Clinical Study to Test the Safety of CDNF by Brain Infusion in Patients With Parkinson's Disease
Primary Purpose
Parkinson Disease, Movement Disorders, Neurodegenerative Diseases
Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
Cerebral Dopamine Neurotrophic Factor
Renishaw Drug Delivery System
Sponsored by
About this trial
This is an interventional treatment trial for Parkinson Disease focused on measuring Parkinson, CDNF, Drug Delivery System, Intracerebral
Eligibility Criteria
Inclusion Criteria:
- Idiopathic Parkinson's disease based on UK brain bank criteria
- Duration of PD motor symptoms 5-15 years (inclusive)
- Age 35-75 years (inclusive)
- Presence of motor fluctuations.
- At least 5 daily doses of levodopa
- Ability to reliably distinguish motor states and accurately complete fluctuation diaries
- UPDRS motor score (part III) in a practically defined OFF-state between 25-50 (inclusive)
- Hoehn and Yahr ≤ stage III in the OFF-state
- Responsiveness to levodopa
- No change in anti-parkinsonian medication for 6 weeks before screening
- Provision of Informed Consent
Exclusion Criteria:
- Diagnosed with atypical parkinsonism or any known secondary parkinsonian syndrome.
- Signs or symptoms suggestive of atypical parkinsonian syndrome.
- Drug-resistant rest tremor.
- Prior neurosurgical treatment for PD, including lesioning or deep brain stimulation
- Significant neurological disorder other than PD including clinically significant head trauma, cerebrovascular disease, epilepsia, CSF shunt or other implanted CNS device
- Presence of significant depression as defined as a BDI score ≥ 20
- Current psychosis requiring therapy.
- Presence of clinically significant impulse control disorder ((QUIP-RS) score > 20), or, presence of dopamine dysregulation syndrome.
- MoCA score < 24.
- Use within 3 months of planned catheter insertion of concomitant medications known to affect PD symptoms other than prescribed PD therapy.
- Any medical condition, which might impair outcome measure assessments or safety measures including ability to undergo MRI or DAT-PET.
- Hypersensitivity or allergy to gadolinium or to any of excipients of macrocyclic GBCA used for the surgical planning MRI.
- Screening and/or planning MRI demonstrating any abnormality, which would suggest an alternative cause for patient's parkinsonism or preclude neurosurgery.
- Any medical condition that would put the patient at undue risk from surgical treatment or chronic implants including but not limited to bleeding disorders, chronic infections, or immunosuppressive illness
- History within the last 5 years of cancer with the exception of basal cell carcinoma of the skin
- History of drug or alcohol abuse within 2 years of screening
- Use of any investigational drug or device within 90 days of screening
- Active breastfeeding
Sites / Locations
- Helsinki University Hospital
- Skåne University Hospital
- Karolinska University Hospital, Huddinge
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Placebo Comparator
Experimental
Experimental
Arm Label
Placebo
CDNF mid-dose
CDNF high-dose
Arm Description
Patients randomized to this group will receive 6 monthly infusions of placebo/vehicle
Patients randomized to this group will receive 6 doses of CDNF titrated to mid-dose
Patients randomized to this group will receive 6 doses of CDNF titrated to high-dose
Outcomes
Primary Outcome Measures
Adverse events (AEs)
Number and severity of adverse events
Electrocardiogram (ECG)
Changes in electrical activity of heartbeat measured by electrocardiogram
Beck Depression Inventory (BDI) score
Assessment of change in depression using Beck Depression Inventory (BDI) score
Questionnaire for impulsive-compulsive disorder in Parkinson's disease rating scale (QUIP_RS)
Assessment of changes in impulsive-compulsive disorders using QUIP_RS
Montreal cognitive assessment (MoCA)
Assessment of change in cognitive domains using MoCA test
Physical examination
Changes in anatomic findings found in physical examination
Vital signs
Changes in vital signs
Clinical laboratory safety screen
Changes in clinical laboratory variables (chemistry, haematology, urinanalysis)
Formation of anti-CDNF antibodies
Change in anti-CDNF antibody concentration
Device related changes in safety measures
Occurrence of adverse device effects (ADE), for either the whole system or the individual sub systems (guide tubes/catheters, subcutaneous components, port), serious adverse device effect (SADE) including long term effects, neurological deficit (seizures), infection (local to components, in CNS), severe skin breakdown or necrosis requiring component removal life threatening or major (requiring intervention) intracerebral haemorrhage.
