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Apomorphine in Parkinson's Disease Patients With Visual Hallucinations

Primary Purpose

Parkinson's Disease, Hallucinations, Visual

Status
Unknown status
Phase
Phase 2
Locations
Netherlands
Study Type
Interventional
Intervention
Apomorphine
Placebo
Sponsored by
University Medical Center Groningen
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Parkinson's Disease focused on measuring Apomorphine

Eligibility Criteria

30 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Female and male subjects aged ≥30;
  • Diagnosis of established PD, defined by the Movement Disorders Society PD criteria (Postuma et al., 2015);
  • Presence of visual severe hallucinations defined as more than 3 times a week (van Laar et al., 2010);
  • Visual hallucinations must have developed after PD diagnosis;
  • Visual hallucinations must have been optimally treated with reduction of dopamine agonists if possible, and prescription of clozapine and/or cholinesterase inhibitors if needed;
  • Female subjects must complaint 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, if sexually active;
  • Subjects should be able and capable of adhering to the protocol, visit schedules, and medication intake according to the judgement of the investigator.

Exclusion Criteria:

  • Symptomatic, clinically relevant and medically uncontrolled orthostatic hypotension;
  • Patients with a prolonged QT interval corrected for heart rate according to Bazett's formula (QTc) of >450 ms for male and >470 ms for female at screening, or history of a long QT syndrome;
  • PD medication change (i.e., dopamine-agonists, amantadine, monoamine oxidase (MAO)-B inhibitors, anticholinergics and cholinesterase inhibitors) in last month prior to initiation (van Laar et al., 2010);
  • Active psychosis or a history of significant psychosis;
  • 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.

Sites / Locations

  • Department of NeurologyRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Apomorphine

Placebo

Arm Description

This arm will be treated with continuous subcutaneous infusion of apomorphine. The infusion will start with 1 mg/hr during the waking day (approximately 16 hours). The flow rate will be adjusted on a weekly basis, and may be increased with 0.5 to 1.0 mg/hr per discretion of the investigator, aiming at the disappearance of visual hallucinations. The duration of treatment is 4 weeks.

This arm will be treated with continuous subcutaneous infusion of placebo. The infusion will start with 1 mg/hr during the waking day (approximately 16 hours). The flow rate will be adjusted on a weekly basis, and may be increased with 0.5 to 1.0 mg/hr per discretion of the investigator aiming at the disappearance of visual hallucinations. The duration of treatment is 4 weeks.

Outcomes

Primary Outcome Measures

Clinical Global Impression of Severity
Clinical Global Impression of Severity questionnaire

Secondary Outcome Measures

Clinical Global Impression of Improvement
Clinical Global Impression of Improvement questionnaire
Cognition
Montreal Cognitive Assessment
Depression
Hamilton Anxiety and Depression Scale
Anxiety
Hamilton Anxiety and Depression Scale
Motor symptoms
Part III of Movement Disorders Society - Unified Parkinson's Disease Rating Scale
Motor complications
Part IV of Movement Disorders Society - Unified Parkinson's Disease Rating Scale
Sleeping problems
Parkinson's Disease Sleep Scale
Neuropsychiatric symptoms
Neuropsychiatric Inventory - Questionnaire
Visual Hallucinations
Dutch Visual Hallucinations Questionnaire
Attention
Reaction Time Task
Visual perception
Visual Object and Space Perception battery
Apathy
Apathy Scale
Quality of Life
Parkinson's Disease Questionnaire (shortened version)

Full Information

First Posted
March 2, 2016
Last Updated
May 1, 2017
Sponsor
University Medical Center Groningen
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1. Study Identification

Unique Protocol Identification Number
NCT02702076
Brief Title
Apomorphine in Parkinson's Disease Patients With Visual Hallucinations
Official Title
Randomized, Double-blind, Placebo-controlled Study to Evaluate the Efficacy of Continuous Subcutaneous Infusion in Parkinson's Disease Patients With Refractory Visual Hallucinations
Study Type
Interventional

