Impact of Nilotinib on Safety, Biomarkers and Clinical Outcomes in Mild to Moderate Alzheimer's Disease (AD)

A Randomized, Double Blind, Placebo-controlled Study to Evaluate the Impact of Low Doses of Nilotinib (Tasigna®) on Safety, Biomarkers and Clinical Outcomes in Subjects With Mild to Moderate Alzheimer's Disease

The investigators hypothesize that Nilotinib will be safe in individuals with mild to moderate AD. Specifically, investigators hypothesize that low daily oral doses of Nilotinib will lead to CSF penetration, CNS Abl inhibition, and stabilization of CSF total Tau and p-Tau231/181 and Abeta42/40 levels. The investigators hypothesize that Nilotinib will decrease brain load of amyloid using amyloid positron emission tomography (PET). The investigators also predict that Nilotinib will reduce CSF markers of cell death, including neuron specific enolase (NSE) and S100B.

Study Overview

• Status: Completed
• Conditions: Alzheimer's Disease
• Intervention / Treatment: Drug: Placebo Capsule(s) Once a Day by Mouth; Drug: Nilotinib Capsule(s) Once a Day by Mouth

Detailed Description

The investigators propose a novel treatment strategy that involves Abl inhibition to alter Abeta40/42, total Tau and p-Tau231/181 in subjects with mild to moderate dementia due to AD. The goal of this study is to evaluate the impact of low dose Nilotinib on safety, biomarkers and clinical symptoms in patients with mild to moderate AD. Forty two (42) participants with mild to moderate and their study partners will be recruited and randomly assigned 1:1 to group 1 (placebo) for one year or group 2 treated with 150mg Nilotinib for 6 months followed by dose escalation to 300mg once for 12 months.

Primary outcomes, we will evaluate the effects of Nilotinib on: Safety and tolerability: Safety will be measured using the occurrence of adverse events (AEs) and serious adverse events (SAEs) deemed to be possibly, probably, or definitely related to the study drug. Tolerability for a given participant will be defined as the ability of participants to remain on treatment. Overall tolerability of the drug will be defined as less than 25% discontinuations due to drug-related AEs and SAEs. Secondary outcomes, we will determine the effects of Nilotinib treatment on measurement of Nilotinib in the CSF and Abl inhibition to demonstrate CNS target engagement and changes of AD related CSF and plasma levels of Abeta42/40, total Tau and p-Tau231/181. Exploratory outcomes will include assessment of: Cognitive function via MMSE, AD Assessment Scale-Cognitive subscale (ADAS-cog), AD Cooperative Study-Activity of Daily Living (ADCS-ADL), Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB), and Neuropsychiatric Inventory (NPI).

• Study Type: Interventional
• Enrollment (Actual): 37
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • District of Columbia
    • Washington D.C., District of Columbia, United States, 20057
      • Georgetown University Medical Center

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

1. Age ≥ 50
2. Fluent in English
3. Biomarker confirmed AD with CSF level of Abeta42 <600ng/mL
4. Able to ingest oral medications
5. Diagnosis of mild to moderate AD according to dementia criteria outlined by McKhann et al.
6. Neuroimaging (MRI or CT) consistent with the diagnosis of AD within the past year
7. MMSE between 17 and 24 (inclusive) at screening
8. Modified Hachinski score ≤ 4
9. QTc interval 350-460ms, inclusive
10. Caregiver/study partner to accompany participant to all visits and have direct contact with the participant > 2 days/week
11. Written informed consent
12. Capability and willingness to comply with all study criteria
13. Supervision available for study medication
14. Stable medical conditions for 3 months prior to screening visit
15. Stable medications for 4 weeks prior to screening visit
16. Able to complete baseline assessments
17. Minimum of 6 years of education, or work history sufficient to exclude mental retardation
18. Stable use of cholinesterase inhibitors and memantine (U.S. FDA-approved medications for patients with probable AD), vitamin E (up to 400 IU daily), estrogens, aspirin (81-300 mg daily), and cholesterol-lowering agents for 3 months prior to screening is allowed.
19. Clinical laboratory values within normal limits or, if abnormal, must be judged to be clinically insignificant by the investigator

Exclusion Criteria:

1. Non-AD dementia, probable AD with Down syndrome, APP, PS-1, or PS-2 mutations (known familial AD), LBD and Fronto-temporal dementia (FTD)
2. History of clinically significant stroke
3. Current evidence or history in past two years of epilepsy, focal brain lesion, head injury with loss of consciousness or DSM-IV criteria for any major psychiatric disorder including psychosis, major depression, bipolar disorder, alcohol or substance abuse
4. Sensory impairment that would preclude participation/cooperation with the protocol
5. Patients with hypokalemia, hypomagnesaemia, or long QTc syndrome.
6. Concomitant drugs known to prolong the QTc interval (>461ms) and history of cardiovascular disease, including myocardial infarction or cardiac failure, angina, arrhythmia
7. Prescribed strong CYP3A4 inhibitors or a medical history of liver or pancreatic disease
8. Evidence of any significant clinical disorder or laboratory finding that renders the participant unsuitable for receiving an investigational drug including clinically significant or unstable hematologic, hepatic, cardiovascular, pulmonary, gastrointestinal, endocrine, metabolic, renal or other systemic disease or laboratory abnormality
9. Active neoplastic disease, history of cancer five years prior to screening, including breast cancer (history of treated basal or squamous skin cancer, or stable prostate cancer are not exclusionary)
10. Pregnancy or possible pregnancy
11. Contraindications to LP: prior lumbosacral spine surgery, severe degenerative joint disease or deformity of the spine, platelets < 100,000, use of Coumadin/warfarin, or history of a bleeding disorder
12. Contraindication to MRI
13. Evidence of more than 4 micro hemorrhages and/or hemosiderosis by a recent (12 months) and/or the screening MRI.
14. A low B12 is exclusionary, unless follow-up labs (homocysteine (HC) and methylmalonic acid (MMA)) indicate that it is not physiologically significant.
15. Enrolled in another active trial investigating an experimental drug or therapy for AD
16. HIV positive

