Effect of LY3154207 on Cognition in Mild-to-Moderate Dementia Due to Lewy Body Dementia (LBD) Associated With Idiopathic Parkinson's Disease (PD) or Dementia With Lewy Bodies (DLB)
A randomized placebo-controlled trial to evaluate the safety and efficacy of three doses of study drug LY3154207 treated for 12 weeks in participants with mild-to-moderate dementia associated with LBD (PDD or DLB).
Sex: All, ages: 40 Years to 85 Years
Inclusion Criteria:
* Have dementia as defined by a decline in cognitive function, which in the opinion of the investigator has resulted in functional impairment.
* Meet diagnostic criteria for PD per MDS criteria or DLB per 4th Consensus Report of the DLB Consortium.
* Have a score on the MoCA of 10 - 23.
* Are Modified Hoehn and Yahr Stages 0 - 4.
* Have a blood pressure (BP) or pulse rate at screening and randomization, as determined by three sequential BP/pulse rate measurements in a seated position:
* Participants <60 years old:
1. A mean systolic BP less than or equal to 140 millimeters of mercury (mmHg), a mean diastolic BP less than or equal to 90 mmHg and a mean pulse rate less than or equal 90 beats/minute in a seated position.
2. Each of the 3 systolic BP measurement must be less than 180 mmHg
* Participants ≥60 years old:
1. A mean systolic BP less than or equal to 150 mmHg, a mean diastolic BP less than or equal to 90 mmHg and a mean pulse rate less than or equal to 90 beats/min in a seated position.
2. Each of the 3 systolic BP measurement must be less than 180 mmHg
* If on anti-parkinsonian agents, participants must be on stable dosage for at least 3 weeks prior to screening, and should remain on stable doses during the course of the study.
* If on medications affecting cognition (rivastigmine, galantamine, donepezil, memantine), participants must be on stable dosage for at least 3 weeks prior to screening and should remain at a stable dosage during the course of the study.
* If on antidepressant medications, participants must be on stable dosage for at least 3 weeks prior to screening and should remain at a stable dosage during the course of the study.
* If on clozapine, quetiapine, and pimavanserin to address drug induced or disease related psychosis, participants must be on stable dosage for 3 weeks prior to screening and should remain at a stable dosage during the course of the study.
* If on antihypertensive medications, participants must be on stable dosage for at least 3 weeks prior to screening.
* Men should use appropriate contraception.
* All participants must have a reliable caregiver who is in frequent contact with the participant (defined as at least 10 hours per week) and will accompany the participant to screening, baseline, day 7, day 42, day 84 and follow-up.
Exclusion Criteria:
* Are women of childbearing potential.
* Have significant central nervous system or psychiatric disease, other than PD or DLB, that in the investigator's opinion may affect cognition or the ability to complete the study.
* Have a history in the last 6 months of transient ischemic attacks or ischemic stroke.
* Have a history of intra cerebral hemorrhage due to hypertension.
* Have a history of hypertensive encephalopathy.
* Have atypical or secondary parkinsonism due to drugs (e.g., antipsychotics) or disease (such as progressive supranuclear palsy, essential tremor, multiple system atrophy (e.g. striatonigral degeneration, olivopontocerebellar atrophy), or postencephalitic parkinsonism).
* Have a current implantable intracranial stimulator or history of intracranial ablation surgery (e.g., subthalamic, globus pallidus-internal segment \[GPi\]).
* Have a history of substance abuse within the past 1 year (drug categories defined by the Diagnostic and Statistical Manual of Mental Disorder, 5th Edition \[DSM-5\], and/or substance dependence within the past 1 year, not including caffeine and nicotine.
* Have a serious or unstable medical illness, other than idiopathic LBD (PDD or DLB), including cardiovascular, hepatic, respiratory, hematologic, endocrinologic, neurologic, or renal disease, or clinically significant laboratory or electrocardiogram (ECG) abnormality as determined by the investigator.
* Have a history in the last 6 months of exertional angina, unstable angina, myocardial infarction, and acute coronary syndrome.
* Have a history of heart failure of either New York Heart Association Class III or IV.
* A history of additional risk factors for Torsades de Pointes (TdP; \[e.g., chronic hypokalemia, family history of Long QT Syndrome\]).
* Participants with acute liver disease (e.g. acute viral hepatitis, alcoholic hepatitis); participants with a known chronic liver disease (e.g. hepatitis B, C, alcoholic liver disease, cirrhosis); alanine aminotransferase (ALT) or aspartate aminotransferase (AST) equal to or higher than 2X upper limit of normal (ULN); total bilirubin (TBL) equal to or higher than 1.5X ULN; (except for participants with Gilbert's syndrome); or alkaline phosphatase (ALP) equal to or higher than 2X ULN.