2. Study Status

Record Verification Date
May 2017
Overall Recruitment Status
Unknown status
Study Start Date
May 2017 (Anticipated)
Primary Completion Date
December 2017 (Anticipated)
Study Completion Date
December 2017 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University Medical Center Groningen

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This randomised, double-blind, placebo-controlled trial will evaluate the efficacy of continuous apomorphine infusion compared to placebo in PD patients with visual hallucinations, inadequately controlled with clozapine and cholinesterase inhibitors.
Detailed Description
Introduction Visual hallucinations occur frequently in Parkinson's disease (PD). The prevalence of visual hallucinations ranges from 22 to 38%, increasing after long-term follow-up to more than 60%. Risk factors for visual hallucinations are age, disease duration, and cognitive impairment. The treatment of visual hallucinations is cumbersome and options are limited. Only clozapine has been proven to be efficacious without deteriorating the motor symptoms of PD. Instead of oral dopamine agonists and rotigotine, continuous infusion of apomorphine is well-tolerated in PD patients with cognitive impairments and/or visual hallucinations. Even beneficial effect of apomorphine on visual hallucinations are suggested, however there is lack of a randomized controlled trial. The purpose of this randomised, double-blind, placebo-controlled trial is to evaluate the efficacy of continuous apomorphine infusion compared to placebo in PD patients with visual hallucinations, inadequately controlled with clozapine and cholinesterase inhibitors.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Parkinson's Disease, Hallucinations, Visual
Keywords
Apomorphine

