title: Estimating sample sizes for predementia Alzheimer's trials based on the Alzheimer's Disease Neuroimaging Initiative.
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 ε4 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.
authors.affiliation: Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA. jgrill@mednet.ucla.edu
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Grill
authors.forename: Lijie
authors.initials: L
authors.lastname: Di
authors.forename: Po H
authors.initials: PH
authors.lastname: Lu
authors.forename: Cathy
authors.initials: C
authors.lastname: Lee
authors.forename: John
authors.initials: J
authors.lastname: Ringman
authors.forename: Liana G
authors.initials: LG
authors.lastname: Apostolova
authors.forename: Nicole
authors.initials: N
authors.lastname: Chow
authors.forename: Omid
authors.initials: O
authors.lastname: Kohannim
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Cummings
authors.forename: Paul M
authors.initials: PM
authors.lastname: Thompson
authors.forename: David
authors.initials: D
authors.lastname: Elashoff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000175:diagnosis* / Q000235:genetics / Q000628:therapy*; D053327:Apolipoprotein E4 / Q000235:genetics; D015415:Biomarkers / Q000134:cerebrospinal fluid; D001921:Brain / Q000473:pathology; D002986:Clinical Trials as Topic; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000209:etiology / Q000235:genetics / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008609:Mental Status Schedule; D015337:Multicenter Studies as Topic; D059906:Neuroimaging; D018401:Sample Size
chemical_list: D053327:Apolipoprotein E4; D015415:Biomarkers