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REVERSE-SD
CompletedPhase 2Results postedProof-of-Concept Study of a Selective p38 MAPK Alpha Inhibitor, Neflamapimod, in Subjects With Mild Alzheimer's Disease
A Double-Blind, Placebo-Controlled Proof-of-Concept Study of a Selective p38 MAP Kinase Alpha Inhibitor, Neflamapimod, Administered for 24 Weeks in Subjects With Mild Alzheimer's Disease
Lead sponsor
Asset
Neflamapimod
Listed sites
38
Recruiting sites
-
Enrollment
161
actual
Study population
Alzheimer’s disease
Key I/E criteria
•Tau biomarker required (CSF)•MMSE 20-28•Study partner/caregiver required•AD symptomatic therapy: stable ≥2 months
Primary endpoint
•Total and Delayed Recall on the Hopkins Verbal Learning Test - Revised (HVLT-R)
Footprint
Where this trial recruits
Site locations as reported to ClinicalTrials.gov. Site count is not enrollment count; per-site enrollment is not available from source.
Identifiers
Registered as
Timeline
Milestones
Assets
Drug assets
Study populations
Who this study enrolls
Eligibility
Who can enroll
Inclusion criteria
1. Men and women age 55 to 85 years, inclusive.
2. Willing and able to provide informed consent.
3. Must have mild cognitive impairment (MCI) or mild AD with evidence of progression ("Mild-AD"), as defined by the following:
1. CDR-Global Score of 0.5 or 1.0, with CDR memory subscore of at least 0.5.
2. MMSE score ranging from 20 to 28, inclusive.
3. Positive biomarker for AD, as defined by a CSF Aβ1-42R below the threshold and phospho-tau above the threshold for the assay utilized in the study and assessed by the central laboratory.
4. Computed tomography (CT) or magnetic resonance imaging (MRI) findings within 2 years of Screening that are compatible with AD and no other pathologic processes that might potentially account for the subject's cognitive impairment.
5. If the subject is taking a single drug for AD (e.g., donepezil or other cholinesterase inhibitors or memantine; dual therapy is excluded), he/she has been on a stable dose for at least 2 months prior to baseline, and the dose must remain unchanged during the study unless required for management of adverse events (AEs).
6. Adequate visual and auditory abilities to perform all aspects of the cognitive and functional assessments.
7. Must have reliable informant or caregiver
Exclusion criteria
1. Evidence that the primary basis for cognitive impairment is neurodegenerative disease other than AD, including, but not limited to, vascular dementia, dementia with Lewy bodies, and Parkinson's disease.
2. Suicidality, defined as active suicidal thoughts within 6 months before Screening or at Baseline, defined as answering yes to items 4 or 5 on the Columbia-Suicide Severity Rating Scale (C-SSRS), or history of suicide attempt in previous 2 years, or, in the Investigator's opinion, at serious risk of suicide.
3. History of major and active psychiatric disorder, moderate to severe depressive symptoms, and or other concurrent medical condition that, EIP-VX17-745-304, Version 1.0, 17 November, 2017 Page 7 of 46 EIP Pharma, LLC Confidential in the opinion of the Investigator, might compromise safety and/or compliance with study requirements.
4. Diagnosis of alcohol or drug abuse within the previous 2 years.
5. History of cancer within the last 5 years, except basal cell carcinoma, squamous skin carcinoma, prostate cancer or carcinoma in situ with no significant progression over the past 2 years.
6. Poorly controlled clinically significant medical illness.
7. History of serum B12 abnormality, anemia with hemoglobin ≤10 g/dL, thyroid function abnormality, electrolyte abnormality, or positive syphilis serology that have not been corrected and/or otherwise addressed.
8. History of epilepsy or unexplained seizure within the past 5 years.
9. Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >3 × the upper limit of normal (ULN), total bilirubin >2 × ULN, and/or International Normalized Ratio (INR) >1.5
10. Known human immunodeficiency virus, hepatitis B, or active hepatitis C virus infection.
11. Subject participated in a study of an investigational drug less than 3 months or 5 half-lives of the investigation drug, whichever is longer, before enrollment in this study.
