Title

A Study of MP-101 in Dementia-Related Psychosis and/or Agitation and Aggression
Tolerability, Pharmacokinetics, and Efficacy of MP-101 in the Treatment of Patients With Dementia-Related Psychosis and/or Agitation and Aggression
  • Phase

    Phase 2
  • Study Type

    Interventional
  • Study Participants

    81
A ten-week study to assess MP-101 in Dementia-Related Psychosis and/or Agitation and Aggression
Study Started
May 04
2017
Primary Completion
Jan 30
2020
Study Completion
Jan 30
2020
Results Posted
Apr 01
2021
Last Update
Apr 01
2021

Drug MP-101

Capsules

  • Other names: LY2979165, LY2812223

Drug Placebo

Capsules

MP-101 Experimental

Week 0: Participants received 20 milligrams (mg) MP-101 orally QD (1 x 20-mg caps) and 2 placebo caps. Week 1: Participants received 40 mg MP-101 orally QD (2 x 20-mg caps) and 1 placebo caps. Week 2 through Week 9: Participants received 60 mg MP-101 orally QD (3 x 20-mg caps ).

Placebo Placebo Comparator

Participants received 3 capsules (caps) of placebo orally once daily (QD) during Week 0, Week 1, and Week 2 through Week 9.

Criteria

Inclusion Criteria:

Females must be of non-childbearing potential, defined as women greater than or equal to (≥) 60 years of age, postmenopausal women ≥50 and less than (<) 60 years of age who have had a cessation of menses for at least 12 months, or women who are congenitally or surgically sterile
Males must agree to use 2 forms of highly effective birth control with female partners of childbearing potential while enrolled in the study, and for at least 28 days following the last dose
Ambulatory (with or without walking device) with a stable gait
Have a Mini-Mental State Examination (MMSE) score of 10 to 24
Meet clinical criteria for one of the following disorders: dementia associated with Parkinson's disease, dementia with Lewy bodies, possible or probable Alzheimer's disease, frontotemporal degeneration spectrum disorders, vascular dementia
Able to communicate verbally
Have an NPI score of ≥4 on either individual item (delusions or hallucinations) or ≥6 on the Psychosis Subscale (combined delusions and hallucinations), or an NPI score of ≥4 on agitation/aggression domain
Have a reliable caregiver who provides written informed consent to participate and who is in frequent contact with the patient (defined as spending at least 4 hours/day at least 4 days/week with the patient and who is knowledgeable about the patient's daytime and nighttime behaviors). The caregiver must be able to communicate with site personnel, and opinion of the investigator, must understand the written protocol-specified questionnaires. If a caregiver cannot continue, one replacement caregiver will be allowed if the above criterion is met
Must be on a stable dose of cholinesterase inhibitor and/or memantine, if applicable
If taking antipsychotic drugs or any drug intended to treat psychosis, must be on a stable treatment regimen for ≥1 month prior to the study
Have venous access sufficient to allow for blood sampling per the protocol
Have clinical laboratory test results within normal reference range for the population or investigative site
Are capable of participating in all study assessments
Are able and willing to provide consent (patients and caregivers)

Exclusion Criteria:

Have a history of significant psychotic disorders (including, schizophrenia, delusional disorder, substance abuse psychosis that lasted over 6 months, major depressive disorder or bipolar disorder with psychotic episodes)
Has a history of ischemic stroke within the last 12 months or any evidence of hemorrhagic stroke
Have renal impairment as defined by Estimated Glomerular Filtration Rate (eGFR) <45 milliliters per minute per 1.73 square meters (ml/min/1.73m2)
Have significant cardiovascular, respiratory, gastrointestinal, renal, hematologic, or oncologic comorbidities that could impact patient safety and study participation over 10 weeks
Have a history of seizures or other condition that would place the patient at increased risk of seizures.
Are, in the investigator's judgment, at risk for suicide, or as indicated by the Columbia Suicide Severity Rating Scale (C-SSRS)
Have a Fridericia's corrected QT interval (QTcF) greater than (>) 450 milliseconds (ms) for males or 470 ms for females
Are currently enrolled in any other clinical trial involving an investigational product or any other type of medical research judged not to be scientifically or medically compatible with this study
Have participated, within the last 30 days, in a clinical trial involving an investigational product. If the previous investigational product has a long half-life, at least 3 months (or more) must have passed
In the opinion of the investigator or sponsor, are unsuitable for inclusion in the study

Summary

Placebo

MP-101

All Events

Event Type Organ System Event Term Placebo MP-101

Percentage of Participants With 30% Improvement From Baseline in the Neuropsychiatric Inventory (NPI) - Psychosis Subscale or Aggression/Agitation Subscale Score

The NPI is a questionnaire that quantifies behavioral changes in dementia. For each of 12 domains there are 4 scores: Frequency (scale:1=occasionally to 4=very frequently), Severity (scale:1=Mild to 3=Severe), Total (frequency x severity), Caregiver distress (scale: 0=not at all distressing to 5=extremely distressing). An NPI response was defined as at least a 30% improvement from baseline on the NPI Psychosis sub-score (for participants with a psychosis diagnosis (Delusions and Hallucinations)) or the NPI Aggression/Agitation sub-score (for participants with an agitation/aggression diagnosis). The delusions, hallucinations, and aggression/agitation domain scores were added together to form a core total score with score range of 0 to 36. Lower score=less severity. A negative change score from baseline indicates improvement.

