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Intranasal Insulin in Parkinson's Disease (INI-PD)

Primary Purpose

Parkinson Disease

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Regular Novolin R
Placebo
Sponsored by
HealthPartners Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Parkinson Disease focused on measuring intranasal, insulin

Eligibility Criteria

41 Years - 89 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Subject has Idiopathic PD defined by the cardinal sign, bradykinesia, plus the presence of at least 1 of the following: resting tremor or rigidity and without any other known or suspected cause of Parkinsonism (according to Movement disorder society (MDS) clinical diagnostic criteria for Parkinson's disease confirmed by a fellowship trained movements disorder specialist
  • Subject is Hoehn & Yahr stage less than or equal to 3
  • Subject has a MOCA score ≥10.
  • Subject is > 40 and <90 years of age.
  • Female subjects are post-menopausal or have a negative pregnancy test
  • The subject must be proficient in speaking, reading and understanding English in order to comply with procedural testing of cognitive function, memory and physiology.
  • Subject has provided informed written consent prior to participation. In the event that subject is legally unable to provide informed written consent due to deterioration in cognitive abilities, fully informed written consent must be provided by a legally authorized representative.
  • Subject is on a stable dose (at least 1 month prior to baseline visit) of antiparkinsonian agents and is willing to remain on this dose for the duration of the study. If the subject is on a cholinesterase inhibitor, a stable dose without changes for 1 month is also required.
  • Subject has undergone a brain CT or MRI prior to the study as part of their previous diagnostic workup for PD to rule out underlying structural lesions, as determined clinically significant by the investigator

Exclusion Criteria:

  • Subject has atypical Parkinson's syndrome(s) due to drugs (e.g., metoclopramide, neuroleptics), metabolic neurogenetic disorders (e.g., Wilson's Disease), encephalitis, cerebrovascular disease, or degenerative disease (e.g., Progressive Supranuclear Palsy, Multiple System Atrophy, Corticobasal Degeneration, Lewy Body dementia)
  • Subject has medical history and/or clinically determined disorders: chronic sinusitis, untreated thyroid disease, or significant head trauma.
  • Subject has history of any of the following: moderate to severe pulmonary disease, poorly controlled congestive heart failure, significant cardiovascular and/or cerebrovascular events within previous 6 months, condition known to affect absorption, distribution, metabolism, or excretion of drugs such as any hepatic, renal or gastrointestinal disease or any other clinically relevant abnormality that inclusion would pose a safety risk to the subject as determined by investigator.
  • Subject has had previous nasal and/or oto-pharyngeal surgery and severe deviated septum and/or other anomalies.
  • Subject has history of any psychiatric illness that would pose a safety risk to the subject as determined by investigator.
  • Subject is currently taking sedative medications that are clinically contraindicated as determined by investigator.
  • Subject has undergone a recent change (<1 month) in their anti-parkinsonian medication, cholinesterase inhibitor or anti-depressant medication.
  • Subject has current or recent drug or alcohol abuse or dependence as defined by Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV TR).
  • Screening laboratory results that are medically relevant, in which inclusion would pose a safety risk to the subject as determined by investigator.
  • Subject has participated in a clinical trial investigation within 3 months of this study.
  • Subject has an insulin allergy.
  • Subject has Insulin-dependent diabetes

Sites / Locations

  • HealthPartners Neuroscience CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Placebo Comparator

Arm Label

Low Insulin

Medium Insulin

High Insulin

Placebo

Arm Description

Regular insulin (Novolin-R) 20 international units (10 units) in one nostril twice daily for 21 days, 100 µl volume.

Regular insulin (Novolin-R) 40 international units (10 units) in each nostril twice daily for 21 days, 100 µl volume.

Regular insulin (Novolin-R) 80 international units (10 units) in each nostril twice daily for 21 days, 200 µl volume.

0.9% sodium chloride in each nostril twice daily for 21 days, 100 µl volume.

Outcomes

Primary Outcome Measures

Safety measured by count of safety events
Composite safety event - this is a count of either a reduction of fasting glucose to <70 mg/dL or an unintended reduction of weight >5%. A larger composite event count indicates a less safe treatment.
Safety measured by fasting glucose
Pre-post change in fasting glucose (mg/dL). A larger decrease in fasting glucose indicates a less safe treatment.
Safety measured by body weight
Pre-post change in body weight (lbs). An unintended decrease in body weight indicates a less safe treatment.
Safety measured by the number of serious adverse events (SAE) and adverse events (AE)
Total number of AEs/SAEs during the course of treatment. More AEs/SAEs indicates a less safe treatment.

