Alzheimer's DiseasePhase 4ACTIONNCT00948766
Effects of Rivastigmine Patch on Activities of Daily Living and Cognition in Patients With Severe Dementia of the Alzheimer's Type (ACTION) (Study Protocol CENA713DUS44, NCT00948766) and a 24 Week Open-label Extension to Study CENA713DUS44
A Phase 4 study testing Rivastigmine 4.6 mg/24 h (5 cm^2), Rivastigmine 9.5 mg/24 h (10 cm^2) and Rivastigmine 13.3 mg/24 h (15 cm^2) in people with Alzheimer's Disease, run by Novartis at 95 sites in 2 countries.
Trial summary
The core study assessed the efficacy of a higher dose of rivastigmine 13.3 mg/24 h transdermally (15 cm^2 patch) compared to a lower dose of the rivastigmine 4.6 mg/24 h transdermally (5 cm^2 patch) in patients with Severe Dementia of the Alzheimer's Type in a 24-week study. Read more about this study
- Who is it for?
- Ages 50 years and older
- Conditions the study is for
- Alzheimer's Disease
- What is being tested?
- Rivastigmine 4.6 mg/24 h (5 cm^2), Rivastigmine 9.5 mg/24 h (10 cm^2) and Rivastigmine 13.3 mg/24 h (15 cm^2)
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 716 participants
- Where
- 95 sitesin 2 countries
- Study dates
- Jul 2009to Jun 2012
- Phase
- Phase 4
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 50 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Diagnosis of probable Alzheimer's disease (AD) according to National Institute of Neurological Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS/ADRDA) criteria.
- A Mini-Mental State Examination (MMSE) score of ≥ 3 and ≤ 12.
- Be able to complete at least 1 item on the Severe Impairment Battery (SIB).
- Residing with someone in the community or in regular contact with the primary caregiver.
- Be ambulatory or ambulatory with aid.
- Complete the double-blind phase (Week 24) of the core study.
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- Provide, if mentally competent, a separate written informed consent prior to participation in the extension study. In addition, the patient's caregiver, will provide written informed consent prior to the patient's participation in the open-label extension study. If the patient is not able to provide written informed consent, written informed consent must be obtained from the legally authorized representative on the patient's behalf.
- Continue to reside with someone in the community or in regular contact with the primary caregiver; patients who reside in an assisted living facility are eligible to participate.
- Continue to have a primary caregiver willing to accept responsibility for supervising treatment (eg, application and removal of the patch daily at approximately the same time of day), assessing the condition of the patient throughout the extension study.
- Must be medically stable and tolerating the current dose of rivastigmine patch as determined by the investigator.
Who cannot join
- An advanced, severe, progressive, or unstable disease of any type that may interfere with efficacy and safety assessments or put the patient at special risk.
- Patients currently residing in a nursing home.
- Any current medical or neurological condition other than AD that could explain the patient's dementia.
- A current diagnosis of probable or possible vascular dementia.
- A current diagnosis of severe or unstable cardiovascular disease.
- A current diagnosis of bradycardia (< 50 beats per minute [bpm]), sick-sinus syndrome, or conduction defects.
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- Clinically significant urinary obstruction.
- History of malignancy of any organ system within the past 5 years unless patient is verified to be in stable condition with no active metastasis.
- Current diagnosis of an active skin lesion/disorder that would prevent the patient from using a transdermal patch every day.
- A known exaggerated pharmacological sensitivity or hypersensitivity to drugs similar to rivastigmine, or to other cholinergic compounds.
- Taken any of the following substances (at the time of the Baseline Visit [Visit 2]).
- Succinylcholine-type muscle relaxants during the previous 2 weeks.
- Lithium during the previous 2 weeks.
- An investigational drug during the previous 4 weeks.
- A drug or treatment known to cause major organ system toxicity during the previous 4 weeks.
- Rivastigmine (oral or transdermal patch), donepezil, galantamine, other cholinesterase inhibitors (eg, tacrine, physostigmine, or pyridostigmine), or other approved treatments for Alzheimer's disease during the previous 2 weeks, with exception of stable treatment with memantine for at least 3 months before study entry (Visit 1).
- Centrally acting anticholinergic drugs including tricyclic and tetracyclic antidepressants during the previous 4 weeks.
- Selegiline unless taken at a stable dose during the previous 4 weeks.
- Peripheral anticholinergics not taken at a stable dose during the previous 4 weeks.
