1
|
Bogert J, Rofael H, Mosca K, Ross RO, Callaerts G, Wang D, Jaeger J, Narayan VA, Drevets WC, Morrison RL. A randomized, multicenter, crossover psychometric evaluation study of an iPad-administered cognitive test battery in participants with major depressive disorder who responded to treatment with oral antidepressants. J Affect Disord 2021; 292:261-269. [PMID: 34134024 DOI: 10.1016/j.jad.2021.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 05/14/2021] [Accepted: 05/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Performance validity and test-retest reliability of ReVeRe.D, an iPad-administered cognitive test battery in major depressive disorder (MDD) were analyzed. METHODS Participants aged 18-59 years had DSM-5 diagnosis of MDD with adequate visual and hearing acuity. All had responded to oral antidepressant treatment for a major depressive episode within the most recent 24-months and were stable with no greater than mild depressive symptoms as evidenced by Montgomery Asberg Depression Rating Scale total score <17. Participants were randomly assigned to 1 of 2 test sequences (AABB or BBAA; A=ReVeRe.D; B=examiner-administered tests) in a crossover design. RESULTS 244 randomized participants (AABB: n=123; BBAA: n=121) had mean age of 38.3 years; 54.9% had a college, baccalaureate, or higher education. At first administration, Pearson correlation coefficients (PCC) for 6/10 pairs of corresponding ReVeRe.D vs examiner-administered tests exceeded the pre-specified acceptance criterion (PCC=0.53) for the primary analysis; 8 test score pairs had PCC exceeding 0.40. At second administration, PCC for 9/10 test scores pairs exceeded PCC=0.53. Together, the series of PCCs supports the concurrent validity for ReVeRe.D. Test-retest reliability for ReVeRe.D test scores was generally moderate to high. LIMITATIONS The study included stable participants with MDD who had responded to oral antidepressant treatment, with most in at least partial remission. The sample was limited to English-speaking participants, and skewed towards white, college-educated women. Further studies in acutely ill MDD patients who represent a broader demographic, are warranted. CONCLUSIONS iPad-administered ReVeRe.D is a valid and reliable computerized test battery for assessment of cognitive performance in MDD.
Collapse
Affiliation(s)
| | - Hany Rofael
- Janssen Research & Development, LLC, NJ, USA
| | | | | | | | - Daniel Wang
- Janssen Research & Development, LLC, CA, USA
| | - Judith Jaeger
- CognitionMetrics, LLC, Wilmington, DE, USA; Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | |
Collapse
|
2
|
Sperling R, Henley D, Aisen PS, Raman R, Donohue MC, Ernstrom K, Rafii MS, Streffer J, Shi Y, Karcher K, Raghavan N, Tymofyeyev Y, Bogert J, Brashear HR, Novak G, Thipphawong J, Saad ZS, Kolb H, Rofael H, Sanga P, Romano G. Findings of Efficacy, Safety, and Biomarker Outcomes of Atabecestat in Preclinical Alzheimer Disease: A Truncated Randomized Phase 2b/3 Clinical Trial. JAMA Neurol 2021; 78:293-301. [PMID: 33464300 PMCID: PMC7816119 DOI: 10.1001/jamaneurol.2020.4857] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/29/2020] [Indexed: 12/11/2022]
Abstract
Importance Atabecestat, a nonselective oral β-secretase inhibitor, was evaluated in the EARLY trial for slowing cognitive decline in participants with preclinical Alzheimer disease. Preliminary analyses suggested dose-related cognitive worsening and neuropsychiatric adverse events (AEs). Objective To report efficacy, safety, and biomarker findings in the EARLY trial, both on and off atabecestat treatment, with focus on potential recovery of effects on cognition and behavior. Design, Setting, and Participants Randomized, double-blind, placebo-controlled, phase 2b/3 study conducted from November 2015 to December 2018 after being stopped prematurely. The study was conducted at 143 centers across 14 countries. Participants were permitted to be followed off-treatment by the original protocol, collecting safety and efficacy data. From 4464 screened participants, 557 amyloid-positive, cognitively normal (Clinical Dementia Rating of 0; aged 60-85 years) participants (approximately 34% of originally planned 1650) were randomized before the trial sponsor stopped enrollment. Interventions Participants were randomized (1:1:1) to atabecestat, 5 mg (n = 189), 25 mg (n = 183), or placebo (n = 185). Main Outcomes and Measures Primary outcome: change from baseline in Preclinical Alzheimer Cognitive Composite