The TOMMORROW study: Design of an Alzheimer's disease delay-of-onset clinical trial.

Journal Article (Journal Article)

INTRODUCTION: Alzheimer's disease (AD) is a continuum with neuropathologies manifesting years before clinical symptoms; thus, AD research is attempting to identify more disease-modifying approaches to test treatments administered before full disease expression. Designing such trials in cognitively normal elderly individuals poses unique challenges. METHODS: The TOMMORROW study was a phase 3 double-blind, parallel-group study designed to support qualification of a novel genetic biomarker risk assignment algorithm (BRAA) and to assess efficacy and safety of low-dose pioglitazone to delay onset of mild cognitive impairment due to AD. Eligible participants were stratified based on the BRAA (using TOMM40 rs 10524523 genotype, Apolipoprotein E genotype, and age), with high-risk individuals receiving low-dose pioglitazone or placebo and low-risk individuals receiving placebo. The primary endpoint was time to the event of mild cognitive impairment due to AD. The primary objectives were to compare the primary endpoint between high- and low-risk placebo groups (for BRAA qualification) and between high-risk pioglitazone and high-risk placebo groups (for pioglitazone efficacy). Approximately 300 individuals were also asked to participate in a volumetric magnetic resonance imaging substudy at selected sites. RESULTS: The focus of this paper is on the design of the study; study results will be presented in a separate paper. DISCUSSION: The design of the TOMMORROW study addressed many key challenges to conducting a dual-objective phase 3 pivotal AD clinical trial in presymptomatic individuals. Experiences from planning and executing the TOMMORROW study may benefit future AD prevention/delay-of-onset trials.

Full Text

Duke Authors

Cited Authors

  • Burns, DK; Chiang, C; Welsh-Bohmer, KA; Brannan, SK; Culp, M; O'Neil, J; Runyan, G; Harrigan, P; Plassman, BL; Lutz, M; Lai, E; Haneline, S; Yarnall, D; Yarbrough, D; Metz, C; Ponduru, S; Sundseth, S; Saunders, AM

Published Date

  • 2019

Published In

Volume / Issue

  • 5 /

Start / End Page

  • 661 - 670

PubMed ID

  • 31720367

Pubmed Central ID

  • PMC6838537

Electronic International Standard Serial Number (EISSN)

  • 2352-8737

Digital Object Identifier (DOI)

  • 10.1016/j.trci.2019.09.010


  • eng

Conference Location

  • United States