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Study of NP002 in Subjects With Idiopathic Parkinson's Disease to Treat Dyskinesias Due to Levodopa Therapy

Primary Purpose

Parkinson's Disease

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
nicotine
placebo comparator
Sponsored by
Neuraltus Pharmaceuticals, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Parkinson's Disease focused on measuring levodopa-induced dyskinesia, Parkinson's disease, parkinsonian, levodopa-induced dyskinesias in Parkinson's disease

Eligibility Criteria

30 Years - 83 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • clinical diagnosis of probable idiopathic Parkinson's disease
  • in stable health
  • male and female aged 30-83 yrs
  • Hoehn and Yahr stage II through IV inclusive
  • levodopa-induced dyskinesias present greater than 25% of waking day; rating equal or greater than 2 on item 32 of UPDRS
  • dyskinesias moderately or severely disabling as determined by a rating of equal or greater than 2 on item 33 of UPDRS
  • Mini-Mental state (MMSE) score of equal or greater than 26
  • on a stable dose of levodopa for at least 30 days
  • if subjects are taking dopamine antagonists, amantadine, MAO-B inhibitors (rasagiline only) or COMT inhibitors, doses must have been stable for at least 30 days

Exclusion Criteria:

  • Secondary or non-idiopathic Parkinson's disease
  • Subjects with parkinsonian symptoms who do not respond to levodopa therapy
  • history of schizophrenia, or other DSM-IV TR axis 1 diagnosis sufficient to interfere with or affect study conduct or interpretation of results
  • any history (past 5 years) of suicide or suicide attempt or thoughts or urges of suicide on direct questioning
  • subjects who score 2 or higher on a single module of the Jay MIDI scale
  • moderate or severe hallucinations, psychoses or delusions
  • any medical condition or lab abnormality presenting an unwarranted risk in the opinion of the Investigator
  • history of HIV positivity, AIDS, or active hepatitis determined by subject report
  • female who is pregnant or breastfeeding
  • female of childbearing potential not using double barrier method of birth control throughout the duration of the study
  • receipt of a neurosurgical intervention (e.g. brain surgery)related to Parkinson's disease or any neurosurgical procedure sufficient to interfere with study conduct or interpretation of results
  • must not have systolic blood pressure ≥150; diastolic ≥95.
  • must not have ECG at screening judged clinically significantly abnormal by investigator
  • must not have QTc > 450 msec at ECG screen
  • must not have current angina pectoris, history of ventricular arrhythmias, uncontrolled hyperthyroidism, known or suspected pheochromocytoma, symptomatic vasospastic disease, or active peptic ulcer
  • must not have a history of stroke, transient ischemic attack (TIA) or myocardial infarction within the last 2 years
  • must not have current drug or alcohol abuse within the last two years. Acceptable alcohol use is no more than 3 ounces of alcohol, 3 beers or 2 glasses of wine per day.
  • must not be participating in another drug trial or have participated in another drug study in the last 30 days. Observational trials with no intervention are acceptable provided permission is obtained from the other study sponsor in writing.
  • must not be unwilling or unable to swallow capsules
  • must not have a positive urine test for cotinine at screening
  • must not be a smoker, previous (less than 5 years since cessation) smoker or have regular exposure to second hand smoke
  • must not be allergic to capsule excipients
  • must not be allergic to ondansetron. If allergic, they may participate provided they understand there is no rescue medication for potential nausea or vomiting during the study
  • must not have known sensitivity to nicotine or nicotine-containing products
  • must not be taking any of the following medications or substances within a minimum of 30 days: nicotine, any form; CYP2A6 inducers or inhibitors during the course of the study or within 30 days of the planned initial dose (your investigator will have a full list of these drugs); Monoamine oxidase inhibitors (with the exception of rasagiline, which is allowed)(your investigator will have a full list of these drugs); apokyn (apomorphine), due to its contraindication with ondansetron); warfarin.

