%)
    1 / 281 (0.36%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Encephalopathy
         subjects affected / exposed
    1 / 282 (0.35%)
    0 / 281 (0.00%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Epilepsy
         subjects affected / exposed
    0 / 282 (0.00%)
    0 / 281 (0.00%)
    1 / 285 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ischaemic stroke
         subjects affected / exposed
    1 / 282 (0.35%)
    0 / 281 (0.00%)
    1 / 285 (0.35%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Syncope
         subjects affected / exposed
    0 / 282 (0.00%)
    0 / 281 (0.00%)
    1 / 285 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Transient ischaemic attack
         subjects affected / exposed
    0 / 282 (0.00%)
    1 / 281 (0.36%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Lymphadenitis
         subjects affected / exposed
    0 / 282 (0.00%)
    0 / 281 (0.00%)
    1 / 285 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Dysphagia
         subjects affected / exposed
    1 / 282 (0.35%)
    0 / 281 (0.00%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrooesophageal reflux disease
         subjects affected / exposed
    0 / 282 (0.00%)
    0 / 281 (0.00%)
    1 / 285 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Inguinal hernia
         subjects affected / exposed
    1 / 282 (0.35%)
    0 / 281 (0.00%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pancreatitis
         subjects affected / exposed
    1 / 282 (0.35%)
    0 / 281 (0.00%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Upper gastrointestinal haemorrhage
         subjects affected / exposed
    0 / 282 (0.00%)
    1 / 281 (0.36%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Bile duct obstruction
         subjects affected / exposed
    0 / 282 (0.00%)
    0 / 281 (0.00%)
    1 / 285 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cholelithiasis
         subjects affected / exposed
    1 / 282 (0.35%)
    0 / 281 (0.00%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    0 / 282 (0.00%)
    0 / 281 (0.00%)
    1 / 285 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Urinary retention
         subjects affected / exposed
    0 / 282 (0.00%)
    0 / 281 (0.00%)
    1 / 285 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia bacterial
         subjects affected / exposed
    0 / 282 (0.00%)
    2 / 281 (0.71%)
    0 / 285 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Urinary tract infection bacterial
         subjects affected / exposed
    0 / 282 (0.00%)
    0 / 281 (0.00%)
    1 / 285 (0.35%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Notes
    [1] - The number of subjects exposed to this adverse event is less than the total number of subjects exposed to this adverse event. These numbers are expected to be equal.
    Justification: This Serious Adverse Event is only applicable for male subjects.
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Placebo Idalopirdine 30 mg Idalopirdine 10 mg
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    33 / 282 (11.70%)
    31 / 281 (11.03%)
    26 / 285 (9.12%)
    Injury, poisoning and procedural complications
    Accidental overdose
         subjects affected / exposed
    33 / 282 (11.70%)
    31 / 281 (11.03%)
    26 / 285 (9.12%)
         occurrences all number
    71
    65
    52

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    06 Mar 2014
    Protocol Amendment PA01: To allow re-screening of patients, changes of eligibility criteria and to provide clarifications where needed. Major Changes: Safety Follow-up visit window: this was defined as up to 7 days for patients who withdrew. Visits taking place over 2 consecutive days: it was clarified that IMP had to be dispensed on the second day, after all assessments were performed. Drop-out Retrieval Visit: it was clarified that only new SAEs which were considered as possibly/probably related to IMP by the investigator were to be reported. Screening period: it was clarified that this need not necessarily be a 2-week period, but that it could be up to 2 weeks. Safety follow-up of patients who withdraw consent: it was clarified that such patients had to have a safety follow-up visit, but that the visit was only to be recorded in the medical records. Exclusion criterion 17: it was clarified that patients with pacemakers were eligible provided they followed a routine check-up with their doctor and were considered stable. Exclusion criterion 28: the exclusion criteria for heart rate and the duration of the PR interval were revised. Re-screening: the possibility of re-screening patients, who failed screening due to certain treatable medical conditions, but who were otherwise eligible was added. MMSE: it was clarified that at the Screening visit, this was to be performed prior to any of the other assessments, including ADAS-Cog. SAEs: it was added that under no circumstance were investigators to report SAEs to Lundbeck beyond 24 hours. Concomitant medication: clarifications on the use of other investigational drugs, selected anticonvulsants, and trazodone were provided.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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