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Efficacy and Tolerability of IRL790 in Parkinson's Disease Dyskinesia

Primary Purpose

Parkinson Disease

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Mesdopetam (IRL790)
Sponsored by
Integrative Research Laboratories AB
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Parkinson Disease focused on measuring Levodopa induced dyskinesia

Eligibility Criteria

18 Years - 79 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or female ≥18 and ≤79 years of age.
  2. Signed a current Ethics Committee approved informed consent form.
  3. Parkinson's disease, per UK Parkinson's Disease Society (UKPDS) Brain Bank Clinical Diagnostic Criteria.
  4. Waking day dyskinesia of ≥25% determined as a score of ≥2 as per Question 4.1 of the MDS-UPDRS.
  5. On a stable regimen of antiparkinson medications for at least 30 days prior to screening, including a levodopa preparation administered not less than three times daily and willing to continue the same doses and regimens during study participation. Rescue medication such as Madopar dispersable and Apomorphine injections are allowed.
  6. Taking a maximum of eight regular levodopa intakes per day, excluding bedtime and night time levodopa.
  7. Any other current and allowed prescription/non-prescription medications and/or nutritional supplements taken regularly must have been at a stable dose and regimen for at least 30 days prior to screening and the patient must be willing to continue the same doses and regimens during study participation (this criterion does not apply to medications that are being taken pre-study only on an as-needed basis).
  8. Patient must be willing and able to avoid direct exposure to sunlight from day 1 to day 28.
  9. Able to complete at least one valid 24-hour patient diary at Visit 1.

Exclusion Criteria:

  1. History of neurosurgical intervention related to Parkinson's disease (e.g. deep brain stimulation).
  2. Treatment with pump delivered antiparkinsonian therapy (i.e. subcutaneous apomorphine or levodopa/carbidopa intestinal infusion).
  3. History of seizures within two years prior to screening.
  4. History of stroke or transient ischemic attack (TIA) within two years prior to screening.
  5. History of cancer within five years prior to screening, with the following exceptions: adequately treated non-melanomatous skin cancers, localised bladder cancer, non-metastatic prostate cancer or in situ cervical cancer.
  6. Presence of cognitive impairment, as evidenced by a Mini-Mental Status Examination (MMSE) score of less than 24 during screening.
  7. A Hoehn and Yahr score of five when "off" as per Question 3.18 of the MDS-UPDRS, assessed during screening.
  8. Any history of a significant heart condition or cardiac arrhythmias within the past 5 years, any repolarisation deficits or any other clinically significant abnormal ECG as judged by the Investigator
  9. Severe or ongoing unstable medical condition including a history of poorly controlled diabetes; obesity associated with metabolic syndrome; uncontrolled hypertension; cerebrovascular disease, or any form of clinically significant cardiac disease; clinically significant symptomatic orthostatic hypotension; clinically significant hepatic disease, renal failure or abnormal renal function.
  10. Any history of a neurological other than Parkinson's disease or a psychiatric disorder, including history of DSM IV diagnosed major depression or psychosis. Patients with illusions or hallucinations with no loss of insight will be eligible. Patients with mild depression who are well controlled on a stable dose of an antidepressant medication for at least 4 weeks before screening will be eligible.
  11. Enrolment in any other clinical study involving medication, medical devices or surgical procedures, current or within three months prior to screening visit, or previous participation in the present study. Patients enrolled in non-interventional clinical trials will be eligible.
  12. Drug and/or alcohol abuse.
  13. History of severe drug allergy or hypersensitivity.
  14. If female, is pregnant or lactating, or has a positive pregnancy test result pre-dose.
  15. Patients unwilling to use two forms of contraception 90 days for men and 30 days for women after last IMP dose
  16. Any planned major surgery within the duration of the study.
  17. Any other condition or symptoms preventing the patient from entering the study, according to the Investigator's judgement.