Endpoints (22)
What's being measured
Protocol endpoints and posted registry outcome measures, grouped into outcome categories. Composite endpoints show their component event types. Standard codes (LOINC, SNOMED CT) are shown where available.
Coverage by outcome category
Global cognition
4 endpointsClinical Dementia Rating Scale - Sum of Boxes (CDR-SB)
Time frame:Baseline and 24 weeks
Clinical Dementia Rating-Sum of Boxes (CDR-SB)
change from baseline, improvement
Mini-Mental State Examination (MMSE)
Time frame:Baseline and 26 Weeks (Follow-up visit, 2 weeks from end of dosing)
Mini-Mental State Examination (MMSE)
descriptive
Clinical Dementia Rating Scale - Sum of Boxes (CDR-SB)
Time frame:Baseline and 24 weeks
Clinical Dementia Rating-Sum of Boxes (CDR-SB)
change from baseline, improvement
Posted result
| Group | Value (mean), Scores on a scale | Standard error |
|---|---|---|
| Placebo Armn=78 Participants | 1.0 | 0.20 |
| Neflamapimod Armn=74 Participants | 1.1 | 0.21 |
Mean change from baseline neflamapimod vs placebo
Mini-Mental State Examination (MMSE)
Time frame:Baseline and 26 Weeks (Follow-up visit, 2 weeks from end of dosing)
Mini-Mental State Examination (MMSE)
descriptive
Posted result
| Group | Value (mean), Scores on a scale | Standard error |
|---|---|---|
| Placebo Armn=79 Participants | -0.5 | 0.31 |
| Neflamapimod Armn=70 Participants | -0.8 | 0.33 |
Mean change from baseline neflamapimod vs placebo
Memory
4 endpointsTotal and Delayed Recall on the Hopkins Verbal Learning Test - Revised (HVLT-R)
Time frame:Baseline and 24 weeks
change from baseline, improvement
Total and Delayed Recall on the Hopkins Verbal Learning Test - Revised (HVLT-R)
Time frame:Baseline and 24 weeks
change from baseline, improvement
Posted result
| Group | Value (mean), Z-score | Standard error |
|---|---|---|
| Placebo Armn=72 Participants | -0.09679 | 0.074840 |
| Neflamapimod Armn=71 Participants | -0.15776 | 0.085805 |
Mean change from baseline neflamapimod vs placebo
Wechsler Memory Scale (WMS) Immediate and Delayed Recall
Time frame:Baseline and 24 weeks
change from baseline, improvement
Wechsler Memory Scale (WMS) Immediate and Delayed Recall
Time frame:Baseline and 24 weeks
change from baseline, improvement
Posted result
| Group | Value (mean), Scores on a scale | Standard error |
|---|---|---|
| Placebo Armn=77 Participants | 16.6 | 2.09 |
| Neflamapimod Armn=71 Participants | 16.0 | 2.07 |
Mean change from baseline neflamapimod vs placebo
Amyloid biomarkers
6 endpointsCerebrospinal Fluid Amyloid Beta 1-40
Time frame:Baseline and 24 weeks
change from baseline, improvement
Cerebrospinal Fluid Amyloid Beta 1-42
Time frame:Baseline and 24 weeks
change from baseline, improvement
Cerebrospinal Fluid P-tau/AB1-42 Ratio
Time frame:Baseline and 24 weeks
Phosphorylated tau 181 (p-tau181)
ratio, descriptive
Cerebrospinal Fluid Amyloid Beta 1-40
Time frame:Baseline and 24 weeks
change from baseline, improvement
Posted result
| Group | Value (mean), pg/mL | Standard error |
|---|---|---|
| Placebo Armn=68 Participants | 399.7 | 249.18 |
| Neflamapimod Armn=62 Participants | 282.3 | 268.58 |
