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Clinical Trial of Apomorphine Subcutaneous Infusion in Patients With Advanced Parkinson's Disease (TOLEDO)

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ClinicalTrials.gov Identifier: NCT02006121
Recruitment Status : Completed
First Posted : December 9, 2013
Results First Posted : July 8, 2019
Last Update Posted : July 8, 2019
Sponsor:
Information provided by (Responsible Party):
Britannia Pharmaceuticals Ltd.

Brief Summary:

The primary objective of the trial was to investigate the efficacy of apomorphine continuous subcutaneous infusion compared to placebo in Parkinson's Disease patients with motor fluctuations not well controlled on medical treatment.

The secondary objective of the study was to investigate the safety and tolerability of apomorphine continuous subcutaneous therapy.


Condition or disease Intervention/treatment Phase
Parkinson's Disease Drug: Apomorphine hydrochloride Drug: Placebo Phase 3

Detailed Description:

The primary efficacy variable is the mean change in time spent "OFF" from baseline (start of blinded treatment) to the end of a 12 weeks' double-blind treatment period based on patient diaries. Patients recorded their motor symptoms in half-hour blocks as OFF, ON without dyskinesia, ON without troublesome dyskinesia, or sleeping using the Hauser Parkinson's Disease home diary.

Key secondary Endpoints (tested hierarchically):

  • Change in time spent "ON without troublesome dyskinesia"
  • Patient Global Impression of Change

Other Endpoints:

  • Percentage of patients with response to therapy, defined as a mean OFF time reduction of at least 2 hours
  • Change in oral levodopa and levodopa equivalent dose

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 107 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Multicentre,Parallel-group,Double-blind,Placebo-controlled Phase III Study to Evaluate the Efficacy and Safety of Apomorphine sc Infusion in Parkinson's Disease Patients With Motor Complications Not Well Controlled on Medical Treatment
Actual Study Start Date : March 3, 2014
Actual Primary Completion Date : June 6, 2016
Actual Study Completion Date : June 8, 2017

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Active Comparator: Apomorphine hydrochloride
Apo-go® Apomorphine hydrochloride 5 mg/ml solution for infusion in pre-filled syringe
Drug: Apomorphine hydrochloride
Apomorphine hydrochloride 5 mg/ml solution for infusion in pre-filled syringe
Other Name: Apo-go

Placebo Comparator: Placebo
Placebo: saline infusion
Drug: Placebo
Sodium chloride 9 mg/ml




Primary Outcome Measures :
  1. Mean Change in Daily OFF Time From Baseline (Start of Blinded Treatment) to the End of Double-blind Phase (Visit 10) Based on Patient Diaries Using MMRM mITT Population [ Time Frame: Baseline and 12 weeks ]
    The least squares mean reduction (improvement) in OFF time as reported by the patient using the Hauser Parkinson's disease home diary. Patients categorised their motor symptoms into OFF, ON with dyskinesia, ON without troublesome dyskinesia or sleeping using half hour blocks over 24 hours. Daily OFF time was computed from the average of valid motor diaries from the two days preceding each visit. Correct diary completion was evaluated during screening and observed by the investigator to ensure patients could categorise their motor symptoms correctly. A diary was considered valid if no more than 4 half-hour periods were either absent or duplicated. There were no invalid diaries at Baseline or Week 12.


Secondary Outcome Measures :
  1. Mean Change in Daily Time Spent "ON Without Troublesome Dyskinesia" From Baseline to the End of the Double-blind Phase (Visit 10), Based on Patient Diaries Using MMRM mITT Population [ Time Frame: Baseline and 12 weeks ]
    The least squares mean change in "ON time without troublesome dyskinesia" as reported by the patient using the Hauser Parkinson's disease home diary. Each half hour of the day categorised as OFF, ON with dyskinesia, ON without troublesome dyskinesia or asleep. "ON time without troublesome dyskinesia" measures good ON time for a Parkinson's disease patient.