- Extension study
- Refer to the core study protocol for full details of the exclusion criteria.
- Patients who discontinued the core study due to any reason are excluded.
- No additional exclusions may be applied by the investigator, in order to ensure that the study population will be representative of all eligible patients.
- Other protocol-defined inclusion/exclusion criteria applied to the study.
Trial locations and contacts
95 sites in 2 countries.
95 sites in 2 countries
United States93 sites
Upstate Clinical Research, LLC
Albany, New York, 12205
Lehigh Center for Clinical Research
Allentown, Pennsylvania, 18104
Dent Neurological Institute
Amherst, New York, 14226
TLC Neurology, P.L.L.C
Arlington, Virginia, 22205
Senior Care of Colorado
Aurora, Colorado, 80014
Pharmasite Research
Baltimore, Maryland, 21208
Jacinto Medical Group, PA
Baytown, Texas, 77521
The Memory Clinic
Bennington, Vermont, 05201
East Bay Physicians Medical Group
Berkeley, California, 94705
Clinical Research Studies Dept. of Clinical Science and Medical Education
Boca Raton, Florida, 33431
Paramount Clinical Research
Bridgeville, Pennsylvania, 15017
Valley Medical Research
Centerville, Ohio, 45459
Alzheimer's Memory Center
Charlotte, North Carolina, 28211
UVA Neurology
Charlottesville, Virginia, 22903
University Neurology, Inc.
Cincinnati, Ohio, 45219
Michigan Neurology Associates, P.C.
Clinton Township, Michigan, 48035
Department of Veterans Affairs Medical Center
Coatesville, Pennsylvania, 19320
IHS Research Center Inc.
Conway, Arkansas, 72034
ATP Clinical Research, Inc.
Costa Mesa, California, 92626
Future Search Trials
Dallas, Texas, 75231
Quantum Laboratories Memory Disorder Center
Deerfield Beach, Florida, 33064
Brain Matters Research, Inc.
Delray Beach, Florida, 33445
Wayne State University/Detroit Medical center
Detroit, Michigan, 48201
Duke University Medical Center
Durham, North Carolina, 27710
Rhode Island Mood & Memory Research Institute
East Providence, Rhode Island, 02914
The Samuel and Alexia Bratton Memory Clinic, William Hill Inc
Easton, Maryland, 21601
Memory Enhancement Center of America, Inc.
Eatontown, New Jersey, 07724
Alexian Brothers Neuroscience Institute
Elk Grove Village, Illinois, 60007
Elkhart Clinic, LLC
Elkhart, Indiana, 46514
Neurologic Consultants, PA
Fort Lauderdale, Florida, 33308
White-Wilson Medical Center
Fort Walton Beach, Florida, 32547
Psychiatric Consultants, PC
Franklin, Tennessee, 37067
Neuro Pain Medical Center
Fresno, California, 90502
Margolin Brain Institute
Fresno, California, 93720
University of Texas Medical Branch
Galveston, Texas, 77555
Collaborative Neuroscience Network Inc.
Garden Grove, California, 92845
Westmoreland Neurology associates, Inc.
Greensburg, Pennsylvania, 15601
MD Clinical
Hallandale, Florida, 33009
Neurological Research Clinic, Hattiesburg Clinic
Hattiesburg, Mississippi, 39401
Sunrise Clinical Research, Inc
Hollywood, Florida, 33021
Indiana University Medical Center
Indianapolis, Indiana, 46202
University of Kansas Medical Center
Kansas City, Kansas, 66160
Volunteer Research Group
Knoxville, Tennessee, 37920
MidAmerica Neuroscience Reseach Institute
Lenexa, Kansas, 66214
Premier Psychiatric Research Institute, LLC
Lincoln, Nebraska, 68510
Neurological Care of Central NY
Liverpool, New York, 13088
Precise Clinical Research Solutions
Manhattan, Kansas, 66502
NeuroCognitive Institute
Mount Arlington, New Jersey, 07856
West Michigan Clinical Research
Muskegon, Michigan, 49442
UMDNJ-Robert Wood Johnson Medical Center
New Brunswick, New Jersey, 08903
Eastside Comprehensive medical Center, LLC
New York, New York, 10021
The Neuroscience Center
Ocean Springs, Mississippi, 39564
University of Nebraska Medical Center
Omaha, Nebraska, 68105
Nathan S. Kline Institute for Psychiatric Research
Orangeburg, New York, 10962
Compass Research, LLC
Orlando, Florida, 32806
Alzheimer's Research Corporation
Paterson, New Jersey, 08759
Integrity Research, LLC
Pensacola, Florida, 32514
Thomas Jefferson University
Philadelphia, Pennsylvania, 19107
Research Protocol Management Specialists
Pittsburgh, Pennsylvania, 15243
Neuroscience Research of the Berkshires
Pittsfield, Massachusetts, 01201
Neurostudies, Inc.