* Participants have answered 'yes' to either Question 4 (Active Suicidal Ideation with Some Intent to Act, Without Specific Plan) or Question 5 (Active Suicidal Ideation with Specific Plan and Intent) on the "Suicidal Ideation" portion of the Columbia Suicide Severity Rating Scale (C-SSRS)- Children's version, or answer "yes" to any of the suicide-related behaviors (actual attempt, interrupted attempt, aborted attempt).
* Have used antipsychotic medications, with the exception of clozapine, quetiapine, pimavanserin in the 6 months prior to screening and at any time during the course of the study.
* Have used anticholinergics trihexyphenidyl and benztropine in the 4 weeks prior to screening and at any time during the course of the study.
* Have motor conditions for which the antiparkinsonian treatment is expected to change during the course of the study, as well as unpredictable motor fluctuations that in the investigator's opinion would interfere with administering assessments.
* Are taking any medications or food, herbal or dietary supplements that are inhibitors (e.g., ketoconazole, grapefruit juice), or strong/moderate inducers of cytochrome P450 3A4 (CYP3A4) (e.g., rifampicin) or are unable or unwilling to discontinue usage of them 4 weeks prior to first dose of study drug.
Participant flow
| Milestone | Placebo | 10 Milligram (mg) LY3154207 | 30 mg LY3154207 | 75 mg LY3154207 |
|---|
| Started | 86 | 86 | 85 | 87 |
| Received at least one dose of study drug | 86 | 86 | 85 | 87 |
| Completed | 79 | 78 | 66 | 60 |
| Not completed | 7 | 8 | 19 | 27 |
Outcome results
- Change From Baseline in the Continuity of Attention (CoA) Composite Score of the Cognitive Drug Research Computerized Cognition Battery (CDR-CCB) (Primary), Least squares mean, Units on a scale: Placebo 1.04 (-0.339 to 2.373); 10 mg LY3154207 0.15 (-1.206 to 1.496); 30 mg LY3154207 0.96 (-0.448 to 2.362); 75 mg LY3154207 0.26 (-1.310 to 1.801)
- Change From Baseline on the Alzheimer's Disease Cooperative Study-Clinician Global Impression of Change (ADCS-CGIC) Score (Secondary), Least squares mean, Score on a scale: Placebo 4.0 +/- 0.13; 10 mg LY3154207 3.8 +/- 0.12; 30 mg LY3154207 3.3 +/- 0.13; 75 mg LY3154207 3.1 +/- 0.15 (p 0.273)
- Change From Baseline on the CDR-CCB Power of Attention (PoA) Composite Score (Secondary), Least squares mean, Units on a scale: Placebo 64.14 +/- 48.681; 10 mg LY3154207 -6.57 +/- 48.396; 30 mg LY3154207 -42.88 +/- 49.804; 75 mg LY3154207 -59.58 +/- 54.379 (p 0.303)
- Change From Baseline in the 13-item Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-Cog13) (Secondary), Least squares mean, Units on a scale: Placebo -0.71 +/- 0.707; 10 mg LY3154207 -1.11 +/- 0.691; 30 mg LY3154207 -1.42 +/- 0.720; 75 mg LY3154207 -1.59 +/- 0.799 (p 0.686)
- Change From Screening in the Montreal Cognitive Assessment (MoCA) Score (Secondary), Least squares mean, Units on a scale: Placebo 0.90 +/- 0.432; 10 mg LY3154207 1.34 +/- 0.423; 30 mg LY3154207 1.12 +/- 0.448; 75 mg LY3154207 1.84 +/- 0.496 (p 0.464)
- Change From Baseline in the Neuropsychiatric Inventory (NPI) Total Score and Individual Item Scores (Secondary), Least squares mean, Units on a scale: Placebo -1.62 +/- 0.868; 10 mg LY3154207 -2.24 +/- 0.852; 30 mg LY3154207 -3.32 +/- 0.920; 75 mg LY3154207 -2.37 +/- 1.005 (p 0.607)
- Change From Baseline in the Epworth Sleepiness Scale (ESS) Score (Secondary), Least squares mean, Units on a scale: Placebo -0.33 +/- 0.437; 10 mg LY3154207 -1.04 +/- 0.426; 30 mg LY3154207 -1.21 +/- 0.452; 75 mg LY3154207 -1.92 +/- 0.500 (p 0.247)
