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Safety and Efficacy Study of VY-AADC01 for Advanced Parkinson's Disease

Primary Purpose

Idiopathic Parkinson's Disease, Parkinson's Disease, Basal Ganglia Disease

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
VY-AADC01
Sponsored by
Neurocrine Biosciences
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Idiopathic Parkinson's Disease focused on measuring Gene Therapy, PD, Parkinson's Disease, Aromatic L- Amino Acid Decarboxylase, AADC, AAV2-AADC, AAV2, Viral Vector, Gene Transfer, MRI, PET, VY-AADC01

Eligibility Criteria

40 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnosed with idiopathic PD.
  • Adequate duration of levodopa therapy.
  • Disease duration of at least 5 years or more.
  • Modified Hoehn & Yahr Staging with at least 2.5 hours or more in the OFF state.
  • Candidate for surgical intervention because of disabling motor complications.
  • UPDRS Part III (total score) of at least 25 in the OFF state.
  • Unequivocal responsiveness to dopaminergic therapy.
  • Stable Parkinson's symptoms and medications for at least 4 weeks prior to screening evaluation.
  • Ability to comprehend and sign the informed consent.
  • Normal laboratory values prior to surgery.
  • Medically and mentally capable of undergoing and complying with the surgical procedure and protocol requirements.
  • Ability to travel to study visits alone or able to designate a caregiver.
  • Subject agrees to defer any neurological surgery, including deep brain stimulation, until after completing the 12 month study visit (unless recommended by study neurologist).
  • Approved by the Eligibility Review Committee.

Exclusion Criteria:

  • Atypical or secondary parkinsonism, including but not limited to symptoms believed to be due to trauma, brain tumor, infection, cerebrovascular disease, other neurological disease, or to drugs, chemicals, or toxins.
  • Presence of dementia as defined by a Mattis Dementia Rating Scale - Second Edition (MDRS-2) score of less than 130 at screening.
  • Presence or history of psychosis, with the exception of mild, benign hallucinations believed in the judgment of the Investigator to be related to Parkinson's medications.
  • Presence of severe depression, as indicated by a BDI-II score greater than 28, or a history of a major affective disorder within 5 years of screening evaluation.
  • Active suicidal ideation or suicide attempt within 5 years of screening evaluation.
  • History of substance abuse within 2 years of screening evaluation.
  • Brain imaging abnormalities in the striatum or other regions that would substantially increase risk of surgery.
  • Contraindication to MRI and/or gadoteridol.
  • Coagulopathy or inability to temporarily stop any anticoagulation or antiplatelet therapy prior to surgery.
  • Prior brain surgery including lesioning procedures, deep brain stimulation, infusion therapies or any other brain surgery.
  • Prior gene transfer.
  • History of stroke, poorly controlled or significant cardiovascular disease, diabetes, or any other acute or chronic medical condition.
  • History of malignancy other than treated carcinoma in situ within 3 years of screening evaluation.
  • Clinically apparent or laboratory-detected infection.
  • Prior or current treatment with any investigational agent within 2 months of screening evaluation.
  • Inability to comply with the procedures of the protocol, including completion of paper Parkinson's disease diaries, frequent and prolonged study visits including off medication visits, and travel.
  • Chronic immunosuppressive therapy, including chronic steroids, immunotherapy, cytotoxic therapy, and chemotherapy.
  • Any serious medical condition or abnormal finding on physical examination or laboratory investigation that would substantially increase the risks of the study procedures.
  • Any medical condition that is likely to lead to disability during the course of the study and interfere with or confound study assessments.
  • Pregnant and lactating women.
  • Male or female with reproductive capacity who is unwilling to use barrier contraception for 6 months after surgery.
  • Plans to receive any vaccination within 30 days of surgery.
  • Any factors, medical or social, which would likely cause the participant to be unable to follow the study protocol, including geographical inaccessibility.
  • Ongoing treatments including neuroleptic medications, apomorphine, or levodopa infusion therapy (Duopa®).
  • Plans to participate in any other therapeutic intervention study within 12 months after surgery.

