Clarity AD
Problem
Early Alzheimer's disease (mild cognitive impairment or mild dementia due to Alzheimer's disease)
Format
Multicenter, double-blind, placebo-controlled, parallel-group phase 3 clinical trial
Intervention
Intravenous lecanemab (10mg/Kg body weight q2w)
Control
Placebo - Intravenous saline
Population
50 to 90 years of age with early Alzheimer’s disease (mild cognitive impairment or mild dementia due to Alzheimer’s disease) with evidence of amyloid on positron emission tomography (PET) or by cerebrospinal fluid testing
Inclusion criteria
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Objective impairment in episodic memory as indicated by at least 1 standard deviation below age-adjusted mean in the Wechsler Memory Scale IV-Logical Memory (subscale) II (WMS-IV LMII)
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Positive biomarker for brain amyloid pathology
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Male or female participants aged greater than or equal to (>=) 50 and less than or equal to (<=) 90 years, at the time of informed consent
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Mini mental state examination (MMSE) score >=22 at Screening and Baseline and <=30 at Screening and Baseline
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Body mass index (BMI) greater than (>)17 and less than (<) 35 at Screening
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If receiving an approved Alzheimer's disease treatment such as acetylcholinesterase inhibitor (AChEIs) or memantine or both for Alzheimer's disease, must be on a stable dose for at least 12 weeks prior to Baseline. Treatment-naive participants for Alzheimer's disease can be entered into the study. Unless otherwise stated, participants must have been on stable doses of all other (that is, non-Alzheimer's disease-related) permitted concomitant medications for at least 4 weeks prior to Baseline. Use of memantine will not be allowed for participants in Japan.​
Exclusion criteria
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Any neurological condition that may be contributing to cognitive impairment above and beyond that caused by the participant's Alzheimer's disease
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History of transient ischemic attacks (TIA), stroke, or seizures within 12 months of Screening
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Any psychiatric diagnosis or symptoms (example, hallucinations, major depression, or delusions) that could interfere with study procedures in the participant
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Geriatric Depression Scale (GDS) score >=8 at Screening
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Contraindications to MRI scanning, including cardiac pacemaker/defibrillator, ferromagnetic metal implants (example in skull and cardiac devices other than those approved as safe for use in MRI scanners)
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Evidence of other clinically significant lesions on brain MRI at Screening that could indicate a dementia diagnosis other than Alzheimer's disease
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Other significant pathological findings on brain MRI at screening, including but not limited to: more than 4 microhemorrhages (defined as 10 millimeter [mm] or less at the greatest diameter); a single macrohemorrhage >10 mm at greatest diameter; an area of superficial siderosis; evidence of vasogenic edema; evidence of cerebral contusion, encephalomalacia, aneurysms, vascular malformations, or infective lesions; evidence of multiple lacunar infarcts or stroke involving a major vascular territory, severe small vessel, or white matter disease; space occupying lesions; or brain tumors (however, lesions diagnosed as meningiomas or arachnoid cysts and <1 centimeter [cm] at their greatest diameter need not be exclusionary)
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Any immunological disease which is not adequately controlled, or which requires treatment with immunoglobulins, systemic monoclonal antibodies (or derivatives of monoclonal antibodies), systemic immunosuppressants, or plasmapheresis during the study
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inadequately controlled bleeding disorder (including a platelet count <50,000 or international normalized ratio [INR] >1.5 for participants who are not on anticoagulant treatment, example, warfarin). Participants who are on anticoagulant therapy should have their anticoagulant status optimized and be on a stable dose for 4 weeks before Screening. Participants who are on anticoagulant therapy are not permitted to participate in cerebrospinal fluid (CSF) assessments
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Uncontrolled comorbidities including cardiac, respiratory, gastrointestinal, renal disease
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Participation in a clinical study involving any therapeutic monoclonal antibody, immunoglobulin therapy, or vaccine within 6 months Participation in a clinical study involving any anti-amyloid therapies known prior exposure to lecanemab
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involved any new chemical entities for AD within 6 months prior to screening
Follow-up
Trial lasted 18 months. OLE thereafter.
Primary endpoint
Clinical Dementia Rating – Sum of Boxes (CDR-SB; range 0 to 18 with higher scores indicating greater impairment)
Secondary endpoint(s)
• Amyloid burden on PET
• Additional clinical scales: Alzheimer’s Disease Composite Score (ADCOMS), Alzheimer’s Disease Cooperative Study–Activities of Daily Living Scale for Mild Cognitive Impairment (ADCS-MCI-ADL), Alzheimer’s Disease Assessment Scale (ADAS- cog14)
Details
N/A
Brief summary
• Baseline Clinical Dementia Rating–Sum of Boxes was approx. 3.2 in both arms. CDR-SB score at 18 months reduced (i.e. improved) by 1.66 with lecanemab and 1.21 with placebo (difference, −0.45; 95% confidence inter- val [CI], −0.67 to −0.23; P<0.001). Statistically significant improvement with lecanemab over placebo.
• In a substudy involving 698 participants, there were greater reductions in brain amyloid burden with lecanemab than with placebo (differ- ence, −59.1 centiloids; 95% CI, −62.6 to −55.6).
• Statistically significant improvement with lecanemab in all other alzheimers/dementia scores selected as secondary outcome measures.
Lecanemab Clarity AD: Quality-of-Life Results from a Randomized, Double-Blind Phase 3 Trial in Early Alzheimer's Disease
Date
29 September 2023
Journal
The Journal of Prevention of Alzheimer's Disease
Reference
Cohen S, van Dyck CH, Gee M, Doherty T, Kanekiyo M, Dhadda S, et al. Lecanemab Clarity AD: Quality-of-Life Results from a Randomized, Double-Blind Phase 3 Trial in Early Alzheimer's Disease. The Journal of Prevention of Alzheimer's Disease. 2023; 10 (4): 771-777. 10.14283/jpad.2023.123.
Content written by Dr Srishti Gupta