Sites / Locations

  • Sahlgrenska University hospital
  • University hospital
  • University hospital
  • Karolinska University hospital
  • Bristol Brain Centre, Southmead Hospital
  • Fairfield General Hospital (Pennine Acute NHS Trust)
  • Ninewells Hospital
  • Lincoln County Hospital
  • Charing Cross Hospital, Imperial College Healthcare NHS Trust
  • The National Hospital of Neurology and Neurosurgery (UCL)
  • Luton and Dunstable University Hospital NHS Foundation Trust
  • North Tyneside General Hospital
  • Qeens' Medical Centre
  • John Radcliffe Hospital
  • Peterborough City Hospital
  • Plymouth Hospitals NHS Trust - Derriford Hospital
  • Queens's Hospital
  • Royal Stoke University Hospital
  • Torbay hospital
  • Royal Cornwall Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Mesdopetam (IRL790)

Placebo

Arm Description

Capsule 2.5 mg, oral administration

Identical capsule, oral administration

Outcomes

Primary Outcome Measures

Unified Dyskinesia Rating Scale (UDysRS)
The change from baseline to day 28 of treatment (Visit 4) in the sum of the items comprising the Unified Dyskinesia Rating Scale (UDysRS). The Unified Dyskinesia Rating Scale (UDysRS) is administered to assess dyskinesia. The scoring range is 0-104, where higher score means more dyskinesia.

Secondary Outcome Measures

Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part IV, Question 4.1 and 4.2
Change in MDS-UPDRS sum score of questions 4.1 (Time spent with dyskinesias) and 4.2 (Functional impact of dyskinesias) in part IV from baseline to visit 4. Minimum score is 0 and maximum score is 8. A higher score means more dyskinesia.
Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Part II and III
Change in MDS-UPDRS sum score of parts II+III (Motor aspects of Experiences of Daily living + Motor Examination) from baseline to visit 4. Minimum value is 0 and maximum value is 124. Higher score mean a worse outcome.

Full Information

First Posted
December 5, 2017
Last Updated
March 17, 2022
Sponsor
Integrative Research Laboratories AB
Collaborators
The Clinical Trial Company
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1. Study Identification

Unique Protocol Identification Number
NCT03368170
Brief Title
Efficacy and Tolerability of IRL790 in Parkinson's Disease Dyskinesia
Official Title
A Randomized, Placebo-controlled, Phase IIa Study Evaluating the Efficacy and Tolerability of IRL790 in Parkinson's Disease Dyskinesia
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Completed
Study Start Date
April 12, 2018 (Actual)
Primary Completion Date
June 12, 2019 (Actual)
Study Completion Date
June 12, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Integrative Research Laboratories AB
Collaborators
The Clinical Trial Company