Device related accuracy of implantation
The accuracy of implantation of the Drug Delivery System (DDS) will be measured comparing the tip of each individual catheters defined in the plan of the surgical procedure with the position of those measured by the post-operative CT scan.
Secondary Outcome Measures
UPDRS (Unified Parkinson's Disease Rating Scale) Part III motor score
Changes in severity of PD (Parkinson's disease) motor symptoms assessed by UPDRS Part III motor scores
TUG (Timed Up and Go) test
Changes in mobility assessed by TUG test
UPDRS Total score (Part I-IV)
Change in severity of PD non-motor and motor symptoms assessed by UPDRS Part I-IV total scores (Parts I, II and IV in ON-state; Part III in OFF-state).
Home diary score
Change in functional status assessed by home diary score
PDQ-39 (Parkinson's Disease Questionnaire) score
Changes in health and daily activity assessed by PDQ-39 questionnaire score
change in CGI (Clinical Global Impressions) scale
• Change from baseline until end of treatment evaluation in mental status as measured by CGI scale.
Occurrence of blockage
Occurrence of blockage of implanted catheter preventing or limiting infusion assessed by measuring catheter pressure
Cessation of infusions
Cessation of infusions in an individual patient
Full Information
NCT ID
NCT03295786
First Posted
September 14, 2017
Last Updated
January 10, 2020
Sponsor
Herantis Pharma Plc.
Collaborators
Renishaw plc.
1. Study Identification
Unique Protocol Identification Number
NCT03295786
Brief Title
Clinical Study to Test the Safety of CDNF by Brain Infusion in Patients With Parkinson's Disease
Official Title
Phase 1-2, Randomised, Double-Blind, Placebo Controlled, Safety and Tolerability Study of Intraputamenal Cerebral Dopamine Neurotrophic Factor (CDNF) Infusions Via an Investigational Drug Delivery System to Patients With Parkinson's Disease
Study Type
Interventional
2. Study Status
Record Verification Date
January 2020
Overall Recruitment Status
Completed
Study Start Date
September 26, 2017 (Actual)
Primary Completion Date
December 19, 2019 (Actual)
Study Completion Date
December 19, 2019 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Herantis Pharma Plc.
Collaborators
Renishaw plc.
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This study evaluates the safety and tolerability of CDNF in patients with Parkinson's disease, when dosed directly into the brain using an implanted investigational drug delivery system (DDS). Safety and accuracy of the DDS is also being evaluated. One-third of the patients will receive monthly infusions with placebo and two-third of the patients will receive monthly infusions with either mid- or high-doses of CDNF for a period of 6 months.
Detailed Description
A patient's participation in the study will last for ten months and will include sixteen to seventeen visits:
Screening (2 visits)
Planning of surgery - Surgery: implantation of drug delivery system - Post-surgery follow-up (3 visits)
Test infusions with vehicle (1-2 visits)
Positron emission tomography (PET) examinations before the first and after the last dose (2 visits)
Baseline and randomisation to CDNF or placebo group (1 visit)
Dosing visits: CDNF or placebo (6 visits)
End-of-study visit (1 visit)
Study examinations and assessments
- Physical examination: pulse rate, blood pressure, temperature, body weight and height
ECG (electrocardiography) and blood and urine tests
HIV, hepatitis B and C blood tests (on first visit)
Pregnancy tests for women of childbearing age
Completion of a patient diary to record mobility and time asleep
Parkinson's Kinetigraph (PKGTM) Data Logger: a watch-type device worn on the wrist for certain periods during the study to record movements
Questionnaires, rating scales and forms: quality of life, mood, memory, impulse control, mental health
Assessment of the port and the skin around the port
Cerebrospinal fluid sampling by lumbar puncture
Magnetic resonance imaging (MRI)
Positron emission tomography scans (PET)
Computed tomography (CT)
For more information: https://treater.eu/clinical-study/
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Parkinson Disease, Movement Disorders, Neurodegenerative Diseases, Nervous System Diseases, Brain Diseases
