Randomized, Double-Blind, Active Placebo-Controlled Study of Ketamine to Treat Levodopa-Induced Dyskinesia
Primary Purpose
Dyskinesias, Movement Disorders, Central Nervous System Diseases
Status
Suspended
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Ketamine
Midazolam
Sponsored by
About this trial
This is an interventional treatment trial for Dyskinesias
Eligibility Criteria
Inclusion Criteria:
- Patients diagnosed with Parkinson's Disease as defined by the UK Parkinson's Disease Society Brain Bank Criteria
- Signed a current IEC approved informed consent form
- Male or female patients between ages 30-85 years
- At least three years of prior treatment with levodopa of at least 400 mg daily subject to a maximum of 8 divided doses per day (excluding bedtime and nighttime)
- Waking day dyskinesia of > 25% determined as a score of ≥2 as per Question 4.1 on the UPDRS
- Ambulatory or ambulatory-aided (e.g., walker or cane) and able to complete study assessments
- Have been on stable doses of all anti-Parkinson's medications for 30 days prior to entry into the study, including a levodopa preparation administered not less than three times daily, and be willing to remain on the same doses of medications throughout the course of the study
- 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.
- The subject/caregiver must demonstrate the ability to complete an accurate home diary based on training and evaluation (visit 2)
- Subjects must have available a responsible adult caregiver/companion who will drive the subject home following infusions
- Female subjects not of childbearing potential
- Male subjects, regardless of their fertility status, with nonpregnant women of childbearing potential (WOCBP) partners must agree to either remain abstinent (if this is their preferred and usual lifestyle) or use a highly effective (less than 1% failure rate) method of contraception (such as combination oral contraceptives, implanted contraceptives, or intrauterine devices) or effective method of contraception (such as diaphragms with spermicide or cervical sponges) for the duration of the study and until their plasma concentrations are below the level that could result in a relevant potential exposure to a possible fetus, predicted to be 90 days following the last dose of study drug
Exclusion Criteria:
- Diagnosis of an atypical or secondary Parkinsonian syndrome
- Lack of documented response to levodopa
- Hoehn and Yahr stage of 5
- Known prior exposure to ketamine or other NMDA inhibitors within the last 30 days
- History of neurosurgical intervention related to PD (e.g., deep brain stimulation)
- History of seizures within two years prior to screening
- History of transient ischemic attacks or stroke within two years prior to screening
- History of intracerebral hemorrhage due to hypertension.
- History of clinically significant arrhythmia or unstable angina within the past five years
- History of myocardial infarction within 2 years prior to screening
- History of NYHA Class 3 or 4 heart failure within 2 years prior to screening
- Aneurysmal vascular disease (e.g., intracranial, thoracic or abdominal aorta)
- History of hypertensive encephalopathy
Sites / Locations
- Investigative Site #7
- Investigative Site #2
- Investigative Site #1
- Investigative Site #3
- Investigative Site #6
- Investigative Site #5
- Investigative Site #4
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
Ketamine
Midazolam
Arm Description
Ketamine will be administered as intravenous infusions with infusion rates ranging from 0.1 mg/kg/hr to 0.30 mg/kg/hr. To maintain blinding, both active and placebo will be infused at similar infusion rates (mL/hr).
Midazolam will be administered as intravenous infusions with infusion rates ranging from 0.009 mg/kg/hr to 0.027 mg/kg/hr. To maintain blinding, both active and placebo will be infused at similar infusion rates (mL/hr).
Outcomes
Primary Outcome Measures
Change in the Unified Dyskinesia Rating Scale (UDysRS) total score from Baseline to Week 8.
The change from baseline to week 8 of treatment 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
Change in total daily OFF times as assessed by subject completed 24-hour diaries, from Baseline to Week 8.
Change in daily "OFF"-time as assessed with patient diaries from run-in to week 8. This is a self administered diary where patients assess their motor state every half hour during 24 hours.
Change in the UPDRS total score of part III (motor) and sum score of Questions 4.1 and 4.2 (dyskinesia) in part IV from Baseline to Week 8.