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Apomorphine
Arm Type
Experimental
Arm Description
This arm will be treated with continuous subcutaneous infusion of apomorphine. The infusion will start with 1 mg/hr during the waking day (approximately 16 hours). The flow rate will be adjusted on a weekly basis, and may be increased with 0.5 to 1.0 mg/hr per discretion of the investigator, aiming at the disappearance of visual hallucinations. The duration of treatment is 4 weeks.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
This arm will be treated with continuous subcutaneous infusion of placebo. The infusion will start with 1 mg/hr during the waking day (approximately 16 hours). The flow rate will be adjusted on a weekly basis, and may be increased with 0.5 to 1.0 mg/hr per discretion of the investigator aiming at the disappearance of visual hallucinations. The duration of treatment is 4 weeks.
Intervention Type
Drug
Intervention Name(s)
Apomorphine
Other Intervention Name(s)
APO-go, N04BC07
Intervention Description
Continuous subcutaneous infusion of apomorphine during waking day
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Continuous subcutaneous infusion of placebo during waking day
Primary Outcome Measure Information:
Title
Clinical Global Impression of Severity
Description
Clinical Global Impression of Severity questionnaire
Time Frame
Four weeks
Secondary Outcome Measure Information:
Title
Clinical Global Impression of Improvement
Description
Clinical Global Impression of Improvement questionnaire
Time Frame
Four weeks
Title
Cognition
Description
Montreal Cognitive Assessment
Time Frame
Four weeks
Title
Depression
Description
Hamilton Anxiety and Depression Scale
Time Frame
Four weeks
Title
Anxiety
Description
Hamilton Anxiety and Depression Scale
Time Frame
Four weeks
Title
Motor symptoms
Description
Part III of Movement Disorders Society - Unified Parkinson's Disease Rating Scale
Time Frame
Four weeks
Title
Motor complications
Description
Part IV of Movement Disorders Society - Unified Parkinson's Disease Rating Scale
Time Frame
Four weeks
Title
Sleeping problems
Description
Parkinson's Disease Sleep Scale
Time Frame
Four weeks
Title
Neuropsychiatric symptoms
Description
Neuropsychiatric Inventory - Questionnaire
Time Frame
Four weeks
Title
Visual Hallucinations
Description
Dutch Visual Hallucinations Questionnaire
Time Frame
Four weeks
Title
Attention
Description
Reaction Time Task
Time Frame
Four weeks
Title
Visual perception
Description
Visual Object and Space Perception battery
Time Frame
Four weeks
Title
Apathy
Description
Apathy Scale
Time Frame
Four weeks
Title
Quality of Life
Description
Parkinson's Disease Questionnaire (shortened version)
Time Frame
Four weeks
Other Pre-specified Outcome Measures:
Title
Blood pressure
Description
Orthostatic blood pressure measurement
Time Frame
Four weeks
Title
Occurrence of adverse events
Description
Occurrence of adverse events
Time Frame
Four weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
30 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Female and male subjects aged ≥30; Diagnosis of established PD, defined by the Movement Disorders Society PD criteria (Postuma et al., 2015); Presence of visual severe hallucinations defined as more than 3 times a week (van Laar et al., 2010); Visual hallucinations must have developed after PD diagnosis; Visual hallucinations must have been optimally treated with reduction of dopamine agonists if possible, and prescription of clozapine and/or cholinesterase inhibitors if needed; Female subjects must complaint 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, if sexually active; Subjects should be able and capable of adhering to the protocol, visit schedules, and medication intake according to the judgement of the investigator. Exclusion Criteria: Symptomatic, clinically relevant and medically uncontrolled orthostatic hypotension; Patients with a prolonged QT interval corrected for heart rate according to Bazett's formula (QTc) of >450 ms for male and >470 ms for female at screening, or history of a long QT syndrome; PD medication change (i.e., dopamine-agonists, amantadine, monoamine oxidase (MAO)-B inhibitors, anticholinergics and cholinesterase inhibitors) in last month prior to initiation (van Laar et al., 2010); Active psychosis or a history of significant psychosis; 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.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Robbert Borgemeester, MD
Phone
+31 50 3611519
Email
r.w.k.borgemeester@umcg.nl
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Teus van Laar, MD PhD
Organizational Affiliation
University Medical Center Groningen
Official's Role
Principal Investigator
Facility Information:
Facility Name
Department of Neurology
City
Groningen
ZIP/Postal Code
9713GZ
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Robbert Borgemeester, MD
Phone
+31 (0) 50-3611519
Email
r.w.k.borgemeester@umcg.nl
First Name & Middle Initial & Last Name & Degree
Robbert Borgemeester, MD
First Name & Middle Initial & Last Name & Degree
Teus van Laar, MD PhD

