Clinical trial NCT04271163: Transcranial Electromagnetic Treatment (TEMT) Against Alzheimer's Disease
Official title: A Phase I Study to Evaluate the Safety and Efficacy of Transcranial Electromagnetic Treatment (TEMT) for the Treatment of Alzheimer's Disease: Extension Study II
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: PHASE1
PHASE2
Conditions: Alzheimer's Disease
Keywords: Alzheimer's, electromagnetic, cognition, A-beta, tau
Lead sponsor: NeuroEM Therapeutics, Inc.
Sponsor class: INDUSTRY
Collaborators: name: Axiom Clinical Research of Florida
name: MegaNano Biotech
name: Invicro, Boston
name: Left Coast Engineering
First posted: 2020-02-17
Enrollment: 6
Sex: ALL
Minimum age (years): 63
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: Open-Label Pilot Study
Primary purpose: TREATMENT

Brief summary: This is a second extension of EM 1000-1 wherein mild/moderate AD subjects who participated in the original study have completed participation in a first extension of 4-months. Most of the eight subjects in the original EM 1000-1 and first extension agreed to participate in this second extension study. The time between completion of the first extension and the second extension is 4 months. This second extension study;'s primary objective is to determine the long-term safety and efficacy of 12 months of daily treatment on performance of these AD subjects in the same comprehensive array of cognitive tasks as they performed in the initial 2-month study and 4-month first extension.Secondary objectives include analysis of blood for AD markers and evaluation of safety throughout the treatment period. Upon completion of this 12-month extension, the period between initial treatment and final treatment will be 2-3 years.

Detailed description: The present study is an Open-Label within-patient (single arm) second extension study of the Open-Label 2-month initial study (EM1000-1) and 4M first extension study, wherein most of the original eight AD subjects agree to participate. This present second extension study is intended to continue evaluation of the safety and efficacy of daily Transcranial Electromagnetic Treatment (TEMT) in patients with mild-to-moderate AD for an additional 12 month period, such that the interval between the initial day of treatment and final day of treatment will be 2-3 years.There will be a total of six clinical visits: pre-baseline, baseline, 2-, 5-, 8-, and 12-months. This second extension study will utilize the same MemorEM devices (designated as NSR and not Food and Drug Administration-regulated) as in the first extension studies, but will involve twice daily treatment for the first two months, followed by once-daily treatment thereafter.

Expected Results: The investigators expect that the additional 12 months of daily TEMT will not present any significant side effects or safety issues, as was the case for the initial study and first extension study. The investigators further expect that cognitive measures will be stable and/or improve by the end of the 12M treatment period. In addition, changes in blood/cerebrospinal fluid levels of various beta-amyloid and tau species are anticipated to reflect the primary mechanism of TEMT action -- disaggregation of both A-beta and tau oligomers.

Eligibility criteria: Inclusion Criteria:

* Male or female age 63+ years
* Patients diagnosed with mild or moderate stage of Alzheimer's Disease at the beginning of the original treatment study, according to the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria.
* MMSE score 16 to 26 : By the end of Extension Study I, all subjects except for one had MMSE scores above 16.
* Physical clearance for study participation as evaluated by the clinician.
* Caregiver (spouse, family member, etc.) who agrees to and is capable of taking care and being responsible for the participation of the patient in the study (keeping a diary of health measures they collect on the patient at home, logging the patient's condition daily, and assuming responsibility for administering daily in-home treatment). Caregiver to have non-impaired mental abilities and normal motor skills, as determined by the investigators at screening. The definition of caregivers for this study is adults providing unpaid care to relatives or friends to help them take care of themselves in such activities as managing finances, shopping, preparing meals, and going to doctor appointments.
* Agreement to participate in approximately 54 weeks during the study.
* Normal to near-normal vision and hearing with correction as needed (e.g. corrective lenses, hearing aid).
* Fluent in English
* Minimum of 8th grade education
* Head circumference between 53 - 60 cm (to minimize variability in head antenna locations)
* If medicated for AD, then use of cholinesterase inhibitors and/or memantine for at least 3 months, on stable dose for at least 60 days prior to screening, and maintenance on that dose for the period of this study.
* All other non-AD medications must be stable for a period of 4 weeks prior to screening

