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Nicotinamide for Retinal Protection in Primary Open-Angle Glaucoma (NADIR Trial) (NADIR)

2026年9月9日 更新者：University of Chicago

NADIR Trial: A Principal Investigator-Initiated, Single-Center, Open-Label, Active-Controlled Phase 2a Study of High-Dose Nicotinamide (Vitamin B3) Supplementation in Adults With Mild to Moderate Primary Open-Angle Glaucoma (POAG)

The goal of this clinical trial is to learn whether a high-dose vitamin B3 supplement called nicotinamide can protect retinal nerve cells in adults with primary open-angle glaucoma (POAG) who are already receiving standard glaucoma eye drops or laser treatment. The main question it aims to answer is: Does adding nicotinamide to standard glaucoma therapy slow the rate of thinning of the inner retinal nerve cell layer (measured by a non-invasive eye scan) compared to standard therapy alone over 12 months?

Participants will be randomly assigned to one of two groups. Participants in the treatment group will take nicotinamide tablets by mouth, starting at a lower dose (1.5 grams per day) for the first 6 weeks and increasing to the full dose (3.0 grams per day) for the remainder of the 12-month study. Participants in the control group will continue their standard glaucoma care without the supplement.

Researchers will compare retinal imaging measurements between the two groups to see whether nicotinamide reduces the rate of retinal nerve cell thinning over time.

調査の概要

状態

まだ募集していません

条件

介入・治療

詳細な説明

Glaucoma causes progressive and irreversible loss of retinal ganglion cells (RGCs), often continuing despite adequate intraocular pressure control. Mitochondrial dysfunction and depletion of NAD+ (nicotinamide adenine dinucleotide) are increasingly recognized as central contributors to RGC vulnerability. Nicotinamide (NAM), a commercially available form of vitamin B3 and potent NAD+ precursor, has demonstrated robust neuroprotection in preclinical glaucoma models and early clinical trials outside the United States.

NADIR is the first IND-regulated, prospective, randomized Phase 2a trial in the United States to evaluate high-dose oral nicotinamide as adjunctive neuroprotective therapy in adults with mild to moderate POAG, using macular ganglion cell layer imaging (SD-OCT) as the primary structural biomarker detectable within 12 months. Ocular vascular perfusion imaging (OCT-A) is included as an exploratory endpoint.

研究の種類

介入

入学 (推定)

96

段階

  • フェーズ2

連絡先と場所

このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。

研究連絡先

研究連絡先のバックアップ

研究場所

  • アメリカ
    • Illinois
      • Chicago、Illinois、アメリカ、60637
        • University of Chicago Medicine Duchossois Center for Advanced Medicine
        • コンタクト：
        • コンタクト：

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

  • 大人
  • 高齢者

健康ボランティアの受け入れ

いいえ

説明

Inclusion Criteria:

  • Age 40 to 80 years, inclusive
  • Diagnosis of primary open-angle glaucoma (POAG) in at least one eye, confirmed by a licensed ophthalmologist or optometrist based on characteristic optic nerve head changes and/or visual field defects with an open anterior chamber angle
  • Mild to moderate glaucoma severity in the study eye: Humphrey Visual Field 24-2 mean deviation (MD) between -2.0 and -12.0 dB on at least one reliable test (fixation losses 33% or less, false positive rate 15% or less)
  • Best-corrected visual acuity (BCVA) of 20/40 or better (Snellen equivalent) in the study eye
  • Confirmed glaucomatous structural damage on SD-OCT (average GCIPL and/or RNFL below age-adjusted normative mean on device-generated classification) and/or a reproducible visual field defect on Humphrey Visual Field 24-2 consistent with glaucoma, as confirmed by the enrolling glaucoma specialist at screening
  • Macular GCIPL and peripapillary RNFL above device-specific SD-OCT floor effect in the study eye
  • Currently receiving stable intraocular pressure-lowering therapy (topical medications and/or prior selective laser trabeculoplasty) for at least 4 months prior to enrollment, with no planned changes to glaucoma therapy at the time of enrollment
  • Intraocular pressure of 21 mmHg or less on current therapy at the screening visit in the study eye
  • Established patient receiving ongoing glaucoma care at University of Chicago Medicine Duchossois Center for Advanced Medicine Eye Clinic
  • Willing and able to provide written informed consent and comply with all study visit schedules and procedures
  • Study eye selection: when POAG is present bilaterally, the study eye is defined as the eye with more severe disease (worse VF MD) that meets all eligibility criteria; if both eyes are equivalent in severity, the right eye is designated by default

