Phase 2 safety trial targeting amyloid β production with a γ-secretase inhibitor in Alzheimer disease

Objective: To evaluate the safety, tolerability, and amyloid beta (A beta) response to the gamma-secretase inhibitor LY450139 in Alzheimer disease. Design: Multicenter, randomized, double-blind, dose-escalation, placebo-controlled trial. Setting: Community-based clinical research centers. Patients: Fifty-one individuals with mild to moderate Alzheimer disease were randomized to receive placebo (n=15) or LY450139 (100mg [n=22] or 140mg [n=14]), with 43 completing the treatment phase. Intervention: The LY450139 groups received 60 mg/d for 2 weeks, then 100 mg/d for 6 weeks, and then either 100 or 140 mg/d for 6 additional weeks. Main Outcome Measures: Primary outcome measures were adverse events, plasma and cerebrospinal fluid A beta levels, vital signs, electrocardiographic data, and laboratory safety test results. Secondary outcome measures included the Alzheimer's Disease Assessment Scale cognitive subscale and the Alzheimer's Disease Cooperative Study Activities of Daily Living Scale. Results: Group differences were seen in skin and subcutaneous tissue concerns (P=.05), including 3 possible drug rashes and 3 reports of hair color change in the treatment groups. There were 3 adverse event-related discontinuations, including 1 transient bowel obstruction. The plasma A beta(40) concentration was reduced by 58.2% for the 100-mg group and 64.6% for the 140-mg group (P <.001). No significant reduction was seen in cerebrospinal fluid A beta levels. No group differences were seen in cognitive or functional measures. Conclusions: LY450139 was generally well tolerated at doses of up to 140 mg/d for 14 weeks, with several findings indicating the need for close clinical monitoring in future studies. Decreases in plasma A beta concentrations were consistent with inhibition of gamma-secretase. Trial Registration: clinicaltrials. gov Identifier: NCT00244322.