score. Secondary outcomes: change from baseline in the Cognitive Function Index and the Repeatable Battery for the Assessment of Neuropsychological Status total scale score. Safety was monitored throughout the study. Results Of 557 participants, 341 were women (61.2%); mean (SD) age was 70.4 (5.56) years. In May 2018, study medication was stopped early owing to hepatic-related AEs; participants were followed up off-treatment for 6 months. Atabecestat, 25 mg, showed significant cognitive worsening vs placebo for Preclinical Alzheimer Cognitive Composite at month 6 (least-square mean difference, -1.09; 95% CI, -1.66 to -0.53; P < .001) and month 12 (least-square mean, -1.62; 95% CI, -2.49 to -0.76; P < .001), and at month 3 for Repeatable Battery for the Assessment of Neuropsychological Status (least-square mean, -3.70; 95% CI, -5.76 to -1.63; P < .001). Cognitive Function Index participant report showed nonsignificant worsening at month 12. Systemic and neuropsychiatric-related treatment-emergent AEs were greater in atabecestat groups vs placebo. After stopping treatment, follow-up cognitive testing and AE assessment provided evidence of reversibility of drug-induced cognitive worsening and AEs in atabecestat groups. Conclusions and Relevance Atabecestat treatment was associated with dose-related cognitive worsening as early as 3 months and presence of neuropsychiatric treatment-emergent AEs, with evidence of reversibility after 6 months off treatment. Trial Registration ClinicalTrials.gov Identifier: NCT02569398.
Collapse
Affiliation(s)
| | - David Henley
- Janssen Research & Development LLC, Titusville, New Jersey
- Indiana University School of Medicine, Indianapolis
| | - Paul S. Aisen
- Alzheimer’s Therapeutic Research Institute, University of Southern California, Los Angeles
| | - Rema Raman
- Alzheimer’s Therapeutic Research Institute, University of Southern California, Los Angeles
| | - Michael C. Donohue
- Alzheimer’s Therapeutic Research Institute, University of Southern California, Los Angeles
| | - Karin Ernstrom
- Alzheimer’s Therapeutic Research Institute, University of Southern California, Los Angeles
| | - Michael S. Rafii
- Alzheimer’s Therapeutic Research Institute, University of Southern California, Los Angeles
| | - Johannes Streffer
- Janssen Research & Development LLC, Titusville, New Jersey
- Translational Medicine Neuroscience, UCB Biopharma SRL, Braine-l'Alleud, Belgium
- Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Yingqi Shi
- Janssen Research & Development LLC, Titusville, New Jersey
| | - Keith Karcher
- Janssen Research & Development LLC, Titusville, New Jersey
| | | | | | | | - H. Robert Brashear
- Janssen Research & Development LLC, Titusville, New Jersey
- Department of Neurology, University of Virginia, Charlottesville
| | - Gerald Novak
- Janssen Research & Development LLC, Titusville, New Jersey
| | | | - Ziad S. Saad
- Janssen Research & Development LLC, Titusville, New Jersey
| | - Hartmuth Kolb
- Janssen Research & Development LLC, Titusville, New Jersey
| | - Hany Rofael
- Janssen Research & Development LLC, Titusville, New Jersey
| | - Panna Sanga
- Janssen Research & Development LLC, Titusville, New Jersey
| | - Gary Romano
- Janssen Research & Development LLC, Titusville, New Jersey
- Passage Bio, Philadelphia, Pennsylvania
| |
Collapse
|
3
|
Novak G, Streffer JR, Timmers M, Henley D, Brashear HR, Bogert J, Russu A, Janssens L, Tesseur I, Tritsmans L, Van Nueten L, Engelborghs S. Long-term safety and tolerability of atabecestat (JNJ-54861911), an oral BACE1 inhibitor, in early Alzheimer's disease spectrum patients: a randomized, double-blind, placebo-controlled study and a two-period extension study. Alzheimers Res Ther 2020; 12:58. [PMID: 32410694 PMCID: PMC7227237 DOI: 10.1186/s13195-020-00614-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/02/2020] [Indexed: 01/18/2023]
Abstract