Exclusion Criteria:

  • Advanced glaucoma: visual field MD worse than -12.0 dB in the study eye
  • Significant retinal disease affecting macular structure or visual field, including advanced age-related macular degeneration, diabetic retinopathy greater than mild non-proliferative, clinically significant diabetic macular edema, major retinal vein occlusion, or non-glaucomatous optic neuropathy
  • Ocular surgery other than uncomplicated cataract extraction or selective laser trabeculoplasty within the past 6 months
  • Hepatic dysfunction at baseline: AST or ALT greater than 2 times the upper limit of normal, or total bilirubin greater than 1.5 times the upper limit of normal
  • Renal dysfunction: eGFR less than 30 mL/min/1.73 m2
  • Current use of, or unwillingness to abstain from:

nicotinamide, niacinamide, nicotinamide riboside (NR), nicotinamide mononucleotide (NMN), or any other NAD+-precursor supplement not dispensed by the study; high-dose niacin or vitamin B3; Ginkgo biloba; CoQ10; isoniazid; pyrazinamide; carbamazepine; phenobarbital; primidone; or sustained-release niacin or nicotinamide formulations

  • Poorly controlled diabetes mellitus: HbA1c greater than 9.0% at screening
  • Normal tension glaucoma with documented intraocular pressure consistently 21 mmHg or less without hypotensive therapy
  • Participation in another investigational drug trial within 30 days of screening
  • Pregnancy, lactation, or intent to become pregnant during the study period
  • Significant cognitive impairment or inability to comply with study requirements
  • Clinically significant media opacity (corneal, lenticular, or vitreal) sufficient to degrade OCT signal quality below device-minimum thresholds, even if BCVA of 20/40 or better is preserved
  • Active or recent uveitis or intraocular inflammation in the study eye within the past 3 months
  • Any condition that, in the investigator's judgment, would preclude safe participation or confound result interpretation

