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Glaucoma, Open-anglePhase 2NADIRNCT07808333

Nicotinamide for Retinal Protection in Primary Open-Angle Glaucoma (NADIR Trial)

A Phase 2 study testing Nicotinamide and Standard Glaucoma Therapy in people with Glaucoma, Open-angle and Primary Open Angle Glaucoma (POAG), run by University of Chicago at 1 site in United States.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

The goal of this clinical trial is to learn whether a high-dose vitamin B3 supplement called nicotinamide can protect retinal nerve cells in adults with primary open-angle glaucoma (POAG) who are already receiving standard glaucoma eye drops or laser treatment. Read more about this study

Who is it for?
Ages 40 to 80 years
What is being tested?
Nicotinamide and Standard Glaucoma Therapy
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
96 participants
Where
1 siteUnited States
Study dates
1 Jun 2027to 27 Feb 2030
Phase
Phase 2
Are there results?
Not yet: the study is under way

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 40 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 40 to 80 years, inclusive
  • Diagnosis of primary open-angle glaucoma (POAG) in at least one eye, confirmed by a licensed ophthalmologist or optometrist based on characteristic optic nerve head changes and/or visual field defects with an open anterior chamber angle
  • Mild to moderate glaucoma severity in the study eye: Humphrey Visual Field 24-2 mean deviation (MD) between -2.0 and -12.0 dB on at least one reliable test (fixation losses 33% or less, false positive rate 15% or less)
  • Best-corrected visual acuity (BCVA) of 20/40 or better (Snellen equivalent) in the study eye
  • Confirmed glaucomatous structural damage on SD-OCT (average GCIPL and/or RNFL below age-adjusted normative mean on device-generated classification) and/or a reproducible visual field defect on Humphrey Visual Field 24-2 consistent with glaucoma, as confirmed by the enrolling glaucoma specialist at screening
  • Macular GCIPL and peripapillary RNFL above device-specific SD-OCT floor effect in the study eye
Show all 11Show fewer
  • Currently receiving stable intraocular pressure-lowering therapy (topical medications and/or prior selective laser trabeculoplasty) for at least 4 months prior to enrollment, with no planned changes to glaucoma therapy at the time of enrollment
  • Intraocular pressure of 21 mmHg or less on current therapy at the screening visit in the study eye
  • Established patient receiving ongoing glaucoma care at University of Chicago Medicine Duchossois Center for Advanced Medicine Eye Clinic
  • Willing and able to provide written informed consent and comply with all study visit schedules and procedures
  • Study eye selection: when POAG is present bilaterally, the study eye is defined as the eye with more severe disease (worse VF MD) that meets all eligibility criteria; if both eyes are equivalent in severity, the right eye is designated by default

Who cannot join

  • Advanced glaucoma: visual field MD worse than -12.0 dB in the study eye
  • Significant retinal disease affecting macular structure or visual field, including advanced age-related macular degeneration, diabetic retinopathy greater than mild non-proliferative, clinically significant diabetic macular edema, major retinal vein occlusion, or non-glaucomatous optic neuropathy
  • Ocular surgery other than uncomplicated cataract extraction or selective laser trabeculoplasty within the past 6 months
  • Hepatic dysfunction at baseline: AST or ALT greater than 2 times the upper limit of normal, or total bilirubin greater than 1.5 times the upper limit of normal
  • Renal dysfunction: eGFR less than 30 mL/min/1.73 m2
  • Current use of, or unwillingness to abstain from:
Show all 15Show fewer
  • nicotinamide, niacinamide, nicotinamide riboside (NR), nicotinamide mononucleotide (NMN), or any other NAD+-precursor supplement not dispensed by the study; high-dose niacin or vitamin B3; Ginkgo biloba; CoQ10; isoniazid; pyrazinamide; carbamazepine; phenobarbital; primidone; or sustained-release niacin or nicotinamide formulations
  • Poorly controlled diabetes mellitus: HbA1c greater than 9.0% at screening
  • Normal tension glaucoma with documented intraocular pressure consistently 21 mmHg or less without hypotensive therapy
  • Participation in another investigational drug trial within 30 days of screening
  • Pregnancy, lactation, or intent to become pregnant during the study period
  • Significant cognitive impairment or inability to comply with study requirements
  • Clinically significant media opacity (corneal, lenticular, or vitreal) sufficient to degrade OCT signal quality below device-minimum thresholds, even if BCVA of 20/40 or better is preserved
  • Active or recent uveitis or intraocular inflammation in the study eye within the past 3 months
  • Any condition that, in the investigator's judgment, would preclude safe participation or confound result interpretation

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

United States1 site
  • University of Chicago Medicine Duchossois Center for Advanced Medicine

