Safinamide for Multiple System Atrophy (MSA)
Primary Purpose
Multiple System Atrophy
Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Safinamide Methanesulfonate
Safinamide Methanesulfonate matching placebo
Sponsored by
About this trial
This is an interventional treatment trial for Multiple System Atrophy focused on measuring MSA, safinamide
Eligibility Criteria
Inclusion Criteria:
- Participant must be 30 to 80 years of age inclusive, at the time of signing the informed consent;
- Participants who are diagnosed (with MRI confirmation) with possible or probable parkinsonian variant of Multiple System Atrophy less than 2 years ago;
- Participants with an anticipated survival of at least 3 years in the opinion of the investigator;
Female not pregnant, not breastfeeding, and at least one of the following conditions applies:
- Not a woman of childbearing potential OR
- A woman of childbearing potential who agrees to follow the contraceptive guidance during the treatment period and for at least 30 days after the last dose of study intervention;
- Capable of giving signed informed consent
Exclusion Criteria:
- History of neurosurgical procedure, including stereotactic surgery;
- History of Deep Brain Stimulation (DBS);
- History of bipolar disorder, severe depression, schizophrenia or other psychotic disorder;
- History of drug and/or alcohol abuse within 12 months prior to screening as defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders;
- History of dementia (DSM-V criteria);
- Ophthalmologic history including any of the following conditions: albinism, uveitis, retinitis pigmentosa, retinal degeneration, active retinopathy, severe progressive diabetic retinopathy, inherited retinopathy or family history of hereditary retinal disease;
- Active hepatitis B or C;
- History of human immunodeficiency virus (HIV) infection;
- Subjects not able to swallow oral medications;
- Subjects with severe orthostatic symptoms;
- Impaired ambulation, i.e. falling more than once per week, bedridden patients or confined to a wheelchair during the whole day;
- Subjects with active malignant neoplasms;
- Movement disorders other than MSA (e.g. Parkinson Disease, dementia with Lewy bodies, essential tremor, progressive supranuclear palsy, pharmacological or post-encephalic parkinsonism);
- Any clinically significant or unstable medical or surgical condition that, in the opinion of the investigator, might preclude safe completion of the study or might affect the results of the study;
Not on a stable regime, for at least 4 weeks prior to the randomization (baseline visit), of
- oral levodopa (including controlled release, immediate release or a combination of controlled release/immediate release), with or without benserazide/carbidopa, with or without addition of a catechol O-methyltransferase (COMT) inhibitor or
- dopamine agonist, anticholinergic and/or amantadine.
- Patients should not have received treatment with monoamine oxidase inhibitors in the 2 weeks prior to the randomization visit, nor treatment with levodopa infusion, pethidine, opiates, opioids, fluoxetine, fluvoxamine in the 4 weeks prior to the randomization visit;
- Patients should not have received treatment with an oral or depot neuroleptic within 12 weeks prior to the randomization visit;
- Use of any investigational drug within 30 days prior to screening or 5 half-lives, whichever is the longest;
- Montreal Cognitive Assessment (MoCA) ≤ 20;
- Laboratory assessments showing moderate or severe hepatic impairment (2x ULN);
- Allergy/sensitivity or contraindications to the investigational medicinal products (IMPs) or their excipients, anticonvulsants, levodopa or other anti-parkinsonian drugs;
- Any clinically significant condition which, in the opinion of the Investigator, would not be compatible with study participation or represent a risk for patients while in the study.
Sites / Locations
- Università di Bologna
- AAST degli Spedali Civili di Brescia
- San Raffaele Cassino
- Fondazione Università "G. D'Annunzio"
- Fondazione IRCCS Istituto Neurologico Carlo Besta
- Azienda Ospedaliera Universitaria - Università degli Studi della Campania Luigi Vanvitelli
- Azienda Ospedaliera di Padova
- Azienda Opsedaliero Universitaria Pisana
- Istituto Clinico Humanitas
- Azienda Ospedaliera Universitaria OO.RR. San Giovanni di Dio - Ruggi d'Aragona
- Azienda Ospedaliera Santa Maria di Terni
- Hospital General Universitario de Elche
- Hospital de Cruces
- Hospital de la Santa Creu i Sant Pau Barcelona
- Hospital Universitario Gregorio Maranon
- Hospital Universitario Puerta de Hierro Majadahonda
- Hospital Universitario Ramon y Cajal
- Hospital Universitario Virgen Macarena
- Hospital Universitario Virgen de Rocio
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Placebo Comparator
Arm Label
Active
Placebo
Arm Description
Safinamide methanesulfonate film-coated tablets once daily
Safinamide Methanesulfonate matching placebo film-coated tablets once daily
Outcomes
Primary Outcome Measures
TEAEs (Treatment Emergent Adverse Events) and SAEs (Serious Adverse Events)
While evaluating safety and tolerability of safinamide, 200 mg od, compared with placebo, severity of TEAEs, their relationship to study drug, their seriousness and their consequences were assessed. TEAEs were defined as adverse events (AEs) that started after the first dose of study drug.
