Background

This compound was initially reported as a γ-secretase modulator but is now portrayed as acting on multiple targets, particularly microglia. Long-term use of NSAIDs confers some protection against incident Alzheimer’s, and a widely noted finding that certain NSAIDs lower Aβ42 production independent of their action on the Cox enzymes prompted widespread research into NSAID derivatives of similar function (see Weggen et al., 2001). From 2007–2011, CHF5074 was being reported as a γ-secretase modulator that affected Aβ- and other amyloid-related outcomes. Subsequent preclinical studies proposed other mechanisms of action, such as restoring neurogenesis, reorganizing the astrocytic cytoskeleton, reducing tau, rescuing synaptic plasticity, or acting on microglia to counteract inflammation (see Nov 2012 conference story; Sivilia et al., 2013).

Findings

Phase 1 clinical trials consisted of three studies in 144 healthy young men to establish pharmacology and initial safety data. CH 5074 was reported to be safe and tolerable in these subjects; one notable side effect was mild diarrhea.

In 2011, a first multicenter Phase 2 trial compared doses of 200, 400, and 600 mg/day, primarily to determine the maximum tolerated dose at 12 weeks. Participants were 96 patients with amnestic or nonamnestic mild cognitive impairment (MCI); no amyloid or tau biomarkers were used for inclusion. CH 5074 pharmacology was similar to Phase 1; some patients withdrew due to diarrhea. An anti-inflammatory benefit measured as reduction in CSF CD40 and TNF-α concentration, as well as a trend toward improved executive function, were reported for carriers of the ApoE4 risk allele but not noncarriers (see Ross et al., 2013).

This trial went into a 24-week extension study to determine longer-term tolerability, and 51 participants then enrolled into a second extension. Clinicaltrials.gov reports this second extension will continue to 48 weeks, a CereSpir™ media release claims 90 weeks. CereSpir™ was founded to complete the clinical development of CHF 5074 and market it.

A second, two-year Phase 2 trial was to have started in 2012 to compare two undisclosed doses of CH 5074 and placebo for their effect on brain volume and other outcomes in a population of people with amnestic MCI who were genetically enriched for AD risk by being ApoE4 carriers. This trial was withdrawn from clinicaltrials.gov prior to enrollment, reportedly to be placed on hold to await the outcome of licensing negotiations (see Nov 2012 news story, Aug 2013 conference story).

Clinical Trial Timeline