The current study is being conducted by the Sponsor to evaluate the efficacy and safety of GV1001 (0.56 mg and 1.12 mg) administered subcutaneously as a treatment for mild to moderate Alzheimer's disease (AD). Studies using in vivo and in vitro AD models have shown that GV1001 inhibits neurotoxicity, apoptosis, and the production of reactive oxygen species induced by amyloid beta (Aβ) in neural stem cells by mimicking the extra-telomeric functions of human telomerase reverse transcriptase (hTERT). In nonclinical studies, using both mild (early stage) and severe (late stage) AD mouse models, GV1001 was shown to improve cognitive function and memory, as well as significantly reduce the amount of Aβ and tau proteins. The multifunctional effect of GV1001 makes it a promising therapeutic option for the treatment for AD. In a completed Phase 2 study conducted in Korea, GV1001 showed significant improvement in change from baseline of Severe Impairment Battery score at Week 24 and demonstrated a clinically acceptable safety profile in patients with moderate to severe AD.
This is a multicenter, randomized, double-blind, placebo-controlled, parallel-group Phase 2 study in participants with mild to moderate AD. The study will consist of a screening visit (up to 60 days prior to first dose), a 52-week double-blind treatment period, and an end-of-study (EOS) visit 2 weeks after the last dose of study drug. Eligible participants will be randomized in a 1:1:1 ratio to receive GV1001 0.56 mg, GV1001 1.12 mg, or placebo (normal saline) every week for 4 weeks beginning on Day 1 (of Week 1) followed by every 2 weeks through Week 50. Prior to randomization, eligibility of potential participants will be confirmed through an adjudication process in which screening data (eg, MMSE, magnetic resonance imaging \[MRI\] scans, positron emission tomography \[PET\] scans) obtained to evaluate AD status are reviewed by a medical monitor. The medical monitor will review the subject eligibility form completed by the Investigator prior to randomization and provide an independent assessment of the participant's eligibility and may request exclusion of a participant from entry into the study. A central independent reader will review MRI to confirm eligibility. Investigators must not randomize a participant prior to receipt of this independent confirmation of the participant's eligibility. Results from MRI, Aβ positron emission tomography (PET) scan, cerebrospinal fluid (CSF) examination or genetic testings performed within the 2 years prior to screening will also be used to confirm eligibility. If no historical results are available, participants will undergo a MRI or an Aβ PET scan at screening. If a participant discontinues treatment prematurely, the participant will be asked to continue with the scheduled study visits until the EOS visit. If a participant discontinues the study prematurely (except for those who withdraw their consent), the participant will be asked to come for an early termination (ET) visit for efficacy scale and safety assessments. These assessments are the same as those scheduled at the primary endpoint (PE) visit at Week 52. If the ET visit takes place within 4 weeks after a completed protocol scheduled visit with efficacy assessments, efficacy scale assessments are not required at the ET visit. For an individual participant, the maximum duration of study participation is approximately 14.5 months, including an up to 60-day screening period. An independent Data and Safety Monitoring Board (DSMB) review to evaluate safety data will be performed when at least 90 participants (50%) have either completed Week 26 or have discontinued the study. The DSMB may recommend early stopping of the study for safety reasons. Efficacy evaluations will be performed at baseline, Week 12, Week 26, Week 38, and Week 52 using the cognitive subscale of the Alzheimer's Disease Assessment Scale \[ADAS-cog11\]), assessment of activities of daily living (ie, Amsterdam Instrumental Activities of Daily Living Questionnaire \[A-IADL-Q\]), and global ratings of dementia (ie, Clinical Dementia Rating-Sum of Boxes \[CDR-SB\], Neuropsychiatric Inventory \[NPI\], Mini-Mental State Examination \[MMSE\], Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change/Clinician's Interview-Based Impression of Change - Plus Family Input \[ADCS-CGIC/CIBIC-Plus\], and Quality of Life in Alzheimer's Disease \[QoL-AD\]). The ADAS-cog11 scale will be evaluated by a central independent reader for each visit. At the visits where several efficacy assessments are administered, every effort should be made to perform the efficacy evaluations in the same order at each visit (ADAS-cog11, A-IADL-Q, NPI, MMSE, CDR-SB, ADCS-CGIC/CIBIC-Plus, and QoL-AD). Safety will be assessed throughout the study by monitoring for AEs, laboratory evaluations, electrocardiogram (ECG) findings, and vital signs measurements. Suicidal ideation and behavior will be assessed using the C-SSRS. Blood and CSF samples will be collected to evaluate the effect of GV1001 on analysis of biomarkers of AD.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
199
0.9% normal saline
Lyophilized peptide from hTERT
Lyophilized peptide from hTERT
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Change from baseline in ADAS-Cog11 score at Week 52
The Alzheimer's Disease Assessment Scale (ADAS) consists of 2 parts, a cognitive subscale and a behavioral subscale. The 11-item cognitive subscale (ADAS-cog) of the ADAS instrument will be used in this study. The ADAS-cog11 is a widely accepted performance-based assessment of cognition used in clinical studies for the treatment of participants with AD. The ADAS-cog11 (score range) consists of word recall (0-10) and word recognition memory tests (0-12), object and finger naming (0-5), commands (0-5), constructional praxis (0-5), ideational praxis (0-5), orientation (0-8), remembering test instructions (0-5), spoken language ability (0-5), comprehension of spoken language (0-5) and word finding difficulty (0-5). The maximum possible total score is 70, with a higher ADAS-cog11 score indicating worse cognitive function.
