Nicotinic Acid for the Treatment of Alzheimer's Disease Protocol Type: Interventional

JB

Jared Brosch, MD

Principal Investigator

Status: Enrolling By Invitation Ages: 60 Years - 85 Years Gender: All Genders Phase: 1/2 1 Locations

Brief Description

The primary objective of this study is to collect data on the penetration of commercially available, FDA approved, extended-release niacin into the spinal fluid. One dose of 500 mg nicotinic acid will be used (in addition to placebo) to build a dose response curve for this compound in human cerebrospinal fluid. This objective will demonstrate target engagement of HCAR2 in the CNS after oral treatment with niacin. The primary endpoints are to show increased nicotinic acid levels in blood and CSF.

THIS STUDY IS ENROLLING - Methods of recruitment include personal contact, database searches, (Registry IRB# 1010002668), review of medical records, identifying potential subjects who meet study criteria. Recruitment will primarily happen in Adult Neurology Clinic through Dr. Brosch’s clinical patients.

Detailed Description

Participants will receive study drug (placebo or 500mg extended-release nicotinic acid).  

  • Study procedures include phlebotomy which will be performed by the study coordinator in the fasting state.
  • Study cognitive, functional, and neuropsychiatric survey’s will be conducted in a closed room with minimal interruption.  
  • Lumbar punctures will be performed using 22 gauge sprotte style needles using gravity to collect 20ml +/- 2mL at the randomization visit and at the final visit.  Participants will lie down for 60 minutes +/- 15 minutes after the procedure.  
  • Approximately 2 mL will be sent to the local laboratory for cell counts, protein, and glucose levels.  Efforts will be made to collect CSF with the participant in a fasted state.

Eligibility of study

Inclusion Criteria:
  • o    Age 60-85 males or females
    o    Clinically have a diagnosis of Alzheimer’s disease in the mild-moderate dementia range
    o    Mini Mental Status Examination (MMSE) between 14-24 inclusive
    o    Must be on a stable dose (30 days minimum) of a cholinesterase inhibitor and/or memantine (or absence thereof)
    o    Have a reliable co-participant who has at least 3 days of face-to-face contact per week with the patient and ensures medical compliance with the study drug. 
    o    Neuroimaging (MRI or CT scan of the brain) should be available within 1 year of screening
Exclusion Criteria:
  • o    Any contraindication to clinical lumbar puncture including increased intracranial pressure, posterior fossa mass, bleeding diathesis, use of antiplatelet medications other than aspirin, use of any anticoagulant
    o    Severe cerebrovascular disease
    o    History of large territory stroke
    o    Allergy or sensitivity to B-vitamins or nicotinic acid
    o    History of elevated liver function tests (ALT/AST > 2x the upper limit of normal) or known liver disease
    o    Current consumption of Vitamin B3 (any form, including nicotinic acid) – including multivitamins and energy drinks.  Participants taking a supplement containing Niacin must washout for 4 weeks prior to screening to participate.
    o    Renal impairment of Stage 2 or greater
    o    Active, uncontrolled peptic ulcer disease
    o    Prior history of myocardial infarction or QTcF >460ms
    o    Cancer diagnosis within prior 5 years or cancer not in remission other than non-melanoma skin cancer
    o    Regular use of benzodiazepines
    o    Unstable dose of antipsychotic medications.  Antipsychotic medications may be used if on a stable dose (30 days minimum) and will not interfere with study assessments in the opinion of the investigator. PI will document review and approval of medications used by participant concurrently with study participation. Changes in dosing of antipsychotic medication must be approved by the investigator for continued participation.
    o    Other medical diagnosis that could be contributory at the discretion of the primary investigator

Interested in participating?

Enrollment in IU School of Medicine clinical trials is managed through our All IN for Health program. Many studies only accept people who are part of an invited group. Visit allinforhealth.info to connect with the study team, or contact your doctor to see if you are eligible.