Keywords
Parkinson, CDNF, Drug Delivery System, Intracerebral
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Randomised, Double-Blind, Placebo Controlled
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Double-Blind
Allocation
Randomized
Enrollment
17 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Patients randomized to this group will receive 6 monthly infusions of placebo/vehicle
Arm Title
CDNF mid-dose
Arm Type
Experimental
Arm Description
Patients randomized to this group will receive 6 doses of CDNF titrated to mid-dose
Arm Title
CDNF high-dose
Arm Type
Experimental
Arm Description
Patients randomized to this group will receive 6 doses of CDNF titrated to high-dose
Intervention Type
Drug
Intervention Name(s)
Cerebral Dopamine Neurotrophic Factor
Other Intervention Name(s)
CDNF
Intervention Description
Repeated intracerebral infusions
Intervention Type
Device
Intervention Name(s)
Renishaw Drug Delivery System
Other Intervention Name(s)
DDS
Intervention Description
Stereotactically implanted device
Primary Outcome Measure Information:
Title
Adverse events (AEs)
Description
Number and severity of adverse events
Time Frame
Week 15 to Week 40
Title
Electrocardiogram (ECG)
Description
Changes in electrical activity of heartbeat measured by electrocardiogram
Time Frame
Week 15 to Week 40
Title
Beck Depression Inventory (BDI) score
Description
Assessment of change in depression using Beck Depression Inventory (BDI) score
Time Frame
Week 15 to Week 40
Title
Questionnaire for impulsive-compulsive disorder in Parkinson's disease rating scale (QUIP_RS)
Description
Assessment of changes in impulsive-compulsive disorders using QUIP_RS
Time Frame
Week 15 to Week 40
Title
Montreal cognitive assessment (MoCA)
Description
Assessment of change in cognitive domains using MoCA test
Time Frame
Week 15 to Week 40
Title
Physical examination
Description
Changes in anatomic findings found in physical examination
Time Frame
Week 15 to Week 40
Title
Vital signs
Description
Changes in vital signs
Time Frame
Week 15 to Week 40
Title
Clinical laboratory safety screen
Description
Changes in clinical laboratory variables (chemistry, haematology, urinanalysis)
Time Frame
Week 15 to Week 40
Title
Formation of anti-CDNF antibodies
Description
Change in anti-CDNF antibody concentration
Time Frame
Week 15 to Week 40
Title
Device related changes in safety measures
Description
Occurrence of adverse device effects (ADE), for either the whole system or the individual sub systems (guide tubes/catheters, subcutaneous components, port), serious adverse device effect (SADE) including long term effects, neurological deficit (seizures), infection (local to components, in CNS), severe skin breakdown or necrosis requiring component removal life threatening or major (requiring intervention) intracerebral haemorrhage.
Time Frame
Week 8 to Week 40
Title
Device related accuracy of implantation
Description
The accuracy of implantation of the Drug Delivery System (DDS) will be measured comparing the tip of each individual catheters defined in the plan of the surgical procedure with the position of those measured by the post-operative CT scan.
Time Frame
Week 8
Secondary Outcome Measure Information:
Title
UPDRS (Unified Parkinson's Disease Rating Scale) Part III motor score
Description
Changes in severity of PD (Parkinson's disease) motor symptoms assessed by UPDRS Part III motor scores
Time Frame
Week 15 to Week 40
Title
TUG (Timed Up and Go) test
Description
Changes in mobility assessed by TUG test
Time Frame
Week 15 to Week 40
Title
UPDRS Total score (Part I-IV)
Description
Change in severity of PD non-motor and motor symptoms assessed by UPDRS Part I-IV total scores (Parts I, II and IV in ON-state; Part III in OFF-state).
Time Frame
Week 15 to Week 40
Title
Home diary score
Description
Change in functional status assessed by home diary score
Time Frame
Week 16 to Week 24
Title
PDQ-39 (Parkinson's Disease Questionnaire) score
Description
Changes in health and daily activity assessed by PDQ-39 questionnaire score
Time Frame
Week 15 to Week 40
Title
change in CGI (Clinical Global Impressions) scale
Description
• Change from baseline until end of treatment evaluation in mental status as measured by CGI scale.