  2. Patient Global Impression of Change (PGIC), Using the mITT Population [ Time Frame: Baseline and 12 weeks ]
    PGIC is a self-administered questionnaire measuring personal general state of health on a 7-point rating scale. The 7 ordinal categories from which patients must choose are 'very much improved', 'much improved', 'minimally improved', 'no change', 'minimally worse', 'much worse', and 'very much worse. Results are presented as the % of patients who reported at least minimal improvement in general health status at week 12 compared to Baseline. A Wilcoxon range sum test was performed to test for treatment differences from baseline to end of 12 weeks' treatment period.

  3. Mean Change in Oral Levodopa Dose From Baseline to Visit 10 Using MMRM for the mITT Population [ Time Frame: Baseline and 12 weeks ]
    The least squares mean change in oral levodopa dose from Baseline to Visit 10 (week 12) was calculated excluding 3 centres who declined to participate in collecting the necessary details of PRN use of levodopa.

  4. Mean Change in Levodopa Equivalent Dose From Baseline to Visit 10 (Week 12) Using MMRM in the mITT Population [ Time Frame: Baseline and 12 weeks ]
    Levodopa equivalent dose is an indication of the burden of medication taken to control symptoms of Parkinson's disease with all medications other than levodopa itself being converted to a calculated levodopa dose using the methodology published by Tomlinson et al, 2010. The computation of LED excludes the study drug.



Information from the National Library of Medicine

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Ages Eligible for Study:   30 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Male or female patients aged ≥30 years
  • Diagnosis of idiopathic PD of >3 years' duration, defined by the UK Brain Bank criteria (with the exception of >1 affected relative being allowed), without any other known or suspected cause of Parkinsonism
  • Hoehn & Yahr stage up to 3 in the ON and 2 to 5 in the OFF state
  • Motor fluctuations not adequately controlled on medical treatment including levodopa which was judged by the treating physician to be optimal
  • Average of OFF time > 3 hours/day based on screening and baseline diary entries with no day with < 2 hours of OFF time recorded
  • Stable medication regimen, with a stable dose of levodopa administered in at least 4 intakes, for at least 28 days prior to baseline. All oral or transdermal antiparkinsonian drugs were permitted, with the exception of budipine. This regimen might include the use of levodopa/DDCI rescue medication, if this occurred up to 2 times a day, at doses of up to 200 mg levodopa/day
  • Patients must be able to differentiate between the ON and OFF state and between troublesome and non-troublesome dyskinesias
  • Male and female patients must be compliant with a highly effective contraceptive method (oral hormonal contraception alone is not considered highly effective and must be used in combination with a barrier method) during the study and for the 12-month OLP, if sexually active
  • Females of childbearing potential must have a negative serum human chorionic gonadotropin (hCG) or urine pregnancy test at screening
  • Ability to accurately complete a paper diary on designated days (with assistance from caregivers, if required), recording periods when they are "ON without troublesome dyskinesia", "ON with troublesome dyskinesia", OFF, and sleeping
  • Written informed consent prior to enrolment, after being provided with detailed information about the nature, risks, and scope of the clinical trial as well as the expected desirable and adverse effects of the study treatments
  • Patients considered reliable and capable of adhering to the protocol, visit schedule, and medication intake according to the judgment of the investigator

Exclusion Criteria:

  • History of respiratory depression
  • Hypersensitivity to apomorphine or any excipients of the medicinal product
  • High suspicion of other parkinsonian syndromes
  • Presence of severe freezing or clinically relevant postural instability leading to falls during the ON state
  • Concomitant therapy or within 28 days prior to baseline with: apomorphine pen injections; alpha-methyl dopa, metoclopramide, reserpine, neuroleptics, methylphenidate, or amphetamine; intrajejunal levodopa
  • Previous use of apomorphine pump treatment
  • History of deep brain stimulation or lesional surgery for PD
  • Any medical condition that is likely to interfere with an adequate participation in the study, including e.g. current diagnosis of unstable epilepsy; clinically relevant cardiac dysfunction and/or myocardial infarction or stroke within the last 12 months
  • Symptomatic, clinically relevant and medically uncontrolled orthostatic hypotension
  • Patients with a borderline QT interval corrected for heart rate according to Bazett's formula (QTcB) of >450 msec for male and >470 msec for female at screening or history of long QT syndrome; or >450 msec absolute duration
  • Clinically relevant hepatic dysfunction (total bilirubin >2.0 mg/dL, alanine transaminase [ALT] and aspartate transaminase [AST] >2 times the upper limit of normal)
  • Clinically relevant renal dysfunction (serum creatinine >2.0 mg/dL)
  • Pregnant and breastfeeding women
  • Clinically relevant cognitive decline, defined as MMSE ≤24 or according to Diagnostic and Statistical Manual of Mental Disorders (DSM) IV criteria for dementia
  • Active psychosis or history of at least moderate psychosis in the past year, or with medically uncontrolled severe depression; very mild illusions or hallucinations in the sense of "feelings of passage or presence" with fully retained insight are not an exclusion criterion
  • Known history of melanoma
  • Any investigational therapy in the 4 weeks prior to randomization
  • History or current drug or alcohol abuse or dependencies

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02006121


Locations
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Austria
Medizinische Universität Graz / Univ. Klinik für Neurologie
Graz, Austria
Medizinische Universität Innsbruck
Innsbruck, Austria
Donauspital / SMZ-Ost, Abteilung für Neurologie, Sekretariat (Stock 1, Ebene 4)
Vienna, Austria, 1220
Denmark
Bispebjerg University Hospital, Movement Disorder Centre
Copenhagen, Denmark
France
CHRU Clermont- Ferrand Gabriel-Montpied
Clermont-Ferrand Cedex 1, France
CHU de Rennes, Hôpital Pontchaillou
Rennes Cedex 9, France
CHU Toulouse, Hôpital Purpan, Centre d'Investigation Clinique
Toulouse Cedex 9, France
Germany
Neurologisches Fachkrankenhausfür Bewegungsstörungen / Parkinson
Beelitz-Heilstätten, Germany
Klinikum Bremerhaven-Reinkenheide gGmbH, Neurologische Klinik
Bremerhaven, Germany
Paracelsus Elena-Klinik Kassel
Kassel, Germany
Schön Klinik München Schwabing / Neurologie und Klinische Neurophysiologie
München, Germany
Netherlands
Universitair Medisch Centrum
Groningen, Netherlands
Atrium MC parkstad
Heerlen, Netherlands
Erasmus MC
Rotterdam, Netherlands
Spain
Hospital Clínic de Barcelona
Barcelona, Spain
Hospital Universitario Fundación Jiménez Díaz
Madrid, Spain
United Kingdom
The Walton Centre Nhs Foundation Trust
Liverpool, United Kingdom
Kings College Hospital NHS Foundation Trust
London, United Kingdom
St George's Heathcare NHS Trust
London, United Kingdom
Newcastle University, Clinical Ageing Research Unit (CARU)
Newcastle, United Kingdom
Sponsors and Collaborators
Britannia Pharmaceuticals Ltd.
Investigators
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Principal Investigator: Regina Katzenschlager, Doz. Dr. Donauspital KH SMZ Ost, Neurologie

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Britannia Pharmaceuticals Ltd.
ClinicalTrials.gov Identifier: NCT02006121     History of Changes
Other Study ID Numbers: CT-37527-13-0124
2013-000980-10 ( EudraCT Number )
First Posted: December 9, 2013    Key Record Dates
Results First Posted: July 8, 2019
Last Update Posted: July 8, 2019
Last Verified: April 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Britannia Pharmaceuticals Ltd.:
Parkinson's disease
motor fluctuations
not well controlled
medical treatment
apomorphine
Additional relevant MeSH terms:
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Parkinson Disease
Parkinsonian Disorders
Basal Ganglia Diseases
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Movement Disorders
Neurodegenerative Diseases
Apomorphine
Emetics
Physiological Effects of Drugs
Autonomic Agents
Peripheral Nervous System Agents
Gastrointestinal Agents
Dopamine Agonists
Dopamine Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action