Sites / Locations

  • University of California, San Francisco (UCSF)
  • Emory University
  • Ohio State University (OSU)
  • University of Pittsburgh Medical Center (UPMC)

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

VY-AADC01 Single Dose

Arm Description

9.4 x 10^12 vector genomes of VY-AADC01

Outcomes

Primary Outcome Measures

Grading of adverse Events/Serious Adverse Events (AE's/SAE's)
Grading will be assessed using NCI CTCAE, version 4.03.
Magnetic Resonance Imaging (MRI)
Safety of VY-AADC01 will be assessed by any clinically significant abnormalities on MRI scans as compared to Baseline.
Routine physical examinations
Safety of VY-AADC01 will be assessed by routine physical examinations.
Routine clinical laboratory analysis
Safety of VY-AADC01 will be assessed by routine clinical laboratory analysis.
Change in Columbia-Suicide Severity Rating Scale (C-SSRS) results
C-SSRS is a standardized suicidal rating system.

Secondary Outcome Measures

Change in Parkinson's medications
Change in Parkinson's medications compared to Baseline.
Change in motor function using Parkinson Disease Diaries
Diary used to assess changes in PD motor symptoms.
Change in motor function using a Stand-Walk-Sit Test
Standardized test used in PD studies to assess functional mobility.
Change in motor function using Modified Hoehn and Yahr Scale
Scale used to measure overall level of disability due to PD.
Change in motor function using Unified Parkinson's Disease Rating Scale (UPDRS)
Standard assessment scale used to quantify signs and symptoms of PD.
Change in occurrence of dyskinesia using Unified Dyskinesia Rating Scale (UDysRS)
Comprehensive rating tool used to assess essential features of dyskinesia in PD.
Change in mood using Beck Depression Inventory II (BDI-II)
Self-administered measure of depression symptoms.
Change in cognitive function using Modified Cognitive Assessment (MoCA)
Rapid screening instrument for mild cognitive dysfunction.
Change in cognitive function using Mattis Dementia Rating Scale - Second Edition (MDRS-2)
Standardized neuropsychological test battery to measure dementia.
Change in compulsive behavior using the Questionnaire Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS)
Rating scale to quantify the severity of a variety of compulsive disorders and behaviors.
Change in sleep quality and disturbance using the Parkinson's Disease Sleep Scale 2 (PDSS-2)
Visual analogue scale addressing 15 commonly reported symptoms associated with sleep disturbance in PD.
Change in Non-Motor System Scale (NMSS)
Standard rating scale that assesses the non-motor symptoms that may be associated with PD.
Change in quality of life using Parkinson's Disease Questionnaire (PDQ39)
Validated questionnaire to measure health related quality of life in PD patients.
Change in quality of life using Schwab and England Scale
PD specific disability scale used to express the levels of independence with activities of daily living.
Change in quality of life using in Clinical Global Impression Scale (CGI)
Scale used to assess treatment response in psychiatric patients.
Change in quality of life using Patient Global Impression Scale (PGI)
Scale used to assess participants improvement in their PD symptoms.

Full Information

First Posted
February 10, 2017
Last Updated
March 17, 2022
Sponsor
Neurocrine Biosciences
Collaborators
Voyager Therapeutics
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1. Study Identification

Unique Protocol Identification Number
NCT03065192
Brief Title
Safety and Efficacy Study of VY-AADC01 for Advanced Parkinson's Disease
Official Title
An Open-label Safety and Efficacy Study of VY-AADC01 Administered by MRI-Guided Convective Infusion Using a Posterior Trajectory Into the Putamen of Participants With Parkinson's Disease With Fluctuating Responses to Levodopa
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Completed
Study Start Date
May 11, 2017 (Actual)
Primary Completion Date
August 10, 2021 (Actual)
Study Completion Date
August 10, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Neurocrine Biosciences
Collaborators
Voyager Therapeutics