Port Charlotte, Florida, 33952
Cognitive Assessment Clinic
Portland, Oregon, 97225
PCND Neuroscience Research Institute Inc./The Center for Memory and Aging
Poway, California, 92064
Anderson Clinical Research
Redlands, California, 92374
Neurological Associates, Inc.
Richmond, Virginia, 23226
Alliance Research Group, LLC
Richmond, Virginia, 23230
Orr & Associates Memory and Geriatric Behavioral Health Clinic
Saint Paul, Minnesota, 55114
Innovative Clinical Trials
San Antonio, Texas, 78229
Radiant Research Inc.
San Antonio, Texas, 78229
San Francisco Clinical Research Center
San Francisco, California, 94109
Neuropsychiatric Research Center of Orange County
Santa Ana, California, 92701
California Neuroscience Research Medical Group, Inc.
Sherman Oaks, California, 91403
LSU Health Sciences Center/Department of Psychiatry Psychopharmacology Research Clinic
Shreveport, Louisiana, 71103
J. Gary Booker, MD APMC
Shreveport, Louisiana, 71104
St. Louis University
St Louis, Missouri, 63104
Sky, LLC.
St Louis, Missouri, 63117
Behavioral Medical Research of Staten Island
Staten Island, New York, 10305
Richmond Behavioral Associates
Staten Island, New York, 10312
UMDNJ-School of Osteopathic Medicine Center
Stratford, New Jersey, 08084
Internal Medicine Northwest
Tacoma, Washington, 98405
Stedman Clinical Trials, LLC
Tampa, Florida, 33613
Viking Clinical Research Center
Temecula, California, 92591
Clinical Research Advantage Inc./Neurological. Physicians of Arizona, Inc
Tempe, Arizona, 85282
Memory Enhancement Center of NJ
Toms River, New Jersey, 08755
Collaborative Neuroscience Network, Inc
Torrance, California, 90502
Northwest Neuro Specialist, PLLC
Tucson, Arizona, 86741
Center for Clinical Trials
Venice, Florida, 34285
Independent Psychiatric Consultants, SC
Waukesha, Wisconsin, 53188
Premiere Research Institute
West Palm Beach, Florida, 33407
The Burke Rehabilitation Hospital
White Plains, New York, 10605
Grayline Clinical Drug Trials
Wichita Falls, Texas, 76309
The Center for Excellence in Aging and Geriatric Health
Williamsburg, Virginia, 23185
Clinical Trials of America, Inc.
Winston-Salem, North Carolina, 27103
Puerto Rico2 sites
Metro Medical Center
Bayamón, 00959
INSPIRA Clinical Research
San Juan, 00918
About this study
Official title: A 24 Week, Prospective, Randomized, Parallel-group, Double-blind, Multi-center Study (ENA713DUS44) Comparing the Effects of Rivastigmine Patch 15 cm^2 vs. Rivastigmine Patch 5 cm^2 on ACTivities of Daily Living and CognitION in Patients With Severe Dementia of the Alzheimer's Type (ACTION) and a 24-week Open-label Extension to Study ENA713DUS44
The core study assessed the efficacy of a higher dose of rivastigmine 13.3 mg/24 h transdermally (15 cm^2 patch) compared to a lower dose of the rivastigmine 4.6 mg/24 h transdermally (5 cm^2 patch) in patients with Severe Dementia of the Alzheimer's Type in a 24-week study. The extension study obtained additional safety and efficacy data, as well as provided the higher dose rivastigmine patch to all patients who completed the core study for an additional 24 weeks.