Time frame: Baseline, Week 12, Week 26, Week 38, and Week 52
Change from baseline in A-IADL-Q score at Week 12, Week 26, Week 38, and Week 52
Assessment of cognitively complex "instrumental activities of daily living" (IADLs), such as managing personal finances, using mobile phones, or even doing grocery shopping, is related to quality of life, caregiver burden, and resource utilization and is a relevant area to assess in AD clinical trials. There are various well validated IADL scales, but some are outdated as they do not assess current daily tasks. The Amsterdam IADL Questionnaire (A-IADL-Q) is an adaptive and computerized questionnaire designed to assess impairments IADL in patients with cognitive decline due to mild dementia. The questionnaire is completed by a caregiver and consists of 70 items in 7 categories (time needed 20-25 minutes).
Time frame: Baseline, Week 12, Week 26, Week 38, and Week 52
Change from baseline in CDR-SB score at Week 12, Week 26, Week 38, and Week 52
The Clinical Dementia Rating (CDR) is a 5-point global rating scale used to characterize 6 domains of cognitive and functional performance applicable to AD and related dementias: memory, orientation, judgment \& problem solving, community affairs, home \& hobbies, and personal care. The information needed to make each rating is obtained through a semi-structured interview of the participant and a reliable informant or collateral source (eg, family member). The CDR rater should be trained to administer the semi-structured interview and should be blinded to results of other assessments. For each domain, a rating is assigned to quantify the severity of impairment/dementia (0=no impairment; 0.5=very mild impairment; 1=mild impairment; 2=moderate impairment; and 3=severe impairment). The sum of the ratings for the 6 domains is the Clinical Dementia Rating-Sum of Boxes (CDR-SB) score.
Time frame: Baseline, Week 12, Week 26, Week 38, and Week 52
Clinical worsening, defined as ≥4 points change from baseline in the ADAS-cog11 score at Week 12, Week 26, Week 38, and Week 52
The Alzheimer's Disease Assessment Scale (ADAS) consists of 2 parts, a cognitive subscale and a behavioral subscale. The 11-item cognitive subscale (ADAS-cog) of the ADAS instrument will be used in this study. The ADAS-cog11 is a widely accepted performance-based assessment of cognition used in clinical studies for the treatment of participants with AD. The ADAS-cog11 (score range) consists of word recall (0-10) and word recognition memory tests (0-12), object and finger naming (0-5), commands (0-5), constructional praxis (0-5), ideational praxis (0-5), orientation (0-8), remembering test instructions (0-5), spoken language ability (0-5), comprehension of spoken language (0-5) and word finding difficulty (0-5). The maximum possible total score is 70, with a higher ADAS-cog11 score indicating worse cognitive function.
Time frame: Baseline, Week 12, Week 26, Week 38, and Week 52
Change from baseline in NPI score at Week 12, Week 26, Week 38, and Week 52
The NPI is a validated informant-based interview that assesses behavioral symptoms of dementia. It covers 12 domains. The NPI is administered to the participant's caregiver and includes an integrated caregiver distress measure. For each domain, abnormal behavior is noted to be absent (score=0) or present. If present, the frequency (rarely=1, sometimes=2, often=3, and very often=4), severity (mild=1, moderate=2, and severe=3), and associated caregiver distress (0=not at all, 1=minimally, 2=mildly, 3=moderately, 4=severely, and 5=very severely or extremely) are to be rated. The product of frequency and severity (maxi.=12) is calculated for each domain. A total NPI was the sum of the frequency and severity products (maxi. =144). A higher NPI score indicates a greater degree of behavioral disturbances.
Time frame: Baseline, Week 12, Week 26, Week 38, and Week 52
Change from baseline in MMSE score at Week 12, Week 26, Week 38, and Week 52
The MMSE is a brief test of cognitive function, defined as the sum of 11 items: orientation in time and place, registration, attention and concentration, recall, naming 2 objects, repetition, 3-stage command, reading, writing and copying. Scores range from 0 to 30; higher scores indicate better cognitive function.
Time frame: Baseline, Week 12, Week 26, Week 38, and Week 52
Change from baseline in ADCS-CGIC/CIBIC-Plus score at Week 12, Week 26, Week 38, and Week 52
The CIBIC-Plus is used as a measure of global clinical status. It is an independent, semi-structured medical interview that is used to assess changes in the participant's condition during a clinical study. An independent, experienced, and properly trained rater will provide a global impression of the participant's condition based on separate interviews with the participant and caregiver. The rater is not to elicit caregiver's opinion of the participant's condition but only factual information about the study participant's functioning. The change from baseline in CIBIC-Plus is rated on a 7-point scale: 1=markedly improved, 2=moderately improved, 3 = minimally improved, 4=no change, 5=minimally worse, 6=moderately worse, and 7=markedly worse.
Time frame: Baseline, Week 12, Week 26, Week 38, and Week 52
Change from baseline in QoL-AD score at Week 26 and Week 52
The QoL-AD includes the participant's and caregiver's appraisal of the participant's physical condition, mood, interpersonal relationships, ability to participate in meaningful activities, financial situation, and an overall assessment of self as a whole and life quality as a whole. It seems to be reliable and valid for individuals with MMSE scores greater than 10. The measure has 13 items, rated on a 4-point scale (poor, fair, good, excellent), with "l" being poor and "4" being excellent. Total scores range from 13 to 52. Separate scores are calculated for participant and caregiver reports.
Time frame: Baseline, Week 26, and Week 52
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