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Safety and efficacy of AADC gene transfer in participants with Parkinson's disease.
Detailed Description
Parkinson's disease (PD) is a neurodegenerative disorder involving loss of dopamine producing neurons located in the striatum. Levodopa is the primary treatment used to treat Parkinson's disease, which converts to dopamine by the enzyme (protein) Aromatic L-Amino Acid Decarboxylase (AADC). As PD progresses, the amount of AADC levels in the brain decreases, and in turn, reduces the amount of dopamine that is produced with each dose of levodopa. The primary objective of this study is to evaluate the safety of increasing AADC levels, via gene delivery. The investigational drug, termed VY-AADC-01, will be injected directly into the striatum during a neurosurgical procedure that is performed with real-time MRI imaging to monitor delivery. Participants will continue to take their Parkinson medications, including levodopa while participating in this study. The safety and potential clinical responses to VY-AADC-01 will be assessed by repeated clinical evaluations of Parkinson's disease, treatment review phone calls, cognitive tests, laboratory blood tests, patient reported outcomes scales, patient diaries, collection of adverse events, and neuro-imaging. Clinical evaluations will be performed over a 3 year follow-up period.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Idiopathic Parkinson's Disease, Parkinson's Disease, Basal Ganglia Disease, Brain Diseases, Central Nervous System Diseases, Movement Disorders, Nervous System Diseases, Neurodegenerative Diseases, Parkinsonian Disorders
Keywords
Gene Therapy, PD, Parkinson's Disease, Aromatic L- Amino Acid Decarboxylase, AADC, AAV2-AADC, AAV2, Viral Vector, Gene Transfer, MRI, PET, VY-AADC01

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
16 (Actual)

8. Arms, Groups, and Interventions

Arm Title
VY-AADC01 Single Dose
Arm Type
Experimental
Arm Description
9.4 x 10^12 vector genomes of VY-AADC01
Intervention Type
Drug
Intervention Name(s)
VY-AADC01
Intervention Description
Single dose, neurosurgically infused, bilaterally into the striatum.
Primary Outcome Measure Information:
Title
Grading of adverse Events/Serious Adverse Events (AE's/SAE's)
Description
Grading will be assessed using NCI CTCAE, version 4.03.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Magnetic Resonance Imaging (MRI)
Description
Safety of VY-AADC01 will be assessed by any clinically significant abnormalities on MRI scans as compared to Baseline.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Routine physical examinations
Description
Safety of VY-AADC01 will be assessed by routine physical examinations.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Routine clinical laboratory analysis
Description
Safety of VY-AADC01 will be assessed by routine clinical laboratory analysis.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Change in Columbia-Suicide Severity Rating Scale (C-SSRS) results
Description
C-SSRS is a standardized suicidal rating system.
Time Frame
Baseline to 3 Years After Gene Transfer
Secondary Outcome Measure Information:
Title
Change in Parkinson's medications
Description
Change in Parkinson's medications compared to Baseline.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Change in motor function using Parkinson Disease Diaries
Description
Diary used to assess changes in PD motor symptoms.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Change in motor function using a Stand-Walk-Sit Test
Description
Standardized test used in PD studies to assess functional mobility.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Change in motor function using Modified Hoehn and Yahr Scale
Description
Scale used to measure overall level of disability due to PD.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Change in motor function using Unified Parkinson's Disease Rating Scale (UPDRS)
Description
Standard assessment scale used to quantify signs and symptoms of PD.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Change in occurrence of dyskinesia using Unified Dyskinesia Rating Scale (UDysRS)
Description
Comprehensive rating tool used to assess essential features of dyskinesia in PD.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Change in mood using Beck Depression Inventory II (BDI-II)
Description
Self-administered measure of depression symptoms.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Change in cognitive function using Modified Cognitive Assessment (MoCA)
Description
Rapid screening instrument for mild cognitive dysfunction.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Change in cognitive function using Mattis Dementia Rating Scale - Second Edition (MDRS-2)
Description
Standardized neuropsychological test battery to measure dementia.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Change in compulsive behavior using the Questionnaire Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS)
Description
Rating scale to quantify the severity of a variety of compulsive disorders and behaviors.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Change in sleep quality and disturbance using the Parkinson's Disease Sleep Scale 2 (PDSS-2)
Description
Visual analogue scale addressing 15 commonly reported symptoms associated with sleep disturbance in PD.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Change in Non-Motor System Scale (NMSS)
Description
Standard rating scale that assesses the non-motor symptoms that may be associated with PD.
Time Frame
Baseline to 3 Years Gene Transfer
Title
Change in quality of life using Parkinson's Disease Questionnaire (PDQ39)
Description
Validated questionnaire to measure health related quality of life in PD patients.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Change in quality of life using Schwab and England Scale
Description
PD specific disability scale used to express the levels of independence with activities of daily living.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Change in quality of life using in Clinical Global Impression Scale (CGI)
Description
Scale used to assess treatment response in psychiatric patients.
Time Frame
Baseline to 3 Years After Gene Transfer
Title
Change in quality of life using Patient Global Impression Scale (PGI)
Description
Scale used to assess participants improvement in their PD symptoms.
Time Frame
Baseline to 3 Years After Gene Transfer

