Huntington disease (HD) is an inherited neurodegenerative disease which affects over 30,000 people in both the United States and Australia. HD is characterized by brain cell death that usually begins between the ages of 30 to 50, and results in motor, cognitive and behavioral signs and symptoms. While there are medications to help relieve some of the disease symptoms, there is no known treatment to address the cognitive impairment associated with HD. Normally occurring metals in the brain play a significant role in diseases such as Alzheimer disease and HD. PBT2 is a drug designed to interrupt interactions between these biological metals and target proteins in the brain, to prevent deterioration of brain cells. PBT2, has shown in animal models, and as well as in a small group of patients with Alzheimer's disease, it may improve cognition. There is some indication in animal models of HD, that the drug may improve motor function and control and reduce the amount of brain cell degeneration. PBT2-203 will evaluate how safe and well tolerated PBT2 is at a dose of 100 mg or 250 mg a day administered as oral daily capsules compared to a placebo over a six month treatment period. The trial will also measure whether there is an effect on cognitive abilities as well as other HD symptoms including motor and overall functioning of individuals with HD.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
109
University of California San Diego
San Diego, California, United States
Colorado Neurological Institute
Englewood, Colorado, United States
University of Connecticut Health Center
Farmington, Connecticut, United States
University of Miami
Miami, Florida, United States
University of Maryland School of Medicine
Baltimore, Maryland, United States
Johns Hopkins University
Baltimore, Maryland, United States
Massachusetts General Hospital East
Charlestown, Massachusetts, United States
Struthers Parkinson's Center
Golden Valley, Minnesota, United States
Washington University
St Louis, Missouri, United States
Albany Medical College
Albany, New York, United States
...and 9 more locations
Safety and Tolerability of PBT2 in Patients With HD
As measured by the total number of participants in each dose group who reported at least one adverse events during the study,
Time frame: Baseline to 26 weeks
Change From Baseline in Cognitive Test Battery - Composite z Scores
Cognition composite z-scores were calculated for each participant. The composite scores were defined as the mean of the individual z-scores for the various cognition assessments. The Main Composite z-score was calculated for Category Fluency Test, Trail Making Test Part B, Map Search, Symbol Digit Modalities Test and Stroop Word Reading Test. The Exploratory Composite z-score was calculated for Category Fluency Test, Trail Making Test Part B, Map Search, Symbol Digit Modalities Test, Stroop Word Reading Test and Speeded Tapping test. The Executive Function Composite z-score was calculated from Category Fluency Test and Trail Making Test Part B. There is no unit of measure for the z score as it is the pure number calculated from the SD from the mean. A higher z score indicates an improvement.
Time frame: Baseline to 26 weeks
Change From Baseline in Motor Function
Total motor score calculated from the Unified Huntington Disease Rating Scale - Motor Function. The motor section of the UHDRS assesses motor features of HD with standardized ratings of oculomotor function, dysarthria, chorea, dystonia, gait, and postural stability. The total motor impairment scores is the sum of all the individual motor ratings, with higher scores indicating more severe motor impairment than lower scores. A maximum score of 60 is possible (range 0-60).
Time frame: Baseline to 26 weeks
Change From Baseline in Functional Abilities
Total Functional Capacity (TFC) assessment was based on an individual's ability to perform common daily tasks. TFC score range was 0 to 13. Higher scores on the function scales indicate better functioning than lower scores.
Time frame: Baseline to 26 weeks
Change From Baseline in Behaviour
Total Behavioural score from the Unified Huntington Disease Rating Scale. The behavioural assessment measures the frequency and severity of symptoms related to affect, thought content and coping styles. The total behaviour score is the sum of all responses, with scale range of 0 to 8. Higher scores on the behaviour assessments indicate more severe disturbance than lower scores.
Time frame: Baseline to 26 weeks
Change From Baseline in Investigator Global Assessments by Efficacy Index
Global function was assessed by the Investigator using the clinical global impression (CGI) scale which included assessing the severity of illness and global improvement and calculating the efficacy index for each participant. The efficacy index aims to relate therapeutic effects to reported side effects as assessed by the Investigator (range from 0 \[marked improvement and no side effects\] to 4 \[unchanged or worse\] and side effects outweigh therapeutic effects) and is calculated for each participant by dividing the therapeutic effect score by the side effects score. An improvement is reflected by CGI scale Efficacy Index values \>1.
Time frame: Baseline to 26 weeks
Change From Baseline in Blood Biomarkers
Biomarkers assessed primarily with mutant huntingtin protein, normalised to lysate protein concentrations, as a change from baseline.
Time frame: Baseline to 26 weeks
Change From Baseline in Brain Function (MRI)
Measure of whole brain iron concentrations.
Time frame: Baseline to 26 weeks
Change From Baseline in Blood Biomarkers
Biomarkers assessed primarily with soluble huntingtin protein, normalised to lysate protein concentrations, as a change from baseline.
Time frame: Baseline to 26 weeks
Change From Baseline in Blood Biomarkers - Selenium
Biomarkers assessed primarily with plasma selenium as a change from baseline.
Time frame: Baseline to 26 weeks
Change From Baseline in Urine Biomarkers
Biomarkers assessed primarily with 8-hydroxy-2'-deoxyguanosine, normalised to creatinine concentrations, as a change from baseline.
Time frame: Baseline to 26 weeks
Change From Baseline in Brain Function (MRI)
Measure of the structural brain volume as assessed by the left caudate volume.
Time frame: Baseline to 26 weeks
Change From Baseline in Cognitive Test Battery - TMT Part B
Trail Making Test Part B was assessed by the number of seconds to complete the test (from 0 to 240 seconds). The Trails Making Test Part B actual change from baseline at Week 26 was analysed.
Time frame: Baseline to 26 weeks
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