Title

Evaluating Simvastatin's Potential Role in Therapy
Effect of Statins on Pathobiology of Alzheimer's Disease
  • Phase

    Phase 2
  • Study Type

    Interventional
  • Intervention/Treatment

    simvastatin ...
  • Study Participants

    103
The purpose of this study is to see how simvastatin, a cholesterol-lowering drug, affects processes related to the development of Alzheimer's disease, including: 1) levels of a substance called beta-amyloid-42 found in the spinal fluid surrounding the brain, 2) blood flow in the brain, 3) inflammation in the brain, and 4) cognitive function.
Some studies suggest that statin medications, which are a group of cholesterol-lowering medicines, may help prevent Alzheimer's disease. However, this has not been proven in humans. The purpose of this study is to see how simvastatin affects a substance in the spinal fluid around the brain called beta-amyloid-42 which is thought to contribute to Alzheimer's disease. This study also evaluates whether simvastatin improves regional brain blood flow (on magnetic resonance imaging [MRI]), reduces inflammation, and improves cognitive function.

The ESPRIT study was a 9-month randomized, controlled clinical trial that randomized 100 middle-aged adults with a parental history of Alzheimer's disease. Participants were randomized to simvastatin 40 mg for one month then 80 mg daily or matching placebo tablets. Fifty of the ESPRIT subjects participated in the MRI sub-study.

Participants had the following data collected: fasting blood tests (baseline and months 3 and 9), medical history and medication questionnaires (each visit), study medication side effect review (all visits), lumbar puncture procedure (baseline and month 9), memory testing (baseline and months 3 and 9), and MRI (baseline and month 9 in 50 sub-study participants).
Study Started
Feb 28
2005
Primary Completion
Jun 30
2009
Study Completion
Jun 30
2009
Results Posted
Nov 05
2015
Estimate
Last Update
Mar 05
2019

Drug Simvastatin

40 mg tablet each night for one month, then 80 mg for 8 months

  • Other names: Zocor

Drug Placebo

Matching tablet each night for 9 months

simvastatin Experimental

simvastatin 40 mg nightly for 1 month then 80 mg nightly for 8 months

Placebo Placebo Comparator

Matching placebo tablet nightly for 9 months

Criteria

Inclusion Criteria:

Age 35 to 69
Parent with Alzheimer's disease

Exclusion Criteria:

Current use of cholesterol-lowering medication
Active liver disease
History of adverse reaction to statins
Contraindication to lumbar puncture
Elevated lab values (creatine kinase and creatinine)
Use of medications known to interact with statins
History of dementia
Currently pregnant or planning to become pregnant
Use of large quantities of grapefruit juice (more than 1 quart per day)
Current involvement in another investigational drug study
Contraindications to MRI (for MRI sub-study)
Ethical contraindication to placebo (persons with high vascular risk)

Summary

Simvastatin

Placebo

All Events

Event Type Organ System Event Term Simvastatin Placebo

Change in Cerebrospinal Fluid (CSF) Beta-amyloid-42

Simvastatin

-5.2
ng/L (Mean)
Standard Deviation: 44.1

Placebo

-3.1
ng/L (Mean)
Standard Deviation: 38.2

Changes in Regional Cerebral Blood Flow on MRI

Mean changes noted in posterior cingulate cortex

Simvastatin

4.09
mL/100 g/min (Mean)
Standard Deviation: 6.69

Placebo

-5.08
mL/100 g/min (Mean)
Standard Deviation: 8.28

Change in Inflammatory Markers

Change noted in serum high-sensitivity c-reactive protein

Simvastatin

-1.16
mg/L (Mean)
Standard Deviation: 3.55

Placebo

-0.31
mg/L (Mean)
Standard Deviation: 1.83

Changes in Cognitive Performance

Change in Hopkins Verbal Learning Test Delayed Recall The Hopkins Verbal Learning Test Delayed Recall score is the raw number of words recalled at Trial 4, adjusted for years of education and age. This is a 12-item word list test.

Simvastatin

0.4
adjusted words recalled (Mean)
Standard Deviation: 1.38

Placebo

0.26
adjusted words recalled (Mean)
Standard Deviation: 1.54

Total

100
Participants

Age, Continuous

52.8
years (Mean)
Standard Deviation: 8.0

Apolipoprotein E4 carrier

38
participants

Cerebrospinal fluid beta-amyloid-42

338.7
ng/L (Mean)
Standard Deviation: 80.2

Cognitive Function

29.5
points (Mean)
Standard Deviation: 0.7

Education

16.2
years (Mean)
Standard Deviation: 2.9

High-sensitivity c-reactive protein

2.32
mg/L (Mean)
Standard Deviation: 3.06

Total cholesterol

190.3
mg/dL (Mean)
Standard Deviation: 32.4

Age, Categorical

Region of Enrollment

Sex: Female, Male

Overall Study

Simvastatin

Placebo

Drop/Withdrawal Reasons

Simvastatin

Placebo