Ambroxol hydrochloride for Dementia with Lewy Bodies

Stratification factors

• A-beta in CSF (normal vs low)
• Number of APOE ε4 alleles (strata in block randomisation)

Inclusion criteria

• {"criterion_text":"- 1. Age ≥ 50 and ≤ 85 years of age, both genders\n- A female participant is eligible to participate if she is of: ● Non-childbearing potential defined as pre-menopausal females with a documented tubal ligation or hysterectomy; or postmenopausal defined as 12 consecutive months of spontaneous amenorrhea, at least 6 weeks post-surgical bilateral oophorectomy (with or without hysterectomy) or post tubal ligation. In questionable cases, menopausal status will be confirmed by demonstrating levels of follicle stimulating hormone (FSH) 25.8 – 134.8 IU/L and oestradiol < 201 pmol/l at entry. ● Women of child-bearing potential must use accepted contraceptive methods (listed below), and must have a negative serum at screening visit 1 and urine pregnancy tests at subsequent visits if applicable. An additional pregnancy test will be performed, and results obtained, prior to administration of the first dose of ambroxol.\n- Caregiver needs to be > 18 years when signing the informed consent form.\n- Confirmed diagnosis of Dementia with Lewybodies (DLB) including Mild Cognitive Impairment in DLB (DLB-MCI).\n- MMSE score>=15 at screening\n- Able and willing to provide informed consent prior to any study related assessments and procedures.\n- Capable of complying with all study procedures.\n- Willing to provide blood samples for genetic analyses of APOE and GBA.\n- Willing and able to self-administer or administer by a caregiver oral ambroxol medication, from day 1 to study end (at 60 mg TID (day 1-7), 120 mg TID (day 8- 14), 315 mg BID (day 15-21), 315 mg TID (day 22-28) and 420 mg TID (day 29-550)).\n- Contact with caregiver at least 3 times a week, to ensure sufficient information from the caregiver regarding participants status and possible change in condition.\n- Able to travel to the participating study site."}

Exclusion criteria

• {"criterion_text":"- Current treatment with anticoagulants (e.g. warfarin, argatroban, dabigatraneteksilat, rivaroksaban, apiksaban, edoksaban).\n- All participants of child bearing potential in the opinion of the Investigator that would preclude participation in the study and who do not agree to use double-barrier birth control or abstinence while participating in the study and for 2 weeks following the last dose of the study drug.\n- clinically significant or unstable medical or surgical condition that in the opinion of the PI or PI-delegated clinician may put the participant at risk when participating in the study or may influence the results of the study or affect the participant’s ability to take part in the study, as determined by medical history, physical examinations, electrocardiogram (ECG), or laboratory tests. Such conditions may include: a) Impaired renal function defined by eGFR<=30 b) Moderate/Severe hepatic impairment defined by Child-Pugh score >1 c) A major cardiovascular event (e.g. myocardial infarction, acute coronary syndrome, decompensated congestive heart failure, pulmonary embolism, coronary revascularisation that occurred within 6 months prior to the screening visit. d) Major stroke e) Major depression defined clinically or by GDS-15 >=11 points or delirium or psychotic disorder unrelated to DLB. f) Cancer, history of metastatic cancer, terminal illness or clinically significant disease within ≤5 years, except for adequately treated basal cell skin cancer.\n- Planned major surgical treatment during the study period.\n- Current use of investigational medicinal product or participation in another interventional clinical trial or who have done so within 30 days prior to the first dose in the current study.\n- Exposure to more than three investigational medicinal products within 12 months prior to the first dose in the current study.\n- Confirmed dysphagia that would preclude self-administration of ambroxol up to 6 tablets daily for the duration of this study.\n- History of known sensitivity to the study medication, ambroxol or its excipients (lactose monohydrate, granulated microcrystalline cellulose, silicon dioxide,magnesium stearate and Bitrex/Denatonium Benzoate in the opinion of the investigator that contraindicates their participation.\n- History of known rare hereditary disorders of galactose Intolerance: Lapp lactase deficiency or glucose-galactose malabsorption.\n- History of illegal substance abuse, drug abuse or alcoholism in the opinion of the Investigator that would preclude participation in the study.\n- Donation of blood (one unit or 350 ml) within three months prior to receiving the first dose of the study drug.\n- Pregnant or breastfeeding."}

Primary endpoints

• {"endpoint_text":"- Mean score on the MMSE at screening to 18 months in the intervention group compared to the control group.","definition_or_measurement_approach":"Mean change in MMSE (measured by MMSE-NR3) from screening to 18 months comparing ambroxol (intervention) versus placebo (control)."}

Secondary endpoints

• {"endpoint_text":"- Mean score in MMSE at 18 months in the ambroxol group compared to the placebo group in subgroups defined by APOE and GBA genotypes and A-Beta in CSF.\n- Mean score at 18 months between the ambroxol group compared to the placebo group for the clock drawing test, COWAT immediate and delayed recall, Trail making test A&B, VOSP siluettes and FAS test.\n- Mean score in the Clinician’s Global Impression of Change (ADCS-CGIC) score at Month 18 in the ambroxol and placebo groups.\n- Mean score in the total NPI score at Month 18 in the ambroxol group compared to the placebo group.\n- Mean score on the UPDRS-part III motor part and the MAYO fluctuation scores at month 18\n- The number of participants with RBD defined from the Mayo Sleep Questionnaire at month 18 in ambroxol and placebo groups.\n- The number of falls at month 18 in the ambroxol and in the placebo groups.","definition_or_measurement_approach":"Secondary endpoints are mean scores or counts at Month 18 (or 18 months) comparing ambroxol versus placebo, including cognitive tests (MMSE subgroups by APOE/GBA/A-beta in CSF), neuropsychological tests (clock drawing, COWAT, Trail Making A&B, VOSP silhouettes, FAS), clinician global impression (ADCS-CGIC), neuropsychiatric inventory (NPI total), UPDRS-part III and MAYO fluctuation scores, number with RBD per Mayo Sleep Questionnaire, and number of falls."}

Norway

Earliest CTIS Part Ii Submission Date

10-10-2024

Latest Decision Or Authorization Date

16-04-2026

Processing Time Days

553

Number Of Sites

8

Number Of Participants

156

Primary sponsor

Full Name

Helse Fonna HF

Organisation Type

Hospital/Clinic/Other health care facility

Country Of Registered Address

Norway