E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Dementia With Lewy Bodies |
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E.1.1.1 | Medical condition in easily understood language |
Dementia with Lewy bodies: A form of dementia with abnormal proteins (Lewy bodies) accumulating in the brain, and symptoms include impaired memory, concentration, visual hallucinations. |
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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 | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10067889 |
E.1.2 | Term | Dementia with Lewy bodies |
E.1.2 | System Organ Class | 10029205 - Nervous system disorders |
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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 |
1- To determine whether E2027 is superior to placebo on the cognitive endpoint of MoCA in subjects with DLB after 12 weeks of treatment 2- To determine whether E2027 is superior to placebo on the global clinical endpoint of CIBIC-Plus after 12 weeks of treatment |
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E.2.2 | Secondary objectives of the trial |
1: To determine whether E2027 is superior to placebo on the following secondary endpoints after 12 weeks of treatment: - Clinician Global Impression of Change in Dementia with Lewy Bodies (CGIC-DLB) - Cognitive Fluctuation Inventory (CFI) - Mini-Mental State Examination (MMSE) - Neuropsychiatric Inventory (NPI) To evaluate the safety and tolerability of E2027 in subjects with DLB To characterize the population pharmacokinetics (PPK) of E2027 in subjects with DLB, including evaluation of the effects of intrinsic and extrinsic factors on E2027 pharmacokinetics (PK) |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Male or female, age 50 to 85 years, inclusive at time of consent. 2. Meet criteria for probable DLB (as defined by the 4th report of the DLB Consortium) (Appendix 1). Specific situations regarding the use the imaging are described below: a. have 1 core clinical feature only by the investigator and who did not have previous reports of DAT brain imaging scan, MIBG scan or polysomnography (PSG) will undertake DAT brain imaging scan or MIBG scan as organized by the investigator. b. have 2 or more core clinical features by the investigator but who are judged as having only 1 core clinical feature by central reviewer and who did not have previous reports of DAT brain imaging scan, MIBG scan or PSG may undertake DAT brain imaging scan or MIBG scan after discussion with the sponsor medical monitor. c. have 2 or more core clinical features by the investigator and the central reviewer and who did not have previous reports of DAT brain imaging scan, MIBG scan or PSG may undertake DAT brain imaging scan or MIBG scan after discussion with the sponsor medical monitor if the investigator considers that imaging is necessary to confirm the diagnosis. 3. MMSE >14 and <26 at Screening Visit. 4. Has experienced visual hallucinations during the past 4 weeks before Screening Visit. 5. If receiving AChEIs, must have been on a stable dose for at least 12 weeks before Screening Visit, with no plans for dose adjustment during the study. Treatment-naïve subjects can be entered into the study but there should be no plans to initiate treatment with AChEIs from Screening to the end of the study. 6. If receiving memantine, must have been on a stable dose for at least 12 weeks before Screening Visit, with no plans for dose adjustment during the study. Treatment naïve subjects can be entered into the study but there should be no plans to initiate treatment with memantine from Screening to the end of the study. (revised per Amendment 03) 7.Must have an identified caregiver or informant who is 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, not be suffering from cognitive impairment, be sufficiently familiar with the subject and spend sufficient time with the subject on a regular basis such that the caregiver or informant can reliably fulfill the study requirements and must provide separate written consent. The caregiver or informant should normally be residing with the subject. If the caregiver or informant is not residing with the subject, the investigator has to be satisfied that the subject can contact the caregiver or informant readily during the times when the caregiver or informant is not with the subject. As a guide the caregiver or informant should have contact with the subject on at least 4 days a week and each day for a total of at least 5 hours. If in doubt about whether a subject's care arrangements are suitable for inclusion, the investigator should discuss this with the medical monitor. At all visits caregivers or informants need to attend the visit in person along with the subject. If during the study, the designated caregiver or informant relinquishes his/her responsibilities as caregiver or informant, a replacement caregiver or informant who meets the criteria above and who has similar knowledge of the subject’s clinical status from Baseline throughout the Treatment Period must be found. If no such replacement caregiver or informant is available, the subject must be discontinued from the study. 8. Provide written informed consent. If a subject lacks capacity to consent in the investigator's opinion, the subject's assent should be obtained, as required in accordance with local laws, regulations and customs, plus the written informed consent of a legal representative should be obtained (capacity to consent and definition of legal representative should be determined in accordance with applicable local laws and regulations). |
