Therapeutics

Atabecestat

Overview

Name: Atabecestat
Synonyms: JNJ-54861911 , BACE inhibitor
Therapy Type: Small Molecule (timeline)
Target Type: Amyloid-Related (timeline)
Condition(s): Alzheimer's Disease
U.S. FDA Status: Alzheimer's Disease (Discontinued)
Company: Janssen, Shionogi Pharma

Background

This is a tablet drug affecting amyloid precursor protein (APP) and its processing products. It inhibits APP cleavage by the enzyme BACE, the rate-limiting step in Aβ generation. The rationale of BACE inhibition is that it represents an upstream interference with the amyloid cascade. BACE inhibition is sometimes envisioned as long-term maintenance therapy to limit Aβ production after an initial round of immunotherapy to remove existing amyloid deposits.

In 2012, Janssen licensed this compound from Shionogi, which had conducted its preclinical development.

Findings

In March 2013, Janssen began a series of Phase 1 trials of JNJ-54861911. A first single-ascending-dose study in 56 healthy volunteers was followed by a second in 70 healthy elderly volunteers. Both assessed safety parameters as well as pharmacological measures relating to drug exposure and concentrations of Aβ fragments in CSF and plasma. Conducted in Belgium, both studies were completed, as was a similar study in 24 healthy volunteers in Japan. Additional studies in 46 healthy volunteers evaluated the effect on the concentration, metabolism, and excretion of JNJ-54861911 and of various other drugs commonly used by the elderly, including coffee, anxiolytic, or diabetes drugs. One trial in 64 people assessed whether JNJ-54861911 affects heart function. The data were published in peer-reviewed journals (Timmers et al., 2016Timmers et al., 2017Timmers et al., 2018).

In December 2013, the first trial in prodromal Alzheimer's disease began, enrolling 45 people in Belgium, the Netherlands, Spain, and Sweden. Study participants were cognitively impaired as measured by the CANTAB Elect test battery, and had evidence of amyloid deposition either as per a pathological Aβ/tau CSF assay result or per flutemetamol amyloid PET scan. Participants took either 10 or 50 mg of JNJ-54861911 or placebo once daily for four weeks, and were assessed on a range of biomarker outcomes related to drug exposure, metabolism, and target engagement, i.e., the concentration of various APP and Aβ fragments in CSF and plasma. 

In November 2014, Phase 2 began with a multinational trial in Europe. It compared a six-month, once-daily course of 10 or 50 mg of JNJ-54861911 to placebo in 114 people with a CDR rating of 0 to 0.5, plus evidence of amyloid pathology supplied either by CSF or PET—i.e., people who had asymptomatic to predementia Alzheimer's disease. This study assessed safety, exposure, target engagement, and a downstream effect in the form of CSF tau concentration, but not cognition/efficacy.

In March 2015, Janssen listed another Phase 1 trial in Japan to compare a one-month course of 10 or 50 mg to placebo in 18 people who were clinically normal as measured by a CDR of zero but had brain amyloid deposition as evidenced by low CSF Aβ42 levels. Called "asymptomatic at risk of AD," this population represents an earlier stage of AD pathophysiology than predementia or prodromal AD, as people with measurable impairment were excluded. This trial measured markers of drug exposure and target engagement. Data from this trial, and the prodromal AD trial above, were formally published (Timmers et al., 2018).

In July 2015, a double-blind safety extension study of up to two years was added for up to 100 patients who completed prior Phase 1 or 2 trials. 

In March 2015, Janssen reported results of a single-ascending- and a multiple-ascending-dose study in healthy elderly participants at the AD/PD conference in Nice, France. According to this presentation, the inhibitor was safe and well-tolerated in 94 people studied up to that point. It reportedly entered the blood and CSF with favorable pharmacokinetics and pharmacodynamics, and dose-dependently reduced Aβ1-37, Aβ1-38, Aβ1-40, and Aβ1-42. Reduction of the BACE cleavage product sAPPβ tracked reduction of Aβ, whereas levels of sAPPα rose (Apr 2015 news). A 5 mg dose was reported to reduce CSF Aβ concentration by half; 25 mg by 80 percent, 50 mg by 90 percent. 

