24 Months Safety and Efficacy Study of AADvac1 in Patients With Mild Alzheimer's Disease (ADAMANT)

A 24 Months Randomised, Placebo-controlled, Parallel Group, Double Blinded, Multi Centre, Phase 2 Study to Assess Safety and Efficacy of AADvac1 Applied to Patients With Mild Alzheimer's Disease

This study evaluates the safety and efficacy of AADvac1 in the treatment of patients with mild Alzheimer's disease.

60% of participants will receive AADvac1 and 40% of participants will receive placebo.

Study Overview

• Status: Completed
• Conditions: Alzheimer's Disease
• Intervention / Treatment: Drug: Placebo; Biological: AADvac1

Detailed Description

Alzheimer's disease (AD) is a chronic progressive neurodegenerative disorder of the brain. Over the course of the disease, pathological proteins accumulate in the brain, damaging neurons, thus causing them to lose their connections and die.

Currently available treatments are designed to compensate for the neurotransmitter loss caused by the disease without affecting the disease process itself.

AADvac1 is designed to raise antibodies against pathological tau protein (the primary constituent of neurofibrillary pathology in AD). These antibodies are expected to prevent tau protein from aggregating, to facilitate the removal of tau protein aggregates and prevent the spreading of pathology, slowing or halting the progress of the disease.

• Study Type: Interventional
• Enrollment (Actual): 208
• Phase: Phase 2

Contacts and Locations

Study Locations

• Austria
  • Niederosterreich
    • Horn, Niederosterreich, Austria, 3580
      • Ordination Dr. Bancher
  • Steiermark
    • Graz, Steiermark, Austria, 8036
      • Universitätsklinik für Neurologie
  • Tirol
    • Hall in Tirol, Tirol, Austria, 6060
      • Abteilung Psychiatrie und Psychotherapie, LKH Hall
    • Innsbruck, Tirol, Austria, 6020
      • Universitätsklinikum Innsbruck
• Czechia
  • Brno, Czechia, 656 91
    • Fakultni nemocnice u sv. Anny v Brne, Mezinarodni centrum klinickeho vyzkumu (ICRC), Centrum pro kognitivni poruchy, Neuro 2
  • Hradec Kralove, Czechia, 500 05
    • Fakultní nemocnice Hradec Králové, Neurologická klinika
  • Klecany, Czechia, 250 67
    • Narodni ustav dusevniho zdravi (NÚDZ), Department of cognitive disorders - AD Center
  • Praha, Czechia, 128 21
    • Vseobecna Fakultni Nemocnice V Praze
  • Praha, Czechia, 150 06
    • Fakultni nemocnice v Motole
• Germany
  • Mannheim, Germany, 68159
    • Universität Heidelberg, Zentralinstitut für Seelische Gesundheit
  • München, Germany, 81675
    • Klinikum rechts der Isar der Technischen Universität München, Klinik und Poliklinik fur Psychiatrie und Psychotherapie
  • Nürnberg, Germany, 90402
    • Praxis Dr. Klaus Christian Steinwachs
  • Ulm, Germany, 89081
    • Universitätsklinikum Ulm, Klinik und Poliklinik für Neurologie
  • Rheinland-Pfalz
    • Erbach, Rheinland-Pfalz, Germany, 64711
      • Neuro Centrum Odenwald
  • Sachsen
    • Leipzig, Sachsen, Germany, 04107
      • Arzneimittelforschung Leipzig (AFL)
• Poland
  • Bialystok, Poland, 15-756
    • Podlaskie Centrum Psychogeriatrii
  • Bydgoszcz, Poland, 85-796
    • Pallmed prowadzacy NZOZ Dom Sue Ryder w Bydgoszczy Centrum Psychoneurologii Wieku Podeszlego
  • Katowice, Poland, 40-123
    • Wielospecjalistyczna Poradnia Lekarska SYNAPSIS
  • Katowice, Poland, 40-752
    • Care Clinic
  • Kraków, Poland, 31-505
    • Centrum Neurologii Klinicznej, Krakowska Akademia Neurologii
  • Lublin, Poland, 20-362
    • KO-MED Centra Kliniczne Sp. z o.o.
  • Olsztyn, Poland, 10-082
    • Oddzial Neurologiczny
  • Poznan, Poland, 61-853
    • NZOZ Neuro-Kard
  • Szczecin, Poland, 70-111
    • Euromedis Sp. z o.o.
  • Warszawa, Poland, 01-697
    • Centrum Medyczne NeuroProtect
  • Wroclaw, Poland, 53-139
    • Wrocławskie Centrum Alzheimerowskie
• Romania
  • Bucharest, Romania, 030447
    • "Dr. Constantin Gorgos" Psychiatry Hospital Titan
• Slovakia
  • Banska Bystrica, Slovakia, 974 04
    • Neurologická ambulancia
  • Bratislava, Slovakia, 81107
    • Nestatna psychiatricka ambulancia
  • Bratislava, Slovakia, 813 69
    • Univerzitna nemocnica Bratislava, Nemocnica Stare Mesto, I. Neurologicka klinika LF UK a UNB
  • Bratislava, Slovakia, 81369
    • Univerzitna nemocnica Bratislava, Psychiatricka klinika LFUK a UNB
  • Kosice, Slovakia, 041 90
    • Univerzitna nemocnica L Pasteura Kosice, Psychiatricka klinika
  • Krompachy, Slovakia, 05342
    • NEURES, s.r.o. Neurologicka ambulancia
  • Svidnik, Slovakia, 089 01
    • Centrum zdravia R.B.K., s.r.o., Psychiatricka ambulancia
  • Trencin, Slovakia, 91108
    • Pro Mente Sana S.R.O., Psychiatricka Ambulancia
  • Zilina, Slovakia, 012 07
    • Fakultna nemocnica s poliklinikou Zilina, Psychiatricke oddelenie
• Slovenia
  • Ljubljana, Slovenia, 1000
    • Univerzitetni klinični Center Ljubljana, Neurology Clinic
  • Maribor, Slovenia, 2000
    • University Clinical Centre Maribor
• Sweden
  • Malmö, Sweden, SE-20502
    • Skånes Universitetssjukhus Malmö, Minneskliniken
  • Mölndal, Sweden, SE-43141
    • Sahlgrenska Universitetssjukhuset, Minnesmottagningen
  • Stockholm, Sweden, SE-14186
    • Karolinska Universitetssjukhuset Huddinge
  • Uppsala, Sweden, SE-75185
    • Akademiska Sjukhuset I Uppsala, Minnes-och geriatrikmottagningen