Background Atabecestat, a potent brain-penetrable inhibitor of BACE1 activity that reduces CSF amyloid beta (Aβ), was developed for oral treatment for Alzheimer’s disease (AD). The long-term safety and effect of atabecestat on cognitive performance in participants with predementia AD in two phase 2 studies were assessed. Methods In the placebo-controlled double-blind parent ALZ2002 study, participants aged 50 to 85 years were randomized (1:1:1) to placebo or atabecestat 10 or 50 mg once daily (later reduced to 5 and 25 mg) for 6 months. Participants entered ALZ2004, a 12-month treatment extension with placebo or atabecestat 10 or 25 mg, followed by an open-label phase. Safety, changes in CSF biomarker levels, brain volume, and effects on cognitive performance were assessed. Results Of 114 participants randomized in ALZ2002, 99 (87%) completed, 90 entered the ALZ2004 double-blind phase, and 77 progressed to the open-label phase. CSF Aβ fragments and sAPPβ were reduced dose-proportionately. Decreases in whole brain and hippocampal volumes were greater in participants with mild cognitive impairment (MCI) due to AD than in preclinical AD, but were not affected by treatment. In ALZ2004, change from baseline in RBANS trended toward worse scores for atabecestat versus placebo. Elevated liver enzyme adverse events reported in 12 participants on atabecestat resulted in dosage modification and increased frequency of safety monitoring. Treatment discontinuation normalized ALT or AST in all except one with pretreatment elevation, which remained mildly elevated. No case met ALT/AST > 3× ULN and total bilirubin > 2× ULN (Hy’s law). Conclusion Atabecestat was associated with trend toward declines in cognition, and elevation of liver enzymes. Trial registration ALZ2002: ClinicalTrials.gov, NCT02260674, registered October 9, 2014; ALZ2004: ClinicalTrials.gov, NCT02406027, registered April 1, 2015.
Collapse
Affiliation(s)
- Gerald Novak
- Janssen Research and Development LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ, 08560, USA.
| | - Johannes Rolf Streffer
- Janssen Research and Development, a Division of Janssen Pharmaceutica NV, Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.,Present address: UCB Biopharma SPRL, Chemin du Foriest, B-1420, Braine-l'Alleud, Belgium
| | - Maarten Timmers
- Janssen Research and Development, a Division of Janssen Pharmaceutica NV, Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - David Henley
- Janssen Research and Development LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ, 08560, USA
| | - H Robert Brashear
- Janssen Research and Development LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ, 08560, USA
| | | | - Alberto Russu
- Janssen Research and Development, a Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Luc Janssens
- Janssen Research and Development, a Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Ina Tesseur
- Janssen Research and Development, a Division of Janssen Pharmaceutica NV, Beerse, Belgium.,Present address: UCB Biopharma SPRL, Chemin du Foriest, B-1420, Braine-l'Alleud, Belgium
| | - Luc Tritsmans
- Janssen Research and Development, a Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Luc Van Nueten
- Janssen Research and Development, a Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.,Department of Neurology and Center for Neurosciences, UZ Brussel and Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
4
|
Timmers M, Tesseur I, Bogert J, Zetterberg H, Blennow K, Börjesson-Hanson A, Baquero M, Boada M, Randolph C, Tritsmans L, Van Nueten L, Engelborghs S, Streffer JR. Relevance of the interplay between amyloid and tau for cognitive impairment in early Alzheimer's disease. Neurobiol Aging 2019; 79:131-141. [PMID: 31055223 DOI: 10.1016/j.neurobiolaging.2019.03.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/08/2019] [Accepted: 03/25/2019] [Indexed: 01/23/2023]
Abstract
Amyloid β (Aβ) and tau are key hallmark features of Alzheimer's disease (AD) neuropathology. The interplay of Aβ and tau for cognitive impairment in early AD was examined with cross-sectional analysis, measured by cerebrospinal fluid biomarkers (Aβ1-42, total tau [t-tau], and phosphorylated tau [p-tau181P]), and on cognitive performance by the repeatable battery for assessment of neuropsychological status (RBANS). Participants (n = 246) included cognitively normal (Aβ-), mild cognitively impaired (Aβ-), preclinical AD (Aβ+), and prodromal AD (Aβ+). Overall, cognitive scores (RBANS total scale score) had a moderate negative correlation to t-tau (n = 246; r = -0.434; p < 0.001) and p-tau181P (r = -0.389; p < 0.001). When classified by Aβ status, this correlation to t-tau was applicable only in Aβ+ participants (n = 139; r = -0.451, p < 0.001) but not Aβ- participants (n = 107; r = 0.137, p = 0.16), with identical findings for p-tau. Both tau (p < 0.0001) and interaction of Aβ1-42 with tau (p = 0.006) affected RBANS, but not Aβ1-42 alone. Cognitive/memory performance correlated well with cerebrospinal fluid tau levels across early stages of AD, although the correlation is Aβ dependent.
