Phase 2
N=252
A Study of Crenezumab Versus Placebo in Preclinical Presenilin1 (PSEN1) E280A Mutation Carriers to Evaluate Efficacy and Safety in the Treatment of Autosomal-Dominant Alzheimer's Disease (AD), Including a Placebo-Treated Non-Carrier Cohort
Alzheimer's Disease
Bottom Line
View on ClinicalTrials.gov: NCT01998841 ↗Enrolled (actual)
252
Serious AEs
14.5%
Results posted
Sep 2023
Primary outcome: Primary: Period A: Annualized Rate of Change in the Autosomal-Dominant Alzheimer's Disease (API ADAD) Composite Cognitive Test Total Score — -1.10; -1.42 points on scale per year — p=0.43
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 2
- Interventions
- Crenezumab (Drug); Placebo (Drug)
- Age
- Adult · 30+ yrs
- Sex
- All
- Sponsor
- Genentech, Inc.
- Primary completion
- Mar 2022
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Period A: Annualized Rate of Change in the Autosomal-Dominant Alzheimer's Disease (API ADAD) Composite Cognitive Test Total Score |
-1.10; -1.42 | 0.43 |
| PRIMARY Period A: Annualized Rate of Change in an Episodic Memory Measure: Free and Cued Selective Reminding Task (FCSRT) Cueing Index |
-0.03; -0.04 | 0.16 |
| SECONDARY Period A: Time to Progression From Preclinical AD to Mild Cognitive Impairment (MCI) Due to AD or From Preclinical AD to Dementia Due to AD |
NA; NA | 0.48 |
| SECONDARY Period A: Time to Progression to Non-zero in CDR Scale Global Score |
2759.0; NA | 0.76 |
| SECONDARY Period A: Annualized Rate of Change in the CDR Scale - Sum of Boxes (SOB) |
0.30; 0.33 | 0.64 |
| SECONDARY Period A: Annualized Rate of Change in a Measure of Overall Neurocognitive Functioning: RBANS |
-0.23; -0.40 | 0.55 |
| SECONDARY Period A: Annualized Rate of Change in Mean Cerebral Fibrillar Amyloid Accumulation Using Florbetapir Positron Emission Tomography (PET) |
0.017; 0.017 | 0.69 |
| SECONDARY Period A: Annualized Rate of Change in Regional Cerebral Metabolic Rate of Glucose (CMRgI) Using Fluorine-18-Labeled 2-Deoxyglucose (FDG)-PET in a Predefined ROI |
-0.012; -0.015 | 0.25 |
| SECONDARY Period A: Annualized Rate of Change in Brain Atrophy Measured by Volumetric Measurements Using Magnetic Resonance Imaging (MRI) |
-721.91; -829.69; -92.62; -102.22; 808.16; 788.25 | 0.25 |
| SECONDARY Period A: Annualized Rate of Change in Tau-Based Cerebral Spinal Fluid (CSF) Biomarkers (Total Tau (tTau) and Phospho-tau (pTau) |
4.91; 6.88; 0.84; 1.34 | 0.53 |
| SECONDARY Period A: Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs) |
251; 56 | — |
| SECONDARY Period A: Number of Participants Who Withdrew From the Study Treatment Due to AEs |
1 | — |
| SECONDARY Period A: Number of Participants With Adverse Events of Special Interest (AESIs) |
6; 1; 0; 1; 0; 0 | — |
| SECONDARY Period A: Number of Participants Injection Reactions and Infusion-related Reaction (IRRs) |
92; 70 | — |
| SECONDARY Period A: Number of Participants With Anti-Crenezumab Antibodies |
5 | — |
| SECONDARY Period A: Cerebrospinal Fluid (CSF) Crenezumab Concentration |
NA; 0.198; 0.311; 0.238; 2.23 | — |
| SECONDARY Period A: Serum Crenezumab Concentration |
NA; 69.2; 93.9; 85.8; 114; 96.5 | — |
| SECONDARY Period A: Annualized Rate of Change in Plasma Concentrations of Amyloid Beta 1(Aβ1)-40 and Amyloid Peptide Beta 42 (Aβ1-42) |
6836.37; -686.18; 509.44; -46.59 | <0.0001 sig |
| SECONDARY Period B: Number of Participants With AEs and SAEs |
219; 12 | — |
| SECONDARY Period B: Number of Participants Who Withdraw From the Study Treatment Due to AEs |
— | — |
| SECONDARY Period B: Number of Participants With AESIs: ARIA-E, ARIA-H, Cerebral Macrohemorrhages, and Pneumonia |
1; 0; 0; 0; 0; 0 | — |
| SECONDARY Period B: Number of Participants With Injection Reactions and IRRs |
1; 12 | — |
Summary
This study consists of 2 periods: [1] Study Period A - evaluating the efficacy and safety of Crenezumab versus Placebo in participants who carry the PSEN1 E280A autosomal-dominant mutation and do not meet the criteria for mild cognitive impairment due to AD or dementia due to AD and are thus, in a preclinical phase of AD. Participants will be randomised in a 1:1 ratio to receive either Crenezumab or Placebo subcutaneously (every 2 weeks) or intravenously (every 4 weeks) for at least 260 weeks. A cohort of participants (non-mutation carriers) will also be enrolled and will be dosed solely on Placebo and [2] Study Period B - Participants will be offered the opportunity to continue to receive study drug until the results of the study are known and post trial access to Crenezumab is started or development of Crenezumab is discontinued.