Secondary Outcome Measures
Change From Baseline to Week 12 in the Goniometric Measurement for Anterior Displacement
To evaluate the potential efficacy of safinamide 200 mg od, as add-on therapy, on quality of life (change in anterior displacement). The goniometric measurement consists in the posture evaluation of the patient, measuring through a goniometer the angle of the flexion of the trunk. Goniometric measurement of "anterior" displacement was determined using a wall goniometer and expressing the value in degrees in the range of 0 to 90.
Change From Baseline to Week 12 in the Goniometric Measurement for Lateral Displacement
To evaluate the potential efficacy of safinamide 200 mg od, as add-on therapy, on quality of life (change in anterior displacement). The goniometric measurement consists in the posture evaluation of the patient, measuring through a goniometer the angle of the flexion of the trunk. Goniometric measurement of "lateral" displacement was determined using a wall goniometer and expressing the value in degrees in the range of 0 to 90.
Change From Baseline to Week 12 in Unified Multiple System Atrophy Rating Scale (UMSARS), Part II (ITT Population)
UMSARS is a validated, disease-specific scale representing the diverse signs and symptoms in MSA. Higher scores on the UMSARS scales mean poorer health.
UMSARS has the following domains:
Part I - Activities of Daily Living score (12 questions ranged in 0-4 [total score 0-48]) that evaluates motor including autonomic activities Part II - Motor Examination score (14 questions, [total score 0-56]) Part III - Autonomic Examination Part IV - Global disability scale ((1=completely independent; 2=not completely independent; 3=more dependent; 4=very dependent; 5=total dependent and helpless).
Only UMSARS Part II total score is reported, which was obtained as the sum of the 14 items in the scale. If any of the items were missing, then the total score was considered missing. Higher scores indicate worse functional situation.
Change From Baseline to Week 12 in Unified Multiple System Atrophy Rating Scale (UMSARS), Part II (PP Population)
UMSARS is a validated, disease-specific scale representing the diverse signs and symptoms in MSA. Higher scores on the UMSARS scales mean poorer health.
UMSARS has the following domains:
Part I - Activities of Daily Living score (12 questions ranged in 0-4 [total score 0-48]) that evaluates motor including autonomic activities Part II - Motor Examination score (14 questions, [total score 0-56]) Part III - Autonomic Examination Part IV - Global disability scale ((1=completely independent; 2=not completely independent; 3=more dependent; 4=very dependent; 5=total dependent and helpless).
Only UMSARS Part II total score is reported, which was obtained as the sum of the 14 items in the scale. If any of the items were missing, then the total score was considered missing. Higher scores indicate worse functional situation.
Change From Baseline to Week 12 in Multiple System Atrophy Health-Related Quality of Life (MSA-QoL) Scale
The MSA-QoL is a self-reported questionnaire focusing on MSA-specific symptoms and has a scale ranging from 0 to 160, with 0= 'no problem' and 160= "extreme problem".
Change From Baseline to Week 12 in Montreal Cognitive Assessment (MoCA) Scale
The Montreal Cognitive Assessment (MoCA) was designed as a tool for rapid screening for mild cognitive impairment. It evaluates different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructive skills, abstraction, calculation and orientation. The administration time of the MoCa is 10 minutes. The MoCA scale ranges from 0 to 30, with higher scores indicating better cognitive functioning.
Change From Baseline to Week 12 in Unified Dystonia Rating Scale (UDRS)
UDRS consists of a Historical Section, divided into questionnaires about 1) on-dyskinesia and 2) off -dystonia, and an Objective Section, divided into 3) impairment and 4) disability scales. The Historical Section is scored from 0-60, and the Objective section is scored 0-44, where higher scores reflect greater difficulty or impairment.