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years to 85 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion criteria (abbreviated):

• Diagnosis of probable Alzheimer's disease according to the revised National Institute on Aging-Alzheimer's Association (NIA-AA) criteria (McKhann 2011).
• Mini Mental State Examination (MMSE) score ≥ 20 and ≤ 26.
• Brain MRI finding consistent with the diagnosis of Alzheimer's disease
• Medial temporal lobe atrophy: Scheltens score of ≥ 2 (on a scale of 0-4 on the more atrophied side) AND/OR positive AD biomarker profile in the CSF (amyloid+, tau+)
• At least 6 years of formal elementary education.
• Age 50-85 years.
• Fluency in the local language and sufficient auditory and visual capacities to allow neuropsychological testing.
• Ability to read and understand the informed consent.
• Stable therapy with an acetylcholinesterase inhibitor for at least 3 months prior to screening.
• If the patient is on memantine treatment, the dose regimen must be stable for at least 3 months prior to screening.
• Hachinski Ischemia Scale score ≤ 4.
• Availability of a caregiver.
• Female patients must be either surgically sterile or at least 2 years postmenopausal.
• Male patients must either be surgically sterile, or he and his female spouse/partner who is of childbearing potential must be using highly effective contraception starting at screening and continuing throughout the study period.
• Patient provides written informed consent.

Exclusion criteria (abbreviated):

• Participation in another clinical study within 3 months prior to screening.
• Pregnant or breastfeeding female.
• Not expected to complete the clinical study.
• Known allergy to components of the vaccine.
• Contraindication for MRI imaging.