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか？

デザインの詳細

  • 主な目的：処理
  • 割り当て：ランダム化
  • 介入モデル：並列代入
  • マスキング：なし（オープンラベル）

武器と介入

参加者グループ / アーム
介入・治療
実験的：High-Dose Oral Nicotinamide Plus Standard Glaucoma Care
Participants receive immediate-release oral nicotinamide titrated from 1.5 g/day (500 mg three times daily with meals, Weeks 1 through 6) to 3.0 g/day (1,500 mg twice daily [three 500 mg tablets per administration, twice daily] with meals, Week 7 through Month 12), in addition to individualized standard glaucoma therapy. Dose advancement at Week 7 requires confirmation at the Month 1 remote safety contact that no Grade 2 or higher hepatic adverse event is present and gastrointestinal tolerability is acceptable.
薬：Nicotinamide
Immediate-release nicotinamide 500 mg tablets (NDC 0-80681-01900; Rugby Laboratories / Contract Pharmacal Corp, Hauppauge NY). Titration phase: 500 mg three times daily (1.5 g/day total) for 6 weeks. Maintenance phase: 1,500 mg twice daily (three 500 mg tablets per administration, twice daily; 3.0 g/day total) from Week 7 through Month 12. Administered orally with meals. Dispensed and tracked by the University of Chicago Institutional Drug Service (IDS) Pharmacy under IND 184022.
他の名前：
  • ビタミンB3
  • ナイアシンアミド
  • ナム
  • Rugby Niacinamide 500 mg
他の：Standard Glaucoma Therapy
Individualized intraocular pressure-lowering therapy per the 2026 American Academy of Ophthalmology Primary Open-Angle Glaucoma Preferred Practice Pattern. Includes topical prostaglandin analog eye drops and/or selective laser trabeculoplasty, with clinical monitoring by optical coherence tomography, standard automated perimetry, and intraocular pressure measurement at 3 to 6 month intervals based on disease status.
アクティブコンパレータ：Standard Glaucoma Care Alone (Active Control)
Participants receive individualized standard glaucoma therapy per the 2026 American Academy of Ophthalmology Primary Open-Angle Glaucoma Preferred Practice Pattern, including intraocular pressure lowering with topical prostaglandin analogs and/or selective laser trabeculoplasty, with monitoring by optical coherence tomography, perimetry, and intraocular pressure measurement at 3 to 6 month intervals. No supplemental nicotinamide is administered.
他の：Standard Glaucoma Therapy
Individualized intraocular pressure-lowering therapy per the 2026 American Academy of Ophthalmology Primary Open-Angle Glaucoma Preferred Practice Pattern. Includes topical prostaglandin analog eye drops and/or selective laser trabeculoplasty, with clinical monitoring by optical coherence tomography, standard automated perimetry, and intraocular pressure measurement at 3 to 6 month intervals based on disease status.

この研究は何を測定していますか？

主要な結果の測定

結果測定
メジャーの説明
時間枠
Annualized Rate of Macular Ganglion Cell-Inner Plexiform Layer (GCIPL) Thinning
時間枠：Baseline (Month 0), Month 3, Month 6, and Month 12 (four repeated assessments over 12 months)
Rate of change in macular GCIPL thickness (micrometers per year) measured by spectral-domain optical coherence tomography (SD-OCT; Heidelberg Spectralis, minimum Q-score 20) with masked central image reading using de-identified participant IDs. The annualized thinning rate is estimated from repeated measurements using a linear mixed-effects model with random intercepts per participant and an arm-by-time interaction term as the primary inferential parameter.
Baseline (Month 0), Month 3, Month 6, and Month 12 (four repeated assessments over 12 months)

二次結果の測定

結果測定
メジャーの説明
時間枠
Annualized Rate of Peripapillary Retinal Nerve Fiber Layer (RNFL) Thinning
時間枠：Baseline (Month 0), Month 3, Month 6, and Month 12 (four repeated assessments over 12 months)
Rate of change in average peripapillary RNFL thickness (micrometers per year) measured by SD-OCT (Heidelberg Spectralis) with masked central reading. Analyzed using the same linear mixed-effects model framework as the primary endpoint. Both average and quadrant-specific RNFL (superior, inferior, temporal, nasal) will be reported.
Baseline (Month 0), Month 3, Month 6, and Month 12 (four repeated assessments over 12 months)
Visual Field Mean Deviation Slope
時間枠：Baseline through Month 12, assessed at Baseline (Month 0), Month 3, Month 6, and Month 12
Rate of change in Humphrey Visual Field Analyzer 24-2 SITA Standard mean deviation (decibels per year), estimated as a continuous slope over 12 months using a linear mixed-effects model with random intercepts per participant. Assessed at four timepoints: Baseline, Month 3, Month 6, and Month 12.
Baseline through Month 12, assessed at Baseline (Month 0), Month 3, Month 6, and Month 12
Incidence of Grade 2 or Higher Hepatic and Gastrointestinal Adverse Events
時間枠：From randomization through 30 days after the Month 12 visit (approximately 13 months)
Proportion of participants experiencing at least one hepatic adverse event (alanine aminotransferase or aspartate aminotransferase elevation, total bilirubin elevation) or gastrointestinal adverse event graded at Grade 2 or higher per the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v6.0). Hepatic laboratory values assessed by comprehensive metabolic panel (CMP) at every study visit and at the Month 1 remote safety contact for all participants in both arms.
From randomization through 30 days after the Month 12 visit (approximately 13 months)
Nicotinamide Adherence Rate
時間枠：Maintenance phase: Week 7 (Month 1 remote contact) through Month 12
Proportion of prescribed nicotinamide doses taken during the maintenance phase (Weeks 7 through 52), assessed by pill count and participant medication diary review at each in-person study visit. Applies to Arm 1 participants only.
Maintenance phase: Week 7 (Month 1 remote contact) through Month 12
Study Retention Rate
時間枠：Month 12 (52 weeks post-randomization)
Proportion of randomized participants completing the Month 12 study visit with at least one valid post-baseline macular GCIPL measurement. Assessed in both arms.
Month 12 (52 weeks post-randomization)

