Alzheimer's Disease Clinical Trial
Official title:
Phase II, Modified Single-Blind, Sequential Treatment, Multiple Ascending Dose Study to Evaluate the Safety, Tolerability and Cerebral Efficacy of CPC-201 in Patients With Alzheimer's Disease Type Dementia: PET Study
The purpose of this study is to compare the effect of low and high dose CPC-201 on brain function including cerebral acetylcholinesterase (AChE) activity measured by positron emission tomography (PET).
Patients will continue on the 10 mg/day dose of donepezil with the addition of 15 mg/day of
solifenacin at least for a week, donepezil will be titrated from 10 to 50 mg/day (maximum
allowed dose; MAD) or each patient's MTD with increments of 5 or 10 mg weekly or bi-weekly as
medically appropriate. When the MTD or MAD of donepezil co-administered with solifenacin 15
mg/day as CPC-201 has been reached, treatment will be stably maintained, as tolerated, for 3
months.
Patients successfully completing this protocol will have the option of continuing in an open
extension of their CPC-201 treatment (separate protocol) or returned to their pre-admission
therapeutic regimen and discharged from the study.
On the days of study drug dose increase, patients will be evaluated at a clinic as an
out-patient.
This is a sequential study conducted in 6 phases in AD patients who had previously been
receiving donepezil at a dose of 10 mg/day:
1. Screening
2. Baseline assessment
3. Solifenacin introduction at a dose of 15 mg/day (given with continued donepezil 10
mg/day as CPC-201);
4. Donepezil dose escalation to each subject's MTD or 50 mg/day (MAD), given in combination
with solifenacin 15 mg/day as CPC-201;
5. Donepezil maintenance at its MTD (or MAD) combined with solifenacin 15 mg/day as CPC-201
for 3 months;
6. Protocol exit (after resumption of pre-study treatment regimen and successful completion
of a one month post-study safety check) or optional entry into a 6 month extension
phase.
Baseline assessment (during solifenacin introduction): Upon successful completion of a
screening evaluation and entry into this study, participants will continue to receive 10 mg
donepezil and receive neuropsychological evaluations at the clinic together with a 11C-PMP
PET scan and associated MRI studies of the brain in accordance with the University of
Michigan.
Solifenacin introduction: After the one week baseline assessment period, solifenacin
treatment will be initiated at 15 mg/day for at least one week while patients continue to
receive donepezil at a dose of 10 mg/day. Those who do not tolerate solifenacin will be
withdrawn from the study and replaced.
Donepezil escalation: During this phase, while continuing to receive 15 mg/day of
solifenacin, the dose of donepezil will be gradually increased at weekly or bi-weekly with
increments of 5 or 10 mg as tolerated. The dose of donepezil will be increased until the
first intolerable dose (FID) is reached or a dose of 50 mg/day is attained, whichever comes
first. Once patients reach their FID, their MTD will be defined as their immediately
preceding, tolerated dose. During dose titration, investigators may extend the same donepezil
dose for additional days or temporarily (or permanently) reduce it as medically indicated. On
the days of donepezil dose increase, patients will remain in the clinic for at least 5 hours
after study drug administration or until signs and symptoms of medically significant adverse
effects abate.
Donepezil dose maintenance: During this phase, patients will continue treatment with
donepezil (at MTD) and solifenacin (15 mg/day) for 3 months (± 2 weeks). All will be followed
by weekly telephone interviews and monthly clinic visits to assess safety and tolerability.
If intolerable adverse events (AEs) develop, the daily dose of donepezil will be
down-titrated, and the patient will continue treatment on their new MTD for an additional 2
weeks or up to completion of the maintenance phase, whichever comes last. Patients who
continue to experience intolerable AEs after several down-titrations will be withdrawn from
the study.
End of study testing at the end of donepezil dose maintenance: After completion of 3-months
(± 2 weeks) treatment with donepezil (at MTD) and solifenacin (15 mg/day), study participants
will receive a repeat of their clinical examination, routine laboratory safety tests and PET
associated studies.
Patients successfully completing this protocol will then have the option of continuing in an
open extension of their CPC-201 treatment (separate protocol) or to be returned to their
pre-admission therapeutic regimen and discharged from the study.
Study Exit: Upon termination of this study, subjects will return to their original daily
donepezil dose. Investigator will decide whether the patient should discontinue high dose of
donepezil without down-titration, or whether donepezil should be down-titrated to their
prestudy donepezil dose. Whatever the decision, the patient will ordinarily be treated at
least an additional 7 days with solifenacin 15 mg/day.
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