Collapse
Affiliation(s)
- Maarten Timmers
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.
| | - Ina Tesseur
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | | | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistery Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK; UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistery Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Anne Börjesson-Hanson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Sahlgrenska University Hospital, Mölndal, Sweden; Clinical Trials, Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Miquel Baquero
- Neurology Department, Hospital Universitari I Politecnic La Fe, Valencia, Spain
| | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya-Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Christopher Randolph
- MedAvante-ProPhase, Hamilton, NJ, USA; Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
| | - Luc Tritsmans
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Luc Van Nueten
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium; Department of Neurology and Center for Neurosciences, UZ Brussel and Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Johannes Rolf Streffer
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
5
|
Brashear HR, Ketter N, Bogert J, Di J, Salloway SP, Sperling R. Clinical Evaluation of Amyloid-Related Imaging Abnormalities in Bapineuzumab Phase III Studies. J Alzheimers Dis 2018; 66:1409-1424. [DOI: 10.3233/jad-180675] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- H. Robert Brashear
- Janssen Alzheimer Immunotherapy Research & Development, LLC, South San Francisco, CA, USA
| | - Nzeera Ketter
- Janssen Alzheimer Immunotherapy Research & Development, LLC, South San Francisco, CA, USA
| | | | - Jianing Di
- Janssen Alzheimer Immunotherapy Research & Development, LLC, South San Francisco, CA, USA
| | - Stephen P. Salloway
- Brown Medical School, Butler Hospital, Blackstone Blvd., Providence, RI, USA
| | - Reisa Sperling
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, MA, USA; General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
6
|
Tateen A, Bogert J, Koller H, Hempfing A. Komplikationen des lumbosakralen Übergangs bei Korrektur von Erwachsenendeformitäten. Orthopäde 2018; 47:320-329. [DOI: 10.1007/s00132-018-3534-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
7
|
Timmers M, Sinha V, Darpo B, Smith B, Brown R, Xue H, Ferber G, Streffer J, Russu A, Tritsmans L, Solanki B, Bogert J, Van Nueten L, Salvadore G, Nandy P. Evaluating Potential QT Effects of JNJ-54861911, a BACE Inhibitor in Single- and Multiple-Ascending Dose Studies, and a Thorough QT Trial With Additional Retrospective Confirmation, Using Concentration-QTc Analysis. J Clin Pharmacol 2018; 58:952-964. [PMID: 29505101 DOI: 10.1002/jcph.1087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/05/2018] [Indexed: 11/10/2022]
Abstract
Nonclinical assays with JNJ-54861911, a β-secretase 1 inhibitor have indicated that at high concentrations, it may delay cardiac repolarization. A 4-way crossover thorough QT (TQT) study was performed in 64 healthy subjects with 50 and 150 mg JNJ-54861911 once daily for 7 days, placebo, and 400 mg moxifloxacin. Retrospective high-precision QT (HPQT) analysis was performed on serial elecrocardiograms extracted from first-in-human single-ascending dose (SAD) and multiple-ascending dose (MAD) studies to evaluate if early studies could detect and predict QT effect. In the TQT study, a high therapeutic 50 mg dose did not cause QT prolongation, and an effect >10 milliseconds could be excluded at all postdose timepoints. QT prolongation with peak effect on placebo-corrected change from baseline QTcF of 15.5 milliseconds (90%CI, 12.9-18.1 milliseconds) was observed following a supratherapeutic dose (150 mg). No clinically relevant QT changes were observed in earlier studies. However, with SAD/MAD findings by HPQT, the slope of the exposure-response (ER) relationship in the SAD study (doses up to 150 mg) was similar to the TQT study slope, and the estimated QT effect was comparable at high plasma levels. In the MAD study, doses up to 90 mg once daily for 7 days resulted in JNJ-54861911 peak plasma concentrations (Cmax ) comparable to those in the SAD study (∼750 ng/mL), but ER by HPQT failed to detect a QT effect and resulted in negative estimations. Adding a higher dose cohort (150 mg; Cmax , 1125 ng/mL) demonstrated a QT effect, with a slightly lower ER slope than the TQT study. JNJ-54861911 (up to 50 mg) did not cause QT prolongation at clinically relevant plasma concentrations in any studies. Provided sufficiently high plasma concentrations were captured, mild QT prolongation observed postdose with a supratherapeutic dose could be detected (TQT study) and estimated in SAD/MAD studies. Based on population pharmacokinetic modeling and simulation, 5 and 25 mg doses are currently considered for further phase 3 studies and are expected not to cause any relevant QT prolongation.