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
Mesdopetam (IRL790) is an experimental small molecule compound with psychomotor stabilizing properties. The primary target is the dopamine D3 receptor, a target implicated in the generation of levodopa-induced dyskinesia, a side-effect frequently occurring with long-term levodopa treatment in patients with Parkinson's disease. In experimental animals mesdopetam potently reduced levodopa-induced involuntary movement without impairing the antiparkinsonian effect of levodopa. The primary purpose of the trial is to investigate whether mesdopetam given as adjunctive treatment can reduce levodopa induced dyskinesia in patients with Parkinson's disease. The trial will also help to establish the most optimal dosing of the compound.
Detailed Description
METHODOLOGY: This is a multicentre study where 74 patients with Parkinson's disease exhibiting levodopa induced dyskinesia will be randomised to receive study drug or placebo. Thirty seven patients will be randomised to mesdopetam and 37 patients to placebo (1:1 randomisation). Patients will be screened for eligibility according to inclusion/exclusion criteria within four weeks of initiation of study treatment (Screening visit). An outpatient study with the patients taking the study drug for four weeks at home. Mesdopetam will be taken twice daily (b.i.d.) as adjunctive treatment to the patients' regular and stable antiparkinsonian medication. The first two weeks of treatment will allow for per patient titration of study medication to the highest tolerated predefined dose, after which patients will continue on this highest tolerated dose for an additional two weeks. Changes in disease state and dyskinesia will be measured using the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Unified Dyskinesia Rating Scale (UDysRS); furthermore, patients will administer two 24-hour diaries on run-in and on the fourth week of dosing to assess daily movements. Pharmacokinetic (PK) samples will be collected for the determination of concentrations of mesdopetam and its metabolites IRL902 and IRL872 in plasma. They will be collected before and after IMP administration at two visits. A Follow-up Visit will be performed for all patients five to eight days after last administration of IMP.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Parkinson Disease
Keywords
Levodopa induced dyskinesia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Double blind, placebo controlled
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
75 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Mesdopetam (IRL790)
Arm Type
Experimental
Arm Description
Capsule 2.5 mg, oral administration
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Identical capsule, oral administration
Intervention Type
Drug
Intervention Name(s)
Mesdopetam (IRL790)
Other Intervention Name(s)
IRL790
Intervention Description
Mesdopetam (IRL790) capsule
Primary Outcome Measure Information:
Title
Unified Dyskinesia Rating Scale (UDysRS)
Description
The change from baseline to day 28 of treatment (Visit 4) in the sum of the items comprising the Unified Dyskinesia Rating Scale (UDysRS). The Unified Dyskinesia Rating Scale (UDysRS) is administered to assess dyskinesia. The scoring range is 0-104, where higher score means more dyskinesia.
Time Frame
Baseline and 4 weeks
Secondary Outcome Measure Information:
Title
Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part IV, Question 4.1 and 4.2
Description
Change in MDS-UPDRS sum score of questions 4.1 (Time spent with dyskinesias) and 4.2 (Functional impact of dyskinesias) in part IV from baseline to visit 4. Minimum score is 0 and maximum score is 8. A higher score means more dyskinesia.
Time Frame
Baseline and 4 weeks
Title
Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Part II and III
Description
Change in MDS-UPDRS sum score of parts II+III (Motor aspects of Experiences of Daily living + Motor Examination) from baseline to visit 4. Minimum value is 0 and maximum value is 124. Higher score mean a worse outcome.
Time Frame
Baseline and 4 weeks
Other Pre-specified Outcome Measures:
Title
Change in Daily Hours Spent in ON-time With Troublesome Dyskinesia as Assessed by 24-hour Patient Diaries
Description
Change in ON-time with troublesome dyskinesia as assessed by patient completed 24-hour diaries, from run-in to visit 4. This is a self administered diary where patients assess their motor state every half hour during 24 hours. The different motor states assessed: ON, ON with troublesome dyskinesia, OFF and asleep.
Time Frame
Run-in and 4 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