Sites / Locations

  • Barrow Neurology Clinics at St. Joseph's Hospital and Medical Center
  • Keck/USC School of Medicine -Department of Neurology
  • Pacific Neuroscience Medical Group
  • Colorado Neurological Institute
  • Parkinson's Disease & Movement Disorders Ctr of Boca Raton
  • Collier Neurologic Specialists, LLC
  • Strurers Parkinson's Center
  • David L. Kreitzman, M.D., P.C.
  • 108-14 72nd Ave, Second floor
  • Duke University Medical Center, Department of Neurology
  • The Movement Disordedr Clinic of Oklahoma
  • Parkinson's Disease and Movement Center, Penn Comprehensive Neuroscience Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Nicotine

placebo

Arm Description

Active drug is nicotine dihydrate bitartrate, provided as an oral capsule at escalating doses, 1 mg to 6 mg, once every 6 hours

Subjects in this arm receive placebo capsules orally

Outcomes

Primary Outcome Measures

frequency and severity of adverse events, active vs placebo
measure of impulse control (rMIDI), active vs placebo

Secondary Outcome Measures

measure of frequency and severity of dyskinesia (USDysRS), active vs placebo
Parkinson's disease severity (UPDRS part II,III,IV), active vs placebo

Full Information

First Posted
August 11, 2009
Last Updated
September 26, 2011
Sponsor
Neuraltus Pharmaceuticals, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT00957918
Brief Title
Study of NP002 in Subjects With Idiopathic Parkinson's Disease to Treat Dyskinesias Due to Levodopa Therapy
Official Title
Randomized, Double-Blind, Parallel Group, Placebo Controlled Safety, Tolerability and Efficacy Study of NP002 in Subjects With Idiopathic Parkinson's Disease With Dyskinesias Due to Levodopa Therapy
Study Type
Interventional

2. Study Status

Record Verification Date
September 2011
Overall Recruitment Status
Completed
Study Start Date
October 2009 (undefined)
Primary Completion Date
September 2010 (Actual)
Study Completion Date
September 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Neuraltus Pharmaceuticals, Inc.

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The study is designed to answer the question: will nicotine at doses that do not cause serious side effects, show feasibility in treatment of levodopa-induced dyskinesia in patients with Parkinson's disease?
Detailed Description
Nicotine will be employed at daily doses lower than those available OTC as smoking-cessation patches, in parkinsonian patients experiencing disabling dyskinesias due to their levodopa treatment. The principal adverse effect from this dose level of nicotine is expected to be nausea on acute administration to nicotine-naive patients. Because tolerance to the effects of nicotine is achieved by repeated dose, the study is designed to gradually escalate from 6 to 24 mg per day, taken in 6 separate oral doses of 6 mg each. The study is designed to see if doses which can be tolerated by parkinsonian patients will also reduce the severity and frequency of the dyskinesias experienced following administration of levodopa, the gold standard medication for Parkinson's disease.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Parkinson's Disease
Keywords
levodopa-induced dyskinesia, Parkinson's disease, parkinsonian, levodopa-induced dyskinesias in Parkinson's disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
65 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Nicotine
Arm Type
Experimental
Arm Description
Active drug is nicotine dihydrate bitartrate, provided as an oral capsule at escalating doses, 1 mg to 6 mg, once every 6 hours
Arm Title
placebo
Arm Type
Placebo Comparator
Arm Description
Subjects in this arm receive placebo capsules orally
Intervention Type
Drug
Intervention Name(s)
nicotine
Other Intervention Name(s)
NP002
Intervention Description
Oral capsule self administered in escalating doses from 1 mg to 6 mg, 4 times a day. Each dose is is taken for two weeks, except the highest dose, which is taken for 4 weeks. At the end of 10 weeks, the dose is tapered down over 9 days. Subject is continued on study through week 14.
Intervention Type
Other
Intervention Name(s)
placebo comparator
Intervention Description
oral capsules containing only excipient will be self-administered with the same regimen as the active drug, 4 times a day, approximately every 6 hours for 10 weeks and nine days. Study is continued through week 14.
Primary Outcome Measure Information:
Title
frequency and severity of adverse events, active vs placebo
Time Frame
Every two weeks during dosing (week 0 to week 12) and weekly thereafter for 2 weeks following cessation of dosing
Title
measure of impulse control (rMIDI), active vs placebo
Time Frame
at screening and 4 weeks, 10 weeks, 12 weeks and 14 weeks
Secondary Outcome Measure Information:
Title
measure of frequency and severity of dyskinesia (USDysRS), active vs placebo
Time Frame
At screen and every two weeks through week 10
Title
Parkinson's disease severity (UPDRS part II,III,IV), active vs placebo
Time Frame
At screen and every two weeks through week 10