Placebo

58.0
percentage of participants

MP-101

62.0
percentage of participants

Percentage of Participants With Improvement From Baseline in the Clinical Global Impression of Improvement (CGI-I) at Week 10

The CGI rating scale, which measures symptom severity, treatment response and the efficacy of treatments, is used in clinical studies on mental disorders. CGI Improvement scale is a 7 point scale that requires the clinician to assess how much the participant's illness has improved or worsened relative to a baseline state at the beginning of the intervention: 1=very much improved; 2=much improved; 3=minimally improved; 4=no change; 5=minimally worse; 6=much worse; 7=very much worse.

Placebo

Minimally improved

34.4
percentage of participants

Minimally worse

15.6
percentage of participants

Much improved

25.0
percentage of participants

Much worse

3.1
percentage of participants

No change

21.9
percentage of participants

Very much improved

Very much worse

MP-101

Minimally improved

28.0
percentage of participants

Minimally worse

12.0
percentage of participants

Much improved

28.0
percentage of participants

Much worse

8.0
percentage of participants

No change

16.0
percentage of participants

Very much improved

8.0
percentage of participants

Very much worse

Change From Baseline in NPI Total Score

The NPI is a questionnaire that quantifies behavioral changes in dementia. For each of 12 domains there are 4 scores: Frequency (scale: 1=occasionally to 4=very frequently), Severity (scale:1=Mild to 3=Severe), Total (frequency x severity), Caregiver distress (scale: 0=not at all distressing to 5=extremely distressing). The NPI Total Score is calculated by adding the Individual Item Scores for all 12 domains, to yield a possible NPI Total Score of 0 to 144. Lower score=less severity. A negative change score from baseline indicates improvement.

Placebo

-3.43
score on a scale (Mean)
Standard Error: 2.34

MP-101

-8.7
score on a scale (Mean)
Standard Error: 2.66

Change From Baseline in NPI Core Total Score

The NPI is a questionnaire that quantifies behavioral changes in dementia. For each of 12 behavioral domains there are 4 scores: Frequency (scale: 1=occasionally to 4=very frequently), Severity (scale:1=Mild to 3=Severe), Total (frequency x severity), Caregiver distress (scale: 0=not at all distressing to 5=extremely distressing). The NPI CoreTotal Score is calculated by adding the Individual Item Scores for all 3 domains (hallucinations, delusions, and agitation/aggression) to yield a possible NPI Core Total Score of 0 to 36. Lower score=less severity. A negative change score from baseline indicates improvement.

Placebo

-3.46
score on a scale (Mean)
Standard Error: 1.15

MP-101

-5.05
score on a scale (Mean)
Standard Error: 1.31

Number of Participants With NPI Caregiver Distress

The NPI is a questionnaire that quantifies behavioral changes in dementia. For each of 12 domains there are 4 scores: Frequency (scale:1=occasionally to 4=very frequently), Severity (scale:1=Mild to 3=Severe), Total (frequency x severity), Caregiver distress (scale:0=not at all distressing to 5=extremely distressing). The NPI Psychosis Subscale Caregiver Distress Score is calculated by adding Individual Item Scores for the domains of Delusions and Hallucinations, to yield a possible total score of 0 to 10. Lower score=less severity. A negative change score from baseline=improvement.

Placebo

Week 10 Delusions (Mildly)

Week 10 Delusions ( Minimally)

Week 10 Delusions (Moderately)

Week 10 Delusions ( Not at all)

Week 10 Delusions (severely)

Week 10 Delusions (Very Severely or extremely)

Week 10 Hallucinations (Mildly)

Week 10 Hallucinations ( Minimally)

Week 10 Hallucinations (Moderately)

Week 10 Hallucinations ( Not at all)

Week 10 Hallucinations (severely)

Week 10 Hallucinations (Very Severely or extremely)

MP-101

Week 10 Delusions (Mildly)

Week 10 Delusions ( Minimally)

Week 10 Delusions (Moderately)

Week 10 Delusions ( Not at all)

Week 10 Delusions (severely)

