A Phase 2 interventional study of Galantamine and Placebo in HIV Associated Cognitive Motor Complex, sponsored by University of Pennsylvania. Completed at 1 site in United States. Open to participants aged 30 Years and older. Per ClinicalTrials.gov, last updated 2024-10-17.
Sponsored by University of Pennsylvania · Phase 2, Interventional, and Treatment
This study tests whether galantamine (GAL) reduces HIV-related inflammation and cognitive deficits. In this double-blind placebo-controlled crossover study, HIV-infected individuals (N=120; 60 smokers and 60 non-smokers) will be randomized to 12 weeks of GAL or placebo, followed by a 4-week washout, then 12 weeks of GAL or placebo (arms switched). Outcomes are monocyte/macrophage and T cell activation and neurocognitive performance.
Although anti-retroviral therapy (ART) enhances life expectancy and overall quality of life (QoL), HIV-infected individuals are increasingly vulnerable to non-AIDS-related diseases including HIV-associated neurocognitive disorders (HAND). Inflammation is a primary mechanism in the pathogenesis of HAND and tobacco use may further exacerbate inflammation. Conversely, nicotine alone has anti-inflammatory effects suggesting that stimulating the cholinergic pathway via pharmacological treatment [e.g., galantamine (GAL)] may suppress inflammation and reverse or prevent neurocognitive deficits in HIV-1 infection. In this double-blind, placebo-controlled crossover study, HIV-infected individuals (N=120; 60 smokers, 60 nonsmokers) will be randomized to 12 weeks of GAL or placebo, followed by a 4-week washout, then 12 weeks of GAL or placebo (arms switched). All subjects will be stable on ART and the GAL dose will follow FDA guidelines. At the beginning and end of each treatment phase, inflammatory biomarkers and viral load will be assessed. Monocyte transcriptomics will also be assessed on a subset of the sample (n=60; 30/group). Neurocognition and clinical outcomes (e.g., QoL) will be measured at baseline and at 4-week intervals during each treatment phase. The primary outcomes are monocyte/macrophage and T-cell activation (CD16, CD163, and CC chemokine receptor type 2 or CCR2 expression; plasma CC chemokine ligand type 2 or CCL2 [MCP-1 or monocyte chemoattractant protein-1], sCD14; CD38/HLA-DR [cluster of differentiation 38/Human Leukocyte Antigen- antigen D Related] on CD8 [cluster of differentiation 8] cells) and neurocognitive performance (processing speed, verbal learning/memory, executive function). Exploratory outcomes include monocyte gene expression patterns and broad plasma cytokine analysis. This study will provide insight into the interactions among nAChR activation, HIV immune activation and pathogenesis, and tobacco use and has translational and therapeutic implications that could improve health outcomes among HIV-infected individuals.
Eligible subjects will be males and females:
If current or past diagnosis of bipolar disorder, eligible if:
Smoking Status
Exclusion Criteria:
Subjects who present with and/or self-report the following criteria will not be eligible to participate in the study.
Smoking Behavior
Alcohol/Drug Use
Medical/Psychiatric Conditions
Medical conditions contraindicated for use with galantamine:
Suicide risk as indicated by at least one of the following on the Columbia Suicide Severity Rating Scale (the PI and/or study psychologist will be consulted to assess safety and determine eligibility in cases close to the eligibility cutoffs):
Medication
Current use or discontinuation within the last 14 days of:
Daily use of:
Subjects will be instructed to refrain from using any study prohibited drugs/medications (both recreational and prescription) throughout their participation in the study.
This is a crossover study such that all participants receive both placebo and galantamine. Participants were randomized to receive galantamine first and placebo second. Timepoints Week 0 through Week 12 represent the first period and Weeks 16 through 28 represent the second period. This study follows the FDA-recommended dosing regimen for galantamine extended release (GAL ER): 4 weeks at 8 mg (once a day), 4 weeks at 16 mg (once a day), and 4 weeks at 24 mg (once a day). The University of Pennsylvania Investigational Drug Service (IDS) will oversee the randomization of all study medication, purchase study medication, manufacture matched placebo, encapsulate and package them in blister packs to maintain double-blind procedures.
Drug: Galantamine · Drug: Placebo
This is a crossover study such that all participants receive both placebo and galantamine. Participants were randomized to receive galantamine first and placebo second. Timepoints Week 0 through Week 12 represent the first period and Weeks 16 through 28 represent the second period. Placebo ingredients will be purchased, encapsulated, and packaged into blister packs by the IDS at the University of Pennsylvania. Both active medication and placebo will look identical. The study medication assignments for each participant in this project is randomized and counterbalanced. This means that approximately 50% of participants will take galantamine during the first medication period, followed by the placebo in the second medication period. Alternatively, approximately 50% of participants will take the placebo during the first medication period, followed by galantamine during the second medication period.
Drug: Galantamine · Drug: Placebo
The study will be performed using the 8mg, 16mg and 24mg doses of galantamine hydrobromide-ER. The dosing regimen will be an initial 4 weeks of drug run-up at the lowest 8mg q.d. dose, followed by 16mg q.d. for the following 4 weeks, and the dose will be increased for the last 4 weeks to 24mg. Participants will be instructed to take one 8mg 16mg or 24mg pill (galantamine-ER or placebo) every morning, preferably with food.
Also known as: Razadyne ER
Matched placebo will be made in-house using lactulose filler in gel capsules. Participants will be instructed to take one pills every morning for 12 weeks.
Also known as: Sugar Pill
Change in Cognition
Cognitive function will be assessed 4 times at Lab Visits. Executive function was measured by the task switch cost from the Color shape task, measured in ms. Executive function was also measured via response time (ms) and accuracy (# correct) on an N-back working memory task. Verbal learning and memory were measured by the Total Recall and Delayed Recall, respectively, from the Hopkins Verbal Learning Test. Response inhibition was measured by the stop signal reaction time (ms) from the Stop Signal Task. A composite score will be created by computed standardized z-scores for each measure (where the mean is 0 and the standard deviation is 1) and then averaging the z-scores. Measures of response time were reverse coded such that higher z-scores indicate better cognitive performance. The primary outcome is the change from baseline cognitive function after 12 weeks of treatment. Change in cognition will be measured during each treatment arm.
Time frame: Period1 Lab 1 (Week 0), Period 1 Lab 2 (Week 12), Period 2 Lab 1 (Week 16), Period 2 Lab 2 (Week 28)
Change in Inflammation (MCP-1)
Cellular markers of immune activation will be measured in whole blood and soluble markers of immune activation will be measured in plasma at Lab Visits. The primary outcome is the change in monocyte and T cell surface activation and soluble markers after 12 weeks of treatment. Because this is a within-subject crossover study, changes in cellular markers will be measured during each treatment arm.
Time frame: Period1 Lab 1 (Week 0), Period 1 Lab 2 (Week 12), Period 2 Lab 1 (Week 16), Period 2 Lab 2 (Week 28)
Change in Inflammation (Percentage of CD14+ Monocytes Expressing CD8)
Cellular markers of immune activation will be measured in whole blood and soluble markers of immune activation will be measured in plasma at Lab Visits. The primary outcome is the change in monocyte and T cell surface activation and soluble markers after 12 weeks of treatment. Because this is a within-subject crossover study, changes in cellular markers will be measured during each treatment arm.
Time frame: Period1 Lab 1 (Week 0), Period 1 Lab 2 (Week 12), Period 2 Lab 1 (Week 16), Period 2 Lab 2 (Week 28)
Change in Inflammation (CD14)
Cellular markers of immune activation will be measured in whole blood and soluble markers of immune activation will be measured in plasma at Lab Visits. The primary outcome is the change in monocyte and T cell surface activation and soluble markers after 12 weeks of treatment. Because this is a within-subject crossover study, changes in cellular markers will be measured during each treatment arm.
Time frame: Period1 Lab 1 (Week 0), Period 1 Lab 2 (Week 12), Period 2 Lab 1 (Week 16), Period 2 Lab 2 (Week 28)
Change in Inflammation (Percentage of CD14+ Monocytes Expressing CD163)
Cellular markers of immune activation will be measured in whole blood and soluble markers of immune activation will be measured in plasma at Lab Visits. The primary outcome is the change in monocyte and T cell surface activation and soluble markers after 12 weeks of treatment. Because this is a within-subject crossover study, changes in cellular markers will be measured during each treatment arm.
Time frame: Period1 Lab 1 (Week 0), Period 1 Lab 2 (Week 12), Period 2 Lab 1 (Week 16), Period 2 Lab 2 (Week 28)
Change in Inflammation (Percentage of CD14+ Monocytes Expressing CD16)
Cellular markers of immune activation will be measured in whole blood and soluble markers of immune activation will be measured in plasma at Lab Visits. The primary outcome is the change in monocyte and T cell surface activation and soluble markers after 12 weeks of treatment. Because this is a within-subject crossover study, changes in cellular markers will be measured during each treatment arm.
Time frame: Period1 Lab 1 (Week 0), Period 1 Lab 2 (Week 12), Period 2 Lab 1 (Week 16), Period 2 Lab 2 (Week 28)
| Milestone | Galantamine First | Placebo First |
|---|---|---|
| Started | 28 | 30 |
| Completed | 25 | 25 |
| Not completed | 3 | 5 |
| Milestone | Galantamine First | Placebo First |
|---|---|---|
| Started | 25 | 25 |
| Completed | 17 | 24 |
| Not completed | 8 | 1 |
| Milestone | Galantamine First | Placebo First |
|---|---|---|
| Started | 17 | 24 |
| Completed | 16 | 21 |
| Not completed | 1 | 3 |
Cognitive function will be assessed 4 times at Lab Visits. Executive function was measured by the task switch cost from the Color shape task, measured in ms. Executive function was also measured via response time (ms) and accuracy (# correct) on an N-back working memory task. Verbal learning and memory were measured by the Total Recall and Delayed Recall, respectively, from the Hopkins Verbal Learning Test. Response inhibition was measured by the stop signal reaction time (ms) from the Stop Signal Task. A composite score will be created by computed standardized z-scores for each measure (where the mean is 0 and the standard deviation is 1) and then averaging the z-scores. Measures of response time were reverse coded such that higher z-scores indicate better cognitive performance. The primary outcome is the change from baseline cognitive function after 12 weeks of treatment. Change in cognition will be measured during each treatment arm.
| Z-score | Galantamine First | Placebo First |
|---|---|---|
| Period1 Lab 1 (Week 0) | .018 ± .469 | .12 ± .509 |
| Period 1 Lab 2 (Week 12) | 0.068 ± 0.695 | 0.201 ± 0.615 |
| Period 2 Lab 1 (Week 16) | 0.020 ± 0.746 | 0.440 ± 0.578 |
| Period 2 Lab 2 (Week 28) | 0.219 ± 0.806 | 0.490 ± 0.472 |
Cellular markers of immune activation will be measured in whole blood and soluble markers of immune activation will be measured in plasma at Lab Visits. The primary outcome is the change in monocyte and T cell surface activation and soluble markers after 12 weeks of treatment. Because this is a within-subject crossover study, changes in cellular markers will be measured during each treatment arm.
| pg/mL | Galantamine First | Placebo First |
|---|---|---|
| Period1 Lab 1 (Week 0) | 405.00 ± 277.68 | 402.05 ± 206.56 |
| Period1 Lab 2 (Week 12) | 423.33 ± 266.71 | 337.01 ± 163.38 |
| Period2 Lab 1 (Week 16) | 411.71 ± 221.34 | 350.00 ± 149.55 |
| Period2 Lab 2 (Week 28) | 410.76 ± 300.29 | 334.91 ± 155.85 |
Cellular markers of immune activation will be measured in whole blood and soluble markers of immune activation will be measured in plasma at Lab Visits. The primary outcome is the change in monocyte and T cell surface activation and soluble markers after 12 weeks of treatment. Because this is a within-subject crossover study, changes in cellular markers will be measured during each treatment arm.
| percentage of monocytes expressing CD8 | Galantamine First | Placebo First |
|---|---|---|
| Period1 Lab 1 (Week 0) | 7.125 ± 6.859 | 5.590 ± 4.528 |
| Period 1 Lab 2 (Week 12) | 5.747 ± 5.789 | 5.221 ± 3.069 |
| Period 2 Lab 1 (Week 16) | 4.329 ± 2.933 | 6.570 ± 6.738 |
| Period 2 Lab 2 (Week 28) | 6.150 ± 5.257 | 6.916 ± 4.658 |
Cellular markers of immune activation will be measured in whole blood and soluble markers of immune activation will be measured in plasma at Lab Visits. The primary outcome is the change in monocyte and T cell surface activation and soluble markers after 12 weeks of treatment. Because this is a within-subject crossover study, changes in cellular markers will be measured during each treatment arm.
| ng/ml | Galantamine First | Placebo First |
|---|---|---|
| Period1 Lab 1 (Week 0) | 1672.64 ± 440.69 | 1645.42 ± 741.79 |
| Period 1 Lab 2 (Week 12) | 1807.66 ± 461.12 | 1512.70 ± 498.86 |
| Period 2 Lab 1 (Week 16) | 1809.55 ± 330.04 | 1517.90 ± 515.77 |
| Period 2 Lab 2 (Week 28) | 1631.96 ± 352.70 | 1521.68 ± 480.99 |
Cellular markers of immune activation will be measured in whole blood and soluble markers of immune activation will be measured in plasma at Lab Visits. The primary outcome is the change in monocyte and T cell surface activation and soluble markers after 12 weeks of treatment. Because this is a within-subject crossover study, changes in cellular markers will be measured during each treatment arm.
| percentage of monocytes expressing CD163 | Galantamine First | Placebo First |
|---|---|---|
| Period1 Lab 1 (Week 0) | 88.68 ± 5.48 | 89.11 ± 6.99 |
| Period 1 Lab 2 (Week 12) | 80.03 ± 20.67 | 83.90 ± 17.87 |
| Period 2 Lab 1 (Week 16) | 86.64 ± 7.67 | 87.15 ± 8.95 |
| Period 2 Lab 2 (Week 28) | 86.44 ± 5.06 | 90.94 ± 5.24 |
Cellular markers of immune activation will be measured in whole blood and soluble markers of immune activation will be measured in plasma at Lab Visits. The primary outcome is the change in monocyte and T cell surface activation and soluble markers after 12 weeks of treatment. Because this is a within-subject crossover study, changes in cellular markers will be measured during each treatment arm.