• Any of the following detected by brain MRI:

  • Infarction in the territory of large vessels
  • More than one lacunar infarct.
  • Any lacunar infarct in a strategically important location.
  • Confluent hemispheric deep white matter lesions (Fazekas grade 3).
  • Other focal lesions which may be responsible for the cognitive status of the patient or any other abnormalities associated with significant central nervous disease other than Alzheimer's disease.
• Surgery (under general anaesthesia) within 3 months prior to screening and/or scheduled surgery (under general anaesthesia) during the whole study period.
• Patient has a history and/or currently suffers from a clinically significant autoimmune disease, or is expected to receive immunosuppressive or immunomodulatory treatment at the present or in the future.
• Recent history of cancer (last specific treatment ≤ 5 years prior to Screening).
• Myocardial infarction within 2 years prior to screening.
• Hepatitis B, C, HIV or Syphilis.
• Active infectious disease.
• Presence and/or history of immunodeficiency.

• Patient currently suffering from a clinically important systemic illness:

  • poorly controlled congestive heart failure (NYHA ≥ 3)
  • BMI > 40
  • poorly controlled diabetes (HbA1c > 7.5%)
  • severe renal insufficiency (eGFR < 30 mL/min)
  • chronic liver disease - ALT (alanine aminotransferase) > 66 U/L in females or > 80 U/L in males, AST (aspartate aminotransferase) > 82 U/L
  • QTc interval prolongation in ECG (> 450 ms)
  • other clinically significant systemic illness, if considered relevant by the investigator
• Hypothyroidism, defined as TSH (thyroid-stimulating hormone) elevation > 5.000 mcIU/mL, and/or FT4 levels < 0.7 ng/dL. Patients with corrected hypothyroidism are eligible for the study provided that treatment has been stable for 3 months before study entry.
• Valid diagnosis of a significant psychiatric illness such as schizophrenia, any type of psychotic disorder or bipolar affective disorder.
• Current depressive episode (Geriatric Depression Scale GDS ≥ 6) or major depressive episode within the last 1 years.
• Metabolic or toxic encephalopathy or dementia due to a general medical condition.
• History of alcohol or drug abuse or dependence within the past 2 years.
• Wernicke's encephalopathy.
• History or evidence of any CNS disorder other than AD that could be the cause of dementia.
• Cerebrovascular disease (ischemic or haemorrhagic stroke), or diagnosis of possible, probable or definite vascular dementia.
• Epilepsy.
• Treatment with experimental immunotherapeutics including intravenous immunoglobulin within 3 months prior to screening.
• Treatment with experimental therapies for AD aiming at disease-modification within 3 months prior to screening.
• Patient is currently being treated or was treated in the past with any active vaccines for AD.
• Treatment with immunosuppressive drugs.
• Change in dose of previous and current medications within the last 30 days prior to Screening (V01), if considered clinically relevant by the investigator.
• Vitamin B12 deficiency (serum vitamin B12 < 191 pg/mL).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: AADvac1; AADvac1 is a suspension for subcutaneous injection. AADvac1 is provided in single-use vials. Dosage: 40 µg Axon peptide 108 (coupled to keyhole limpet haemocyanin (KLH)) using aluminium hydroxide (containing 0.5 mg Al3+) as adjuvant, in a phosphate buffer. Patients receive 6 doses in 4-week intervals, and then 5 individual booster doses in 3-month intervals, for a total of 11 doses.	Biological: AADvac1
Placebo Comparator: Placebo; Placebo is a suspension for subcutaneous injection. Placebo is provided in single-use vials. Dosage: aluminium hydroxide (containing 0.5 mg Al3+), in a phosphate buffer. Patients receive 6 doses in 4-week intervals, and then 5 individual booster doses in 3-month intervals, for a total of 11 doses.	Drug: Placebo

