E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Agitation and Aggression in Alzheimer's Disease |
Agitación y agresion en la enfermedad de Alzheimer |
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E.1.1.1 | Medical condition in easily understood language |
Patients with Alzheimer's disease with symptoms that include agitation and aggressive behaviors |
Pacientes con sintomas de la enfermedad de Alzheimer que incluyen agitación y conductas agresivas |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nervous System Diseases [C10] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10001896 |
E.1.2 | Term | Alzheimer's disease |
E.1.2 | System Organ Class | 100000004852 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To evaluate the safety and tolerability of pimavanserin after 52 weeks of treatment in subjects with probable AD who have symptoms of agitation and aggression. |
Evaluar la seguridad y tolerabilidad del Pimavanserin después de 52 semanas de tratamiento en los sujetos con probable EA que tienen síntomas de gaitación y agresión |
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E.2.2 | Secondary objectives of the trial |
To evaluate the persistence of the effects of pimavanserin treatment on: • Agitation and aggression • Caregiver burden • The clinician’s global assessment of treatment benefit • Other neuropsychiatric symptoms • Cognition • Functional status • Sleep and daytime wakefulness |
Evaluar la persistencia del efecto del tratamiento con pimavanserin sobre los parámetros siguientes: Agitación y agresividad. Carga para el cuidador. Evaluación global por el médico de los beneficios del tratamiento. Otros síntomas neuropsiquiátricos. Estado cognitivo. Estado funcional. Sueño y vigilia diurna. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Able to understand and provide signed informed consent, and must be able to sign and date a request for medical records and/or privacy form, if applicable, according to local regulations. • from the subject, if the subject is deemed competent to provide informed consent • from the subject’s legally authorized representative (LAR) with the subject’s assent, if the subject is deemed not competent to provide informed consent 2. Lives at home or in an assisted living facility 3. Has a designated study partner/caregiver (e.g., relative, housemate, close personal friend, or professional caregiver) who is in contact with the subject at least 3 times a week on 3 separate days. The study partner/caregiver should: • be willing and able to accompany the subject to all clinic visits, • be capable of routinely monitoring and reporting study drug use, • be regarded by the Investigator as sufficiently informed to report accurately on the subject’s behavioral and functional status. 4. The subject’s study partner/caregiver provides written agreement that they understand the study, including the role of the study partner/caregiver and will participate in the study 5. Both subject and study partner/caregiver are fluent in and able to read the local language in which study assessments are administered at the clinical site 6. Both subject and study partner/caregiver are willing and able to participate in all scheduled evaluations and complete all required tests 7. Must complete the Week 12 visit in Study ACP-103-032 while continuing to take his/her assigned dose of blinded study drug 8. If female, must be of non-childbearing potential (defined as either surgically sterilized or at least 1 year postmenopausal) or must agree to use a clinically acceptable method of contraception (e.g., oral, intrauterine device [IUD; diaphragm], injectable, transdermal or implantable contraception) or abstinence during the study, and 1 month following completion of the study. Females of childbearing potential must have a negative urine human chorionic gonadotropin (hCG) pregnancy test at Baseline. |
1. Capacidad de comprender y otorgar el consentimiento informado firmado y de firmar y fechar una solicitud de historia clínica o un documento de privacidad, cuando proceda, conforme a la normativa local. - del sujeto, si se considera que este es competente para otorgar el consentimiento informado; - del representante legalmente autorizado del sujeto, con el asentimiento de este último, si se considera que el sujeto nes competente para otorgar el consentimiento informado. 2. El sujeto vive en casa o en un centro de residencia asistida. 3. El sujeto tiene un compañero/cuidador del estudio (por ejemplo, un pariente, un compañero de casa, un amigo íntimo o un cuidaprofesional) que está en contacto con el sujeto al menos 3 veces por semana en tres días diferentes. El compañero/cuidador del estudio deberá: - estar dispuesto a acompañar al sujeto a todas las visitas aclínica y ser capaz de hacerlo. - ser capaz de supervisar sistemáticamente y notificar el uso del fármaco del estudio. - ser considerado por el investigador como suficiente informado para informar con exactitud sobre el estado decomportamiento y funcional del sujeto. 