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E.4 | Principal exclusion criteria |
1. Any neurological condition that may be contributing to cognitive impairment above and beyond those caused by the subject’s DLB, including any comorbidities detected by clinical assessment or MRI. 2. History of transient ischemic attacks or stroke within 12 months of Screening. 3. Modified Hachinski Ischemic Scale >4. 4. Parkinsonian (extrapyramidal) features with Hoehn & Yahr stage IV or higher. 5. Any major psychiatric diagnosis, including schizophrenia, bipolar disorder and current major depressive disorder as per Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V). 6. GDS score >8. 7. Evidence of other clinically significant lesions that suggest a dementia diagnosis other than DLB 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. 8. Other significant pathological findings on brain MRI at Screening, including but not limited to: any macrohemorrhage (greater than 10 mm at greatest diameter); an area of superficial siderosis; evidence of cerebral contusion, encephalomalacia, aneurysms, arteriovenous malformations, or infective lesions; evidence of multiple lacunar infarcts or stroke involving a major vascular territory, severe small vessel or white matter disease; space occupying lesions; or brain tumors [however, lesions diagnosed as meningiomas or arachnoid cysts and less than or equal to 1 cm at their greatest diameter need not be exclusionary]) 9. Hypersensitivity to E2027 or any of the excipients. 10. A prolonged corrected QT interval calculated using Fridericia’s formula (QTcF) as demonstrated by triplicate ECG at the Screening or Baseline Visit (ie, mean value >450 msec). 11. Had symptomatic orthostatic hypotension or symptomatic orthostatic tachycardia which resulted in hospitalization or urgent medical review in hospital in the past 12 months before Screening. 12. Has a “yes” answer to 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. 13. Taking any of the prohibited medications or not meeting the requirements regarding stable doses of permitted medications. 14. Participation in a clinical study involving any investigational drug/device for DLB within 6 months before Screening or any other investigational drug/device in the 8 weeks or 5 half-lives (whichever is longer) of the study medication before Screening unless it can be documented that the subject was in a placebo treatment arm. 15. Females of childbearing potential. (NOTE: 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 [ie, bilateral tubal ligation, total hysterectomy, or bilateral oophorectomy, all with surgery at least 1 month before dosing]). 16. For subjects who participate in the CSF substudy, the following exclusions apply: a. A bleeding disorder that is not under adequate control (including a plate count <50,000, international normalized ratio [INR] >1.5 or partial thromboplastin time [PTT] > upper limit of normal [ULN]). b. Any contraindications to LP (eg, lower spinal malformation on physical examination, local spinal infection or other abnormality, or obesity to the extent that it makes LP technically difficult). |
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E.5 End points |
E.5.1 | Primary end point(s) |
1- Change from baseline in the MoCA total score at 12 weeks of treatment 2- CIBIC-Plus scale at 12 weeks of treatment |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
CGIC-DLB scale at 12 weeks of treatment Change from baseline at 12 weeks of treatment in the following endpoints: o CFI score o MMSE total score o NPI total score, subscores and caregiver or informant distress score Safety and tolerability of E2027 as measured by (revised per Amendment 02): o Incidence of adverse events including severe AEs, serious AEs, AEs resulting in discontinuation o Incidence of orthostatic hypotension and orthostatic tachycardia o Incidence of markedly abnormal laboratory values and shifts from baseline of laboratory values o Incidence of abnormal ECG parameters and abnormal ECG findings o Incidence of suicidality based on C-SSRS o Changes from baseline in the total score of Unified Parkinson's Disease Rating Scale Part III: Motor Examination (UPDRS-III). |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
12 weeks for : (1) Change from baseline at 12 weeks of treatment in the following endpoints: o NPI total score, subscores and caregiver or informant distress score o MMSE total score o CFI score
12 weeks for : (2) CGIC-DLB scale at 12 weeks of treatment
Over the period of 12 weeks for : (3) Safety and tolerability of E2027 |
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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 | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
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 | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
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 | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
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 | 1 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 25 |
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 |
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E.8.7 | Trial 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
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The end of study is defined as the last subject completing the Follow-Up Visit. |
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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 | 1 |
E.8.9.1 | In the Member State concerned months | 8 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 8 |