Collapse
Affiliation(s)
- Maarten Timmers
- Janssen Research & Development, a Division of Janssen Pharmaceutica N.V., Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Vikash Sinha
- Janssen Research & Development LLC, Titusville, NJ, USA
| | - Borje Darpo
- Karolinska Institute, Stockholm, Sweden.,iCardiac Technologies, Rochester, NY, USA
| | | | | | - Hongqi Xue
- iCardiac Technologies, Rochester, NY, USA
| | - Georg Ferber
- Statistik Georg Ferber GmbH, Riehen, Switzerland
| | - Johannes Streffer
- Janssen Research & Development, a Division of Janssen Pharmaceutica N.V., Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Alberto Russu
- Janssen Research & Development, a Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Luc Tritsmans
- Janssen Research & Development, a Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | | | | | - Luc Van Nueten
- Janssen Research & Development, a Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Giacomo Salvadore
- Janssen Research & Development, a Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Partha Nandy
- Janssen Research & Development, a Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| |
Collapse
|
8
|
Ketter N, Brashear HR, Bogert J, Di J, Miaux Y, Gass A, Purcell DD, Barkhof F, Arrighi HM. Central Review of Amyloid-Related Imaging Abnormalities in Two Phase III Clinical Trials of Bapineuzumab in Mild-To-Moderate Alzheimer's Disease Patients. J Alzheimers Dis 2018; 57:557-573. [PMID: 28269765 DOI: 10.3233/jad-160216] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Amyloid-related imaging abnormalities (ARIA) consist of ARIA-E (with effusion or edema) and ARIA-H (hemosiderin deposits [HDs]). OBJECTIVES To address accurate ascertainment of ARIA identification, a final magnetic resonance imaging (MRI) reading was performed on patients with mild-to-moderate Alzheimer's disease randomized to bapineuzumab IV or placebo during two Phase III trials (APOE ɛ4 allele carriers or noncarriers). METHODS Final MRI central review consisted of a systematic sequential locked, adjudicated read in 1,331 APOE ɛ4 noncarriers and 1,121 carriers by independent neuroradiologists. Assessment of ARIA-E, ARIA-H, intracerebral hemorrhages, and age-related white matter changes is described. RESULTS In the Final Read, treatment-emergent ARIA-E were identified in 242 patients including 76 additional cases not noted previously in real time. Overall, incidence proportion of ARIA-E was higher in carriers (active 21.2%; placebo 1.1%) than in noncarriers (pooled active 11.3%; placebo 0.6%), and was more often identified in homozygote APOE ɛ4 carriers than heterozygotes (34.5% versus 16.9%). Incidence rate of ARIA-E increased with increased dose in noncarriers. Frequency of ARIA-E first episodes was highest after the first and second bapineuzumab infusion and declined after repeated infusions. Incidence of total HDs <10 mm (cerebral microhemorrhages) was higher in active groups versus placebo. CONCLUSION ARIA was detected more often on MRI scans when every scan was reviewed by trained neuroradiologists and results adjudicated. There was increased incidence of ARIA-E in bapineuzumab-treated carriers who had a microhemorrhage at baseline. ARIA-E was a risk factor for incident ARIA-H and late onset ARIA-E was milder radiologically. Age-related white matter changes did not progress during the study.