- Conditions
- Alzheimer's Disease
- Being tested
- Rivastigmine 4.6 mg/24 h (5 cm^2), Rivastigmine 9.5 mg/24 h (10 cm^2), Rivastigmine 13.3 mg/24 h (15 cm^2), Placebo
- Keywords
- Alzheimer's disease, dementia, Alzheimer's type
- Medical subject headings
- Alzheimer Disease, Dementia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Rivastigmine 4.6 mg/24 h (5 cm^2)Drug
Also called ENA713D, Exelon, Exelon patch
Rivastigmine was supplied in a 5 cm^2 patch which released 4.6 mg/24 h. Patches were changed daily.
Rivastigmine 9.5 mg/24 h (10 cm^2)Drug
Also called ENA713D, Exelon, Exelon path
Rivastigmine was supplied in a 10 cm^2 patch which released 9.5 mg/24 h. Patches were changed daily.
Rivastigmine 13.3 mg/24 h (15 cm^2)Drug
Also called ENA713D, Exelon, Exelon patch
Rivastigmine was supplied in a 15 cm^2 patch which released 13.3 mg/24 h. Patches were changed daily.
PlaceboDrug
Placebo patches were identical in size and composition to the corresponding rivastigmine patches, except that they did not contain rivastigmine. Patches were changed daily.
| Study group | Role | What they receive |
|---|---|---|
| Rivastigmine 13.3 mg/24 h transdermal patch | Experimental | In the core study, patients were titrated to the rivastigmine 13.3 mg/24 h dose in 2 steps. For Weeks 1-4, patients received rivastigmine 4.6 mg/24 h. For Weeks 5-8, patients received rivastigmine 9.5 mg/24 h and placebo. For Weeks 9-24, patients received rivastigmine 13.3 mg/24 h and placebo. In the extension study, all patients were switched to rivastigmine 9.5 mg/24 h for a 4-week titration period and were then titrated up to 13.3 mg/24 h for a further 20 weeks of treatment. Receives: Drug: Rivastigmine 4.6 mg/24 h (5 cm^2); Drug: Rivastigmine 9.5 mg/24 h (10 cm^2); Drug: Rivastigmine 13.3 mg/24 h (15 cm^2); Drug: Placebo |
| Rivastigmine 4.6 mg/24 h transdermal patch | Active comparator | In the core study, patients received rivastigmine 4.6 mg/24 h daily. For Weeks 1-4, patients received rivastigmine 4.6 mg/24 h. For Weeks 5-24, patients received rivastigmine 4.6 mg/24 h and placebo. No patients received this treatment in the extension study. Receives: Drug: Rivastigmine 4.6 mg/24 h (5 cm^2); Drug: Placebo |
What is being measured
The primary outcome is the main question the study is designed to answer.
Core Study: Change From Baseline in the Alzheimer's Disease Cooperative Study-Activities of Daily Living-Severe Impairment Version (ADCS-ADL-SIV) Score at Week 24
The ADCS-ADL-SIV is designed to assess the patient's performance of both basic and instrumental activities of daily living such as those necessary for personal care, communicating and interacting with other people, maintaining a household, conducting hobbies and interests, and making judgments and decisions. For each of the 19 questions in the ADCS-ADL-SIV, there was either a forced choice of best response or a "yes" or "no" question with additional sub-questions. Responses for each item were obtained from the caregiver through an interview. Higher numbered scores and answers of "yes" reflected a more self-sufficient individual. The total score was calculated as the sum of all items and sub-questions and ranged from 0 to 54. A higher total score represented a higher functioning patient. A positive change score indicates improvement.
Measured: Baseline of the core study to Week 24 of the core study
Core Study: Change From Baseline in the Severity Impairment Battery (SIB) Score at Week 24
The SIB is a 40-item scale developed for the evaluation of the severity of cognitive dysfunction in more advanced Alzheimer Disease patients. The domains assessed included social interaction, memory, language, attention, orientation, praxis, visuo-spatial ability, construction, and orienting to name. The items of the SIB were developed as simple 1-step commands which are presented by a trained rater with gestural cues and repeated if necessary. The SIB was scored from 0 to 100, with higher scores reflecting higher levels of cognitive ability. A positive change score indicates improvement.
Measured: Baseline of the core study to Week 24 of the core study
Secondary outcomes (5)
Core Study: Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) Score at Week 24
The ADCS-CGIC assesses the clinical meaningfulness of a treatment based on the clinician's rating of change. The rating is provided by a trained clinician or psychometrician blinded to the patient's treatment. The rater interviewed the patient and caregiver separately at Baseline using a worksheet that provided space for notes and comments. At baseline, raters had access to all of the patient's available records and evaluations. The rater used a similar worksheet at follow-up visits, and referred to the baseline worksheet prior to making a rating of change. The worksheets were divided into 3 domains: mental/cognitive state, behavior, and functioning. Change ratings were based on a 7-point scale: Marked (1), moderate (2), and minimal improvement (3), no change (4), and marked (5), moderate (6), and minimal worsening (7). The percentage of patients in each of the 7 categories is reported.
