Further analyses of the safety of verubecestat in the phase 3 EPOCH trial of mild-to-moderate Alzheimer's disease.

ABSTRACT: BACKGROUND:Verubecestat, a BACE1 inhibitor that reduces A? levels in the cerebrospinal fluid of humans, was not effective in a phase 3 trial (EPOCH) of mild-to-moderate AD and was associated with adverse events. To assist in the development of BACE1 inhibitors, we report detailed safety findings from EPOCH. METHODS:EPOCH was a randomized, double-blind, placebo-controlled 78-week trial evaluating verubecestat 12?mg and 40?mg in participants with mild-to-moderate AD diagnosed clinically. The trial was terminated due to futility close to its scheduled completion. Of 1957 participants who were randomized and took treatment, 652 were assigned to verubecestat 12?mg, 652 to verubecestat 40?mg, and 653 to placebo. Adverse events and relevant laboratory, vital sign, and ECG findings were assessed. RESULTS:Verubecestat 12?mg and 40?mg were associated with an increase in the percentage of participants reporting adverse events versus placebo (89 and 92% vs. 82%), although relatively few participants discontinued treatment due to adverse events (8 and 9% vs. 6%). Adverse events that were increased versus placebo included falls and injuries, suicidal ideation, weight loss, sleep disturbance, rash, and hair color change. Most were mild to moderate in severity. Treatment differences in suicidal ideation emerged within the first 3 months but did not appear to increase after 6?months. In contrast, treatment differences in falls and injuries continued to increase over time. CONCLUSIONS:Verubecestat was associated with increased risk for several types of adverse events. Falls and injuries were notable for progressive increases over time. While the mechanisms underlying the increased adverse events are unclear, they may be due to BACE inhibition and should be considered in future clinical development programs of BACE1 inhibitors. TRIAL REGISTRATION:ClinicalTrials.gov NCT01739348 , registered on 29 November 2012.

SUBMITTER: Egan MF 

PROVIDER: S-EPMC6685277 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature