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Study to Assess the Clinical Benefit and Safety of Droxidopa in Parkinson's Disease

Primary Purpose

Parkinson's Disease, Freezing of Gait, Cognitive Ability, General

Status
Unknown status
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Droxidopa
sugar pill
Sponsored by
Henry Ford Health System
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Parkinson's Disease focused on measuring Parkinson's disease, Freezing of gait, Gait

Eligibility Criteria

30 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Provide written informed consent to participate in the study
  • Diagnosed with probable levodopa-responsive idiopathic PD (meeting United Kingdom PD Brain Bank diagnostic criteria), and receiving levodopa therapy for this disorder. Other PD medications can also be used.
  • Must have AT LEAST ONE of below two criteria:

    1. At least 3 months incidence of typical freezing of gait symptoms, occurring while levodopa is otherwise providing an "on" mobility state (including at least one of the following Freezing of Gait patterns: start hesitancy, freezing at making turns or when passing through a doorway, spontaneous freezing during continued walking, or Freezing of Gait related to a simultaneous mental or physical activity) OR
    2. Have a screening score between 22 and 26 (inclusive) on the Montreal Cognitive Assessment

Exclusion Criteria:

  • Taking direct acting vasoconstriction agent (i.e. ephedrine or midodrine). Subjects taking vasoconstrictor agents such as ephedrine or midodrine must stop taking these drugs at least 2 days or 5 half-lives (whichever is longer) prior to their baseline visit
  • Taking anti-hypertensive medication for the treatment of hypertension. Anti-hypertensive medication taken at night to prevent supine hypertension will be allowed
  • Changing dose or frequency of PD medication within 2 weeks of baseline
  • Use of cognitive-enhancing medications (donepezil, galantamine, rivastigmine, tacrine, or memantine), catechol-O-methyltransferase inhibitors (tolcapone or entacapone), anticholinergic drugs, or antipsychotic drugs (including quetiapine or clozapine).
  • Known or suspected alcohol or substance abuse within 1 year (e.g. DSM-IV definition of alcoholism)
  • Past or current history of chronic severe hypertension (with repeated findings of BP 150/90 mmHg in the supine or standing position)
  • Symptomatic coronary artery disease, severe congestive heart failure (NYHA Class 3 or 4)
  • Unable to remain off any effective Freezing of Gait medications for 12 hrs prior to Evaluation visits)
  • Women who are pregnant, lactating, or plan to become pregnant during the course of this study
  • Women of child bearing potential who are not using two methods of contraception (at least one barrier, i.e. condom) with their partner.
  • Male subjects who are sexually active with a woman of child bearing potential and not using two methods of contraception (at least one barrier, for example, condom)
  • A history of closed angle glaucoma;
  • Active (in the last 6 months) atrial fibrillation or, in the investigator's opinion, any other significant cardiac arrhythmia that should preclude the subject from this trial
  • History of myocardial infarction or unstable angina
  • Congestive heart failure (NYHA Class 3 or 4)
  • Diabetes insipidus, insulin-dependent diabetes mellitus, or diabetic neuropathy
  • In the investigator's opinion, any other significant systemic illness
  • Known or suspected malignancy (other than basal cell carcinoma)
  • Known gastrointestinal illness or other gastrointestinal disorder that may, in the investigator's opinion, affect the absorption of study drug
  • Any major surgical procedure within 30 days of the baseline visit
  • Currently receiving any investigational drug or have received an investigational drug within 30 days of the baseline visit
  • In the investigator's opinion, clinically significant abnormalities on clinical examination or laboratory testing that should preclude the subject from this trial.
  • Findings from suicidality screening that are compatible with risk for suicide

Sites / Locations

  • Rush University Medical Center
  • Henry Ford Hospital, West Bloomfield

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

Other

Arm Label

droxidopa, then sugar pill

sugar pill, then droxidopa

Arm Description

Droxidopa will be titrated over a 2-week period up to 300 mg twice daily (600 mg total daily dose). Subjects will be titrated to highest tolerated dose and will continue on that dose for two weeks. Then, the subject will start sugar pills.

Subject will be be on sugar pill for 5 weeks (4 weeks of placebo treatment and one week of wash-out or sugar pills). Then, droxidopa will be titrated over 2 week period up to 300 mg twice daily (600 mg total daily dose). Subjects will be titrated to highest tolerated dose and will continue on that dose for two weeks.

Outcomes

Primary Outcome Measures

Change from baseline in freezing of gait symptoms using Freezing of Gait Questionnaire
Evaluate the effect of droxidopa on freezing of gait symptoms using the Freezing of Gait Questionnaire completed by patients. All measures will be performed at baseline and after two and four weeks of study medication.
Change from baseline in cognitive testing
Battery of cognitive testing is performed. All measures will be performed at baseline and after two and four weeks of study medication.

Secondary Outcome Measures

Change in measurement of freezing of gait
Videotaped evaluations quantifying the number of episodes of freezing of gait and their severity will be rated using the Observed Freezing of Gait scale. The Timed Up and Go test will evaluate the effect of droxidopa on PD symptoms. The effect of droxidopa treatment on gait features of stride, swing time variability, and gait asymmetry will be analyzed. All measures will be performed at baseline and after two and four weeks of study medication.
Change in the incidence of falls
Videotaped evaluations quantifying the number of fall episodes will be rated using the Observed Freezing of Gait scale. The Timed Up and Go test will evaluate the effect of droxidopa on PD symptoms and freezing of gait. The effect of droxidopa on falls will be analyzed using the GaitRite system. All measures will be performed at baseline and after two and four weeks of study medication.
Change in signs and symptoms of Parkinson's disease
The UPDRS (Unified Parkinson's Disease Rating Scale) will be performed at baseline and after 2 and 4 weeks on study drug for each arm.
Number of participants with serious and non-serious adverse events
Safety of droxidopa will be evaluated based on the occurrence of treatment emergent adverse events with specific evaluation of blood pressure, heart rate , ECG, suicidality, and laboratory findings across the study

Full Information

First Posted
February 18, 2014
Last Updated
November 2, 2016
Sponsor
Henry Ford Health System
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1. Study Identification

Unique Protocol Identification Number
NCT02066571
Brief Title
Study to Assess the Clinical Benefit and Safety of Droxidopa in Parkinson's Disease
Official Title
A Phase II, Double-Blind, Placebo-Controlled, Crossover Study to Assess Clinical Benefit and Safety of Droxidopa in the Treatment of Parkinson's Disease
Study Type
Interventional

2. Study Status

Record Verification Date
November 2016
Overall Recruitment Status
Unknown status
Study Start Date
March 2015 (undefined)
Primary Completion Date
April 2017 (Anticipated)
Study Completion Date
December 2017 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Henry Ford Health System

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Since droxidopa has been approved in Japan for treating freezing of gait in Parkinson's disease patients, this is to confirm and further investigate the safety and efficacy using a similar dose. The possible beneficial effects on cognition in mildly cognitively impaired Parkinson's disease patients will also be tested, since this problem in Parkinson's disease may be associated with decreased brain synthesis of norepinephrine (a neurotransmitter associated with multiple brain functions). During this 11 week study, droxidopa will be slowly titrated up to 600 mg daily. Walking and freezing of gait will be evaluated and rated. Cognitive functions will be evaluated by a computer-based program.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Parkinson's Disease, Freezing of Gait, Cognitive Ability, General
Keywords
Parkinson's disease, Freezing of gait, Gait