4. El compañero/cuidador del estudio acuerda por escrito que comprende el estudio, incluida la función del compañero/cuidador del estudio, y que participará en él. 5. Tanto el sujeto como el compañero/cuidador del estudio hablan deforma fluida y leen el idioma local en el que se realicen las evaluaciones del estudio en el centro clínico. 6. Tanto el sujeto como el compañero/cuidador del estudio están dispuestos a participar en todas las evaluaciones programadas y a completar todas las pruebas exigidas, y son capaces de hacerlo. 7. El sujeto debe completar la visita 12 del estudio ACP-103-032 mientras sigue recibiendo la dosis asignada de fármaco del estudio en régimen enmascarado. 8. Si el sujeto es una mujer, no debe tener capacidad reproductiva (definido como haber sido esterilizada quirúrgicamente o haber tenido la posmenopausia al menos 1 año antes) o debe comprometerse a usar un método anticonceptivo clínicamente aceptable (p. ej., anticonceptivos orales, dispositivo intrauterino [DIU; diafragma], anticonceptivos inyectables, transdérmicos o implantables) o a practicar la abstinencia durante el estudio y hastaun mes después de la finalización de su participación en el mismo. Las mujeres con capacidad reproductiva deben tener un resultado negativo en una prueba de embarazo de gonadotropina coriónica (hCG) en orina en la visita basal. |
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E.4 | Principal exclusion criteria |
1. Is participating in another clinical trial (other than Study ACP-103-032) of any investigational drug, device, or intervention 2. The Investigator determines that enrollment in the study would be detrimental to a subject’s well-being 3. The Investigator becomes aware of an impending and unexpected change in the subject’s living situation (e.g., change in caregiver, change in facility, moving from home to facility, moving from one family member or caregiver’s home to another) that s/he judges may cause a major disruption in the subject’s behaviour 4. Subject or study partner/caregiver has an uncorrected medical condition (e.g., hearing, vision impairments) that would impair the ability to perform the study assessments. 5. Subject is judged by the Investigator or the Medical Monitor to be inappropriate for the study 6. Subject was significantly non-compliant in Study ACP-103-032 7. Subject has had a QRS interval <120 msec and whose Fridericia’s corrected QT interval (QTcF) is >460 msec at baseline OR subject has had a QRS interval ≥120 msec and QTcF is >480 msec at Baseline 8. Has clinically significant laboratory abnormalities that in the judgment of the Investigator would jeopardize the safe participation of the subject in the study 9. Subject has become bedridden or has any significant medical condition that is unstable and that would either: • place the subject at undue risk from study drug or undergoing study procedures; or • interfere with the interpretation of safety or efficacy evaluations performed during the course of the study |
1. El sujeto está participando en otro ensayo clínico (distinto del estudio ACP-103-032) de un fármaco, dispositivo o intervención en investigación. 2. El investigador determina que la inclusión en el estudio sería perjudicial para el sujeto. 3. El investigador tiene conocimiento de un cambio inminente e imprevisto en la condiciones de vida del sujeto (p. ej., cambio de cuidador, cambio de residencia, traslado desde casa a una residencia, traslado desde el hogar de un familiar o cuidador al hogar de otro) que considera que puede afectar de manera importante a su conducta. 4. El sujeto o su compañero/cuidador del estudio padece un trastorno médico no corregido (p. ej., alteración de la audición o de la visión) que mermaría la capacidad para realizar las evaluaciones del estudio. 5. El investigador o el monitor médico consideran que el sujeto no es apto para el estudio. 6. El sujeto incumplió de manera importante las condiciones del estudio ACP-103-032. 7. El sujeto presentó un intervalo QRS < 120 ms y un intervalo QT corregido conforme a la fórmula de Fridericia (QTcF) > 460 ms en el momento basal O un intervalo QRS ≥ 120 ms y un QTcF > 480 ms en el momento basal. 8. El sujeto presenta una anomalía analítica de importancia clínica que, a criterio del investigador, pondría en peligro la participación segura del sujeto en el estudio. 9. El sujeto está encamado o padece algún trastorno médico importante que sea inestable y que: - pondría al sujeto en un riesgo excesivo si se le administrara la medicación del estudio o se le sometiera a los procedimientos del estudio; o - interferiría en la interpretación de las evaluaciones de la seguridad o de la eficacia realizadas en el transcurso del estudio. |