Change in MDS-UPDRS sum score of part III (Motor Examination) from baseline to week 8. Minimum value is 0 and maximum value is 124. Higher score mean a worse outcome.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04912115
Brief Title
Randomized, Double-Blind, Active Placebo-Controlled Study of Ketamine to Treat Levodopa-Induced Dyskinesia
Official Title
A Multi-Center, Phase II, Randomized, Double-Blind, Prospective, Active Placebo- Controlled Trial of Sub-Anesthetic Intravenous Infusion of Ketamine to Treat Levodopa- Induced Dyskinesia in Subjects With Parkinson's Disease
Study Type
Interventional
2. Study Status
Record Verification Date
September 2022
Overall Recruitment Status
Suspended
Why Stopped
Seeking Pivotal study initiation
Study Start Date
October 5, 2021 (Actual)
Primary Completion Date
December 30, 2022 (Anticipated)
Study Completion Date
March 30, 2023 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
PharmaTher Inc.
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
5. Study Description
Brief Summary
A Multi-Center, Phase II, Randomized, Double-Blind, Prospective, Active Placebo-Controlled Trial of Sub-Anesthetic Intravenous Infusion of Ketamine to Treat Levodopa-Induced Dyskinesia in Subjects with Parkinson's Disease.
Detailed Description
This Phase II trial is a prospective, double-blind, randomized, parallel trial-design with two arms. Subjects will be randomized to treatment with the investigational product (ketamine) or an active control (midazolam). The active control causes mild sedation and is employed to minimize unmasking of the test article.
The study is an out-patient study. However, infusion days and days involving prolonged assessments are expected to require the subject to be onsite. Subjects will return to the site for safety and efficacy evaluations. On Day 1, PK samples will be collected near the end of Infusion 1 and post-infusion to evaluate near-steady-state blood levels in all subjects. Intensive PK sampling will be conducted in all subjects prior to, during, and a few hours after Infusion 2 (Day 5 ± 2).
The primary objective of the study is to evaluate the effects of low-dose intravenous infusion of ketamine on levodopa-induced dyskinesia (LID) in patients with Parkinson's disease. All patients included in the study should meet the inclusion criteria. Half of the participants will receive ketamine, while the other half will receive active placebo (Midazolam). All participants will be assigned to either the active group or the control group randomly. During the clinical trial, both investigators and patients are double-blind except serious adverse events occurred.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Dyskinesias, Movement Disorders, Central Nervous System Diseases, Nervous System Diseases, Neurologic Manifestations
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
30 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Ketamine
Arm Type
Experimental
Arm Description
Ketamine will be administered as intravenous infusions with infusion rates ranging from 0.1 mg/kg/hr to 0.30 mg/kg/hr. To maintain blinding, both active and placebo will be infused at similar infusion rates (mL/hr).
Arm Title
Midazolam
Arm Type
Active Comparator
Arm Description
Midazolam will be administered as intravenous infusions with infusion rates ranging from 0.009 mg/kg/hr to 0.027 mg/kg/hr. To maintain blinding, both active and placebo will be infused at similar infusion rates (mL/hr).
Intervention Type
Drug
Intervention Name(s)
Ketamine
Intervention Description
Ketamine is an FDA-approved N-methyl-D-aspartate (NMDA) receptor-modulating drug pharmacologically classified as an NMDA receptor antagonist (also noted to be a weak opioid receptor agonist).
Intervention Type
Drug
Intervention Name(s)
Midazolam
Intervention Description
Midazolam is a benzodiazepine used for anesthesia, procedural sedation, trouble sleeping, and severe agitation.
Primary Outcome Measure Information:
Title
Change in the Unified Dyskinesia Rating Scale (UDysRS) total score from Baseline to Week 8.
Description
The change from baseline to week 8 of treatment 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
8 weeks
Secondary Outcome Measure Information:
Title
Change in total daily OFF times as assessed by subject completed 24-hour diaries, from Baseline to Week 8.
