Clinical trial NCT01300728: Study of Intravenous Immunoglobulin in Amnestic Mild Cognitive Impairment
Official title: A Randomized Double-Blinded Placebo-Controlled Exploratory Study of Intravenous Immunoglobulin (NewGam 10%) in Amnestic Mild Cognitive Impairment
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Mild Cognitive Impairment
Keywords: Intravenous immunotherapy
Conversion to Alzheimer Disease
Lead sponsor: Sutter Health
Sponsor class: OTHER
First posted: 2011-02-23
Enrollment: 52
Sex: ALL
Minimum age (years): 50
Maximum age (years): 84
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Patients with mild cognitive impairment (MCI) are a group recognized at being at high risk of progressing to Alzheimer disease. Treatment of MCI with immunotherapy with intravenous immunoglobulins (IVIG) could potentially reduce the risk of progression to Alzheimer disease.

This study will evaluate the efficacy of intravenous immunoglobulin in patients with MCI over 24 months after the first infusion. This study will also document conversion from MCI to Alzheimer's Disease.

Detailed description: Screening procedures at visit 1 will take place up to 28 days prior to Visit 2 (Day 1) dosing. Screening labs and assessments will be performed during the screening period. A brain MRI will be obtained as standard of care within 6 months prior to the screening period. The first dose of study drug is administered on Day 1. Visits 2 through 6 have a ±1 day window and occur every 14 days over two months. The investigator will determine if a subject is suitable to continue following the missed infusion. Visits 7 through 12 (Month 4 through Month 24) have a ±7 day window.

All study screening data from Visit 1 including laboratory results must be reviewed for study eligibility prior to receiving first dose of study drug. Visit 2 physical exams and neurological exams prior to infusion may occur within 72 hours prior to the first infusion. Prior to infusion, a review of concomitant medications and adverse events takes place to ensure that no excluded medications have been added or medication discontinued or dose changed that were required to have been stable. If the subject continues to be eligible for enrollment, the subject will be randomized, infused with study medication and will remain in the infusion clinic for at least 4 hours following the start of the infusion for safety assessments on Visit 2 (Day 1).

Eligibility criteria: Inclusion Criteria:

1. Age from 50 to \< 85 years old.
2. Diagnosis of Mild Cognitive Impairment, Amnestic type (single or multi domain) according to Petersen criteria (Appendix B) and supported by a CDR score of 0.5.
3. Mini-Mental State Examination (MMSE) score of 24-30, inclusive.
4. Rosen Modified Hachinski Ischemic score ≤ 4.
5. Willing to consent to Apolipoprotein E (ApoE) testing and agree to disclose Apolipoprotein E4 (ApoE4) status. Previous ApoE testing will be accepted.
6. Receiving stable doses of medication(s) for the treatment of non-excluded medical condition(s) for at least 30 days prior to screening.
7. Ability to attend all clinical visits and have an informant capable of accompanying the subject on specific clinic visits for two years or the duration of the study.
8. The subject's collaborative informant (support person) must be someone who has known the subject for at least 4 years; agrees to have at least 2 separate communications with the study participant per month for the duration of the study (one of these communications must be in person); and attends and completes the CDR interview at 8 study visits along with the subject.
9. Fluency in English and evidence of adequate premorbid intellectual functioning.
10. Adequate manual dexterity, visual, and auditory abilities to perform all aspects of the cognitive and functional assessments.
11. Venous access suitable for repeated infusion and phlebotomy.

Exclusion criteria:

1. Has significant neurological disease, other than a-MCI that may affect cognition.
2. History of clinically evident stroke or history of clinically significant carotid or vertebrobasilar stenosis or plaque.
3. History of seizures, excluding febrile seizures in childhood.
4. Brain MRI shows moderate or severe cortical or hippocampal atrophy.
5. Presence of pacemakers, aneurysm clips, artificial heart valves, ear implants, CSF shunts, claustrophobia, metal fragments or foreign objects in the eyes, skin, or body that would contraindicate a brain MRI scan.
6. Current presence of a clinically significant major psychiatric disorder according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR).
7. History of cancer within the last 5 years, with the exception of nonmetastatic basal cell carcinoma, and squamous cell carcinoma of the skin.
8. Uncontrolled hypertension (diastolic BP\> 100 mmHg or systolic BP\> 160 mmHg, sitting).
9. History or evidence of any clinically significant autoimmune disease or disorder of the immune system (eg., Crohn's Disease, Rheumatoid Arthritis)
10. Women of childbearing potential.
11. Weight greater than 120 kg (264 lbs).
12. Excessive smoking defined as more than 20 cigarettes per day.
13. History of alcohol or drug dependence or abuse as defined by DSM-IV criteria within the last 2 years.
14. Severe liver or kidney disease verified by the PI review of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and creatinine.
15. Known coagulopathy, thrombosis, or low platelet count.
16. Known deficiency to Immunoglobulin A (IgA).
17. Positive serology for Hepatitis B or C, or HIV.
18. Concurrent or prior treatment with cholinesterase inhibitors and/or memantine, or Axona for cognitive enhancement. Exceptions (e.g. brief exposure to one of these medications) may be authorized if agreed upon by PI and sub-I.
19. Concurrent use of anticholinergic drugs including diphenhydramine.
20. Current use of anticonvulsant drugs for seizures, antiparkinson drugs, anticoagulant medications (except the use of aspirin 325 mg/day or less, plavix, aggrenox, and persantine but not for stroke).
21. Concurrent use of opioid pain relievers and related synthetic derivatives.
22. Use of experimental medications for AD or any other investigational medications or devices within 60 days prior to screening or within 5 half-lives of use of such a medication prior to screening, whichever is longer.
23. Prior treatment with IVIG or other experimental immunotherapeutic or vaccine for MCI or AD, or prior treatment with a biological product for the treatment of a-MCI or AD.

Primary outcomes:
measure: Annualized Percent Change in Ventricular Volume (APCV) as Measured by MRI
timeFrame: Baseline, 12, and 24 month MRI evaluation
Secondary outcomes:
measure: Number of Participants Who Converted From Amnestic Mild Cognitive Impairment (a-MCI) to Alzheimer Disease (AD)
timeFrame: Baseline to 24 months
measure: Change in Ventricular Volume in Patients With Positive Cerebrospinal Fluid (CSF) Aβ1-42/CSF P-Tau181P Alzheimer Signature
timeFrame: Baseline to 24 months following infusion
measure: Mean Cognitive Performance at 12 Months
timeFrame: 12 months
measure: Mean Cognitive Performance at 24 Months
timeFrame: 24 month
Other outcomes:
Locations:
city: Sacramento
country: United States
facility: Sutter Neuroscience Medical Group
state: California
Study officials:
affiliation: Sutter Health
name: Shawn Kile, M.D.
role: PRINCIPAL_INVESTIGATOR
References:
citation: Relkin NR, Szabo P, Adamiak B, Burgut T, Monthe C, Lent RW, Younkin S, Younkin L, Schiff R, Weksler ME. 18-Month study of intravenous immunoglobulin for treatment of mild Alzheimer disease. Neurobiol Aging. 2009 Nov;30(11):1728-36. doi: 10.1016/j.neurobiolaging.2007.12.021. Epub 2008 Feb 21.
citation: Kile S, Au W, Parise C, Rose K, Donnel T, Hankins A, Chan M, Ghassemi A. IVIG treatment of mild cognitive impairment due to Alzheimer's disease: a randomised double-blinded exploratory study of the effect on brain atrophy, cognition and conversion to dementia. J Neurol Neurosurg Psychiatry. 2017 Feb;88(2):106-112. doi: 10.1136/jnnp-2015-311486. Epub 2015 Sep 29.
citation: Kile S, Au W, Parise C, Rose K, Donnel T, Hankins A, Au Y, Chan M, Ghassemi A. Five-year outcomes after IVIG for mild cognitive impairment due to alzheimer disease. BMC Neurosci. 2021 Aug 6;22(1):49. doi: 10.1186/s12868-021-00651-2.