Favorable cognitive effects of the BET protein inhibitor apabetalone in patients 70 and older

Abstract

AbstractBackgroundCognitive decline in late life including Alzheimer’s disease (AD) and vascular dementia (VaD) may be caused by epigenetic change. Bromodomain and extra‐terminal (BET) proteins are epigenetic transcriptional “readers” found to contribute to chronic disease. Apabetalone, a small molecule BET protein inhibitor for oral administration, was assessed for therapeutic effects on cognitive performance in a randomized trial of patients at high risk for cardiovascular disease (CVD).MethodIn the BETonMACE post‐Acute Coronary Syndrome trial in type 2 diabetes mellitus patients were randomized to apabetalone capsule 100 mg b.i.d. or placebo (n=2425). The Montreal Cognitive Assessment (MoCA) was performed on all patients 70 years or older at baseline (n=464) and yearly in the embedded cognition study. In a prespecified analysis, participants were assigned to one of three groups: MoCA score ≥ 26 (normal performance), MoCA score 25 – 22 (mild cognitive impairment), and MoCA score ≤ 21 (dementia).ResultApabetalone exposure was equivalent in each of the three MoCA‐score defined groups. Apabetalone treatment over approximately two years was associated with an increased total MoCA score in participants with baseline MoCA score of ≤ 21 (p = 0.02). Onset of cognition benefit appeared after 12 months treatment. There was no significant difference in change from baseline in the treatment groups with higher MoCA scores.ConclusionIn the BETonMACE trial epigenetic BET protein inhibition by apabetalone capsule 100 mg b.i.d. vs placebo was associated with improved cognition as measured by MoCA in patients with baseline scores of < 21. It is feasible to embed cognition assessment in randomized Phase 3 CVD endpoint studies. BET protein inhibitors warrant further investigation for late life cognitive disorders.