Description
Change in daily "OFF"-time as assessed with patient diaries from run-in to week 8. This is a self administered diary where patients assess their motor state every half hour during 24 hours.
Time Frame
8 weeks
Title
Change in the UPDRS total score of part III (motor) and sum score of Questions 4.1 and 4.2 (dyskinesia) in part IV from Baseline to Week 8.
Description
Change in MDS-UPDRS sum score of part III (Motor Examination) from baseline to week 8. Minimum value is 0 and maximum value is 124. Higher score mean a worse outcome.
Time Frame
8 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
30 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patients diagnosed with Parkinson's Disease as defined by the UK Parkinson's Disease Society Brain Bank Criteria
Signed a current IEC approved informed consent form
Male or female patients between ages 30-85 years
At least three years of prior treatment with levodopa of at least 400 mg daily subject to a maximum of 8 divided doses per day (excluding bedtime and nighttime)
Waking day dyskinesia of > 25% determined as a score of ≥2 as per Question 4.1 on the UPDRS
Ambulatory or ambulatory-aided (e.g., walker or cane) and able to complete study assessments
Have been on stable doses of all anti-Parkinson's medications for 30 days prior to entry into the study, including a levodopa preparation administered not less than three times daily, and be willing to remain on the same doses of medications throughout the course of the study
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.
The subject/caregiver must demonstrate the ability to complete an accurate home diary based on training and evaluation (visit 2)
Subjects must have available a responsible adult caregiver/companion who will drive the subject home following infusions
Female subjects not of childbearing potential
Male subjects, regardless of their fertility status, with nonpregnant women of childbearing potential (WOCBP) partners must agree to either remain abstinent (if this is their preferred and usual lifestyle) or use a highly effective (less than 1% failure rate) method of contraception (such as combination oral contraceptives, implanted contraceptives, or intrauterine devices) or effective method of contraception (such as diaphragms with spermicide or cervical sponges) for the duration of the study and until their plasma concentrations are below the level that could result in a relevant potential exposure to a possible fetus, predicted to be 90 days following the last dose of study drug
Exclusion Criteria:
Diagnosis of an atypical or secondary Parkinsonian syndrome
Lack of documented response to levodopa
Hoehn and Yahr stage of 5
Known prior exposure to ketamine or other NMDA inhibitors within the last 30 days
History of neurosurgical intervention related to PD (e.g., deep brain stimulation)
History of seizures within two years prior to screening
History of transient ischemic attacks or stroke within two years prior to screening
History of intracerebral hemorrhage due to hypertension.
History of clinically significant arrhythmia or unstable angina within the past five years
History of myocardial infarction within 2 years prior to screening
History of NYHA Class 3 or 4 heart failure within 2 years prior to screening
Aneurysmal vascular disease (e.g., intracranial, thoracic or abdominal aorta)
History of hypertensive encephalopathy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Study Director
Organizational Affiliation
PharmaTher Inc.
Official's Role
Study Director
Facility Information:
Facility Name
Investigative Site #7
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85719
Country
United States
Facility Name
Investigative Site #2
City
Chula Vista
State/Province
California
ZIP/Postal Code
91910
Country
United States
Facility Name
Investigative Site #1
City
Fountain Valley
State/Province
California
ZIP/Postal Code
92708
Country
United States
Facility Name
Investigative Site #3
City
Miami
State/Province
Florida
ZIP/Postal Code
33032
Country
United States
Facility Name
Investigative Site #6
City
Miami
State/Province
Florida
ZIP/Postal Code
33175
Country
United States
Facility Name
Investigative Site #5
City
Rolling Meadows
State/Province
Illinois
ZIP/Postal Code
60008
Country
United States
Facility Name
Investigative Site #4
City
Plymouth
State/Province
Michigan
ZIP/Postal Code
48170
Country
United States
12. IPD Sharing Statement
Learn more about this trial
Randomized, Double-Blind, Active Placebo-Controlled Study of Ketamine to Treat Levodopa-Induced Dyskinesia
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