Secondary Outcome Measures

Cognitive function measured by the Montreal cognitive assessment (MoCA)
Pre-post difference. Total sum of scores. Range: 0-30. Higher score indicates less memory loss
Cognitive function measured by the Weschler Adult Intelligence Scale - Fourth Edition (WAIS-IV) Digit Span
Pre-post difference. Scaled score. Range: 1-19. Forward and backward. Lower score indicates more impairment.
Cognitive function measured by the Trailmaking Test Part A Time
Pre-post difference. T-score. Range: 0-25. Lower score indicates more impairment.
Cognitive function measured by the Trailmaking Test Part B Time
Pre-post difference. T-score. Range: 0-26. Lower score indicates more impairment.
Cognitive function measured by the Trailmaking Test Parts A & B Errors
Pre-post difference. Total number of errors. No range. More errors indicate more impairment.
Cognitive function measured by the Judgement of Line Orientation
Pre-post difference. Z-score. Range: 0-29. Lower score indicates more impairment.
Cognitive function measured by the Logical Memory Scaled Scores
Pre-post difference. Scaled score. Range: 1-19. Logical memory immediate, delayed and recognition. Lower score indicates more impairment.
Cognitive function measured by the Logical Memory Recognition
Pre-post difference. No range. Lower score indicates more impairment.
Cognitive function measured by the Hopkins Verbal Learning Test - Revised (HVLT)
Pre-post difference. T-score. Range: 0-12. Immediate recall, delayed recall, and recognition. Lower score indicates more impairment.
Cognitive function measured by the Visuospatial Memory Test - Revised (BVMT)
Pre-post difference. T-score. Range: 0-6. Immediate recall, delayed recall, and recognition. Lower score indicates more impairment.
Cognitive function measured by the Stroop Color Word Test (CWT)
Pre-post difference. T-score. Range: 0-25. Word reading, color naming, color-word, and interference. Lower score indicates more impairment.
Cognitive function measured by Fluency
Pre-post difference. T-score. No range. Letter fluency and category fluency. Lower score indicates more impairment.
Mood measured by the Beck Depression Inventory - Second Edition
Pre-post difference. Raw score. Range: 0-63. Higher score indicates more symptomatic.
Apathy measured by the Apathy scale
Pre-post difference. Raw score. Range: 0-42. Higher score indicates more symptomatic.
Mood measured by the Columbia Suicide Severity Rating (C-SSRS)
Pre-post difference. Raw score. Range:1 or 0. 1 score - more symptomatic, 0 score - no symptoms.
Motor function as measured by the United Parkinson's Disease Rating Scale (UPDRS)
Pre-post difference. Raw score. Range: 0-72. Higher score indicates more symptomatic.

Full Information

First Posted
January 28, 2020
Last Updated
July 10, 2023
Sponsor
HealthPartners Institute
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1. Study Identification

Unique Protocol Identification Number
NCT04251585
Brief Title
Intranasal Insulin in Parkinson's Disease
Acronym
INI-PD
Official Title
Single Center Safety and Tolerability Trial of Intranasal Insulin in Parkinson's Disease
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 4, 2020 (Actual)
Primary Completion Date
October 2023 (Anticipated)
Study Completion Date
December 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
HealthPartners Institute

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
This project will investigate exploratory outcomes related to the effect of intranasal insulin on cognition, mood, apathy and motor performance of subjects with Parkinson's disease over a 3 week period.
Detailed Description
Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's dementia and was originally described as a motor disease. The diagnosis of PD is still based on the core motor features of bradykinesia, resting tremor, and rigidity, primarily as a result of degeneration of nigrostriatal dopaminergic neurons. In addition to the classic motor symptoms, however, PD is increasingly recognized as a multisystem disorder. A variety of non-motor symptoms, including cognitive deficits and dementia, are commonly observed in patients with PD. In this study, we aim to investigate which intranasal insulin dose out of three doses and placebo, administered at three different doses or placebo over a 21-day period, is the optimum dosage based on safety and tolerability in Parkinson's disease. A similar design was used in a trial investigating intranasal oxytocin in frontotemporal dementia. Dosing for the first two groups of this study is based on previously conducted intranasal insulin studies in Alzheimer's disease (AD) and mild cognitive impairment (MCI), using daily doses on 20 and 40 IU of intranasal insulin. Higher dose have been found to be safe in healthy adults. Prior studies performed have demonstrated favorable effects of this regimen in the MCI/AD population without peripheral hypoglycemia.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Parkinson Disease
Keywords
intranasal, insulin