The Unified Dystonia Rating Scale (UDRS) assesses the motor severity and duration of dystonia in 14 body areas. The total score, obtained as the sum of the severity and duration factors, ranges from 0 to 112. Higher scores indicate worse dystonia.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT03753763
Brief Title
Safinamide for Multiple System Atrophy (MSA)
Official Title
12-weeks, Multicentre, Randomized, Double-blind, Placebo-controlled, Exploratory, Pilot Study to Evaluate the Safety and Efficacy of Safinamide 200 mg OD, as add-on Therapy, in Patients With Possible or Probable Parkinsonian Variant of MSA
Study Type
Interventional
2. Study Status
Record Verification Date
July 2021
Overall Recruitment Status
Completed
Study Start Date
October 29, 2019 (Actual)
Primary Completion Date
January 5, 2021 (Actual)
Study Completion Date
January 5, 2021 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Zambon SpA
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
The study is a placebo controlled study, with two parallel arms, in which participants will be randomly assigned in a 2:1 ratio to receive either active (200 mg safinamide) or placebo in a double blind manner. Study population is patients diagnosed, with possible or probable parkinsonian variant of Multiple System Atrophy who are on a stable treatment of levodopa
Detailed Description
The overall design is a parallel group, placebo controlled, double blind study. The target population are participants diagnosed with possible or probable parkinsonian variant of Multiple System Atrophy who are on stable doses of levodopa.
Trial participation will be up to a maximum duration of 14 weeks and will comprise a screening period (up to 2 weeks), a 2-week run in period during which subjects will receive 1 tablet (either 100 mg safinamide or matching placebo), followed by a 10-week period, during which study participants will take 2 tablets of study medication (200 mg safinamide or placebo) once daily, taken in the morning in addition to their morning levodopa dose. A telephone follow-up call will be performed 2 weeks after the end of treatment.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple System Atrophy
Keywords
MSA, safinamide
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
49 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Active
Arm Type
Experimental
Arm Description
Safinamide methanesulfonate film-coated tablets once daily
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Safinamide Methanesulfonate matching placebo film-coated tablets once daily
Intervention Type
Drug
Intervention Name(s)
Safinamide Methanesulfonate
Other Intervention Name(s)
Xadago
Intervention Description
100 mg (free base)
Intervention Type
Drug
Intervention Name(s)
Safinamide Methanesulfonate matching placebo
Other Intervention Name(s)
placebo
Intervention Description
100 mg placebo
Primary Outcome Measure Information:
Title
TEAEs (Treatment Emergent Adverse Events) and SAEs (Serious Adverse Events)
Description
While evaluating safety and tolerability of safinamide, 200 mg od, compared with placebo, severity of TEAEs, their relationship to study drug, their seriousness and their consequences were assessed. TEAEs were defined as adverse events (AEs) that started after the first dose of study drug.
Time Frame
Throughout the study, from baseline (and at each interim visit) to telephone follow-up visit at 14 week.
Secondary Outcome Measure Information:
Title
Change From Baseline to Week 12 in the Goniometric Measurement for Anterior Displacement
Description
To evaluate the potential efficacy of safinamide 200 mg od, as add-on therapy, on quality of life (change in anterior displacement). The goniometric measurement consists in the posture evaluation of the patient, measuring through a goniometer the angle of the flexion of the trunk. Goniometric measurement of "anterior" displacement was determined using a wall goniometer and expressing the value in degrees in the range of 0 to 90.
Time Frame
From baseline to week 12
Title
Change From Baseline to Week 12 in the Goniometric Measurement for Lateral Displacement
Description
To evaluate the potential efficacy of safinamide 200 mg od, as add-on therapy, on quality of life (change in anterior displacement). The goniometric measurement consists in the posture evaluation of the patient, measuring through a goniometer the angle of the flexion of the trunk. Goniometric measurement of "lateral" displacement was determined using a wall goniometer and expressing the value in degrees in the range of 0 to 90.
Time Frame
From baseline to week 12
Title
Change From Baseline to Week 12 in Unified Multiple System Atrophy Rating Scale (UMSARS), Part II (ITT Population)
Description
UMSARS is a validated, disease-specific scale representing the diverse signs and symptoms in MSA. Higher scores on the UMSARS scales mean poorer health.