    Chicago, Illinois, 60637

    Steven C Quan, OD, 773-702-1611, scquan@bsd.uchicago.edu

    Elza Rachid, MD, 773-702-1611, Elza.Rachid@bsd.uchicago.edu

Other trials in United States

About this study

Official title: NADIR Trial: A Principal Investigator-Initiated, Single-Center, Open-Label, Active-Controlled Phase 2a Study of High-Dose Nicotinamide (Vitamin B3) Supplementation in Adults With Mild to Moderate Primary Open-Angle Glaucoma (POAG)

The goal of this clinical trial is to learn whether a high-dose vitamin B3 supplement called nicotinamide can protect retinal nerve cells in adults with primary open-angle glaucoma (POAG) who are already receiving standard glaucoma eye drops or laser treatment. The main question it aims to answer is: Does adding nicotinamide to standard glaucoma therapy slow the rate of thinning of the inner retinal nerve cell layer (measured by a non-invasive eye scan) compared to standard therapy alone over 12 months?

Participants will be randomly assigned to one of two groups. Participants in the treatment group will take nicotinamide tablets by mouth, starting at a lower dose (1.5 grams per day) for the first 6 weeks and increasing to the full dose (3.0 grams per day) for the remainder of the 12-month study. Participants in the control group will continue their standard glaucoma care without the supplement.

Researchers will compare retinal imaging measurements between the two groups to see whether nicotinamide reduces the rate of retinal nerve cell thinning over time.

Read the detailed description

Glaucoma causes progressive and irreversible loss of retinal ganglion cells (RGCs), often continuing despite adequate intraocular pressure control. Mitochondrial dysfunction and depletion of NAD+ (nicotinamide adenine dinucleotide) are increasingly recognized as central contributors to RGC vulnerability. Nicotinamide (NAM), a commercially available form of vitamin B3 and potent NAD+ precursor, has demonstrated robust neuroprotection in preclinical glaucoma models and early clinical trials outside the United States.

NADIR is an IND-regulated, prospective, randomized Phase 2a trial evaluating high-dose oral nicotinamide as adjunctive neuroprotective therapy in adults with mild to moderate POAG, using macular ganglion cell layer imaging (SD-OCT) as the primary structural biomarker detectable within 12 months. Ocular vascular perfusion imaging (OCT-A) is included as an exploratory endpoint.

Being tested
Nicotinamide, Standard Glaucoma Therapy
Keywords
nicotinamide, NAD+, neuroprotection, retinal ganglion cells, GCIPL, optical coherence tomography, OCT-A, glaucoma progression, macular imaging, vitamin B3
Medical subject headings
Glaucoma, Open-Angle

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • NicotinamideDrug

    Also called Niacinamide, Vitamin B3, NAM, Rugby Niacinamide 500 mg

    Immediate-release niacinamide (nicotinamide) 500 mg tablets (Rugby Laboratories, re-order no. 370739; manufactured by Contract Pharmacal Corp., Hauppauge, NY). Titration phase: 500 mg three times daily (1.5 g/day total) for 6 weeks. Maintenance phase: 1,500 mg twice daily (three 500 mg tablets per administration, twice daily; 3.0 g/day total) from Week 7 through Month 12. Administered orally with meals. Dispensed and tracked by the University of Chicago Institutional Drug Service (IDS) Pharmacy under IND 184022.

  • Standard Glaucoma TherapyOther

    Individualized intraocular pressure-lowering therapy per the AAO Primary Open-Angle Glaucoma Preferred Practice Pattern, which may include topical IOP-lowering medications (e.g., prostaglandin analogs) and/or selective laser trabeculoplasty, with clinical monitoring by optical coherence tomography, standard automated perimetry, and intraocular pressure measurement at 3 to 6 month intervals based on disease status.

Study groups in NCT07808333
Study groupRoleWhat they receive
High-Dose Oral Nicotinamide Plus Standard Glaucoma CareExperimentalParticipants receive immediate-release oral nicotinamide titrated from 1.5 g/day (500 mg three times daily with meals, Weeks 1 through 6) to 3.0 g/day (1,500 mg twice daily [three 500 mg tablets per administration, twice daily] with meals, Week 7 through Month 12), in addition to individualized standard glaucoma therapy. Dose advancement at Week 7 requires confirmation at the Month 1 remote safety contact that no Grade 2 or higher hepatic adverse event is present and gastrointestinal tolerability is acceptable.
Receives: Drug: Nicotinamide; Other: Standard Glaucoma Therapy
Standard Glaucoma Care Alone (Active Control)Active comparatorParticipants receive individualized intraocular pressure-lowering therapy per the AAO Primary Open-Angle Glaucoma Preferred Practice Pattern, which may include topical IOP-lowering medications (e.g., prostaglandin analogs) and/or selective laser trabeculoplasty, with monitoring by optical coherence tomography, perimetry, and intraocular pressure measurement at 3 to 6 month intervals. No supplemental nicotinamide is administered.
Receives: Other: Standard Glaucoma Therapy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Annualized Rate of Macular Ganglion Cell-Inner Plexiform Layer (GCIPL) Thinning

    Rate of change in macular GCIPL thickness (micrometers per year) measured by spectral-domain optical coherence tomography (SD-OCT; Heidelberg Spectralis, minimum Q-score 20) with masked central image reading using de-identified participant IDs. The annualized thinning rate is estimated from repeated measurements using a linear mixed-effects model with random intercepts per participant and an arm-by-time interaction term as the primary inferential parameter.