| percentage of monocytes expressing CD16 | Galantamine First | Placebo First |
|---|---|---|
| Period1 Lab 1 (Week 0) | 64.18 ± 19.49 | 64.90 ± 20.14 |
| Period 1 Lab 2 (Week 12) | 67.44 ± 17.88 | 68.02 ± 17.79 |
| Period 2 Lab 1 (Week 16) | 74.78 ± 15.27 | 69.04 ± 17.37 |
| Period 2 Lab 2 (Week 28) | 67.83 ± 13.23 | 59.78 ± 21.14 |
Collected over 28 weeks: From the start of treatment through the end of treatment. Non-serious events are listed at a 1% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Galantamine 8mg | 1/52 (1.9%) | 1/52 (1.9%) | 2/52 (3.8%) |
| Galantamine 16mg | 0/49 (0%) | 0/49 (0%) | 4/49 (8.2%) |
| Galantamine 24mg | 0/48 (0%) | 2/48 (4.2%) | 2/48 (4.2%) |
| Placebo | 0/47 (0%) | 2/47 (4.3%) | 3/47 (6.4%) |
| Event | Galantamine 8mg | Galantamine 16mg | Galantamine 24mg | Placebo |
|---|---|---|---|---|
| Gastrointestinal BleedingGastrointestinal disorders | 0/52 | 0/49 | 1/48 | 1/47 |
| Pulled muscleMusculoskeletal and connective tissue disorders | 0/52 | 0/49 | 0/48 | 1/47 |
| Low HemoglobinBlood and lymphatic system disorders | 0/52 | 0/49 | 1/48 | 0/47 |
| Bone fractureMusculoskeletal and connective tissue disorders | 1/52 | 0/49 | 0/48 | 0/47 |
| Event | Galantamine 8mg | Galantamine 16mg | Galantamine 24mg | Placebo |
|---|---|---|---|---|
| FatigueGeneral disorders | 1/52 | 4/49 | 1/48 | 1/47 |
| DepressionPsychiatric disorders | 1/52 | 2/49 | 1/48 | 2/47 |
| NauseaGastrointestinal disorders | 0/52 | 0/49 | 0/48 | 2/47 |
| Age, Categorical(Participants) | Galantamine First | Placebo First | Total |
|---|---|---|---|
| <=18 years | 0 | 0 | 0 |
| Between 18 and 65 years | 28 | 30 | 58 |
| >=65 years | 0 | 0 | 0 |
| Age, Continuous(years) | Galantamine First | Placebo First | Total |
|---|---|---|---|
| Mean | 57.9 ± 3.7 | 57.3 ± 5.1 | 57.6 ± 4.4 |
| Sex: Female, Male(Participants) | Galantamine First | Placebo First | Total |
|---|---|---|---|
| Female | 5 | 8 | 13 |
| Male | 23 | 22 | 45 |
| Ethnicity (NIH/OMB)(Participants) | Galantamine First | Placebo First | Total |
|---|---|---|---|
| Hispanic or Latino | 3 | 1 | 4 |
| Not Hispanic or Latino | 25 | 29 | 54 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Race (NIH/OMB)(Participants) | Galantamine First | Placebo First | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 21 | 19 | 40 |
| White | 4 | 10 | 14 |
| More than one race | 1 | 0 | 1 |
| Unknown or Not Reported | 2 | 1 | 3 |
| Region of Enrollment(participants) | Galantamine First | Placebo First | Total |
|---|---|---|---|
| United States | 28 | 30 | 58 |
| Smoking History(Participants) | Galantamine First | Placebo First | Total |
|---|---|---|---|
| Non-Smoker | 10 | 22 | 32 |
| Current Smoker | 18 | 8 | 26 |
| CD4 Levels at Intake(cells/microliter) | Galantamine First | Placebo First | Total |
|---|---|---|---|
| Mean | 769.8 ± 311.2 | 611.6 ± 201.1 | 687.9 ± 269.7 |
1 further baseline measures are reported on the registry.
Documents are hosted by the registry — open the source record to download them.
Plan to share: Yes — The final dataset will include demographic and behavioral assessments and laboratory data bio-specimens. Because the dataset will contain personal health information, identifying information will be collected. Even though the final dataset will be stripped of identifiers prior to release for sharing, investigators will do the following to reduce the possibility confidentiality loss. We will make the data and associated documentation available to users only under a data-sharing agreement that provides for: (1) a commitment to using data only for research purposes and not to identify any individual participant; (2) a commitment to securing the data using appropriate computer technology; and (3) a commitment to destroying or returning the data after analyses are completed. Transcriptomic data will be deposited with a public access database such as NCBI's Gene Expression Omnibus (GEO) database (http://www.ncbi.nlm.nih.gov/geo/)
Supporting information: Study protocol, Sap, Icf
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