Mean change from baseline neflamapimod vs placebo
Cerebrospinal Fluid Amyloid Beta 1-42
Time frame:Baseline and 24 weeks
change from baseline, improvement
Posted result
| Group | Value (mean), pg/mL | Standard error |
|---|---|---|
| Placebo Armn=68 Participants | 31.1 | 12.70 |
| Neflamapimod Armn=62 Participants | 10.0 | 13.75 |
Mean change from baseline neflamapimod vs placebo
Cerebrospinal Fluid P-tau/AB1-42 Ratio
Time frame:Baseline and 24 weeks
Phosphorylated tau 181 (p-tau181)
ratio, descriptive
Posted result
| Group | Value (mean), ratio | Standard error |
|---|---|---|
| Placebo Armn=68 Participants | -0.0 | 0 |
| Neflamapimod Armn=62 Participants | -0.0 | 0 |
Mean change from baseline neflamapimod vs placebo
Tau biomarkers
2 endpointsCerebrospinal Fluid Total Tau
Time frame:Baseline and 24 weeks
descriptive
Cerebrospinal Fluid Total Tau
Time frame:Baseline and 24 weeks
descriptive
Posted result
| Group | Value (mean), pg/mL | Standard error |
|---|---|---|
| Placebo Armn=68 Participants | 10.0 | 6.83 |
| Neflamapimod Armn=62 Participants | -8.6 | 7.36 |
Mean change from baseline neflamapimod vs placebo
Neurodegeneration biomarkers
4 endpointsCerebrospinal Fluid Neurogranin
Time frame:Baseline and 24 weeks
change from baseline, improvement
Cerebrospinal Fluid Neurofilament Light Chain
Time frame:Baseline and 24 weeks
Neurofilament light (NfL)
change from baseline, improvement
Cerebrospinal Fluid Neurogranin
Time frame:Baseline and 24 weeks
change from baseline, improvement
Posted result
| Group | Value (mean), pg/mL | Standard error |
|---|---|---|
| Placebo Armn=68 Participants | 11.1 | 9.16 |
| Neflamapimod Armn=62 Participants | -9.9 | 9.82 |
Mean change from baseline neflamapimod vs placebo
Cerebrospinal Fluid Neurofilament Light Chain
Time frame:Baseline and 24 weeks
Neurofilament light (NfL)
change from baseline, improvement
Posted result
| Group | Value (mean), pg/mL | Standard error |
|---|---|---|
| Placebo Armn=68 Participants | 231.9 | 61.31 |
| Neflamapimod Armn=62 Participants | 121.7 | 66.92 |
Mean change from baseline neflamapimod vs placebo
Fluid / digital biomarkers
2 endpointsCerebrospinal Fluid Phospho-tau
Time frame:Baseline and 24 weeks
Phosphorylated tau 181 (p-tau181)
change from baseline, improvement
Cerebrospinal Fluid Phospho-tau
Time frame:Baseline and 24 weeks
Phosphorylated tau 181 (p-tau181)
change from baseline, improvement
Posted result
| Group | Value (mean), pg/mL | Standard error |
|---|---|---|
| Placebo Armn=68 Participants | 0.9 | 0.63 |
| Neflamapimod Armn=62 Participants | -1.1 | 0.68 |
Mean change from baseline neflamapimod vs placebo
Publications (2)
Bibliography
Records linked to this trial through ClinicalTrials.gov references, PubMed NCT search, and curated study seeds. 'Canonical' marks design/result papers; others are registry references or candidates.
Registry references + supporting bibliography
- PMID33974419via DERIVED
- PMID34044875via DERIVED
Provenance
Sources
Trial facts come from public ClinicalTrials.gov records. Endpoint categories are Delfa's classification of those records, not a ClinicalTrials.gov field. All figures reflect the July 21, 2026 snapshot.