Exclusion Criteria:

* Severe agitation
* Mental retardation
* Unstable medical condition
* Use of benzodiazepines or barbiturates 2 weeks prior to screening
* Pharmacological immunosuppression
* Participation in a clinical trial with any investigational agent within 6 months prior to study enrollment and no history of immunotherapy research participation
* History of Epileptic Seizures or Epilepsy
* Patients with major depression (not controlled with medication), bipolar disorder or psychotic disorders or any other neurological or psychiatric condition (whether now or in the past). The investigator will obtain this information from available patient medical records, history provided by the patient and caregiver, interview, and neurological exam.
* Alcoholism or drug addiction as defined by (Diagnostic and Statistic Manual of Mental Disorders (DSM)-IV within last 5 years (addicted more than one year and or in remission less than 3 years) or severe sleep deprivation
* Patients with metal implants in the head, (i.e. cochlear implants, implanted brain stimulators, aneurysm clips) with the exception of metal implants in mouth
* Patients with vitamin B12 deficiency, abnormal thyroid function, or personal history of either any clinically defined medical disorder or any clinically defined neurological/psychiatric disorder (other than AD), including (but not limited to):, stroke, brain lesions, , cerebrovascular condition, other neurodegenerative disease, significant head trauma (loss of consciousness greater than half an hour, or related anterograde amnesia), multiple sclerosis; or personal history of previous neurosurgery or brain radiation
* Patients with any signs or symptoms of increased intracranial pressure, as determined in a neurological exam.
* Patients with demonstrated brain micro-hemorrhages (more than 5) at screening
* Patients with a score of 4 or higher on the Hachinski Test
* Patients with a score of 2 or less on the Global Deterioration Scale
* Patients with hypertension that is unresponsive to anti-hypertensive medications
* Patients with a history of migraine headaches occurring more than once a month
* Patients with a history of cancer within last 3 years (basal cell and squamous cell carcinomas will be considered on a case by case basis by investigator)
* Patients chronically taking anticoagulants or anti-platelets (at discretion of PI)
* Pregnant women and women who have the ability to become pregnant
* Patients with compressed hair thickness of more than 5mm (which could increase distance between head antennas and the scalp).
* Cardiac pacemakers
* Implanted medication pumps
* Intracardiac lines
* Significant heart disease

Primary outcomes:
measure: Alzheimer's Disease Assessment Scale (ADAS)-cog13 score
timeFrame: Changes from baseline ADAS-cog at two, five, eight, and 12 months into treatment
Secondary outcomes:
measure: Blood (plasma) levels of beta-amyloid1-40 and 1-42, total tau (t-tau), and phospho-tau (p-tau)
timeFrame: Changes from baseline at two, five, eight, and 12 months into treatment
measure: Adverse Event Assessment (Adverse Event Assessment)
timeFrame: Change from baseline Adverse Event Assessment at two, five, eight, and 12 months into treatment.
measure: Rey AVLT (Auditory Verbal Learning) score
timeFrame: Changes from baseline Rey AVLT score at two, five, eight, and 12 months into treatment
measure: Digit span score
timeFrame: Changes from baseline Digit span score at two, five, eight, and 12 months into treatment
measure: (Mini Mental State Examination (MMSE) score
timeFrame: Changes from baseline MMSE score at two, five, eight, and 12 months into treatment
measure: Global Deterioration score (GDS)
timeFrame: Changes from baseline GDS score at two, five, eight, and 12 months into treatment
measure: Trails A & B score
timeFrame: Changes from baseline in Trails A & B scores at two, five, eight, and 12 months into treatment
measure: Clock draw score
timeFrame: Changes from baseline in clock draw score at two, five, eight, and 12 months into treatment
measure: MRI Scan (acquisition only)
timeFrame: Change from baseline at 12 months into treatment
Other outcomes:
Locations:
city: Tampa
country: United States
facility: Axiom Clinical Research of Florida
state: Florida
Study officials:
References: