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    Clinical Trial Results:
    A 36-Week Safety Extension Study of Oral ELND005 for Treatment of Agitation and Aggression in Patients With Moderate to Severe Alzheimer’s Disease

    Summary
    EudraCT number
    2012-005524-15
    Trial protocol
    GB   ES  
    Global end of trial date
    18 Aug 2015

    Results information
    Results version number
    v1(current)
    This version publication date
    24 Jun 2016
    First version publication date
    24 Jun 2016
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    ELND005-AG251
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01766336
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Transition Therapeutics Ireland Limited
    Sponsor organisation address
    Arthur Cox Building, Earlsfort Centre, Earlsfort Terrace, Dublin, Ireland, Dublin 2
    Public contact
    Aleksandra Pastrak, MD, PhD, VP of Clinical Development and Medical Officer, Transition Therapeutics Ireland Limited, +1 416 263 1227, apastrak@transitiontherapeutics.com
    Scientific contact
    Aleksandra Pastrak, MD, PhD, VP of Clinical Development and Medical Officer, Transition Therapeutics Ireland Limited, +1 416 263 1227, apastrak@transitiontherapeutics.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
    30 Nov 2015
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    18 Aug 2015
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    To evaluate the safety and tolerability of ELND005 treatment with up to 24 weeks exposure, in Moderate to Severe Alzheimer's Disease patients with agitation and aggression. To evaluate the effects and persistence of effects of ELND005 on agitation and aggression and other assessments including neuropsychiatric symptoms, cognitive status, patient's dependence status and caregiver distress.
    Protection of trial subjects
    400 subjects were planned. This study was conducted according to ICH guidelines concerning Good Clinical Practice.
    Background therapy
    During the Treatment Period, the doses of concomitant antidepressants, mood stabilizers, permitted doses of specified antipsychotics, cholinesterase inhibitors, memantine, and other permitted medications for the treatment of non-excluded medical conditions were maintained constant.
    Evidence for comparator
    -
    Actual start date of recruitment
    19 Feb 2013
    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
    Spain: 19
    Country: Number of subjects enrolled
    United Kingdom: 5
    Country: Number of subjects enrolled
    Canada: 15
    Country: Number of subjects enrolled
    United States: 257
    Worldwide total number of subjects
    296
    EEA total number of subjects
    24
    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)
    27
    From 65 to 84 years
    231
    85 years and over
    38

    Subject disposition

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    Recruitment
    Recruitment details
    Patients enrolled from February 2013 to May 2015.

    Pre-assignment
    Screening details
    Patients that completed Study AG201 and who were willing and eligible to continue into AG251 open-label safety extension study.

    Period 1
    Period 1 title
    Treatment period (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded
    Blinding implementation details
    Blinding from study AG201 was maintained in this extension study.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Placebo/ELND005
    Arm description
    ELND005 250 mg
    Arm type
    Experimental

    Investigational medicinal product name
    ELND005
    Investigational medicinal product code
    Other name
    Scyllo Inositol
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Group 1- ELND005/ELND005 250 mg Tablet BID (Mock loading dose to maintain blind) Group 2- 1000 mg BID for 4 weeks followed by 250 mg BID for 32 weeks

    Arm title
    ELND005/ELND005
    Arm description
    ELND005 250 mg
    Arm type
    Experimental

    Investigational medicinal product name
    ELND005
    Investigational medicinal product code
    Other name
    Scyllo Inositol
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Group 1- ELND005/ELND005 250 mg Tablet BID (Mock loading dose to maintain blind) Group 2- 1000 mg BID for 4 weeks followed by 250 mg BID for 32 weeks

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Patients who met eligibility criteria and who received ELND005 during Study AG201 were assigned to Group 1 in Study AG251 and received a mock loading dose of ELND005 (one 250 mg ELND005 tablet and three matching placebo tablets BID for 4 weeks) followed by a Maintenance Dose of 250 mg BID for subsequent 32 weeks.

