Feasibility and Effects of Valaciclovir Treatment in Persons With Early Alzheimer’s Disease

Overview

This study investigates the effects of Valaciclovir treatment to individuals with Alzheimer's disease or Mild Cognitive Impairment of Alzheimer's Disease Type. It is an open pilot trial where 36 participants will receive 4 weeks of Valaciclovir treatment. Participants will be investigated using different measures before and after the treatment period.

Full Title of Study: “Feasibility and Effects on Markers in Spinal Fluid in Persons With Early Alzheimer’s Disease When Treated With Valaciclovir – Open Fas II Pilot Study (VALZ-Pilot)”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: N/A
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: March 4, 2020

Detailed Description

This study investigates the effects of valaciclovir treatment to individuals with Alzheimer's disease (AD) or Mild Cognitive Impairment of Alzheimer's Disease Type. It is an open pilot trial where 36 participants will receive 4 weeks of oral valaciclovir treatment. To find 36 persons fulfilling inclusion criteria, up to 120 persons will be screened. Important inclusion criteria are Herpes Simplex Virus (HSV) Immunoglobulin G (IgG)-positivity (HSV carriage), Apolipoprotein E allele 4 carriage and sufficient kidney function (estimated glomerular filtration rate above 30 ml/min). All participants must give their informed consent to participation. The valaciclovir dose will be 500 mg three times daily the first week and 1000 mg three times daily week 2-4. Participants will be investigated using different measures before and after the treatment period: Mini Mental State Examination to assess cognitive function, Cerebrospinal fluid biomarkers of Alzheimer's disease and [18F]-FHBG-PET/CT (9-[4-[18F]fluoro-3-(hydroxymethyl)butyl]guanine positron emission tomography/computed tomography)) to possibly indicate active HSV infection within the central nervous system.

Interventions

  • Drug: Valaciclovir 500Mg Tablet
    • Valaciclovir treatment (oral, 500 mg tablets). First week: 500 mg three times daily, second to fourth week: 1000 mg three times daily.

Arms, Groups and Cohorts

  • Experimental: Valaciclovir treatment
    • Valaciclovir 500Mg Tablet

Clinical Trial Outcome Measures

Primary Measures

  • Cerebrospinal fluid (CSF) Total Tau
    • Time Frame: Baseline and treatment day 28
    • Change in CSF Total Tau between samples taken before and after drug treatment

Secondary Measures

  • Cerebrospinal fluid (CSF) Neurofilament light chain (NFL)
    • Time Frame: Baseline and treatment day 28
    • Change in CSF NFL between samples taken before and after drug treatment
  • Cerebrospinal fluid (CSF) phosphorylated Tau (p-Tau)
    • Time Frame: Baseline and treatment day 28
    • Change in CSF p-Tau between samples taken before and after drug treatment
  • Cerebrospinal fluid (CSF) Amyloid beta 1-42
    • Time Frame: Baseline and treatment day 28
    • Change in Amyloid beta 1-42 between samples taken before and after drug treatment
  • PET/CT: [18F]-FHBG accumulation within the central nervous system (CNS)
    • Time Frame: One week before drug treatment start
    • Can [18F]-FHBG-PET/CT detect replicating HSV infection within the CNS?
  • PET/CT: Location of [18F]-FHBG accumulation
    • Time Frame: One week before drug treatment start
    • Do [18F]-FHBG accumulation locate to brain areas affected in AD?
  • PET/CT: [18F]-FHBG accumulation
    • Time Frame: One week before and one week after drug treatment
    • Change in [18F]-FHBG accumulation after, as compared to before, drug treatment
  • Mini Mental State Examination – Swedish Revision (MMSE-SR)
    • Time Frame: Baseline and treatment day 28
    • Change in MMSE-SR scores from baseline to after drug treatment
  • Cerebrospinal fluid (CSF) acyclovir concentration
    • Time Frame: Treatment day 28
    • Cerebrospinal fluid (CSF) acyclovir concentration
  • Cerebrospinal fluid (CSF) 9-carboxymethoxymethylguanine (CMMG) concentration
    • Time Frame: Treatment day 28
    • Concentration of CMMG, main acyclovir metabolite
  • Serum acyclovir concentration
    • Time Frame: Treatment day 28
    • Serum acyclovir concentration
  • Serum 9-carboxymethoxymethylguanine (CMMG) concentration
    • Time Frame: Treatment day 28
    • Concentration of CMMG, main acyclovir metabolite
  • Proportion completing the [18F]-FHBG-PET/CT investigations
    • Time Frame: For the investigations one week before and one week after drug treatment
    • Is [18F]-FHBG-PET/CT a feasible examination among persons with Alzheimer’s disease
  • Proportion completing the 28 days treatment with valaciclovir at specified doses
    • Time Frame: Treatment day 28
    • Feasibility of valaciclovir treatment as measured by the number of participants completing the full treatment period at the specified dose

