This is a confirmatory investigational medicinal product (IMP) study to investigate the effects on cognition, functional decline and on neuropsychiatric symptoms of the Glucocerebrosidase (GCase) enhancing chaperone ambroxol in participants diagnosed with prodromal and early dementia with Lewybodies (DLB).
Participants will be recruited through established network of Norwegian Memory Clinics. Patients will be randomised to ambroxol with proven effect on the lysosomal and glucocerebrosidase pathology in DLB or placebo. The randomization will be stratified based on APOE e4 and on the concentration of A-beta in CSF. The frequency of GBA genotypes in the active treatment and placebo groups will be calculated at study end. The blinded phase will last for 18 months and an open extension with ambroxol will be offered to all participants for one additional year. The primary outcomes will be cognition, global function, disease stage, progression, and neuropsychiatric symptoms. Secondary outcomes will be on sleep disturbances, falls, fluctuations and parkinsonism, and exploratory outcomes will be impact on the potential biomarkers for drug effects defined as qEEG, DaTSCAN, MRI and α-synuclein in CSF. One hundred and eighty participants will be recruited in total. Each participant will orally self-administer or administer by a caregiver ambroxol or placebo at 5 intra-participant dose escalations at 60 mg TID (day 1-7), 120 mg TID (day 8- 14), 315 BID (day 15-21), 315 mg TID (day 22-28) and 420 mg TID (day 29-550)).Participants will be subjected to clinical and laboratory assessments to assess the safety, tolerability effects of ambroxol on blood biomarkers and MRI, DaTSCAN, ECG, EEG and lumbar puncture. Each participant will undergo 8 hospital visits and 16 telephone visits for the blinded phase of the study during the first 18 months. Hospital visits will additionally include 1 or 2 screening appointments within 60 days of Day 1 hospital visit (at which participants will receive the first dose of ambroxol), followed by visits at week 4, week 8, week 24, week 36, week 52, month 15 and month 18. Participants will receive a telephone call 3 days after lumbar puncture to record any complaints. Participants will receive 16 telephone calls to record any drug related adverse events in between hospital visits, between 1-3 days before and after each dose escalation (day 1, 8, 15, 22 and 29, week 12,16, 20, 28, 32, 40, 44, 48 and month 13, 14, 16 and 17). All participants will be offered treatment with the IMP for 12 additional months from month 18 - month 30.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
180
Oral ambroxol medication (60 mg) from day 1 to study end (at 60 mg TID (day 1-7), 120 mg TID (day 8- 14), 315 mg BID (day 15-21), 315 mg TID (day 22-28) and 420 mg TID (day 29-550)
Oral placebo medication (60 mg) from day 1 to study end (at 60 mg TID (day 1-7), 120 mg TID (day 8- 14), 315 mg BID (day 15-21), 315 mg TID (day 22-28) and 420 mg TID (day 29-550)
Helse Fonna
Haugesund, Haugesund, Norway
RECRUITINGHaraldsplass Deaconess Hospital
Bergen, Norway
RECRUITINGUniversity Hospital, Akershus
Hågån, Norway
Change in the incidence, nature and severity of AE's and SAE's from baseline.
Change in the number of participants with AE's and SAE's.
Time frame: All patient visits including phonecalls trough study completion, planned duration 18 months
Change in the number of participants with treatment discontinuations and study discontinuation due to AEs from baseline.
Change from baseline in the number of participants with treatment and/or study discontinuation will be used to demonstrate safety and tolerability
Time frame: All patient visits including phonecalls trough study completion, planned duration 18 months
Change in the number of participants with electrocardiogram (ECG) abnormalities.
Including QTc interval.
Time frame: Through study completion at the following visits: Screening, Baseline, week 4, week 24, week 36, week 52, month 15, and month 18.
Change in blood analyses from baseline over time abnormalities.
Change from baseline in number of participants with abnormal changes in clinical laboratory blood tests from baseline over time for safety.
Time frame: Through study completion at the following visits: Screening, week 4, week 8, week 24, week 36, week 52, month 15, and month 18.