7. Study Design

Primary Purpose
Other
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Participants will be randomly assigned to one of 3 treatment groups or the placebo group. 20 international units twice daily (n=7) 40 international units twice daily (n=7) 80 international units twice daily (n=9) placebo (n=7)
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
All participants, care providers, investigators, and outcomes assessors are masked.
Allocation
Randomized
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Low Insulin
Arm Type
Experimental
Arm Description
Regular insulin (Novolin-R) 20 international units (10 units) in one nostril twice daily for 21 days, 100 µl volume.
Arm Title
Medium Insulin
Arm Type
Experimental
Arm Description
Regular insulin (Novolin-R) 40 international units (10 units) in each nostril twice daily for 21 days, 100 µl volume.
Arm Title
High Insulin
Arm Type
Experimental
Arm Description
Regular insulin (Novolin-R) 80 international units (10 units) in each nostril twice daily for 21 days, 200 µl volume.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
0.9% sodium chloride in each nostril twice daily for 21 days, 100 µl volume.
Intervention Type
Drug
Intervention Name(s)
Regular Novolin R
Intervention Description
Intranasal insulin
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Intranasal placebo (0.9% saline)
Primary Outcome Measure Information:
Title
Safety measured by count of safety events
Description
Composite safety event - this is a count of either a reduction of fasting glucose to <70 mg/dL or an unintended reduction of weight >5%. A larger composite event count indicates a less safe treatment.
Time Frame
3 weeks
Title
Safety measured by fasting glucose
Description
Pre-post change in fasting glucose (mg/dL). A larger decrease in fasting glucose indicates a less safe treatment.
Time Frame
3 weeks
Title
Safety measured by body weight
Description
Pre-post change in body weight (lbs). An unintended decrease in body weight indicates a less safe treatment.
Time Frame
3 weeks
Title
Safety measured by the number of serious adverse events (SAE) and adverse events (AE)
Description
Total number of AEs/SAEs during the course of treatment. More AEs/SAEs indicates a less safe treatment.
Time Frame
3 weeks
Secondary Outcome Measure Information:
Title
Cognitive function measured by the Montreal cognitive assessment (MoCA)
Description
Pre-post difference. Total sum of scores. Range: 0-30. Higher score indicates less memory loss
Time Frame
5 weeks
Title
Cognitive function measured by the Weschler Adult Intelligence Scale - Fourth Edition (WAIS-IV) Digit Span
Description
Pre-post difference. Scaled score. Range: 1-19. Forward and backward. Lower score indicates more impairment.
Time Frame
3 weeks
Title
Cognitive function measured by the Trailmaking Test Part A Time
Description
Pre-post difference. T-score. Range: 0-25. Lower score indicates more impairment.
Time Frame
3 weeks
Title
Cognitive function measured by the Trailmaking Test Part B Time
Description
Pre-post difference. T-score. Range: 0-26. Lower score indicates more impairment.
Time Frame
3 weeks
Title
Cognitive function measured by the Trailmaking Test Parts A & B Errors
Description
Pre-post difference. Total number of errors. No range. More errors indicate more impairment.
Time Frame
3 weeks
Title
Cognitive function measured by the Judgement of Line Orientation
Description
Pre-post difference. Z-score. Range: 0-29. Lower score indicates more impairment.
Time Frame
3 weeks
Title
Cognitive function measured by the Logical Memory Scaled Scores
Description
Pre-post difference. Scaled score. Range: 1-19. Logical memory immediate, delayed and recognition. Lower score indicates more impairment.
Time Frame
3 weeks
Title
Cognitive function measured by the Logical Memory Recognition
Description
Pre-post difference. No range. Lower score indicates more impairment.
Time Frame
3 weeks
Title
Cognitive function measured by the Hopkins Verbal Learning Test - Revised (HVLT)
Description
Pre-post difference. T-score. Range: 0-12. Immediate recall, delayed recall, and recognition. Lower score indicates more impairment.
Time Frame
3 weeks
Title
Cognitive function measured by the Visuospatial Memory Test - Revised (BVMT)
Description
Pre-post difference. T-score. Range: 0-6. Immediate recall, delayed recall, and recognition. Lower score indicates more impairment.
Time Frame
3 weeks
Title
Cognitive function measured by the Stroop Color Word Test (CWT)
Description
Pre-post difference. T-score. Range: 0-25. Word reading, color naming, color-word, and interference. Lower score indicates more impairment.
Time Frame
3 weeks
Title
Cognitive function measured by Fluency
Description
Pre-post difference. T-score. No range. Letter fluency and category fluency. Lower score indicates more impairment.
Time Frame
3 weeks
Title
Mood measured by the Beck Depression Inventory - Second Edition
Description
Pre-post difference. Raw score. Range: 0-63. Higher score indicates more symptomatic.
Time Frame
3 weeks
Title
Apathy measured by the Apathy scale