UMSARS has the following domains:
Part I - Activities of Daily Living score (12 questions ranged in 0-4 [total score 0-48]) that evaluates motor including autonomic activities Part II - Motor Examination score (14 questions, [total score 0-56]) Part III - Autonomic Examination Part IV - Global disability scale ((1=completely independent; 2=not completely independent; 3=more dependent; 4=very dependent; 5=total dependent and helpless).
Only UMSARS Part II total score is reported, which was obtained as the sum of the 14 items in the scale. If any of the items were missing, then the total score was considered missing. Higher scores indicate worse functional situation.
Time Frame
From baseline to week 12
Title
Change From Baseline to Week 12 in Unified Multiple System Atrophy Rating Scale (UMSARS), Part II (PP Population)
Description
UMSARS is a validated, disease-specific scale representing the diverse signs and symptoms in MSA. Higher scores on the UMSARS scales mean poorer health.
UMSARS has the following domains:
Part I - Activities of Daily Living score (12 questions ranged in 0-4 [total score 0-48]) that evaluates motor including autonomic activities Part II - Motor Examination score (14 questions, [total score 0-56]) Part III - Autonomic Examination Part IV - Global disability scale ((1=completely independent; 2=not completely independent; 3=more dependent; 4=very dependent; 5=total dependent and helpless).
Only UMSARS Part II total score is reported, which was obtained as the sum of the 14 items in the scale. If any of the items were missing, then the total score was considered missing. Higher scores indicate worse functional situation.
Time Frame
From baseline to week 12
Title
Change From Baseline to Week 12 in Multiple System Atrophy Health-Related Quality of Life (MSA-QoL) Scale
Description
The MSA-QoL is a self-reported questionnaire focusing on MSA-specific symptoms and has a scale ranging from 0 to 160, with 0= 'no problem' and 160= "extreme problem".
Time Frame
From baseline to week 12
Title
Change From Baseline to Week 12 in Montreal Cognitive Assessment (MoCA) Scale
Description
The Montreal Cognitive Assessment (MoCA) was designed as a tool for rapid screening for mild cognitive impairment. It evaluates different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructive skills, abstraction, calculation and orientation. The administration time of the MoCa is 10 minutes. The MoCA scale ranges from 0 to 30, with higher scores indicating better cognitive functioning.
Time Frame
From baseline to week 12
Title
Change From Baseline to Week 12 in Unified Dystonia Rating Scale (UDRS)
Description
UDRS consists of a Historical Section, divided into questionnaires about 1) on-dyskinesia and 2) off -dystonia, and an Objective Section, divided into 3) impairment and 4) disability scales. The Historical Section is scored from 0-60, and the Objective section is scored 0-44, where higher scores reflect greater difficulty or impairment.
The Unified Dystonia Rating Scale (UDRS) assesses the motor severity and duration of dystonia in 14 body areas. The total score, obtained as the sum of the severity and duration factors, ranges from 0 to 112. Higher scores indicate worse dystonia.
Time Frame
From baseline to week 12
10. Eligibility
Sex
All
Minimum Age & Unit of Time
30 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Participant must be 30 to 80 years of age inclusive, at the time of signing the informed consent;
Participants who are diagnosed (with MRI confirmation) with possible or probable parkinsonian variant of Multiple System Atrophy less than 2 years ago;
Participants with an anticipated survival of at least 3 years in the opinion of the investigator;
Female not pregnant, not breastfeeding, and at least one of the following conditions applies:
Not a woman of childbearing potential OR
A woman of childbearing potential who agrees to follow the contraceptive guidance during the treatment period and for at least 30 days after the last dose of study intervention;
Capable of giving signed informed consent
Exclusion Criteria:
History of neurosurgical procedure, including stereotactic surgery;
History of Deep Brain Stimulation (DBS);
History of bipolar disorder, severe depression, schizophrenia or other psychotic disorder;
History of drug and/or alcohol abuse within 12 months prior to screening as defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders;
History of dementia (DSM-V criteria);
Ophthalmologic history including any of the following conditions: albinism, uveitis, retinitis pigmentosa, retinal degeneration, active retinopathy, severe progressive diabetic retinopathy, inherited retinopathy or family history of hereditary retinal disease;
Active hepatitis B or C;
History of human immunodeficiency virus (HIV) infection;
Subjects not able to swallow oral medications;
Subjects with severe orthostatic symptoms;
Impaired ambulation, i.e. falling more than once per week, bedridden patients or confined to a wheelchair during the whole day;
Subjects with active malignant neoplasms;
Movement disorders other than MSA (e.g. Parkinson Disease, dementia with Lewy bodies, essential tremor, progressive supranuclear palsy, pharmacological or post-encephalic parkinsonism);
Any clinically significant or unstable medical or surgical condition that, in the opinion of the investigator, might preclude safe completion of the study or might affect the results of the study;
Not on a stable regime, for at least 4 weeks prior to the randomization (baseline visit), of
oral levodopa (including controlled release, immediate release or a combination of controlled release/immediate release), with or without benserazide/carbidopa, with or without addition of a catechol O-methyltransferase (COMT) inhibitor or
dopamine agonist, anticholinergic and/or amantadine.