79 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female ≥18 and ≤79 years of age. Signed a current Ethics Committee approved informed consent form. Parkinson's disease, per UK Parkinson's Disease Society (UKPDS) Brain Bank Clinical Diagnostic Criteria. Waking day dyskinesia of ≥25% determined as a score of ≥2 as per Question 4.1 of the MDS-UPDRS. On a stable regimen of antiparkinson medications for at least 30 days prior to screening, including a levodopa preparation administered not less than three times daily and willing to continue the same doses and regimens during study participation. Rescue medication such as Madopar dispersable and Apomorphine injections are allowed. Taking a maximum of eight regular levodopa intakes per day, excluding bedtime and night time levodopa. Any other current and allowed prescription/non-prescription medications and/or nutritional supplements taken regularly must have been at a stable dose and regimen for at least 30 days prior to screening and the patient must be willing to continue the same doses and regimens during study participation (this criterion does not apply to medications that are being taken pre-study only on an as-needed basis). Patient must be willing and able to avoid direct exposure to sunlight from day 1 to day 28. Able to complete at least one valid 24-hour patient diary at Visit 1. Exclusion Criteria: History of neurosurgical intervention related to Parkinson's disease (e.g. deep brain stimulation). Treatment with pump delivered antiparkinsonian therapy (i.e. subcutaneous apomorphine or levodopa/carbidopa intestinal infusion). History of seizures within two years prior to screening. History of stroke or transient ischemic attack (TIA) within two years prior to screening. History of cancer within five years prior to screening, with the following exceptions: adequately treated non-melanomatous skin cancers, localised bladder cancer, non-metastatic prostate cancer or in situ cervical cancer. Presence of cognitive impairment, as evidenced by a Mini-Mental Status Examination (MMSE) score of less than 24 during screening. A Hoehn and Yahr score of five when "off" as per Question 3.18 of the MDS-UPDRS, assessed during screening. Any history of a significant heart condition or cardiac arrhythmias within the past 5 years, any repolarisation deficits or any other clinically significant abnormal ECG as judged by the Investigator Severe or ongoing unstable medical condition including a history of poorly controlled diabetes; obesity associated with metabolic syndrome; uncontrolled hypertension; cerebrovascular disease, or any form of clinically significant cardiac disease; clinically significant symptomatic orthostatic hypotension; clinically significant hepatic disease, renal failure or abnormal renal function. Any history of a neurological other than Parkinson's disease or a psychiatric disorder, including history of DSM IV diagnosed major depression or psychosis. Patients with illusions or hallucinations with no loss of insight will be eligible. Patients with mild depression who are well controlled on a stable dose of an antidepressant medication for at least 4 weeks before screening will be eligible. Enrolment in any other clinical study involving medication, medical devices or surgical procedures, current or within three months prior to screening visit, or previous participation in the present study. Patients enrolled in non-interventional clinical trials will be eligible. Drug and/or alcohol abuse. History of severe drug allergy or hypersensitivity. If female, is pregnant or lactating, or has a positive pregnancy test result pre-dose. Patients unwilling to use two forms of contraception 90 days for men and 30 days for women after last IMP dose Any planned major surgery within the duration of the study. Any other condition or symptoms preventing the patient from entering the study, according to the Investigator's judgement.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Camille Carroll, MD
Organizational Affiliation
Plymouth University Peninsula Schools of Medicine and Dentistry
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sahlgrenska University hospital
City
Göteborg
Country
Sweden
Facility Name
University hospital
City
Linköping
Country
Sweden
Facility Name
University hospital
City
Lund
Country
Sweden
Facility Name
Karolinska University hospital
City
Stockholm
Country
Sweden
Facility Name
Bristol Brain Centre, Southmead Hospital
City
Bristol
Country
United Kingdom
Facility Name
Fairfield General Hospital (Pennine Acute NHS Trust)
City
Bury
Country
United Kingdom
Facility Name
Ninewells Hospital
City
Dundee
Country
United Kingdom
Facility Name
Lincoln County Hospital
City
Lincoln
Country
United Kingdom
Facility Name
Charing Cross Hospital, Imperial College Healthcare NHS Trust
City
London
Country
United Kingdom
Facility Name
The National Hospital of Neurology and Neurosurgery (UCL)
City
London
Country
United Kingdom
Facility Name
Luton and Dunstable University Hospital NHS Foundation Trust
City
Luton
Country
United Kingdom
Facility Name
North Tyneside General Hospital
City
North Shields
Country
United Kingdom
Facility Name
Qeens' Medical Centre
City
Nottingham
Country
United Kingdom
Facility Name
John Radcliffe Hospital
City
Oxford
Country
United Kingdom
Facility Name
Peterborough City Hospital
City
Peterborough
Country
United Kingdom
Facility Name
Plymouth Hospitals NHS Trust - Derriford Hospital
City
Plymouth
ZIP/Postal Code
PL6 8DH
Country
United Kingdom
Facility Name
Queens's Hospital
City
Romford
Country
United Kingdom
Facility Name
Royal Stoke University Hospital
City
Stoke-on-Trent
Country
United Kingdom
Facility Name
Torbay hospital
City
Torquay
Country
United Kingdom
Facility Name
Royal Cornwall Hospital
City
Truro
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
31356217
Citation
McFarthing K, Prakash N, Simuni T. CLINICAL TRIAL HIGHLIGHTS - DYSKINESIA. J Parkinsons Dis. 2019;9(3):449-465. doi: 10.3233/JPD-199002. No abstract available.
Results Reference
derived

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Efficacy and Tolerability of IRL790 in Parkinson's Disease Dyskinesia

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