- Change From Baseline in the Movement Disorder Society's Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Total Score (Sum of Parts I-III) (Secondary), Least squares mean, Units on a scale: Placebo -0.18 +/- 2.112; 10 mg LY3154207 -6.58 +/- 1.941; 30 mg LY3154207 -7.56 +/- 2.084; 75 mg LY3154207 -10.77 +/- 2.287 (p 0.026)
- Change From Baseline in the Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15) Total Score (Secondary), Least squares mean, Units on a scale: Placebo -0.32 +/- 0.976; 10 mg LY3154207 0.23 +/- 0.961; 30 mg LY3154207 2.09 +/- 1.018; 75 mg LY3154207 1.24 +/- 1.128 (p 0.683)
- Change From Baseline in Delis-Kaplan Executive Function System (D-KEFS) Verbal Fluency Test Score (Secondary), Least squares mean, Units on a scale: Placebo -0.19 +/- 0.280; 10 mg LY3154207 0.44 +/- 0.271; 30 mg LY3154207 0.88 +/- 0.292; 75 mg LY3154207 0.30 +/- 0.325 (p 0.105)
- Change in MDS-UPDRS Parts II (Motor Experiences of Daily Living) and III (Motor Exam) From Baseline to Week 12 (Secondary), Least squares mean, Units on a scale: Placebo 0.28 +/- 0.656; 10 mg LY3154207 -1.45 +/- 0.649; 30 mg LY3154207 -2.08 +/- 0.700; 75 mg LY3154207 -3.22 +/- 0.779 (p 0.061)
- Number of Participants Who Met the Potentially Clinically Significant Vital Signs Criteria at 3 Consecutive Time Points at Visit 3 (Secondary), Count of participants, Participants: Placebo 0; 10 mg LY3154207 0; 30 mg LY3154207 1; 75 mg LY3154207 1
- Change From Baseline in Clinic Blood Pressure (BP) to 8 Hours Post Dose (Secondary), Least squares mean, millimeter of mercury (mmHg): Placebo 9.8 +/- 1.90; 10 mg LY3154207 10.1 +/- 1.89; 30 mg LY3154207 10.4 +/- 1.92; 75 mg LY3154207 19.2 +/- 1.87 (p 0.898)
- Change From Baseline in Pulse Rate to 8 Hours Post Dose (Secondary), Least squares mean, beats/min: Placebo -2.2 +/- 0.94; 10 mg LY3154207 0.2 +/- 0.95; 30 mg LY3154207 1.3 +/- 0.95; 75 mg LY3154207 6.4 +/- 0.93 (p 0.065)
- Change From Baseline In-clinic BP to Week 12 (Secondary), Least squares mean, millimeters of mercury (mmHg): Placebo -1.2 +/- 1.22; 10 mg LY3154207 0.5 +/- 1.19; 30 mg LY3154207 0.1 +/- 1.29; 75 mg LY3154207 3.0 +/- 1.38 (p 0.339)
- Change From Baseline in Pulse Rate to Week 12 (Secondary), Least squares mean, beats/min: Placebo -0.2 +/- 0.67; 10 mg LY3154207 0.3 +/- 0.66; 30 mg LY3154207 1.5 +/- 0.71; 75 mg LY3154207 2.6 +/- 0.75 (p 0.550)
- Change in Home Blood Pressure Measurement (HBPM), for SBP, DBP From Baseline to Week 12 (Secondary), Least squares mean, mmHg: Placebo -1.1 +/- 2.52; 10 mg LY3154207 -8.2 +/- 2.40; 30 mg LY3154207 2.0 +/- 2.58; 75 mg LY3154207 -2.2 +/- 2.62 (p 0.045)
- Change in HBPM for Pulse Rate From Baseline to Week 12 (Secondary), Least squares mean, beats/min: Placebo 1.4 +/- 1.52; 10 mg LY3154207 1.4 +/- 1.47; 30 mg LY3154207 0.7 +/- 1.59; 75 mg LY3154207 0.8 +/- 1.62 (p 0.996)
- Change From Baseline in the Physician Withdrawal Checklist (PWC)-20 Total Score From Week 12 to In-Clinic Follow-up Visit (Secondary), Least squares mean, Units on a scale: Placebo -1.51 +/- 0.670; 10 mg LY3154207 -0.53 +/- 0.690; 30 mg LY3154207 -0.47 +/- 0.701; 75 mg LY3154207 0.05 +/- 0.811 (p 0.312)
- Pharmacokinetics (PK): Steady-State Trough Plasma Concentrations of LY3154207 (Secondary), Mean, nanogram per milliliter (ng/mL): 10 mg LY3154207 34.95 +/- 28.82; 30 mg LY3154207 89.36 +/- 88.03; 75 mg LY3154207 223.30 +/- 208.63
Adverse events
Time frame: Up To 4 Months
| Arm | Deaths | Serious adverse events | Other adverse events |
|---|