Patients should not have received treatment with monoamine oxidase inhibitors in the 2 weeks prior to the randomization visit, nor treatment with levodopa infusion, pethidine, opiates, opioids, fluoxetine, fluvoxamine in the 4 weeks prior to the randomization visit;
Patients should not have received treatment with an oral or depot neuroleptic within 12 weeks prior to the randomization visit;
Use of any investigational drug within 30 days prior to screening or 5 half-lives, whichever is the longest;
Montreal Cognitive Assessment (MoCA) ≤ 20;
Laboratory assessments showing moderate or severe hepatic impairment (2x ULN);
Allergy/sensitivity or contraindications to the investigational medicinal products (IMPs) or their excipients, anticonvulsants, levodopa or other anti-parkinsonian drugs;
Any clinically significant condition which, in the opinion of the Investigator, would not be compatible with study participation or represent a risk for patients while in the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Charlotte Keywood, MD
Organizational Affiliation
Zambon SpA
Official's Role
Study Director
Facility Information:
Facility Name
Università di Bologna
City
Bologna
ZIP/Postal Code
40123
Country
Italy
Facility Name
AAST degli Spedali Civili di Brescia
City
Brescia
ZIP/Postal Code
25123
Country
Italy
Facility Name
San Raffaele Cassino
City
Cassino
ZIP/Postal Code
03043
Country
Italy
Facility Name
Fondazione Università "G. D'Annunzio"
City
Chieti
ZIP/Postal Code
66013
Country
Italy
Facility Name
Fondazione IRCCS Istituto Neurologico Carlo Besta
City
Milano
ZIP/Postal Code
20133
Country
Italy
Facility Name
Azienda Ospedaliera Universitaria - Università degli Studi della Campania Luigi Vanvitelli
City
Napoli
ZIP/Postal Code
80138
Country
Italy
Facility Name
Azienda Ospedaliera di Padova
City
Padova
ZIP/Postal Code
35128
Country
Italy
Facility Name
Azienda Opsedaliero Universitaria Pisana
City
Pisa
ZIP/Postal Code
56126
Country
Italy
Facility Name
Istituto Clinico Humanitas
City
Rozzano
ZIP/Postal Code
20089
Country
Italy
Facility Name
Azienda Ospedaliera Universitaria OO.RR. San Giovanni di Dio - Ruggi d'Aragona
City
Salerno
ZIP/Postal Code
84131
Country
Italy
Facility Name
Azienda Ospedaliera Santa Maria di Terni
City
Terni
ZIP/Postal Code
05100
Country
Italy
Facility Name
Hospital General Universitario de Elche
City
Alicante
ZIP/Postal Code
03203
Country
Spain
Facility Name
Hospital de Cruces
City
Barakaldo
ZIP/Postal Code
48903
Country
Spain
Facility Name
Hospital de la Santa Creu i Sant Pau Barcelona
City
Barcelona
ZIP/Postal Code
08025
Country
Spain
Facility Name
Hospital Universitario Gregorio Maranon
City
Madrid
ZIP/Postal Code
28007
Country
Spain
Facility Name
Hospital Universitario Puerta de Hierro Majadahonda
City
Madrid
ZIP/Postal Code
28222
Country
Spain
Facility Name
Hospital Universitario Ramon y Cajal
City
Madrid
ZIP/Postal Code
28304
Country
Spain
Facility Name
Hospital Universitario Virgen Macarena
City
Sevilla
ZIP/Postal Code
41009
Country
Spain
Facility Name
Hospital Universitario Virgen de Rocio
City
Sevilla
ZIP/Postal Code
41013
Country
Spain
12. IPD Sharing Statement
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Safinamide for Multiple System Atrophy (MSA)
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