    Measured: Baseline (Month 0), Month 3, Month 6, and Month 12 (four repeated assessments over 12 months)

Secondary outcomes (5)
  1. Annualized Rate of Peripapillary Retinal Nerve Fiber Layer (RNFL) Thinning

    Rate of change in average peripapillary RNFL thickness (micrometers per year) measured by SD-OCT (Heidelberg Spectralis) with masked central reading. Analyzed using the same linear mixed-effects model framework as the primary endpoint. Both average and quadrant-specific RNFL (superior, inferior, temporal, nasal) will be reported.

    Measured: Baseline (Month 0), Month 3, Month 6, and Month 12 (four repeated assessments over 12 months)

  2. Visual Field Mean Deviation Slope

    Rate of change in Humphrey Visual Field Analyzer 24-2 SITA Standard mean deviation (decibels per year), estimated as a continuous slope over 12 months using a linear mixed-effects model with random intercepts per participant. Assessed at four timepoints: Baseline, Month 3, Month 6, and Month 12.

    Measured: Baseline through Month 12, assessed at Baseline (Month 0), Month 3, Month 6, and Month 12

  3. Incidence of Grade 2 or Higher Hepatic and Gastrointestinal Adverse Events

    Proportion of participants experiencing at least one hepatic adverse event (alanine aminotransferase or aspartate aminotransferase elevation, total bilirubin elevation) or gastrointestinal adverse event graded at Grade 2 or higher per NCI CTCAE v6.0. Hepatic laboratory values are assessed by comprehensive metabolic panel (CMP) at screening for all participants, and at Baseline, the Month 1 remote safety contact, and Months 3, 6, and 12 for Arm 1 participants. Adverse events are captured by symptom review and AE reporting in both arms.

    Measured: From randomization through 30 days after the Month 12 visit (approximately 13 months)

  4. Nicotinamide Adherence Rate

    Proportion of prescribed nicotinamide doses taken during the maintenance phase (Weeks 7 through 52), assessed by pill count and participant medication diary review at each in-person study visit. Applies to Arm 1 participants only.

    Measured: Maintenance phase: Week 7 (Month 1 remote contact) through Month 12

  5. Study Retention Rate

    Proportion of randomized participants completing the Month 12 study visit with at least one valid post-baseline macular GCIPL measurement. Assessed in both arms.

    Measured: Month 12 (52 weeks post-randomization)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Sep 2026
  2. Study start1 Jun 2027 (estimated)
  3. Primary completion31 Dec 2029 (estimated)
  4. Study completion27 Feb 2030 (estimated)

Resources

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 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Participants are randomized 1:1 to two parallel arms using computer-generated permuted-block randomization with variable, concealed block sizes, stratified by glaucoma severity (mild: VF MD -2 to -6 dB vs. moderate: VF MD -6 to -12 dB) and race/ethnicity. Arm 1 receives high-dose oral nicotinamide plus standard glaucoma care; Arm 2 receives standard glaucoma care alone. Central SD-OCT, OCT-A, and visual field readers are masked to arm assignment and use de-identified participant IDs. There is no crossover between arms.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
96 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07808333
Sponsor's protocol ID
IRB26-0972
Other IDs
IND Number: 184022
Acronym
NADIR
Status last verified
Oct 2026
First submitted
2 Sep 2026
Last updated
13 Oct 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes: De-identified individual participant data supporting primary and secondary outcome analyses will be made available following study completion and primary manuscript publication, subject to University of Chicago data governance policies and a data use agreement. Requests will be reviewed by the principal investigator.

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Nicotinamide and Standard Glaucoma Therapy in people with Glaucoma, Open-angle and Primary Open Angle Glaucoma (POAG), run by University of Chicago at 1 site in United States.

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 11 inclusion and 15 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: opening soon, as of the sponsor's last update on 13 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. 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 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Steven C Quan, OD (773-702-1611, scquan@bsd.uchicago.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Annualized Rate of Macular Ganglion Cell-Inner Plexiform Layer (GCIPL) Thinning (time frame: Baseline (Month 0), Month 3, Month 6, and Month 12 (four repeated assessments over 12 months)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 13 Oct 2026.

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