Study Protocol, Receive the Treatment in the Established Time Period, and Continue During the Follow-Up Interval
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Confidential A MULTICENTER, RANDOMIZED, CONTROLLED STUDY TO EVALUATE THE EFFICACY AND SAFETY OF SHORT- TERM PLASMA EXCHANGE FOLLOWED BY LONG-TERM PLASMAPHERESIS WITH INFUSION OF HUMAN ALBUMIN COMBINED WITH INTRAVENOUS IMMUNOGLOBULIN IN PATIENTS WITH MILD-MODERATE ALZHEIMER’S DISEASE Sponsor for the Clinical Trial: Instituto Grifols, S.A. Polígono Levante, C/ Can Guasc 2 08150 - Parets del Vallès Barcelona Spain Contract Resource Organization: Product: Albutein Flebogamma® DIF Type of study: Multicenter, randomized, controlled, parallel- group. Protocol Number: IG1002 Study Phase 2b/3 EudraCT Number 2011-1598-25 Version Number: 5.0 (IND version) Date: February 2018 Confidentiality Statement: The information contained in this protocol is provided to you in confidence, for review by you, your staff and an applicable regulatory authority or institutional review committee/research ethics board. It is understood that this information may not be disclosed to any other party, in any form, without prior authorization from Sponsor, except to the extent necessary to obtain informed consent from the persons to whom the drug may be administered. Protocol IG1002 Page 1 of 68 Version 5.0 (IND version) / February 2018 Confidential A MULTICENTER, RANDOMIZED, CONTROLLED STUDY TO EVALUATE THE EFFICACY AND SAFETY OF SHORT-TERM PLASMA EXCHANGE FOLLOWED BY LONG-TERM PLASMAPHERESIS WITH INFUSION OF HUMAN ALBUMIN COMBINED WITH INTRAVENOUS IMMUNOGLOBULIN IN PATIENTS WITH MILD-MODERATE ALZHEIMER’S DISEASE Protocol Number: IG1002 Version Number: Version 5.0 (IND version) Version Date: February 2018 AUTHORIZED SIGNATURE PAGE I have read this protocol and agree to conduct this trial in accordance with Good Clinical Practice (GCP), all stipulations of the protocol, the Declaration of Helsinki and applicable regulatory requirements. I will provide copies of the protocol and all pertinent information to all individuals responsible to me who assist in the conduct of this study. I will discuss this material with them to ensure that they are fully informed regarding the conduct of the study. Investigator: ____________________________________________________________ (Print Name) ____________________________________________________________ (Signature) (Date) Protocol IG1002 Page 3 of 68 Version 5.0 (IND version) / February 2018 Confidential PRIMARY CONTACT INFORMATION For the Sponsor Clinical Project Manager Instituto Grifols, S.A. Can Guasc, 2 Parets del Vallès 08150 Barcelona. SPAIN For the Sponsor Clinical Research Associate Instituto Grifols, S.A. Can Guasc, 2 Parets del Vallès 08150 Barcelona. SPAIN Phone: Protocol IG1002 Page 4 of 68 Version 5.0 (IND version) / February 2018 Confidential TABLE OF CONTENTS SIGNATURE/APPROVAL PAGE ....................................................................................... 2 AUTHORIZED SIGNATURE PAGE .................................................................................. 3 PRIMARY CONTACT INFORMATION ........................................................................... 4 TABLE OF CONTENTS ....................................................................................................... 5 LIST OF ABBREVIATIONS ................................................................................................ 8 PROTOCOL SYNOPSIS (ALBUMIN GRIFOLS + FLEBOGAMMADIF) ................. 11 1.1 Rationale ................................................................................................................ 18 1.1.1 Characteristics of Alzheimer’s disease and Its Relation to β-Amyloid Peptide .................... 18 1.1.2 Existence of a Dynamic Equilibrium between Brain and Plasma Aβ ................................... 19 1.1.3 The Role of Plasma exchange with Albutein® 5% in Alzheimer’s disease ............................ 20 1.1.4 Previous Clinical Studies of Plasma exchange with Albutein® 5% in Alzheimer’s disease .. 21 1.1.5 The role of intravenous immunoglobulin in Alzheimer’s disease ......................................... 22 1.1.6 Potential role of a combination of plasma exchange with Albutein® with Flebogamma®DIF 22 2. STUDY PURPOSE AND OBJECTIVES ................................................ 22 3. INVESTIGATIONAL PLAN ................................................................... 23 3.1 Global Study Design/Developmental Phase ........................................................ 23 3.2 Randomization and Treatment Assignment ....................................................... 23 3.3 Type of Control ...................................................................................................... 24 3.4 Blinding Techniques .............................................................................................. 