    Number of subjects in period 1
    Placebo/ELND005 ELND005/ELND005
    Started
    146
    150
    Completed
    71
    60
    Not completed
    75
    90
         Consent withdrawn by subject
    15
    18
         Physician decision
    2
    4
         adverse event, not serious
    8
    11
         death
    3
    4
         Lost to follow-up
    3
    1
         sponsor's decision
    43
    52
         Protocol deviation
    1
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Placebo/ELND005
    Reporting group description
    ELND005 250 mg

    Reporting group title
    ELND005/ELND005
    Reporting group description
    ELND005 250 mg

    Reporting group values
    Placebo/ELND005 ELND005/ELND005 Total
    Number of subjects
    146 150 296
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    17 10 27
        From 65-84 years
    110 121 231
        85 years and over
    19 19 38
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    75.8 ( 8.7 ) 76.6 ( 7.9 ) -
    Gender categorical
    Units: Subjects
        Female
    81 84 165
        Male
    65 66 131
    Race
    Units: Subjects
        White
    127 138 265
        Black
    17 10 27
        Asian
    1 1 2
        Other
    1 1 2
    Subject analysis sets

    Subject analysis set title
    Safety Analysis Set
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    All patients who were enrolled into the study and received at least one dose of study drug.

    Subject analysis sets values
    Safety Analysis Set
    Number of subjects
    296
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    27
        From 65-84 years
    231
        85 years and over
    38
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    ( )
    Gender categorical
    Units: Subjects
        Female
    165
        Male
    131
    Race
    Units: Subjects
        White
        Black
        Asian
        Other

    End points

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    End points reporting groups
    Reporting group title
    Placebo/ELND005
    Reporting group description
    ELND005 250 mg

    Reporting group title
    ELND005/ELND005
    Reporting group description
    ELND005 250 mg

    Subject analysis set title
    Safety Analysis Set
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    All patients who were enrolled into the study and received at least one dose of study drug.

    Primary: Change from Baseline to Week 36 in NPI-C A+A Score

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    End point title
    Change from Baseline to Week 36 in NPI-C A+A Score [1]
    End point description
    Changes from Baseline to Week 36 in Study AG251 (for all patients), and changes from Baseline in Study AG201 to Week 36 of Study AG251 (for patients in Group 1: ELND005/ELND005)
    End point type
    Primary
    End point timeframe
    Up to 36 weeks
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Study discontinued prematurely. No Efficacy Analysis performed.
    End point values
    Safety Analysis Set
    Number of subjects analysed
    296
    Units: NPI-C A+A Score
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    All subjects who were enrolled in the study and received at least one dose of study drug were included in safety analyses. Mean duration on study for subjects in the ELND005 group was 153.6 days and for subjects in the placebo group was 167.4 days.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    17.1
    Reporting groups
    Reporting group title
    Placebo/ELND005
    Reporting group description
    Patients who met study eligibility criteria and who received placebo during Study AG201 were assigned to Group 2 in Study AG251, and received a loading dose of ELND005 (four 250 mg ELND005 tablets BID for 4 weeks) followed by a Maintenance Dose of 250 mg BID for a subsequent 32 weeks, for a total of up to 36 consecutive weeks of active treatment.

    Reporting group title
    ELND005/ELND005
    Reporting group description
    Patients who met eligibility criteria and who received ELND005 during Study AG201 were assigned to Group 1 in Study AG251 and received a mock loading dose of ELND005 (one 250 mg ELND005 tablet and three matching placebo tablets BID for 4 weeks) followed by a Maintenance Dose of 250 mg BID for a subsequent 32 weeks. Thus, patients in Group 1 might have received up to a total of 48 consecutive weeks of active treatment (12 weeks during Study AG201 and 36 weeks during Study AG251).

    Serious adverse events
    Placebo/ELND005 ELND005/ELND005
    Total subjects affected by serious adverse events
         subjects affected / exposed
    26 / 146 (17.81%)
    29 / 150 (19.33%)
         number of deaths (all causes)
    8
    7
         number of deaths resulting from adverse events
    8
    7
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Basal Cell Carcinoma
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bladder Neoplasm
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    0 / 146 (0.00%)
    2 / 150 (1.33%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Femur Fracture
         subjects affected / exposed
    0 / 146 (0.00%)
    2 / 150 (1.33%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Hip Fracture
         subjects affected / exposed
    1 / 146 (0.68%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Femoral Neck Fracture
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Laceration
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Vascular Pseudoaneurysm
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Vascular disorders
    Hypotension
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Cardiac disorders
    Atrial Fibrillation
         subjects affected / exposed
    1 / 146 (0.68%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Cardiac Arrest
         subjects affected / exposed
    2 / 146 (1.37%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    2 / 8
    0 / 7
    Myocardial Infarction
         subjects affected / exposed
    1 / 146 (0.68%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    1 / 8
    0 / 7
    Acute Myocardial Infarction
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    1 / 7
    Coronary Artery Disease
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Nervous system disorders
    Syncope
         subjects affected / exposed
    1 / 146 (0.68%)
    3 / 150 (2.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Dementia Alzheimer Type
         subjects affected / exposed
    3 / 146 (2.05%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    1 / 8
    0 / 7
    Transient Ischaemic Attack
         subjects affected / exposed
    1 / 146 (0.68%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Ataxia
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Brain Hypoxia
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    1 / 7
    Carotid Artery Stenosis
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Convulsion
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Depressed level of Consciousness
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Haemorrhage Intracranial
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    General disorders and administration site conditions
    Death
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    1 / 7
    General Physical Health Deterioration
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    1 / 7
    Systemic Inflammatory Response Syndrome
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Gastrointestinal disorders
    Gastritis
         subjects affected / exposed
    0 / 146 (0.00%)
    2 / 150 (1.33%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Intestinal Ischaemia
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Respiratory, thoracic and mediastinal disorders
    Acute Respiratory Failure
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    1 / 8
    0 / 7
    Bronchospasm
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Chronic Obstructive Pulmonary Disease
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Pneumonia Aspiration
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    1 / 8
    0 / 7
    Pulmonary Embolism
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Psychiatric disorders
    Mental Status Changes
         subjects affected / exposed
    3 / 146 (2.05%)
    3 / 150 (2.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    1 / 8
    0 / 7
    Agitation
         subjects affected / exposed
    3 / 146 (2.05%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Aggression
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Behavioural and psychiatric Symptoms of Dementia
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Homicidal Ideation
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psychotic Disorder
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Musculoskeletal and connective tissue disorders
    Rhabdomyolysis
         subjects affected / exposed
    0 / 146 (0.00%)
    2 / 150 (1.33%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Musculoskeletal Stiffness
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    1 / 146 (0.68%)
    3 / 150 (2.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Bronchitis
         subjects affected / exposed
    1 / 146 (0.68%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    1 / 8
    1 / 7
    Diverticulitis
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Gastroenteritis Viral
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Influenza
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Metabolism and nutrition disorders
    Failure to Thrive
         subjects affected / exposed
    0 / 146 (0.00%)
    2 / 150 (1.33%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    2 / 7
    Dehydration
         subjects affected / exposed
    0 / 146 (0.00%)
    1 / 150 (0.67%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Hypophagia
         subjects affected / exposed
    1 / 146 (0.68%)
    0 / 150 (0.00%)
         occurrences causally related to treatment / all
    0 / 26
    0 / 29
         deaths causally related to treatment / all
    0 / 8
    0 / 7
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Placebo/ELND005 ELND005/ELND005
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    26 / 146 (17.81%)
    41 / 150 (27.33%)
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    7 / 146 (4.79%)
    20 / 150 (13.33%)
         occurrences all number
    26
    41
    Psychiatric disorders
    Agitation
         subjects affected / exposed
    14 / 146 (9.59%)
    15 / 150 (10.00%)
         occurrences all number
    26
    41
    Infections and infestations
    Urinary Tract Infection
         subjects affected / exposed
    7 / 146 (4.79%)
    14 / 150 (9.33%)
         occurrences all number
    26
    41

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    06 Nov 2013
    Extended the duration of Study AG251 from 12 weeks to 36 weeks.

    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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