Participating in This Clinical Trial

Inclusion Criteria

  • Man or women, age ≥ 65 years – Ability to take a stand and to make and to sign an informed consent to participate in the study. This implies that a person with MMSE (Mini Mental State Examination) < 18 will probably not be included. – Diagnosed with Alzheimer's disease or mild cognitive impairment due to Alzheimer's disease. At least one brain imaging examination should have been done (CT, MR, SPECT or PET/CT) and at least one objective finding should support the diagnosis beyond specific medical history. Reduced perfusion or reduced metabolism bilaterally temporally, hippocampal atrophy or pathological markers for Alzheimer's disease in cerebrospinal fluid is such findings. Persons with vascular brain disorders e.g. severe white matter changes or previous brain infarction will not be included but those with white matter changes considered normal for their age can be included. – Positive for anti-HSV (Herpes Simplex Virus) Immunoglobulin G (IgG) in plasma, i.e. carrier of HSV. – Hetero or Homozygote for allele 4 of gene Apolipoprotein E. – Stable over all medication including medication for Alzheimer's disease (rivastigmine, galantamin, donepezil or memantin) for at least one month. – No known allergy or oversensitivity against valaciclovir or aciclovir. – Ability to independently or by support from relative or other caretaker comply to study drug. Exclusion Criteria:

  • Renal insufficiency with estimated GFR (Glomerular Filtration Rate) ≤ 30 ml/min/1.73m2 – Ongoing treatment with anticoagulants (Warfarin, low molecular heparin or other anticoagulant agents). Antiplatelet agents in recommended dose are accepted (i.e. Acetylsalicylic acid 75 mgx1) – Life expectancy < 1 year due to other comorbidity – Ongoing severe somatic condition that might interfere with the patients participation in the study (i.e. ongoing cancer treatment) – Ongoing illness that makes exams in a supine position impossible (i.e. severe heart failure, severe back pain). – Dementia diagnosis other than Alzheimer's disease, including Vascular dementia. – Other known neurological/neurodegenerative disorder (i.e. brain tumor, MS (Multiple sclerosis), ALS (amyotrophic lateral sclerosis)) – Claustrophobia or other contraindication for doing a PET/CT scanning. – Depression or other psychiatric illness that requires treatment (i.e. severe psychosis or other illness with equal grade of seriousness) – Dementia or cognitive dysfunction to such extent that an informed consent is impossible to obtain, corresponding to about MMSE-SR (Mini Mental State Examination-Swedish revision) <18. – History of substance abuse (i.e. central nervous system stimulants or alcohol). Nicotine use is accepted. – Not willing to participate in the study.

Gender Eligibility: All

Minimum Age: 65 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Hugo Lovheim
  • Provider of Information About this Clinical Study
    • Sponsor-Investigator: Hugo Lovheim, Associate professor – Umeå University
  • Overall Official(s)
    • Hugo Lövheim, M.D., Ph.D., Principal Investigator, Umeå University, Umeå, Sweden

Clinical trials entries are delivered from the US National Institutes of Health and are not reviewed separately by this site. Please see the identifier information above for retrieving further details from the government database.

At TrialBulletin.com, we keep tabs on over 200,000 clinical trials in the US and abroad, using medical data supplied directly by the US National Institutes of Health. Please see the About and Contact page for details.