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety (all-case treatment-emergent adverse events except local reactions)	The safety and tolerability of AADvac1 in the treatment of patients with mild Alzheimer disease, as assessed by AEs, vital signs, ECG, laboratory measures, MRI of the brain, physical and neurological examination, Columbia Suicide Severity Rating Scale (C-SSRS) and review of the Patient Diary	24 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinical Dementia Rating (CDR) Sum of Boxes	The domain scores of the standard 6-domain CDR assessment will be summed up to obtain a Sum-of-Boxes score of 0-18	24 months
Custom cognitive battery (composite standard score)	A composite standard score will be calculated from the following tests: Cogstate International Shopping List Task (memory); immediate free recall; delayed free recall; delayed recognition Cogstate One Card Learning Task (memory) Cogstate One Card Back Task (memory) Category Fluency Test (executive function, language) Letter Fluency Test (executive function, language) Digit Symbol Coding (executive functioning, working memory and processing speed)	24 months
Alzheimer's Disease Cooperative Study - Activities of Daily Living questionnaire (version for Mild Cognitive Impairment) (ADCS MCI ADL)	Activities of daily living will be assessed using the informant-based ADCS questionnaire (both the score for the 18-point and the 24-point version will be calculated)	24 months
Immunogenicity		24 months

Other Outcome Measures

Outcome Measure	Time Frame
Exploratory: Fludeoxyglucose Positron Emission Tomography (FDG PET) assessment of brain metabolism (change in cerebral glucose metabolic rate expressed as Standardised Uptake Value Ratio [SUVR] change, multiple regions of interest)	24 months
Exploratory: MRI volumetry	24 months
Exploratory: Cerebrospinal fluid (CSF) biomarkers	24 months

Collaborators and Investigators

• Sponsor: Axon Neuroscience SE
• Investigators: Principal Investigator: Reinhold Schmidt, Prof. MD., Medical University, Graz, Austria

Publications and helpful links

General Publications

• Kontsekova E, Zilka N, Kovacech B, Skrabana R, Novak M. Identification of structural determinants on tau protein essential for its pathological function: novel therapeutic target for tau immunotherapy in Alzheimer's disease. Alzheimers Res Ther. 2014 Aug 1;6(4):45. doi: 10.1186/alzrt277. eCollection 2014.
• Kontsekova E, Zilka N, Kovacech B, Novak P, Novak M. First-in-man tau vaccine targeting structural determinants essential for pathological tau-tau interaction reduces tau oligomerisation and neurofibrillary degeneration in an Alzheimer's disease model. Alzheimers Res Ther. 2014 Aug 1;6(4):44. doi: 10.1186/alzrt278. eCollection 2014.
• Novak P, Schmidt R, Kontsekova E, Zilka N, Kovacech B, Skrabana R, Vince-Kazmerova Z, Katina S, Fialova L, Prcina M, Parrak V, Dal-Bianco P, Brunner M, Staffen W, Rainer M, Ondrus M, Ropele S, Smisek M, Sivak R, Winblad B, Novak M. Safety and immunogenicity of the tau vaccine AADvac1 in patients with Alzheimer's disease: a randomised, double-blind, placebo-controlled, phase 1 trial. Lancet Neurol. 2017 Feb;16(2):123-134. doi: 10.1016/S1474-4422(16)30331-3. Epub 2016 Dec 10.

Study record dates

Study Major Dates

• Study Start: March 1, 2016
• Primary Completion (Actual): June 1, 2019
• Study Completion (Actual): June 1, 2019

Study Registration Dates

• First Submitted: October 9, 2015
• First Submitted That Met QC Criteria: October 15, 2015
• First Posted (Estimate): October 19, 2015

Study Record Updates

• Last Update Posted (Actual): November 14, 2019
• Last Update Submitted That Met QC Criteria: November 13, 2019
• Last Verified: November 1, 2019

More Information

Terms related to this study

• Keywords: immunotherapy; tau; vaccine; immunization; active; tau protein; KLH
• Additional Relevant MeSH Terms: Mental Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurocognitive Disorders; Neurodegenerative Diseases; Dementia; Tauopathies; Alzheimer Disease
• Other Study ID Numbers: AC-AD-003; 2015-000630-30 (EudraCT Number)