Reduction of agitation and caregiver distress using a combination intervention of tetrahydrocannabinol and melatonin in dementia due to Alzheimer disease

Abstract

Abstract Background Agitation, common in AD, often associated with higher caregiver burden, increases in intensity and duration as the disease progresses. Although about 76% of AD patients suffer from agitation, only 6.9% of ongoing trials for AD target symptoms such as agitation. Here, we present preliminary data for improvement in NPI‐agitation (NPI‐ag) scores and associated caregiver distress (NPI caregiver distress, NPI‐D) scores using IGC‐AD1, a combination of tetrahydrocannabinol (THC) and melatonin (IGC‐AD1). Method Twelve patients with mild (15.38%) to moderate (84.6%) AD (NIA‐criteria, 10‐active, 2‐placebo, 81.5±5.5yrs, 69.2% women) participated in a three Cohort Phase‐1, MAD, safety and tolerability trial (IND146069, NCT04749563). In Cohort‐1, IGC‐AD1 was administered QD at 1ml for 14‐days (EOT). In Cohorts 2 and 3, one ml BID and TID were administered respectively, with a minimum of 4‐days washout between Cohorts. In Cohort‐1 (QD), 9 participants (7‐active, 2‐placebo) with NPI‐ag and NPI‐D assessment at baseline were analyzed. In Cohort‐2 (BID), and Cohort‐3 (TID) six patients and five patients respectively had NPI‐ag and NPI‐D scores at baseline. Daily, solicited and non‐solicited adverse events (AEs) were monitored along with vital signs. A Wilcoxon matched pairs signed‐rank test (R‐Studio, dplyr) was used to compare separately the difference between the mean NPI‐ag and mean NPI‐D scores at baseline and EOT. Result In Cohort‐1 mean NPI‐ag at baseline and EOT was 4.71 and 3 respectively (mean difference = ‐1.75, 36.3%, V = 10, p = 0.047). In Cohort‐2 mean NPI‐ag at baseline and EOT was 4.33 and 1.5 respectively (mean difference = ‐2.83, 65.3%, V = 10, p = 0.049). In Cohort‐3 mean NPI‐ag at baseline and EOT was 4.2 and 1.4 respectively (mean difference = ‐2.8, 66.6%, V = 10, p = 0.04). We report similar improvements in NPI‐D. (Cohort‐1: mean difference = ‐1.57, 50%, v = 15, p = 0.028; Cohort‐2: mean difference = ‐2, 66.6%, v = 10, p = 0.049; Cohort‐3: mean difference = ‐1.45, 8.3%, v = 10, p = 0.049). No serious AEs, no deaths, and no dropouts due to AEs were reported. No major changes in concomitant medications were observed. Conclusion IGC‐AD1 was safe and well tolerated and is potentially efficacious in reducing agitation and associated caregiver distress in AD as measured by the NPI, warranting a larger placebo‐controlled study.