Memantine for the Treatment of Cognitive Impairment in Systemic Lupus Erythematosus

Lupus Erythematosus, Systemic Clinical Trial

— ClearMEMory  

Official title:

A Randomized Placebo-controlled, Double Blind Phase 2 Clinical Trial of Memantine for the Treatment of Cognitive Impairment in Systemic Lupus Erythematosus

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03527472
• Other study ID #: 180256
• Status: Recruiting
• Phase: Phase 2
• Start date: August 23, 2018
• Est. completion date: December 2026

Study information

• Verified date: May 2024
• Source: Vanderbilt University Medical Center
• Contact: Jonathan M Williams, PhD
• Phone: 6158759200
• Email: jon.williams[@]vumc.org
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

A phenome-wide association study (PheWAS) identified an association between a variant in the human gene for the N2A subunit of the N-methyl-D-aspartate (NMDA) receptor, GRIN2A, and Systemic Lupus Erythematosus (SLE). A single nucleotide polymorphism (SNP) in this gene encodes for increased NMDA receptor activity. Based on the potential function of the associated SNP and published literature, alterations in SNP function signaling may underlie a cluster of symptoms. The objective of this study is to evaluate the safety, tolerability and efficacy of memantine, an NMDA receptor antagonist, in a precise patient subset with SLE. Participants will complete a full 14-week clinical trial, receiving either memantine or a placebo. Participants' blood will be drawn to test for various antibodies as well as organ function. Patients' urine will also be collected to assess organ function and pregnancy for females at a number of specific time points. The overall goal is to develop a safe and inexpensive therapeutic approach to reduce debilitating cognitive symptoms in a precisely selected SLE sub-population.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 80
• Est. completion date: December 2026
• Est. primary completion date: June 2026
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 70 Years

Eligibility

Inclusion Criteria:

1. Meet American College of Rheumatology (ACR) criteria for SLE

2. Report NPSLE symptoms on the screening survey recommended by EULAR guideline but limited to the psychiatric manifestations questions

3. Score = 85 on the RBANS total index (= 1 SD below the normative mean of 100)

Exclusion Criteria:

1. Male and female subjects <18 or >60 years

2. Change in medication that may affect mood or cognition including prednisone, antidepressant medications, or stimulants within the last 4 weeks

3. Regular (daily) use of opioids or other drugs of abuse including heavy alcohol or marijuana use

4. Metabolic derangement defined as liver function tests >3x upper limit of normal or severe renal disease defined as calculated creatinine clearance <30 mL

5. Severe psychiatric disease including schizophrenia, psychosis, suicidal depression

6. Other factors which in the opinion of the investigator could potentially impact the study outcomes (e.g., underlying disease, medications, history)* or prevent the participant from completing the protocol (poor compliance or unpredictable schedule)

7. Inability or refusal to give informed consent for any reason including a diagnosis of dementia or significant cognitive impairment**

8. Patients who are pregnant

9. Patients who are enrolled in other investigational drug studies

Related Conditions & MeSH terms

• Cognitive Dysfunction
• Lupus Erythematosus, Systemic

Intervention

Drug:
• Memantine
Memantine is an FDA-approved drug for the treatment of Alzheimer's disease.
• Placebo
The placebo will match the study drug in appearance, dose, and frequency. It will not contain any active drug (memantine).

Locations

Country	Name	City	State
United States	The Cleveland Clinic	Cleveland	Ohio
United States	The University of Texas Health Science Center, Houston	Houston	Texas
United States	Vanderbilt University Medical Center	Nashville	Tennessee

Sponsors (4)

Lead Sponsor	Collaborator
Vanderbilt University Medical Center	Evergreen Therapeutics, Inc., The Cleveland Clinic, The University of Texas Health Science Center, Houston

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Repeatable Battery for Assessment of Neuropsychological Status (RBANS) Total Index Score at endpoint (Visit 4)	RBANS is a widely used psychiatric tool that objectively measures cognitive impairment. It is comprised of 12 subtests and takes approximately 30 minutes. For scoring, the RBANS index scores are converted to classifications including Very Superior (130 and above), Superior (120-129), High Average (110-119), Average (90-109), Low Average (80-89), Borderline (70-79), and Extremely Low (69 and below). A score of Extremely Low equates to severe cognitive impairment. The primary outcome measure will be analyzed using ANCOVA controlling for memantine/placebo, baseline RBANS, sex, age, and NMDAR status.	12 weeks
Secondary	Incidence of Treatment-Emergent Adverse Events	We will determine the safety of memantine as measured by treatment-emergent adverse events.	12 weeks
Secondary	Polysymptomatic Distress Scale	The Polysymptomatic Distress (PSD) scale measures the effect of PSD over a range of pain-related clinical symptoms. The scale was derived from variables used in the 2010 American College of Rheumatology fibromyalgia criteria, modified for use in clinical research, and broadened to be applicable for patients not meeting fibromyalgia diagnostic criteria. The PSD score is calculated by summing two components, the Widespread Pain Index (WPI) and Symptom Severity Scale (SSS). The WPI is a count of painful nonarticular body regions, and the SSS is a symptom severity measure that includes fatigue, sleep, and cognitive problems.	12 weeks
Secondary	Beck Depression Inventory	The Beck Depression Inventory (BDI) is a 21-item, self-report inventory that measures depression symptoms and attitudes. It takes approximately 10 minutes to complete and requires a fifth to sixth grade reading level to adequately comprehend the questions.	12 weeks
Secondary	Hospital Anxiety and Depression Scale	The Hospital Anxiety and Depression Scale (HADS) is a self-assessment scale and was developed to detect states of depression, anxiety, and emotional distress among patients who were being treated for a variety of clinical problems. The scale has a total of 14 items, with responses being scored on a scale of 0-3 (3 indicates higher symptom frequencies). Scores for each subscale (anxiety and depression) range from 0 to 21, categorized as follows: normal 0-7, mild 8-10, moderate 11-14, and severe 15-21.	12 weeks
Secondary	Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K	SLEDAI-2K is an updated version of the SLEDAI which was originally developed in 1985 as a clinical index to assess lupus disease activity in the preceding 10 days. It is a cumulative and weighted index of 24 different clinical and laboratory variables/disease descriptors, comprising 9 organ systems. The Investigator will assess disease descriptors on the SLEDAI-2K collection sheet (e.g., arthritis, myositis, alopecia, rash, mucosal ulcers, etc.).	12 weeks
Secondary	Patient Global Impression of Change	Participants will answer the standard question, "Considering all the ways your health affects you, how are you doing since the beginning of your treatment?" Answers include very much worse, much worse, worse, unchanged, improved, much improved, and very much improved.	Endpoint (Visit 4)
Secondary	RBANS Subscales	Our primary outcome is the RBANS Total Index Score, which is the sum of several subscales/tests. For a secondary outcome, we will look at each subscale/test individually to see if there is a trend for any one test in particular. The subscales are all scored the same (40 - 160) and include immediate memory, delayed memory, visuospatial/constructional, language, and attention.	12 weeks