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
19524477
Citation
van Laar T, Postma AG, Drent M. Continuous subcutaneous infusion of apomorphine can be used safely in patients with Parkinson's disease and pre-existing visual hallucinations. Parkinsonism Relat Disord. 2010 Jan;16(1):71-2. doi: 10.1016/j.parkreldis.2009.05.006. Epub 2009 Jun 12. No abstract available.
Results Reference
result
PubMed Identifier
26474316
Citation
Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, Obeso J, Marek K, Litvan I, Lang AE, Halliday G, Goetz CG, Gasser T, Dubois B, Chan P, Bloem BR, Adler CH, Deuschl G. MDS clinical diagnostic criteria for Parkinson's disease. Mov Disord. 2015 Oct;30(12):1591-601. doi: 10.1002/mds.26424.
Results Reference
result
PubMed Identifier
19740486
Citation
Fenelon G, Alves G. Epidemiology of psychosis in Parkinson's disease. J Neurol Sci. 2010 Feb 15;289(1-2):12-7. doi: 10.1016/j.jns.2009.08.014. Epub 2009 Sep 8.
Results Reference
result
PubMed Identifier
20962287
Citation
Goetz CG, Ouyang B, Negron A, Stebbins GT. Hallucinations and sleep disorders in PD: ten-year prospective longitudinal study. Neurology. 2010 Nov 16;75(20):1773-9. doi: 10.1212/WNL.0b013e3181fd6158. Epub 2010 Oct 20.
Results Reference
result
PubMed Identifier
21921019
Citation
Gallagher DA, Parkkinen L, O'Sullivan SS, Spratt A, Shah A, Davey CC, Bremner FD, Revesz T, Williams DR, Lees AJ, Schrag A. Testing an aetiological model of visual hallucinations in Parkinson's disease. Brain. 2011 Nov;134(Pt 11):3299-309. doi: 10.1093/brain/awr225. Epub 2011 Sep 15.
Results Reference
result
PubMed Identifier
26709292
Citation
Borgemeester RW, Drent M, van Laar T. Motor and non-motor outcomes of continuous apomorphine infusion in 125 Parkinson's disease patients. Parkinsonism Relat Disord. 2016 Feb;23:17-22. doi: 10.1016/j.parkreldis.2015.11.013. Epub 2015 Nov 22.
Results Reference
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PubMed Identifier
18442107
Citation
Garcia Ruiz PJ, Sesar Ignacio A, Ares Pensado B, Castro Garcia A, Alonso Frech F, Alvarez Lopez M, Arbelo Gonzalez J, Baiges Octavio J, Burguera Hernandez JA, Calopa Garriga M, Campos Blanco D, Castano Garcia B, Carballo Cordero M, Chacon Pena J, Espino Ibanez A, Gorospe Onisalde A, Gimenez-Roldan S, Granes Ibanez P, Hernandez Vara J, Ibanez Alonso R, Jimenez Jimenez FJ, Krupinski J, Kulisevsky Bojarsky J, Legarda Ramirez I, Lezcano Garcia E, Martinez-Castrillo JC, Mateo Gonzalez D, Miquel Rodriguez F, Mir P, Munoz Fargas E, Obeso Inchausti J, Olivares Romero J, Olive Plana J, Otermin Vallejo P, Pascual Sedano B, Perez de Colosia Rama V, Perez Lopez-Fraile I, Planas Comes A, Puente Periz V, Rodriguez Oroz MC, Sevillano Garcia D, Solis Perez P, Suarez Munoz J, Vaamonde Gamo J, Valero Merino C, Valldeoriola Serra F, Velazquez Perez JM, Yanez Bana R, Zamarbide Capdepon I. Efficacy of long-term continuous subcutaneous apomorphine infusion in advanced Parkinson's disease with motor fluctuations: a multicenter study. Mov Disord. 2008 Jun 15;23(8):1130-6. doi: 10.1002/mds.22063.
Results Reference
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PubMed Identifier
23934921
Citation
Martinez-Martin P, Reddy P, Antonini A, Henriksen T, Katzenschlager R, Odin P, Todorova A, Naidu Y, Tluk S, Chandiramani C, Martin A, Chaudhuri KR. Chronic subcutaneous infusion therapy with apomorphine in advanced Parkinson's disease compared to conventional therapy: a real life study of non motor effect. J Parkinsons Dis. 2011;1(2):197-203. doi: 10.3233/JPD-2011-11037.
Results Reference
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PubMed Identifier
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Citation
Martinez-Martin P, Reddy P, Katzenschlager R, Antonini A, Todorova A, Odin P, Henriksen T, Martin A, Calandrella D, Rizos A, Bryndum N, Glad A, Dafsari HS, Timmermann L, Ebersbach G, Kramberger MG, Samuel M, Wenzel K, Tomantschger V, Storch A, Reichmann H, Pirtosek Z, Trost M, Svenningsson P, Palhagen S, Volkmann J, Chaudhuri KR. EuroInf: a multicenter comparative observational study of apomorphine and levodopa infusion in Parkinson's disease. Mov Disord. 2015 Apr;30(4):510-6. doi: 10.1002/mds.26067. Epub 2014 Nov 10.
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PubMed Identifier
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Citation
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Apomorphine in Parkinson's Disease Patients With Visual Hallucinations

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