Time Frame
Week 16 to Week 40
Title
Occurrence of blockage
Description
Occurrence of blockage of implanted catheter preventing or limiting infusion assessed by measuring catheter pressure
Time Frame
Week 11 to Week 36
Title
Cessation of infusions
Description
Cessation of infusions in an individual patient
Time Frame
Week 11 to Week 36
Other Pre-specified Outcome Measures:
Title
DAT (dopamine transporter)-PET imaging
Description
Change in caudate and putamen DAT availability using PET imaging.
Time Frame
Week 14 to Week 38
Title
alpha-synuclein levels
Description
Changes in serum and CSF (cerebrospinal fluid) concentrations of various α-synuclein species
Time Frame
Week 15 to Week 40
Title
Distribution of CDNF
Description
Level of distribution of CDNF in serum and Cmax of CDNF in CSF
Time Frame
Week 24 and Week 36
Title
Daily activity measurement
Description
Change in daily activity measured by Parkinson's KinetiGraph™ (PKG™) Data Logger
Time Frame
Week 16 to Week 40
Title
Coverage of infusate
Description
Coverage of the infusate in target anatomy assessed by MRI (Magnetic resonance imaging)
Time Frame
Week 11 to Week 36
10. Eligibility
Sex
All
Minimum Age & Unit of Time
35 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Idiopathic Parkinson's disease based on UK brain bank criteria
Duration of PD motor symptoms 5-15 years (inclusive)
Age 35-75 years (inclusive)
Presence of motor fluctuations.
At least 5 daily doses of levodopa
Ability to reliably distinguish motor states and accurately complete fluctuation diaries
UPDRS motor score (part III) in a practically defined OFF-state between 25-50 (inclusive)
Hoehn and Yahr ≤ stage III in the OFF-state
Responsiveness to levodopa
No change in anti-parkinsonian medication for 6 weeks before screening
Provision of Informed Consent
Exclusion Criteria:
Diagnosed with atypical parkinsonism or any known secondary parkinsonian syndrome.
Signs or symptoms suggestive of atypical parkinsonian syndrome.
Drug-resistant rest tremor.
Prior neurosurgical treatment for PD, including lesioning or deep brain stimulation
Significant neurological disorder other than PD including clinically significant head trauma, cerebrovascular disease, epilepsia, CSF shunt or other implanted CNS device
Presence of significant depression as defined as a BDI score ≥ 20
Current psychosis requiring therapy.
Presence of clinically significant impulse control disorder ((QUIP-RS) score > 20), or, presence of dopamine dysregulation syndrome.
MoCA score < 24.
Use within 3 months of planned catheter insertion of concomitant medications known to affect PD symptoms other than prescribed PD therapy.
Any medical condition, which might impair outcome measure assessments or safety measures including ability to undergo MRI or DAT-PET.
Hypersensitivity or allergy to gadolinium or to any of excipients of macrocyclic GBCA used for the surgical planning MRI.
Screening and/or planning MRI demonstrating any abnormality, which would suggest an alternative cause for patient's parkinsonism or preclude neurosurgery.
Any medical condition that would put the patient at undue risk from surgical treatment or chronic implants including but not limited to bleeding disorders, chronic infections, or immunosuppressive illness
History within the last 5 years of cancer with the exception of basal cell carcinoma of the skin
History of drug or alcohol abuse within 2 years of screening
Use of any investigational drug or device within 90 days of screening
Active breastfeeding
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Per Svenningsson, MD
Organizational Affiliation
Karolinska University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Helsinki University Hospital
City
Helsinki
ZIP/Postal Code
00029
Country
Finland
Facility Name
Skåne University Hospital
City
Lund
ZIP/Postal Code
221 85
Country
Sweden
Facility Name
Karolinska University Hospital, Huddinge
City
Stockholm
ZIP/Postal Code
141 86
Country
Sweden
12. IPD Sharing Statement
Plan to Share IPD
No
Learn more about this trial
Clinical Study to Test the Safety of CDNF by Brain Infusion in Patients With Parkinson's Disease
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