Collapse
Affiliation(s)
- Nzeera Ketter
- Janssen Alzheimer Immunotherapy Research and Development, LLC, South San Francisco, CA, USA
| | - H Robert Brashear
- Janssen Alzheimer Immunotherapy Research and Development, LLC, South San Francisco, CA, USA
| | | | - Jianing Di
- Janssen Alzheimer Immunotherapy Research and Development, LLC, South San Francisco, CA, USA
| | - Yves Miaux
- BioClinica Inc. (formerly Synarc), Newtown, PA, USA
| | - Achim Gass
- BioClinica Inc. (formerly Synarc), Newtown, PA, USA
| | | | - Frederik Barkhof
- Department of Radiology, VU University Medical Center, Amsterdam, Netherlands
| | - H Michael Arrighi
- Janssen Alzheimer Immunotherapy Research and Development, LLC, South San Francisco, CA, USA
| |
Collapse
|
9
|
Timmers M, Barão S, Van Broeck B, Tesseur I, Slemmon J, De Waepenaert K, Bogert J, Shaw LM, Engelborghs S, Moechars D, Mercken M, Van Nueten L, Tritsmans L, de Strooper B, Streffer JR. BACE1 Dynamics Upon Inhibition with a BACE Inhibitor and Correlation to Downstream Alzheimer's Disease Markers in Elderly Healthy Participants. J Alzheimers Dis 2018; 56:1437-1449. [PMID: 28157093 PMCID: PMC5325057 DOI: 10.3233/jad-160829] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The β-site amyloid-β protein precursor (AβPP) cleaving enzyme-1 (BACE1) is the rate limiting enzyme in the generation of amyloid-β peptide (Aβ) from AβPP, one of the major pathways in Alzheimer's disease (AD) pathology. Increased BACE1 levels and activity have been reported in the brain of patients with sporadic AD. Therefore, changes of BACE1 levels in the cerebrospinal fluid (CSF) have also been investigated as a possible biomarker of the disease. We analyzed BACE1 levels in CSF of elderly healthy participants before and after chronic treatment with a BACE inhibitor (BACEi) and evaluated the correlation between BACE1 levels and downstream AD markers. Overall, BACE1 CSF levels showed strong correlations to all downstream AD markers investigated. This is the first reported finding that shows BACE1 levels in CSF were well correlated to its end product Aβ1 - 42. As previously described, BACE1 levels were strongly correlated to total-tau and phosphorylated tau levels in CSF. Generally, chronic BACE inhibition did not influence BACE1 CSF protein levels. Follow-up studies including early-stage AD pathophysiology and prodromal AD patients will help to understand the importance of measuring BACE1 routinely in daily clinical practice and AD clinical trials.
Collapse
Affiliation(s)
- Maarten Timmers
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Soraia Barão
- VIB Center for the Biology of Disease, VIB-Leuven, Belgium.,Center for Human Genetics, Universitaire ziekenhuizen and LIND, KU Leuven, Belgium
| | - Bianca Van Broeck
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Ina Tesseur
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - John Slemmon
- Janssen Research and Development LLC, La Jolla, CA, USA
| | - Katja De Waepenaert
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | | | - Leslie M Shaw
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Dieder Moechars
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Marc Mercken
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Luc Van Nueten
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Luc Tritsmans
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Bart de Strooper
- VIB Center for the Biology of Disease, VIB-Leuven, Belgium.,Center for Human Genetics, Universitaire ziekenhuizen and LIND, KU Leuven, Belgium.,Institute of Neurology, University College London, UK
| | - Johannes Rolf Streffer
- Janssen Research and Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
10
|
Timmers M, Van Broeck B, Ramael S, Slemmon J, De Waepenaert K, Russu A, Bogert J, Stieltjes H, Shaw LM, Engelborghs S, Moechars D, Mercken M, Liu E, Sinha V, Kemp J, Van Nueten L, Tritsmans L, Streffer JR. Profiling the dynamics of CSF and plasma Aβ reduction after treatment with JNJ-54861911, a potent oral BACE inhibitor. Alzheimers Dement (N Y) 2016; 2:202-212. [PMID: 29067308 PMCID: PMC5651349 DOI: 10.1016/j.trci.2016.08.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Safety, tolerability, pharmacokinetics, and pharmacodynamics of a novel β-site amyloid precursor protein cleaving enzyme 1 (BACE1) inhibitor, JNJ-54861911, were assessed after single and multiple dosing in healthy participants. METHODS Two randomized, placebo-controlled, double-blind studies were performed using single and multiple ascending JNJ-54861911 doses (up to 14 days) in young and elderly healthy participants. Regular blood samples and frequent CSF samples, up to 36 hours after last dose, were collected to assess the pharmacokinetic and pharmacodynamic (Aβ, sAPPα,β,total levels) profiles of JNJ-54861911. RESULTS JNJ-54861911 was well-tolerated, adverse events were uncommon and unrelated to JNJ-54861911. JNJ-54861911 showed dose-proportional CSF and plasma pharmacokinetic profiles. Plasma- and CSF-Aβ and CSF-sAPPβ were reduced in a dose-dependent manner. Aβ reductions (up to 95%) outlasted exposure to JNJ-54861911. APOE ε4 carrier status and baseline Aβ levels did not influence Aβ/sAPPβ reductions. CONCLUSION JNJ-54861911, a potent brain-penetrant BACE1 inhibitor, achieved high and stable Aβ reductions after single and multiple dosing in healthy participants.