Measured: Baseline of the core study to Week 24 of the core study
Core Study: Change From Baseline in the Neuropsychiatric Inventory (NPI-12) Score at Week 24
The NPI-12 assesses a wide range of behaviors encountered in patients with dementia to provide a means of distinguishing the frequency and severity of behavioral changes over time. Ten behavioral and 2 neurovegetative domains were evaluated in an interview with the caregiver given by a mental health professional. The scale included both frequency and severity ratings of each domain as well as a composite domain score (frequency x severity). The sum of the composite scores for the 12 domains yielded the NPI-12 total score. The NPI-12 was scored from 0 to 144, with lower scores reflecting improvement in psychiatric behavior. A negative change score indicates improvement.
Measured: Baseline of the core study to Week 24 of the core study
Extension Study: Change From Baseline in the Alzheimer's Disease Cooperative Study-Activities of Daily Living-Severe Impairment Version (ADCS-ADL-SIV) Score at Week 24
The ADCS-ADL-SIV is designed to assess the patient's performance of both basic and instrumental activities of daily living such as those necessary for personal care, communicating and interacting with other people, maintaining a household, conducting hobbies and interests, and making judgments and decisions. For each of the 19 questions in the ADCS-ADL-SIV, there was either a forced choice of best response or a "yes" or "no" question with additional sub-questions. Responses for each item were obtained from the caregiver through an interview. Higher numbered scores and answers of "yes" reflected a more self-sufficient individual. The total score was calculated as the sum of all items and sub-questions and ranged from 0 to 54. A higher total score represented a higher functioning patient. A positive change score indicates improvement.
Measured: Baseline of the core study to Week 24 of the extension study
Extension Study: Change From Baseline in the Severity Impairment Battery (SIB) Score at Week 24
The SIB is a 40-item scale developed for the evaluation of the severity of cognitive dysfunction in more advanced Alzheimer Disease patients. The domains assessed included social interaction, memory, language, attention, orientation, praxis, visuo-spatial ability, construction, and orienting to name. The items of the SIB were developed as simple 1-step commands which are presented by a trained rater with gestural cues and repeated if necessary. The SIB was scored from 0 to 100, with higher scores reflecting higher levels of cognitive ability. A positive change score indicates improvement.
Measured: Baseline of the core study to Week 24 of the extension study
Extension Study: Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) Score at Week 24
The ADCS-CGIC assesses the clinical meaningfulness of a treatment based on the clinician's rating of change. The rating is provided by a trained clinician or psychometrician blinded to the patient's treatment. The rater interviewed the patient and caregiver separately at Baseline using a worksheet that provided space for notes and comments. At baseline, raters had access to all of the patient's available records and evaluations. The rater used a similar worksheet at follow-up visits, and referred to the baseline worksheet prior to making a rating of change. The worksheets were divided into 3 domains: mental/cognitive state, behavior, and functioning. Change ratings were based on a 7-point scale: Marked (1), moderate (2), and minimal improvement (3), no change (4), and marked (5), moderate (6), and minimal worsening (7). The percentage of patients in each of the 7 categories is reported.
Measured: Baseline of the core study to Week 24 of the extension study
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Jul 2009 (estimated)
- Study startJul 2009
- Primary completionJan 2012
- Study completionJun 2012
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Alzheimer's DiseaseStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 4
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 716 participants (actual)
Sponsor and investigators
- Lead sponsor
- Novartis
- Sponsor type
- Industry (pharma, biotech, devices)
- Responsible party
- Sponsor
- Investigators
- Novartis Pharmaceuticals, Study director, Novartis Pharmaceuticals
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00948766
- Sponsor's protocol ID
- CENA713DUS44
- Acronym
- ACTION
- Status last verified
- Aug 2013
- First submitted
- 28 Jul 2009
- Last updated
- 28 Aug 2013
- Results posted
- Yes, on ClinicalTrials.gov
Publications
Grossberg GT, Farlow MR, Meng X, Velting DM. Evaluating high-dose rivastigmine patch in severe Alzheimer's disease: analyses with concomitant memantine usage as a factor. Curr Alzheimer Res. 2015;12(1):53-60. doi: 10.2174/1567205011666141218122835.