| Placebo | 0/86 (0.0%) | 3/86 (3.5%) | 20/86 (23.3%) |
| 10 mg LY3154207 | 0/86 (0.0%) | 5/86 (5.8%) | 26/86 (30.2%) |
| 30 mg LY3154207 | 1/85 (1.2%) | 3/85 (3.5%) | 30/85 (35.3%) |
| 75 mg LY3154207 | 1/87 (1.1%) | 10/87 (11.5%) | 43/87 (49.4%) |
Serious adverse events by term
| Term | Organ system | Placebo | 10 mg LY3154207 | 30 mg LY3154207 | 75 mg LY3154207 |
|---|
| Angina pectoris | Cardiac disorders | 1/86 | 0/86 | 0/85 | 0/87 |
| Cardiac failure congestive | Cardiac disorders | 0/86 | 0/86 | 0/85 | 1/87 |
| Constipation | Gastrointestinal disorders | 0/86 | 1/86 | 0/85 | 0/87 |
| Oesophagitis | Gastrointestinal disorders | 1/86 | 0/86 | 0/85 | 0/87 |
| Pancreatitis | Gastrointestinal disorders | 0/86 | 0/86 | 1/85 | 0/87 |
| Chest pain | General disorders | 0/86 | 0/86 | 0/85 | 1/87 |
| Death | General disorders | 0/86 | 0/86 | 0/85 | 1/87 |
| Cellulitis | Infections and infestations | 0/86 | 0/86 | 0/85 | 1/87 |
| Herpes zoster meningoencephalitis | Infections and infestations | 0/86 | 1/86 | 0/85 | 0/87 |
| Localised infection | Infections and infestations | 0/86 | 0/86 | 0/85 | 1/87 |
| Pseudomonas infection | Infections and infestations | 1/86 | 0/86 | 0/85 | 0/87 |
| Septic shock | Infections and infestations | 0/86 | 0/86 | 1/85 | 0/87 |
| Fall | Injury, poisoning and procedural complications | 0/86 | 0/86 | 1/85 | 0/87 |
| Hyperammonaemia | Metabolism and nutrition disorders | 0/86 | 1/86 | 0/85 | 0/87 |
| Rhabdomyolysis | Musculoskeletal and connective tissue disorders | 0/86 | 0/86 | 1/85 | 0/87 |
| B-cell lymphoma | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | 0/86 | 0/86 | 0/85 | 1/87 |
| Cerebrovascular accident | Nervous system disorders | 0/86 | 0/86 | 0/85 | 1/87 |
| Dizziness | Nervous system disorders | 0/86 | 0/86 | 0/85 | 1/87 |
| Facial paralysis | Nervous system disorders | 0/86 | 0/86 | 0/85 | 1/87 |
| Hemianaesthesia | Nervous system disorders | 0/86 | 0/86 | 0/85 | 1/87 |
| Hemiparesis | Nervous system disorders | 0/86 | 0/86 | 0/85 | 1/87 |
| Hypertensive encephalopathy | Nervous system disorders | 0/86 | 0/86 | 0/85 | 1/87 |
| Subarachnoid haemorrhage | Nervous system disorders | 0/86 | 1/86 | 0/85 | 0/87 |
| Syncope | Nervous system disorders | 0/86 | 1/86 | 0/85 | 1/87 |
| Confusional state | Psychiatric disorders | 0/86 | 0/86 | 0/85 | 1/87 |
| Disorientation | Psychiatric disorders | 0/86 | 1/86 | 0/85 | 0/87 |
| Tubulointerstitial nephritis | Renal and urinary disorders | 0/86 | 0/86 | 0/85 | 1/87 |
| Pulmonary embolism | Respiratory, thoracic and mediastinal disorders | 0/86 | 1/86 | 0/85 | 0/87 |
| Hypertension | Vascular disorders | 0/86 | 0/86 | 0/85 | 1/87 |
Other adverse events by term
| Term | Organ system | Placebo | 10 mg LY3154207 | 30 mg LY3154207 | 75 mg LY3154207 |
|---|
| Diarrhoea | Gastrointestinal disorders | 1/86 | 2/86 | 5/85 | 2/87 |
| Nausea | Gastrointestinal disorders | 3/86 | 2/86 | 7/85 | 8/87 |
| Vomiting | Gastrointestinal disorders | 3/86 | 0/86 | 2/85 | 7/87 |
| Fatigue | General disorders | 4/86 | 2/86 | 1/85 | 9/87 |
| Urinary tract infection | Infections and infestations | 2/86 | 5/86 | 1/85 | 0/87 |
| Fall | Injury, poisoning and procedural complications | 4/86 | 12/86 | 6/85 | 12/87 |
| Dizziness | Nervous system disorders | 4/86 | 4/86 | 6/85 | 9/87 |
| Dyskinesia | Nervous system disorders | 2/86 | 2/86 | 3/85 | 5/87 |
| Headache | Nervous system disorders | 1/86 | 2/86 | 8/85 | 7/87 |
| Hallucination | Psychiatric disorders | 4/86 | 2/86 | 5/85 | 9/87 |
| Insomnia | Psychiatric disorders | 0/86 | 4/86 | 4/85 | 5/87 |