Collapse
Affiliation(s)
- Maarten Timmers
- Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Bianca Van Broeck
- Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium
| | | | - John Slemmon
- Janssen Research and Development LLC, La Jolla, CA, USA
| | - Katja De Waepenaert
- Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Alberto Russu
- Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium
| | | | - Hans Stieltjes
- Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Leslie M Shaw
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Dieder Moechars
- Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Marc Mercken
- Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Enchi Liu
- Janssen Research and Development LLC, La Jolla, CA, USA
| | - Vikash Sinha
- Janssen Research and Development LLC, Titusville, NJ, USA
| | - John Kemp
- Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Luc Van Nueten
- Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Luc Tritsmans
- Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Johannes Rolf Streffer
- Janssen Research and Development, Janssen Pharmaceutica N.V., Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
11
|
Van Broeck B, Timmers M, Ramael S, Bogert J, Shaw LM, Mercken M, Slemmon J, Van Nueten L, Engelborghs S, Streffer JR. Impact of frequent cerebrospinal fluid sampling on Aβ levels: systematic approach to elucidate influencing factors. Alzheimers Res Ther 2016; 8:21. [PMID: 27206648 PMCID: PMC4875639 DOI: 10.1186/s13195-016-0184-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/11/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) amyloid-beta (Aβ) peptides are predictive biomarkers for Alzheimer's disease and are proposed as pharmacodynamic markers for amyloid-lowering therapies. However, frequent sampling results in fluctuating CSF Aβ levels that have a tendency to increase compared with baseline. The impact of sampling frequency, volume, catheterization procedure, and ibuprofen pretreatment on CSF Aβ levels using continuous sampling over 36 h was assessed. METHODS In this open-label biomarker study, healthy participants (n = 18; either sex, age 55-85 years) were randomized into one of three cohorts (n = 6/cohort; high-frequency sampling). In all cohorts except cohort 2 (sampling started 6 h post catheterization), sampling through lumbar catheterization started immediately post catheterization. Cohort 3 received ibuprofen (800 mg) before catheterization. Following interim data review, an additional cohort 4 (n = 6) with an optimized sampling scheme (low-frequency and lower volume) was included. CSF Aβ(1-37), Aβ(1-38), Aβ(1-40), and Aβ(1-42) levels were analyzed. RESULTS Increases and fluctuations in mean CSF Aβ levels occurred in cohorts 1-3 at times of high-frequency sampling. Some outliers were observed (cohorts 2 and 3) with an extreme pronunciation of this effect. Cohort 4 demonstrated minimal fluctuation of CSF Aβ both on a group and an individual level. Intersubject variability in CSF Aβ profiles over time was observed in all cohorts. CONCLUSIONS CSF Aβ level fluctuation upon catheterization primarily depends on the sampling frequency and volume, but not on the catheterization procedure or inflammatory reaction. An optimized low-frequency sampling protocol minimizes or eliminates fluctuation of CSF Aβ levels, which will improve the capability of accurately measuring the pharmacodynamic read-out for amyloid-lowering therapies. TRIAL REGISTRATION ClinicalTrials.gov NCT01436188 . Registered 15 September 2011.
Collapse
Affiliation(s)
- Bianca Van Broeck
- Janssen Research & Development, a division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Maarten Timmers
- Janssen Research & Development, a division of Janssen Pharmaceutica N.V., Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | | | | | - Leslie M Shaw
- University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Marc Mercken
- Janssen Research & Development, a division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - John Slemmon
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Luc Van Nueten
- Janssen Research & Development, a division of Janssen Pharmaceutica N.V., Beerse, Belgium
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.,Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Johannes Rolf Streffer
- Janssen Research & Development, a division of Janssen Pharmaceutica N.V., Beerse, Belgium. .,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.
| |
Collapse
|