Change in MMSE-NR3 (Mini Mental Status Examination, Norwegian revised version) over time.
To confirm the effect of the IMP ambroxol in participants diagnosed with DLB measured by a defined battery of cognitive tests defining MMSE-NR3 as the primary outcome. The MMSE-NR3 is a screening test for cognitive impairment that spans the visuospatial/executive, naming, memory, attention, language, delayed recall and orientation domains (score range from 0 to 30 points).
Time frame: Through study completion at the following visits: Screening, week 24, week 36, week 52, Month 18.
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University Hospital, Akershus
Lørenskog, Norway
RECRUITINGOslo University Hospital
Oslo, Norway
RECRUITINGStavanger University Hospital
Stavanger, Norway
RECRUITINGUniversity Hospital North-Norway
Tromsø, Norway
RECRUITINGTrondheim University Hospital
Trondheim, Norway
RECRUITINGADCS-CGIC (Clinician's Global Impression of Change)
To confirm the effect of the IMP Ambroxol on the rate of functional decline in DLB.
Time frame: Through study completion at the following visits: Screening, week 24, week 36, week 52, month 18.
Change in CDR-SB (Clinical Dementia Rating-Sum of Boxes).
Measure Rate of decline from screening to study completion at month 18 using CDR-SB.
Time frame: Through study completion at the following visits: Screening, week 24, week 36 week 52, Month 18.
Change NPI (neuropsychiatric inventory)
To confirm the effect of the IMP Ambroxol on neuropsychiatric symptoms in DLB from screening to study completion at month 18 by using NPI. The NPI is a semistructured clinician interview of caretakers in which the severity and frequency of disturbance in 12 symptom domains is rated. The scoring reflects not only the effect on the patient, but also the extent to which the symptom causes distress in the caregiver. Score 0-144. The higher the score the more disease progression.
Time frame: Through study completion at the following visits: Screening, week 24, week 36, week 52, month 18.
GDS (geriatric depression scale) - 15 items
To confirm the effect of the IMP Ambroxol on neuropsychiatric symptoms in DLB from screening to study completion at month 18 by using GDS. The Geriatric Depression Scale (GDS) is a 15-item self-report assessment used to identify depression in the elderly. A high score usually always indicates depression and more severe depression.
Time frame: Through study completion at the following visits: Screening, week 24, week 36, week 52, month 18.
Mayo Sleep Questionnaire (MSQ).
To confirm the effect of The IMP Ambroxol in DLB measured on MSQ for evaluating sleep disturbances. MSQ is developed and validated in English version to detect Rapid Eye Movement - (REM) Sleep Behavior Disorder - (RBD) and several other sleep disorders in people with dementia and Parkinson's disease. RBD is part of the diagnosis of dementia with Lewy bodies. No score - only yes/no questions.
Time frame: Through study completion at the following visits: Screening, week 24, week 36, week 52, Month 18.
Mayo Fluctuation Scale (MFS)
To confirm the effect of The IMP Ambroxol in DLB measured on MFS for evaluating fluctuations. The Mayo Fluctuations Scale is a short questionnaire that evaluates cognitive fluctuation. Three or four points shows cognitive fluctuation. Scale 0-4.The higher the score the more disease progression
Time frame: Through study completion at the following visits: Screening, week 24, week 36, week 52, Month 18.
Unified Parkinson Disease Rating Scale (UPDRS-III)
To confirm the effect of The IMP Ambroxol in DLB measured on UPDRS-III for evaluating Parkinsonism. The unified Parkinson's disease rating scale (UPDRS) is used to follow the longitudinal course of Parkinson's disease. The UPD rating scale is the most commonly used scale in the clinical study of Parkinson's disease. Following the UPDRS scores over time provides insight into the patient's disease progression. Scale 0-138 points. The higher the score the more disease progression
Time frame: Through study completion at the following visits: Screening, week 8, week 24, week 36, week 52, Month 18.
Number of falls and related injury
To confirm the effect of The IMP Ambroxol in DLB measured on questions evaluating number of falls and related injury.
Time frame: Through study completion at the following visits: Screening, week 24, week 36, week 52, Month 18.