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosed with idiopathic PD. Adequate duration of levodopa therapy. Disease duration of at least 5 years or more. Modified Hoehn & Yahr Staging with at least 2.5 hours or more in the OFF state. Candidate for surgical intervention because of disabling motor complications. UPDRS Part III (total score) of at least 25 in the OFF state. Unequivocal responsiveness to dopaminergic therapy. Stable Parkinson's symptoms and medications for at least 4 weeks prior to screening evaluation. Ability to comprehend and sign the informed consent. Normal laboratory values prior to surgery. Medically and mentally capable of undergoing and complying with the surgical procedure and protocol requirements. Ability to travel to study visits alone or able to designate a caregiver. Subject agrees to defer any neurological surgery, including deep brain stimulation, until after completing the 12 month study visit (unless recommended by study neurologist). Approved by the Eligibility Review Committee. Exclusion Criteria: Atypical or secondary parkinsonism, including but not limited to symptoms believed to be due to trauma, brain tumor, infection, cerebrovascular disease, other neurological disease, or to drugs, chemicals, or toxins. Presence of dementia as defined by a Mattis Dementia Rating Scale - Second Edition (MDRS-2) score of less than 130 at screening. Presence or history of psychosis, with the exception of mild, benign hallucinations believed in the judgment of the Investigator to be related to Parkinson's medications. Presence of severe depression, as indicated by a BDI-II score greater than 28, or a history of a major affective disorder within 5 years of screening evaluation. Active suicidal ideation or suicide attempt within 5 years of screening evaluation. History of substance abuse within 2 years of screening evaluation. Brain imaging abnormalities in the striatum or other regions that would substantially increase risk of surgery. Contraindication to MRI and/or gadoteridol. Coagulopathy or inability to temporarily stop any anticoagulation or antiplatelet therapy prior to surgery. Prior brain surgery including lesioning procedures, deep brain stimulation, infusion therapies or any other brain surgery. Prior gene transfer. History of stroke, poorly controlled or significant cardiovascular disease, diabetes, or any other acute or chronic medical condition. History of malignancy other than treated carcinoma in situ within 3 years of screening evaluation. Clinically apparent or laboratory-detected infection. Prior or current treatment with any investigational agent within 2 months of screening evaluation. Inability to comply with the procedures of the protocol, including completion of paper Parkinson's disease diaries, frequent and prolonged study visits including off medication visits, and travel. Chronic immunosuppressive therapy, including chronic steroids, immunotherapy, cytotoxic therapy, and chemotherapy. Any serious medical condition or abnormal finding on physical examination or laboratory investigation that would substantially increase the risks of the study procedures. Any medical condition that is likely to lead to disability during the course of the study and interfere with or confound study assessments. Pregnant and lactating women. Male or female with reproductive capacity who is unwilling to use barrier contraception for 6 months after surgery. Plans to receive any vaccination within 30 days of surgery. Any factors, medical or social, which would likely cause the participant to be unable to follow the study protocol, including geographical inaccessibility. Ongoing treatments including neuroleptic medications, apomorphine, or levodopa infusion therapy (Duopa®). Plans to participate in any other therapeutic intervention study within 12 months after surgery.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Steve Hersch, MD
Organizational Affiliation
Voyager Therapeutics, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
University of California, San Francisco (UCSF)
City
San Francisco
State/Province
California
ZIP/Postal Code
94143
Country
United States
Facility Name
Emory University
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States
Facility Name
Ohio State University (OSU)
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States
Facility Name
University of Pittsburgh Medical Center (UPMC)
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Links:
URL
http://voyagertherapeutics.com/
Description
Company Website

Learn more about this trial

Safety and Efficacy Study of VY-AADC01 for Advanced Parkinson's Disease

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