PubMed 25523430
Study at a glance
From the registry record, last updated by the sponsor on 28 Aug 2013. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A 24 Week, Prospective, Randomized, Parallel-group, Double-blind, Multi-center Study (ENA713DUS44) Comparing the Effects of Rivastigmine Patch 15 cm^2 vs. Rivastigmine Patch 5 cm^2 on ACTivities of Daily Living and CognitION in Patients With Severe Dementia of the Alzheimer's Type (ACTION) and a 24-week Open-label Extension to Study ENA713DUS44
- ClinicalTrials.gov ID
- NCT00948766
- Acronym / sponsor ID
- ACTION / CENA713DUS44
- Conditions
- Alzheimer's Disease
- Keywords
- Alzheimer's disease, dementia, Alzheimer's type
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 716 participants (actual)
- Lead sponsor
- NovartisIndustry (pharma, biotech, devices)
- Study start
- Jul 2009
- Primary completion
- Jan 2012 (actual)
- Study completion
- Jun 2012 (actual)
- First posted
- 29 Jul 2009 (estimated)
- Results
- Posted 11 Feb 2013
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The core study assessed the efficacy of a higher dose of rivastigmine 13.3 mg/24 h transdermally (15 cm^2 patch) compared to a lower dose of the rivastigmine 4.6 mg/24 h transdermally (5 cm^2 patch) in patients with Severe Dementia of the Alzheimer's Type in a 24-week study. The extension study obtained additional safety and efficacy data, as well as provided the higher dose rivastigmine patch to all patients who completed the core study for an additional 24 weeks.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Rivastigmine 13.3 mg/24 h transdermal patch | Experimental | Drug: Rivastigmine 4.6 mg/24 h (5 cm^2), Drug: Rivastigmine 9.5 mg/24 h (10 cm^2), Drug: Rivastigmine 13.3 mg/24 h (15 cm^2), Drug: PlaceboIn the core study, patients were titrated to the rivastigmine 13.3 mg/24 h dose in 2 steps. For Weeks 1-4, patients received rivastigmine 4.6 mg/24 h. For Weeks 5-8, patients received rivastigmine 9.5 mg/24 h and placebo. For Weeks 9-24, patients received rivastigmine 13.3 mg/24 h and placebo. In the extension study, all patients were switched to rivastigmine 9.5 mg/24 h for a 4-week titration period and were then titrated up to 13.3 mg/24 h for a further 20 weeks of treatment. |
| Rivastigmine 4.6 mg/24 h transdermal patch | Active comparator | Drug: Rivastigmine 4.6 mg/24 h (5 cm^2), Drug: PlaceboIn the core study, patients received rivastigmine 4.6 mg/24 h daily. For Weeks 1-4, patients received rivastigmine 4.6 mg/24 h. For Weeks 5-24, patients received rivastigmine 4.6 mg/24 h and placebo. No patients received this treatment in the extension study. |
Who may qualify
- Ages
- 50 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (10 listed)
- Diagnosis of probable Alzheimer's disease (AD) according to National Institute of Neurological Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS/ADRDA) criteria.
- A Mini-Mental State Examination (MMSE) score of ≥ 3 and ≤ 12.
- Be able to complete at least 1 item on the Severe Impairment Battery (SIB).
- Residing with someone in the community or in regular contact with the primary caregiver.
- Be ambulatory or ambulatory with aid.
Key exclusion criteria (24 listed)
- An advanced, severe, progressive, or unstable disease of any type that may interfere with efficacy and safety assessments or put the patient at special risk.
- Patients currently residing in a nursing home.
- Any current medical or neurological condition other than AD that could explain the patient's dementia.
- A current diagnosis of probable or possible vascular dementia.
