Cited by 347Alzheimer's disease research and treatmentsDementia and Cognitive Impairment ResearchAmyotrophic Lateral Sclerosis Research

Tau-targeting antisense oligonucleotide MAPTRx in mild Alzheimer’s disease: a phase 1b, randomized, placebo-controlled trial

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Mummery, Catherine J., Börjesson-Hanson, Anne, Blackburn, Daniel J., Vijverberg, Everard G. B., De Deyn, Peter Paul, Ducharme, Simon, Jonsson, Michael, Schneider, Anja +19 more·2023·Nature Medicine

Abstract

Abstract Tau plays a key role in Alzheimer’s disease (AD) pathophysiology, and accumulating evidence suggests that lowering tau may reduce this pathology. We sought to inhibit MAPT expression with a tau-targeting antisense oligonucleotide (MAPT Rx ) and reduce tau levels in patients with mild AD. A randomized, double-blind, placebo-controlled, multiple-ascending dose phase 1b trial evaluated the safety, pharmacokinetics and target engagement of MAPT Rx . Four ascending dose cohorts were enrolled sequentially and randomized 3:1 to intrathecal bolus administrations of MAPT Rx or placebo every 4 or 12 weeks during the 13-week treatment period, followed by a 23 week post-treatment period. The primary endpoint was safety. The secondary endpoint was MAPT Rx pharmacokinetics in cerebrospinal fluid (CSF). The prespecified key exploratory outcome was CSF total-tau protein concentration. Forty-six patients enrolled in the trial, of whom 34 were randomized to MAPT Rx and 12 to placebo. Adverse events were reported in 94% of MAPT Rx -treated patients and 75% of placebo-treated patients; all were mild or moderate. No serious adverse events were reported in MAPT Rx -treated patients. Dose-dependent reduction in the CSF total-tau concentration was observed with greater than 50% mean reduction from baseline at 24 weeks post-last dose in the 60 mg (four doses) and 115 mg (two doses) MAPT Rx groups. Clinicaltrials.gov registration number: NCT03186989 .

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  1. [54]Schobel, S. A. Preliminary results from GENERATION HD1, a phase III trial of tominersen in individuals with manifest HD. In CHDI 16th Annual HD Therapeutics Conference (2021).
  2. [55]Viglietta, V. A Ph1b/2a study of WVE-003, an investigational allele-selective, mHTT–lowering oligonucleotide for the treatment of early manifest Huntington’s disease, and review of PRECISION-HD results. In CHDI 16th Annual HDTherapeutics Conference (2021).

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Authors
Mummery, C. J., Börjesson-Hanson, A., Blackburn, D. J., Vijverberg, E. G. B., De Deyn, P. P., Ducharme, S., Jonsson, M., Schneider, A., Rinne, J. O., Ludolph, A. C., Bodenschatz, R., Kordasiewicz, H., Swayze, E. E., Fitzsimmons, B., Mignon, L., Moore, K. M., Yun, C., Baumann, T., Li, D., Norris, D. A., Crean, R., Graham, D. L., Huang, E., Ratti, E., Bennett, C. F., Junge, C., & Lane, R. M.
Affiliations
  • National Hospital for Neurology and Neurosurgery (GB)
  • Royal Hallamshire Hospital (GB)
  • Amsterdam Neuroscience (NL)
  • Douglas Mental Health University Institute (CA)
  • Sahlgrenska University Hospital (SE)
  • University Hospital Bonn (DE)
  • University of Turku (FI)
  • Universität Ulm (DE)
  • Ionis Pharmaceuticals (United States) (US)
  • Biogen (United States) (US)
Corresponding author
Mummery, Catherine J.
Venue
Nature Medicine
Published
2023-04-24
Volume
29
Issue
6
Pages
1437-1447
ISSN
  • 1078-8956 (ISSN-L)
  • 1546-170X
OpenAlex
W4366824059
Cited by
347
References
65
Citations by year
2026: 91 · 2025: 114 · 2024: 103 · 2023: 39
FWCI
61.80
Type
journal article
Language
en
Open access
Locations
  • Nature Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, cc-by)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • UCL Discovery (University College London) (submittedVersion, cc-by)
  • DZNE Pub (submittedVersion, cc-by)
  • UTUPub (University of Turku) (submittedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders
  • Biogen
  • Ionis Pharmaceuticals
Topics
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Neurology › Amyotrophic Lateral Sclerosis Research
Keywords
antisense oligonucleotides, tau protein, Alzheimer's disease, intrathecal administration, cerebrospinal fluid tau, pharmacokinetics, target engagement, drug safety, mild Alzheimer's disease
MeSH terms
Alzheimer Disease, Double-Blind Method, Humans, Oligonucleotides, Antisense, tau Proteins, Treatment Outcome

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