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E.5 End points |
E.5.1 | Primary end point(s) |
• Incidence and severity of AEs, serious AEs (SAEs), and withdrawals due to AEs • Changes from Baseline in vital sign measurements, weight, clinical laboratory assessments, physical examinations, and electrocardiograms (ECGs) |
- Incidencia e intensidad de los acontecimientos adversos (AA), los AA graves (AAG) y las retiradas debidas a AA. - Cambios respecto al momento basal de las determinaciones de las constantes vitales, el peso, las valoraciones de laboratorio clínico, las exploraciones físicas y los electrocardiogramas (ECG). |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
• Adverse events during ACP-103-033 will be recorded through the follow-up safety assessment approximately 30 days after the last dose of open-label study drug. • Physical and neurological examinations will be conducted at Baseline (Visit 1) and Weeks 12 and 52 (i.e., Visits 5 and 10 [EOS/ET]). • Vital signs and weight will be performed at Baseline (Visit 1) and at all scheduled visits. • A 12-lead ECG (single recording) will be performed at Baseline (Visit 1) and at Weeks 4, 12, 28, and 52 (i.e., Visits 3, 5, 7, and 10 [EOS/ET]). • Samples for safety laboratory evaluations will be collected at Baseline (Visit 1) and Weeks 4, 12, 28, and 52 (i.e., Visits 3, 5, 7, and 10 [EOS/ET]). |
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E.5.2 | Secondary end point(s) |
• Change from Baseline in Cohen-Mansfield Agitation Inventory (CMAI) total score • Change from Baseline in Zarit Burden Interview (ZBI) total score • modified Alzheimer’s Disease Cooperative Study - Clinical Global Impression of Change (mADCS-CGIC) agitation score • Change from Baseline in Neuropsychiatric Inventory-Clinician Rating Scale (NPI-C) combined agitation and aggression domain scores • Change from Baseline in NPI-C total score • Change from Baseline in NPI-C individual domain scores • Change from Baseline in Mini-Mental State Examination (MMSE) score • Change from Baseline in Karolinska Sleepiness Scale (KSS) score • Change from Baseline in CMAI factor scores • Change from Baseline in Alzheimer’s Disease Cooperative Study - Activities of Daily Living Inventory (ADCS-ADL) score |
Variación, con respecto al momento basal, de la puntuación total del Índice de agitación de Cohen-Mansfield (CMAI). Variación, con respecto al momento basal, de la puntuación total de la Escala de sobrecarga del cuidador de Zarit (ZBI). Puntuación de agitación en el Cuestionario de impresión clínica global de cambio de la Escala del Alzheimer’s Disease Cooperative Study modificada (mADCS-CGIC). Variación, con respecto al momento basal, del Inventario neuropsiquiátrico-escala de valoración por el clínico (NPI-C). Variación, con respecto al momento basal, de la puntuación total del NPI-C. Variación, con respecto al momento basal, de la puntuación de cada dominio del NPI-C por separado. Variación, con respecto al momento basal, de la puntuación del Miniexamen del estado mental (MMSE). Variación, con respecto al momento basal, de la puntuación de la Escala de somnolencia de Karolinska (KSS). Variación, con respecto al momento basal, de la puntuación de los factores del CMAI. Variación, con respecto al momento basal, de la puntuación en el Cuestionario de actividades de la vida diaria de la Escala del Alzheimer’s Disease Cooperative Study (ADCS-ADL). |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
• The CMAI, ZBI and mADCS-CGIC will be performed at Baseline (Day 1) and at all scheduled clinic visits. • The complete NPI-C (i.e., all domains) will be performed at Baseline, Weeks 12, 28, and 52 (i.e., Visits 1, 5, 7, and 10 [EOS/ET]). The agitation and aggression domains of the NPI-C alone will be performed at Weeks 2, 4, and 8 (i.e., Visits 2, 3, and 4). • The MMSE will be administered at Baseline (Visit 1) and at Weeks 4, 8, 12, 20, 28, 36, 44, and 52 (i.e., Visits 3, 4, 5, 6, 7, 8, 9 and 10 [EOS/ET]). • The ADCS-ADL and KSS will be administered at Baseline (Visit 1) and at Weeks 12, 28, and 52 (i.e., Visits 5, 7, and 10 [EOS/ET]). |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
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.8.4.1 | Number of sites anticipated in Member State concerned | 5 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 20 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Argentina |
Chile |
France |
Germany |
Spain |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | No |
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
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 3 |