Description
Pre-post difference. Raw score. Range: 0-42. Higher score indicates more symptomatic.
Time Frame
3 weeks
Title
Mood measured by the Columbia Suicide Severity Rating (C-SSRS)
Description
Pre-post difference. Raw score. Range:1 or 0. 1 score - more symptomatic, 0 score - no symptoms.
Time Frame
3 weeks
Title
Motor function as measured by the United Parkinson's Disease Rating Scale (UPDRS)
Description
Pre-post difference. Raw score. Range: 0-72. Higher score indicates more symptomatic.
Time Frame
3 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
41 Years
Maximum Age & Unit of Time
89 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject has Idiopathic PD defined by the cardinal sign, bradykinesia, plus the presence of at least 1 of the following: resting tremor or rigidity and without any other known or suspected cause of Parkinsonism (according to Movement disorder society (MDS) clinical diagnostic criteria for Parkinson's disease confirmed by a fellowship trained movements disorder specialist Subject is Hoehn & Yahr stage less than or equal to 3 Subject has a MOCA score ≥10. Subject is > 40 and <90 years of age. Female subjects are post-menopausal or have a negative pregnancy test The subject must be proficient in speaking, reading and understanding English in order to comply with procedural testing of cognitive function, memory and physiology. Subject has provided informed written consent prior to participation. In the event that subject is legally unable to provide informed written consent due to deterioration in cognitive abilities, fully informed written consent must be provided by a legally authorized representative. Subject is on a stable dose (at least 1 month prior to baseline visit) of antiparkinsonian agents and is willing to remain on this dose for the duration of the study. If the subject is on a cholinesterase inhibitor, a stable dose without changes for 1 month is also required. Subject has undergone a brain CT or MRI prior to the study as part of their previous diagnostic workup for PD to rule out underlying structural lesions, as determined clinically significant by the investigator Exclusion Criteria: Subject has atypical Parkinson's syndrome(s) due to drugs (e.g., metoclopramide, neuroleptics), metabolic neurogenetic disorders (e.g., Wilson's Disease), encephalitis, cerebrovascular disease, or degenerative disease (e.g., Progressive Supranuclear Palsy, Multiple System Atrophy, Corticobasal Degeneration, Lewy Body dementia) Subject has medical history and/or clinically determined disorders: chronic sinusitis, untreated thyroid disease, or significant head trauma. Subject has history of any of the following: moderate to severe pulmonary disease, poorly controlled congestive heart failure, significant cardiovascular and/or cerebrovascular events within previous 6 months, condition known to affect absorption, distribution, metabolism, or excretion of drugs such as any hepatic, renal or gastrointestinal disease or any other clinically relevant abnormality that inclusion would pose a safety risk to the subject as determined by investigator. Subject has had previous nasal and/or oto-pharyngeal surgery and severe deviated septum and/or other anomalies. Subject has history of any psychiatric illness that would pose a safety risk to the subject as determined by investigator. Subject is currently taking sedative medications that are clinically contraindicated as determined by investigator. Subject has undergone a recent change (<1 month) in their anti-parkinsonian medication, cholinesterase inhibitor or anti-depressant medication. Subject has current or recent drug or alcohol abuse or dependence as defined by Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV TR). Screening laboratory results that are medically relevant, in which inclusion would pose a safety risk to the subject as determined by investigator. Subject has participated in a clinical trial investigation within 3 months of this study. Subject has an insulin allergy. Subject has Insulin-dependent diabetes
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Sharon Hwee
Phone
651-495-6363
Email
Sharon.X.Hwee@HealthPartners.com
First Name & Middle Initial & Last Name or Official Title & Degree
Maria Pyle
Phone
651-495-6363
Email
Maria.X.Pyle@HealthPartners.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Julia C Johnson, MD
Organizational Affiliation
HealthPartners Neurology
Official's Role
Principal Investigator
Facility Information:
Facility Name
HealthPartners Neuroscience Center
City
Saint Paul
State/Province
Minnesota
ZIP/Postal Code
55130
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sharon Hwee
Phone
651-495-6363
Email
Sharon.x.Hwee@HealthPartners.com
First Name & Middle Initial & Last Name & Degree
Maria Pyle
Phone
651-495-6363
Email
Maria.X.Pyle@HealthPartners.com
First Name & Middle Initial & Last Name & Degree
Julia C Johnson, MD

12. IPD Sharing Statement

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Intranasal Insulin in Parkinson's Disease

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