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
Placebo Comparator: Group 1 (placebo); Out of 42 total participants with mild to moderate AD (MMSE=17-24 inclusive) and their study partners that will be recruited and 1:1 randomized, 21 (twenty-one) will be assigned to group 1 and given 1 capsule of a placebo drug by mouth every day for the first 6 months followed by 2 capsules once daily for the subsequent 6 months, every time taken without a meal, for the total duration of the study for 12 months.	Drug: Placebo Capsule(s) Once a Day by Mouth; 1 capsule of Placebo once a day for 6 months followed by 2 capsules of Placebo for another 6 months; Other Names: Nilotinib in Alzheimer's Disease
Active Comparator: Group 2 (treated); Out of 42 total participants with mild to moderate AD (MMSE=17-24 inclusive) and their study partners that will be recruited and 1:1 randomized, 21 (twenty-one) will be assigned to group 2 treated with 1 capsule (150mg Nilotinib) once a day by mouth for the first 6 months followed by dose escalation to 2 capsules (300mg Nilotinib) once daily by mouth for the subsequent 6 months, every time taken without a meal, for the total study duration of 12 months.	Drug: Nilotinib Capsule(s) Once a Day by Mouth; 1 capsule of Nilotinib 150 mg once a day for 6 months followed by 2 capsules of Nilotinib (150 mg each capsule = 300 mb total) for the subsequent 6 months; Other Names: Nilotinib in Alzheimer's Disease

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety Will be Measured by Number of Participants Experiencing the Occurrence of Adverse Events and/or Abnormal Laboratory Values	Safety will be measured by assessing number of participants with abnormal laboratory values, as well as adverse events (AEs) and serious adverse events (SAEs) deemed to be possibly, probably, or definitely related to the study drug.	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pharmacokinetics of Nilotinib in Individuals With Alzheimer's Disease	To determine the Cmax (ng/ml), we will measure Bosutinib in both the CSF and Plasma and perform population pharmacokinetics using Liquid chromatography-tandem mass spectrometry (LC-MS/MS)	12 months
Pharmacokinetics of Nilotinib in Individuals With Alzheimer's Disease	To determine the Tmax, we will measure Bosutinib in both the CSF and Plasma and perform population pharmacokinetics using Liquid chromatography-tandem mass spectrometry (LC-MS/MS)	12 months
Pharmacokinetics of Nilotinib in Individuals With Alzheimer's Disease	To determine the AUC (ng/ml*h) , we will measure Bosutinib in both the CSF and Plasma and perform population pharmacokinetics using Liquid chromatography-tandem mass spectrometry (LC-MS/MS)	12 months

Collaborators and Investigators

• Sponsor: Georgetown University
• Investigators: Principal Investigator: Raymond S Turner, MD, PhD, Georgetown University; Study Director: Charbel E Moussa, MBBS, PhD, Georgetown University

Publications and helpful links

General Publications

• Pagan F, Hebron M, Valadez EH, Torres-Yaghi Y, Huang X, Mills RR, Wilmarth BM, Howard H, Dunn C, Carlson A, Lawler A, Rogers SL, Falconer RA, Ahn J, Li Z, Moussa C. Nilotinib Effects in Parkinson's disease and Dementia with Lewy bodies. J Parkinsons Dis. 2016 Jul 11;6(3):503-17. doi: 10.3233/JPD-160867.
• Pagan FL, Hebron ML, Wilmarth B, Torres-Yaghi Y, Lawler A, Mundel EE, Yusuf N, Starr NJ, Anjum M, Arellano J, Howard HH, Shi W, Mulki S, Kurd-Misto T, Matar S, Liu X, Ahn J, Moussa C. Nilotinib Effects on Safety, Tolerability, and Potential Biomarkers in Parkinson Disease: A Phase 2 Randomized Clinical Trial. JAMA Neurol. 2020 Mar 1;77(3):309-317. doi: 10.1001/jamaneurol.2019.4200.

Helpful Links

• MEMORY DISORDERS PROGRAM Georgetown University Medical Center & Medstar Georgetown University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2017
• Primary Completion (Actual): December 1, 2020
• Study Completion (Actual): March 1, 2021

Study Registration Dates

• First Submitted: October 21, 2016
• First Submitted That Met QC Criteria: October 27, 2016
• First Posted (Estimated): October 28, 2016

Study Record Updates

• Last Update Posted (Actual): July 23, 2026
• Last Update Submitted That Met QC Criteria: June 26, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Nilotinib in Alzheimer's disease
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Mental Disorders; Neurocognitive Disorders; Dementia; Tauopathies; Neurodegenerative Diseases; Alzheimer Disease
• Other Study ID Numbers: 2016-0315

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO