Alzheimer 1-3

Estimating sample sizes for predementia Alzheimer’s trials based on the Alzheimer’s Disease Neuroimaging Initiative

J. D. Grill, L. J. Di, P. H. Lu, C. Lee, J. Ringman, L. G. Apostolova, N. Chow, O. Kohannim, J. L. Cummings, P. M. Thompson, et al.

Neurobiol Aging.2013 Jan;34(1):62-72.

Abstract: This study modeled predementia Alzheimer’s disease clinical trials. Longitudinal data from cognitively normal (CN) and mild cognitive impairment (MCI) participants in the Alzheimer’s Disease Neuroimaging Initiative were used to calculate sample size requirements for trials using outcome measures, including the Clinical Dementia Rating scale sum of boxes, Mini-Mental State Examination, Alzheimer’s Disease Assessment Scale-cognitive subscale with and without delayed recall, and the Rey Auditory Verbal Learning Task. We examined the impact on sample sizes of enrichment for genetic and biomarker criteria, including cerebrospinal fluid protein and neuroimaging analyses. We observed little cognitive decline in the CN population at 36 months, regardless of the enrichment strategy. Nonetheless, in CN subjects, using Rey Auditory Verbal Learning Task total as an outcome at 36 months required the fewest subjects across enrichment strategies, with apolipoprotein E genotype epsilon 4 carrier status requiring the fewest (n = 499 per arm to demonstrate a 25% reduction in disease progression). In MCI, enrichment reduced the required sample sizes for trials, relative to estimates based on all subjects. For MCI, the Clinical Dementia Rating scale sum of boxes consistently required the smallest sample sizes. We conclude that predementia clinical trial conduct in Alzheimer’s disease is enhanced by the use of biomarker inclusion criteria. (C) 2013 Elsevier Inc. All rights reserved.

*Times cited: 2

Keywords: Alzheimer’s disease, Clinical trials, Mild cognitive impairment, Preclinical, Predementia, Sample size, Enrichment, mild cognitive impairment, efficient clinical-trials, csf biomarkers, drug development, amyloid-beta(1-42) biomarker, hippocampal, segmentation, association workgroups, diagnostic guidelines, national, institute, power calculations


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