- A current diagnosis of severe or unstable cardiovascular disease.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Rivastigmine 4.6 mg/24 h (5 cm^2)Also: ENA713D, Exelon, Exelon patchRivastigmine was supplied in a 5 cm^2 patch which released 4.6 mg/24 h. Patches were changed daily. | Drug | Rivastigmine 13.3 mg/24 h transdermal patch, Rivastigmine 4.6 mg/24 h transdermal patch |
| Rivastigmine 9.5 mg/24 h (10 cm^2)Also: ENA713D, Exelon, Exelon pathRivastigmine was supplied in a 10 cm^2 patch which released 9.5 mg/24 h. Patches were changed daily. | Drug | Rivastigmine 13.3 mg/24 h transdermal patch |
| Rivastigmine 13.3 mg/24 h (15 cm^2)Also: ENA713D, Exelon, Exelon patchRivastigmine was supplied in a 15 cm^2 patch which released 13.3 mg/24 h. Patches were changed daily. | Drug | Rivastigmine 13.3 mg/24 h transdermal patch |
| PlaceboPlacebo patches were identical in size and composition to the corresponding rivastigmine patches, except that they did not contain rivastigmine. Patches were changed daily. | Drug | Rivastigmine 13.3 mg/24 h transdermal patch, Rivastigmine 4.6 mg/24 h transdermal patch |
Primary outcome
Core Study: Change From Baseline in the Alzheimer's Disease Cooperative Study-Activities of Daily Living-Severe Impairment Version (ADCS-ADL-SIV) Score at Week 24
Time frame: Baseline of the core study to Week 24 of the core study
The ADCS-ADL-SIV is designed to assess the patient's performance of both basic and instrumental activities of daily living such as those necessary for personal care, communicating and interacting with other people, maintaining a household, conducting hobbies and interests, and making judgments and decisions. For each of the 19 questions in the ADCS-ADL-SIV, there was either a forced choice of best response or a "yes" or "no" question with additional sub-questions. Responses for each item were obtained from the caregiver through an interview. Higher numbered scores and answers of "yes" reflected a more self-sufficient individual. The total score was calculated as the sum of all items and sub-questions and ranged from 0 to 54. A higher total score represented a higher functioning patient. A positive change score indicates improvement.
Core Study: Change From Baseline in the Severity Impairment Battery (SIB) Score at Week 24
Time frame: Baseline of the core study to Week 24 of the core study
The SIB is a 40-item scale developed for the evaluation of the severity of cognitive dysfunction in more advanced Alzheimer Disease patients. The domains assessed included social interaction, memory, language, attention, orientation, praxis, visuo-spatial ability, construction, and orienting to name. The items of the SIB were developed as simple 1-step commands which are presented by a trained rater with gestural cues and repeated if necessary. The SIB was scored from 0 to 100, with higher scores reflecting higher levels of cognitive ability. A positive change score indicates improvement.
5 secondary outcomes
Core Study: Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) Score at Week 24
Time frame: Baseline of the core study to Week 24 of the core study
Core Study: Change From Baseline in the Neuropsychiatric Inventory (NPI-12) Score at Week 24
Time frame: Baseline of the core study to Week 24 of the core study
Extension Study: Change From Baseline in the Alzheimer's Disease Cooperative Study-Activities of Daily Living-Severe Impairment Version (ADCS-ADL-SIV) Score at Week 24
Time frame: Baseline of the core study to Week 24 of the extension study
Extension Study: Change From Baseline in the Severity Impairment Battery (SIB) Score at Week 24
Time frame: Baseline of the core study to Week 24 of the extension study
Extension Study: Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) Score at Week 24
Time frame: Baseline of the core study to Week 24 of the extension study
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 28 Aug 2013.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Derived from this study: PubMed 25523430Grossberg GT, Farlow MR, Meng X, Velting DM. Evaluating high-dose rivastigmine patch in severe Alzheimer's disease: analyses with concomitant memantine usage as a factor. Curr Alzheimer Res. 2015;12(1):53-60. doi: 10.2174/1567205011666141218122835.
- Online Screening Questionnaire is availableLink provided by the sponsor.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Novartis Pharmaceuticals study director
Novartis Pharmaceuticals
95 sites in 2 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing Rivastigmine 4.6 mg/24 h (5 cm^2), Rivastigmine 9.5 mg/24 h (10 cm^2) and Rivastigmine 13.3 mg/24 h (15 cm^2) in people with Alzheimer's Disease, run by Novartis at 95 sites in 2 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 10 inclusion and 24 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 28 Aug 2013. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 95 sites in United States, Puerto Rico. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 11 Feb 2013). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Core Study: Change From Baseline in the Alzheimer's Disease Cooperative Study-Activities of Daily Living-Severe Impairment Version (ADCS-ADL-SIV) Score at Week 24 (time frame: Baseline of the core study to Week 24 of the core study). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00948766, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Aug 2013.