その他の成果指標

結果測定
メジャーの説明
時間枠
Change in Macular Superficial Capillary Plexus Perfusion Density on OCT-A
時間枠：Baseline (Month 0) and Month 12 (pre- and post-intervention comparison)
Change from baseline in macular superficial capillary plexus perfusion density (percent) measured by optical coherence tomography angiography (OCT-A; Optovue Solix FullRange AngioVue, FDA 510(k) K222166; minimum signal strength index 30). Analyzed by ANCOVA with baseline perfusion density as covariate. Designated an exploratory endpoint in this Phase 2a trial; not a pre-specified confirmatory secondary outcome.
Baseline (Month 0) and Month 12 (pre- and post-intervention comparison)
Change in Peripapillary Radial Capillary Plexus Perfusion Density on OCT-A
時間枠：Baseline (Month 0) and Month 12 (pre- and post-intervention comparison)
Change from baseline in peripapillary radial capillary plexus (RPC) perfusion density (percent) measured by optical coherence tomography angiography (OCT-A; Optovue Solix FullRange AngioVue, FDA 510(k) K222166; minimum signal strength index 30). Analyzed by ANCOVA with baseline peripapillary perfusion density as covariate and treatment arm as fixed factor. Macular and peripapillary perfusion density metrics are analyzed and reported separately. Designated an exploratory endpoint in this Phase 2a trial.
Baseline (Month 0) and Month 12 (pre- and post-intervention comparison)

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

University of Chicago

捜査官

  • 主任研究者：Steven C Quan, OD、University of Chicago

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始 (推定)

2027年6月1日

一次修了 (推定)

2029年9月30日

研究の完了 (推定)

2029年10月31日

試験登録日

最初に提出

2026年9月2日

QC基準を満たした最初の提出物

2026年9月2日

最初の投稿 (実際)

2026年9月8日

学習記録の更新

投稿された最後の更新 (実際)

2026年9月11日

QC基準を満たした最後の更新が送信されました

2026年9月9日

最終確認日

2026年9月1日

詳しくは

本研究に関する用語

キーワード

追加の関連 MeSH 用語

その他の研究ID番号

  • IRB26-0972
  • IND Number: 184022 (その他の識別子：U.S. Food and Drug Administration (FDA))

個々の参加者データ (IPD) の計画

個々の参加者データ (IPD) を共有する予定はありますか?

はい

IPD プランの説明

De-identified individual participant data supporting primary and secondary outcome analyses will be made available following study completion and primary manuscript publication, subject to University of Chicago data governance policies and a data use agreement. Requests will be reviewed by the principal investigator.

IPD 共有時間枠

Beginning 12 months after primary study results publication

IPD 共有アクセス基準

Requests submitted to the principal investigator with a brief description of the proposed analysis and intended use. De-identified data shared under a formal data use agreement per University of Chicago institutional policy.

IPD 共有サポート情報タイプ

  • STUDY_PROTOCOL
  • SAP
  • ICF

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米国FDA規制医薬品の研究

はい

米国FDA規制機器製品の研究

いいえ

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