Eligibility Criteria
Inclusion Criteria
- Membership in PSEN1 E280A mutation carrier kindred
- Agrees to conditions of, and is willing to undergo, genetic testing (for example [e.g.], apolipoprotein E [APOE], PSEN1 E280A, and other genetic testing)
- PSEN1 E280A mutation carrier or non-carrier status has been confirmed prior to or during the screening period
- Mini-Mental Stage Examination (MMSE) greater than or equal to (>=) 24 for participants with less than ( =26 for participants with 9 or more years of education
- Does not meet criteria for dementia due to AD per the National Institute on Aging and the Alzheimer's Association Workgroup (McKhann et al. 2011) criteria
- Does not meet criteria for mild cognitive impairment (MCI) due to AD per the National Institute on Aging and the Alzheimer's Association Workgroup (Albert et al. 2011) criteria
- Adequate vision and hearing in the investigator's judgment to be able to complete testing
- If female, and not documented (by medical records or physician's note) to be surgically sterile (absence of ovaries and/or uterus) or postmenopausal, willing to undergo pregnancy tests at protocol-specific timepoints
- For women who are not documented (by medical records or physician's note) to be surgically sterile (absence of ovaries and/or uterus) or postmenopausal, agreement to remain abstinent or use two adequate methods of contraception, including at least one method with a failure rate of =2 years prior to screening
- History of severe, clinically significant (persistent neurological deficit or structural brain damage) central nervous system trauma (e.g. cerebral contusion)
- Body weight 120 kilograms (kg)
- History or presence of atrial fibrillation that poses a risk for future stroke in the investigator's judgment
- Clinically significant laboratory or ECG abnormalities (e.g., abnormally prolonged or shortened QTc interval) in the investigator's judgment
- Current presence of bipolar disorder or other clinically significant major psychiatric disorder according to Diagnostic and Statistical Manual of Mental Disorders 4th Edition Text Revision (DSM-IV-TR) or symptom (e.g., hallucinations, agitation, paranoia) that could affect the participant's ability to complete evaluations
- Clinically significant depression, based in part by a Geriatric Depression Scale (short form) (15-point scale) score >9 at screening
- History of seizures (excluding febrile seizures of childhood, or other isolated seizure episodes that were not due to epilepsy in the judgment of the investigator, and required at most time-limited anticonvulsant treatment, and which occurred more than 7 years prior to the screening visit)
- Myocardial infarction within 2 years, congestive heart failure, atrial fibrillation, or uncontrolled hypertension
- Pregnant or nursing women, or women who intend to become pregnant or to nurse infants during the conduct of this trial
- Clinically significant infection within the last 30 days prior to screening
- Positive urine test for drugs of abuse at screening
- History of alcohol or substance dependence within the previous two years
- Use of any other medications with the potential to significantly affect cognition; intermittent or short-term use of these medications may be allowed if deemed medically necessary for the treatment of a non-excluded medical condition with approval from the Medical Monitor. In addition, use of tricyclic antidepressants or benzodiazepines will be permitted if used in stable, low doses for the treatment of a non-excluded medical condition with approval from the Medical Monitor
- Use of typical anti-psychotics or barbiturates
- Use of non-anti-cholinergic antidepressant medications or atypical anti-psychotics unless maintained on a stable dose regimen for at least 6 weeks prior to screening
- Use of any Food and Drug Administration (FDA)/Instituto Nacional de Vigilancia de Medicamentos y Alimentos (INVIMA)-approved medications for treatment of late onset Alzheimer's disease (LOAD)
Data sourced from ClinicalTrials.gov (NCT01998841). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.