In July 2015, a long-term safety and tolerability study began enrolling 100 patients from previous Phase 1 and 2 trials who were willing to continue their randomized, blinded treatment for another year. 

In October 2015, a Phase 2/3 study called EARLY began enrolling asymptomatic people at risk of developing Alzheimer's dementia. Their risk was determined by a CDR score of zero combined with CSF or PET evidence of brain amyloid accumulation. The trial enrolled people aged 60 to 85. To limit screen failures, 60- to 64-year-old candidates had to have either a family history of dementia, previously known ApoE4 genotype, or previously known biomarker evidence of amyloid deposition. The primary endpoint was slowing of cognitive decline, as measured by change on the Alzheimer's Disease Cooperative Study Preclinical Alzheimer Cognitive Composite (ADCS-PACC) between baseline and 54 months of treatment with either 10 or 25 mg of drug, or placebo. Secondary outcomes included 10 different functional, clinical, neuropsychological, exposure, and biomarker measures. This trial was to enroll 1,650 participants at 121 locations in Europe, Australia, Japan, North America, and Mexico, and run until the year 2023. For detail on the EARLY trial, and a brief Phase 1 data summary, see Aug 2016 conference news.

In January 2016, Janssen added a Phase 1 study in 32 healthy adults in Germany to evaluate drug interactions between JNJ-54861911, the antidiabetic metformin, and rosuvastatin.

On May 17, 2018, Janssen announced the discontinuation of this program, citing findings of elevated liver enzymes among some of 600 people exposed to atabecestat thus far (May 2018 news). At the 2018 CTAD conference, Janssen reported that EARLY participants who took 25 mg atabecestat scored four points worse than the placebo group on the RBANS at three months, and one point worse on the PACC at six and 12 months. Treatment groups reported more depression, anxiety, and sleep problems than controls (Nov 2018 conference news). 

See all trials at clinicaltrials.gov.

Clinical Trial Timeline

  • Phase 2
  • Phase 2/3
  • Study completed / Planned end date
  • Planned end date unavailable
  • Study aborted
Sponsor Clinical Trial 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029
Janssen NCT02260674
N=114
Janssen NCT02406027
N=90
Janssen NCT02569398
N=596

Last Updated: 07 Mar 2019

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References

News Citations

  1. At AD/PD Meeting, New BACE Inhibitor Struts Its Stuff
  2. New Ways to Target Aβ and BACE Show Promising Phase 1 Data
  3. Liver Tox Ends Janssen BACE Program
  4. Bump in the Road or Disaster? BACE Inhibitors Worsen Cognition

Paper Citations

  1. . Profiling the dynamics of CSF and plasma Aβ reduction after treatment with JNJ-54861911, a potent oral BACE inhibitor. Alzheimers Dement (N Y). 2016 Sep;2(3):202-212. Epub 2016 Aug 24 PubMed.
  2. . BACE1 Dynamics Upon Inhibition with a BACE Inhibitor and Correlation to Downstream Alzheimer's Disease Markers in Elderly Healthy Participants. J Alzheimers Dis. 2017;56(4):1437-1449. PubMed.
  3. . Pharmacodynamics of atabecestat (JNJ-54861911), an oral BACE1 inhibitor in patients with early Alzheimer's disease: randomized, double-blind, placebo-controlled study. Alzheimers Res Ther. 2018 Aug 23;10(1):85. PubMed.

External Citations

  1. clinicaltrials.gov

Further Reading

Papers

  1. . The BACE1 inhibitor verubecestat (MK-8931) reduces CNS β-amyloid in animal models and in Alzheimer's disease patients. Sci Transl Med. 2016 Nov 2;8(363):363ra150. PubMed.