24 3.5 Screening Period (Pre-Randomization or Pharmacological Washout) ............ 24 4. SELECTION OF STUDY POPULATION ............................................. 24 4.1 Inclusion and Exclusion Criteria ......................................................................... 24 4.1.1 Inclusion Criteria .................................................................................................................. 24 4.1.2 Exclusion Criteria ................................................................................................................. 25 4.2 Disease Diagnostic Criteria .................................................................................. 25 4.3 Planned Number of Subjects ................................................................................ 26 4.4 Withdrawal Criteria and Planned Analyses of Withdrawals and Dropouts ... 26 4.5 Treatment of Pre-Randomization Losses, Entry Reclassification .................... 26 4.6 Estimated Duration of the Recruitment Period ................................................. 26 5. TREATMENT OF SUBJECTS ............................................................... 26 5.1 Treatment Regimen ............................................................................................... 26 5.1.1 Study Treatment Procedure .................................................................................................. 26 5.1.2 Dosage and Treatment Regimen ........................................................................................... 27 5.1.3 Method of Application........................................................................................................... 27 5.2 Criteria for Treatment Modification or Interruption ....................................... 29 5.2.1 Criteria for Modifying Regimens .......................................................................................... 29 5.2.2 Special Warnings and Precautions for Use .......................................................................... 30 5.3 Concomitant Treatment ....................................................................................... 36 5.4 Special Guidelines for Study Drug Handling ..................................................... 36 5.4.1 Storage of Albutein® and Flebogamma® DIF ....................................................................... 36 5.5 Measures to Assess Compliance ........................................................................... 37 Protocol IG1002 Page 5 of 68 Version 5.0 (IND version) / February 2018 Confidential 5.6 Rescue Medication ................................................................................................. 37 6. TRIAL CONDUCT AND RESPONSE ASSESSMENT ........................ 37 6.1 Study Variables ..................................................................................................... 37 6.1.1 Primary Efficacy Variable .................................................................................................... 37 6.1.2 Secondary Efficacy Variables ............................................................................................... 37 6.1.3 Safety Variables .................................................................................................................... 38 6.2 Conduction of the Trial. Study Procedures. ....................................................... 38 6.2.1 Screening Visits (Weeks -3, -2 and -1) .................................................................................. 38 6.2.2 Weeks 1 to 6 - Intensive plasma exchange period ................................................................. 39 6.2.3 Weeks 7 to 8 – Intermediate visit (Window range +/- 2 days) .............................................. 40 6.2.4 Months 3 to 14 - Maintenance Period .................................................................................. 41 6.2.5 Final Visit (Month 14) .......................................................................................................... 42 6.2.6 Description of the Response Evaluation Methods................................................................. 43 7. SPECIFIC METHODOLOGY ................................................................ 44 7.1 Behavioral and cognitive impairment scales and tests ...................................... 44 7.1.1 Gold standards for the study of dementia ............................................................................. 44 7.1.2 Specific neuropsychological battery (NPS battery) .............................................................. 44 7.2 Method of Behavioral and Cognitive Testing ..................................................... 46 7.3 Method of Biochemical Marker Testing ............................................................. 48 7.4 Method