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
droxidopa, then sugar pill
Arm Type
Other
Arm Description
Droxidopa will be titrated over a 2-week period up to 300 mg twice daily (600 mg total daily dose). Subjects will be titrated to highest tolerated dose and will continue on that dose for two weeks. Then, the subject will start sugar pills.
Arm Title
sugar pill, then droxidopa
Arm Type
Other
Arm Description
Subject will be be on sugar pill for 5 weeks (4 weeks of placebo treatment and one week of wash-out or sugar pills). Then, droxidopa will be titrated over 2 week period up to 300 mg twice daily (600 mg total daily dose). Subjects will be titrated to highest tolerated dose and will continue on that dose for two weeks.
Intervention Type
Drug
Intervention Name(s)
Droxidopa
Intervention Description
Droxidopa will be supplied in 100 and 200 mg pill sizes. The proposed dosing is 100mg twice daily at baseline, then titrate to 200 mg twice daily at day 7 and then titrate to 300mg twice daily at day 14. Subjects will stay on the 600mg daily for 2 weeks. Total exposure 28 days of study drug.
Intervention Type
Drug
Intervention Name(s)
sugar pill
Other Intervention Name(s)
placebo
Intervention Description
Sugar pill or placebo will be supplied in pill sizes matched to droxidopa formulation. The study titration will be the same. Sugar pills will be used for 5 weeks during the study.
Primary Outcome Measure Information:
Title
Change from baseline in freezing of gait symptoms using Freezing of Gait Questionnaire
Description
Evaluate the effect of droxidopa on freezing of gait symptoms using the Freezing of Gait Questionnaire completed by patients. All measures will be performed at baseline and after two and four weeks of study medication.
Time Frame
4 weeks
Title
Change from baseline in cognitive testing
Description
Battery of cognitive testing is performed. All measures will be performed at baseline and after two and four weeks of study medication.
Time Frame
4 weeks
Secondary Outcome Measure Information:
Title
Change in measurement of freezing of gait
Description
Videotaped evaluations quantifying the number of episodes of freezing of gait and their severity will be rated using the Observed Freezing of Gait scale. The Timed Up and Go test will evaluate the effect of droxidopa on PD symptoms. The effect of droxidopa treatment on gait features of stride, swing time variability, and gait asymmetry will be analyzed. All measures will be performed at baseline and after two and four weeks of study medication.
Time Frame
4 weeks
Title
Change in the incidence of falls
Description
Videotaped evaluations quantifying the number of fall episodes will be rated using the Observed Freezing of Gait scale. The Timed Up and Go test will evaluate the effect of droxidopa on PD symptoms and freezing of gait. The effect of droxidopa on falls will be analyzed using the GaitRite system. All measures will be performed at baseline and after two and four weeks of study medication.
Time Frame
4 weeks
Title
Change in signs and symptoms of Parkinson's disease
Description
The UPDRS (Unified Parkinson's Disease Rating Scale) will be performed at baseline and after 2 and 4 weeks on study drug for each arm.
Time Frame
4 weeks
Title
Number of participants with serious and non-serious adverse events
Description
Safety of droxidopa will be evaluated based on the occurrence of treatment emergent adverse events with specific evaluation of blood pressure, heart rate , ECG, suicidality, and laboratory findings across the study
Time Frame
up to 11 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
30 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Provide written informed consent to participate in the study Diagnosed with probable levodopa-responsive idiopathic PD (meeting United Kingdom PD Brain Bank diagnostic criteria), and receiving levodopa therapy for this disorder. Other PD medications can also be used. Must have AT LEAST ONE of below two criteria: At least 3 months incidence of typical freezing of gait symptoms, occurring while levodopa is otherwise providing an "on" mobility state (including at least one of the following Freezing of Gait patterns: start hesitancy, freezing at making turns or when passing through a doorway, spontaneous freezing during continued walking, or Freezing of Gait related to a simultaneous mental or physical activity) OR Have a screening score between 22 and 26 (inclusive) on the Montreal Cognitive Assessment Exclusion Criteria: Taking direct acting vasoconstriction agent (i.e. ephedrine or midodrine). Subjects taking vasoconstrictor agents such as ephedrine or midodrine must stop taking these drugs at least 2 days or 5 half-lives (whichever is longer) prior to their baseline visit Taking anti-hypertensive medication for the treatment of hypertension. Anti-hypertensive medication taken at night to prevent supine hypertension will be allowed Changing dose or frequency of PD medication within 2 weeks of baseline Use of cognitive-enhancing medications (donepezil, galantamine, rivastigmine, tacrine, or memantine), catechol-O-methyltransferase inhibitors (tolcapone or entacapone), anticholinergic drugs, or antipsychotic drugs (including quetiapine or clozapine). Known or suspected alcohol or substance abuse within 1 year (e.g. DSM-IV definition of alcoholism) Past or current history of chronic severe hypertension (with repeated findings of BP 150/90 mmHg in the supine or standing position) Symptomatic coronary artery disease, severe congestive heart failure (NYHA Class 3 or 4) Unable to remain off any effective Freezing of Gait medications for 12 hrs prior to Evaluation visits) Women who are pregnant, lactating, or plan to become pregnant during the course of this study Women of child bearing potential who are not using two methods of contraception (at least one barrier, i.e. condom) with their partner. Male subjects who are sexually active with a woman of child bearing potential and not using two methods of contraception (at least one barrier, for example, condom) A history of closed angle glaucoma; Active (in the last 6 months) atrial fibrillation or, in the investigator's opinion, any other significant cardiac arrhythmia that should preclude the subject from this trial History of myocardial infarction or unstable angina Congestive heart failure (NYHA Class 3 or 4) Diabetes insipidus, insulin-dependent diabetes mellitus, or diabetic neuropathy In the investigator's opinion, any other significant systemic illness Known or suspected malignancy (other than basal cell carcinoma) Known gastrointestinal illness or other gastrointestinal disorder that may, in the investigator's opinion, affect the absorption of study drug Any major surgical procedure within 30 days of the baseline visit Currently receiving any investigational drug or have received an investigational drug within 30 days of the baseline visit In the investigator's opinion, clinically significant abnormalities on clinical examination or laboratory testing that should preclude the subject from this trial. Findings from suicidality screening that are compatible with risk for suicide
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Peter LeWitt, M.D.
Organizational Affiliation
Henry Ford Health System
Official's Role
Principal Investigator
Facility Information:
Facility Name
Rush University Medical Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
Facility Name
Henry Ford Hospital, West Bloomfield
City
West Bloomfield
State/Province
Michigan
ZIP/Postal Code
48322
Country
United States

12. IPD Sharing Statement

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Study to Assess the Clinical Benefit and Safety of Droxidopa in Parkinson's Disease

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