Week 10 Delusions (Very Severely or extremely)

Week 10 Hallucinations (Mildly)

Week 10 Hallucinations ( Minimally)

Week 10 Hallucinations (Moderately)

Week 10 Hallucinations ( Not at all)

Week 10 Hallucinations (severely)

Week 10 Hallucinations (Very Severely or extremely)

Change From Baseline in NPI Domains - Anxiety

The 12 individual items in NPI that quantify changes in dementia are delusions, hallucinations, agitation, depression, anxiety, apathy, disinhibition, irritability, euphoria, aberrant motor behavior, nighttime behaviors, and appetite. For each of 12 behavioral domains there are 4 scores: Frequency (scale:1=occasionally to 4=very frequently), Severity (scale:1=Mild to 3=Severe), Total (frequency x severity), Caregiver distress (scale: 0=not at all distressing to 5=extremely distressing). The NPI Psychosis Subscale Anxiety consists of anxiety item to yield a possible NPI Score of 0 to 12. Lower score=less severity. A negative change score from baseline indicates improvement.

Placebo

-0.1
units on a scale (Mean)
Standard Deviation: 3.53

MP-101

-0.6
units on a scale (Mean)
Standard Deviation: 2.69

Number of Participants With Any Treatment Emergent Adverse Event

Number of participants with untoward medical occurrences that emerge during the treatment period, having been absent pretreatment, or worsen relative to the pretreatment state, which do not necessarily have a causal relationship with this treatment. A summary of serious adverse events (SAEs) and other non-serious adverse events (AEs) is located in the reported adverse events module.

Placebo

MP-101

Change From Baseline in the Unified Parkinson's Disease Rating Scale (UPDRS) Part III

Part III of the UPDRS is an investigator-scored scale used to assess the motor symptoms of patients with Parkinson's disease. The investigator rates the patient on 14 items based on observation or the performance of a task the patient performs (even in the context of any comorbidities) on a 5-point scale. The scores range from 0 to 4, with higher scores indicating greater impairment. The total UPDRS score was calculated as the sum of all items, ranging from 0 to 56 with higher scores indicating greater impairment. If any individual item was missing, the UPDRS score was be set to missing.

Placebo

-0.29
units on a scale (Mean)
Standard Error: 0.76

MP-101

-0.37
units on a scale (Mean)
Standard Error: 0.87

Population Pharmacokinetics (PK): Plasma Levels of MP-101 and Metabolite

Summary statistics of sparse blood concentration samples at weeks 2, 4, 6, 10 and Early Termination obtained utilizing a population PK approach.

MP-101

Early Termination

Week 10: 2- 4 hours

9.3
Nanomoles per liter (nmol/L) (Geometric Mean)
Geometric Coefficient of Variation: 1.12

Week 2: 4-8 hours

7.9
Nanomoles per liter (nmol/L) (Geometric Mean)
Geometric Coefficient of Variation: 1.11

Week 4: 0-2 hours

11.4
Nanomoles per liter (nmol/L) (Geometric Mean)
Geometric Coefficient of Variation: 1.09

Week 6: 8-12 hours

4.1
Nanomoles per liter (nmol/L) (Geometric Mean)
Geometric Coefficient of Variation: 1.36

LY2812223 (MP-101 Metabolite)

Early Termination

13.0
Nanomoles per liter (nmol/L) (Geometric Mean)
Geometric Coefficient of Variation: 1.24

Week 10: 2- 4 hours

929.0
Nanomoles per liter (nmol/L) (Geometric Mean)
Geometric Coefficient of Variation: 1.00

Week 2: 4-8 hours

429.8
Nanomoles per liter (nmol/L) (Geometric Mean)
Geometric Coefficient of Variation: 1.00

Week 4: 0-2 hours

249.0
Nanomoles per liter (nmol/L) (Geometric Mean)
Geometric Coefficient of Variation: 1.01

Week 4: Predose

85.0
Nanomoles per liter (nmol/L) (Geometric Mean)
Geometric Coefficient of Variation: 1.01

Week 6: 8-12 hours

808.4
Nanomoles per liter (nmol/L) (Geometric Mean)
Geometric Coefficient of Variation: 1.00

Total

81
Participants

Age, Continuous

74.7
years (Mean)
Standard Deviation: 8.60

Neuropsychiatric Inventory (NPI) Psychosis Score

8.0
units on a scale (Mean)
Standard Deviation: 6.02

NPI Agitation/Aggression Score

5.5
units on a scale (Mean)
Standard Deviation: 3.24

Ethnicity (NIH/OMB)

Race (NIH/OMB)

Region of Enrollment

Sex: Female, Male

Overall Study

Placebo

MP-101

Drop/Withdrawal Reasons

Placebo

MP-101