10. Eligibility

Sex
All
Minimum Age & Unit of Time
30 Years
Maximum Age & Unit of Time
83 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: clinical diagnosis of probable idiopathic Parkinson's disease in stable health male and female aged 30-83 yrs Hoehn and Yahr stage II through IV inclusive levodopa-induced dyskinesias present greater than 25% of waking day; rating equal or greater than 2 on item 32 of UPDRS dyskinesias moderately or severely disabling as determined by a rating of equal or greater than 2 on item 33 of UPDRS Mini-Mental state (MMSE) score of equal or greater than 26 on a stable dose of levodopa for at least 30 days if subjects are taking dopamine antagonists, amantadine, MAO-B inhibitors (rasagiline only) or COMT inhibitors, doses must have been stable for at least 30 days Exclusion Criteria: Secondary or non-idiopathic Parkinson's disease Subjects with parkinsonian symptoms who do not respond to levodopa therapy history of schizophrenia, or other DSM-IV TR axis 1 diagnosis sufficient to interfere with or affect study conduct or interpretation of results any history (past 5 years) of suicide or suicide attempt or thoughts or urges of suicide on direct questioning subjects who score 2 or higher on a single module of the Jay MIDI scale moderate or severe hallucinations, psychoses or delusions any medical condition or lab abnormality presenting an unwarranted risk in the opinion of the Investigator history of HIV positivity, AIDS, or active hepatitis determined by subject report female who is pregnant or breastfeeding female of childbearing potential not using double barrier method of birth control throughout the duration of the study receipt of a neurosurgical intervention (e.g. brain surgery)related to Parkinson's disease or any neurosurgical procedure sufficient to interfere with study conduct or interpretation of results must not have systolic blood pressure ≥150; diastolic ≥95. must not have ECG at screening judged clinically significantly abnormal by investigator must not have QTc > 450 msec at ECG screen must not have current angina pectoris, history of ventricular arrhythmias, uncontrolled hyperthyroidism, known or suspected pheochromocytoma, symptomatic vasospastic disease, or active peptic ulcer must not have a history of stroke, transient ischemic attack (TIA) or myocardial infarction within the last 2 years must not have current drug or alcohol abuse within the last two years. Acceptable alcohol use is no more than 3 ounces of alcohol, 3 beers or 2 glasses of wine per day. must not be participating in another drug trial or have participated in another drug study in the last 30 days. Observational trials with no intervention are acceptable provided permission is obtained from the other study sponsor in writing. must not be unwilling or unable to swallow capsules must not have a positive urine test for cotinine at screening must not be a smoker, previous (less than 5 years since cessation) smoker or have regular exposure to second hand smoke must not be allergic to capsule excipients must not be allergic to ondansetron. If allergic, they may participate provided they understand there is no rescue medication for potential nausea or vomiting during the study must not have known sensitivity to nicotine or nicotine-containing products must not be taking any of the following medications or substances within a minimum of 30 days: nicotine, any form; CYP2A6 inducers or inhibitors during the course of the study or within 30 days of the planned initial dose (your investigator will have a full list of these drugs); Monoamine oxidase inhibitors (with the exception of rasagiline, which is allowed)(your investigator will have a full list of these drugs); apokyn (apomorphine), due to its contraindication with ondansetron); warfarin.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Abrahan N Lieberman, MD
Organizational Affiliation
St. Joseph's Hospital and Medical Center, Barrow Neurology Clinics
Official's Role
Principal Investigator
Facility Information:
Facility Name
Barrow Neurology Clinics at St. Joseph's Hospital and Medical Center
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85013
Country
United States
Facility Name
Keck/USC School of Medicine -Department of Neurology
City
Los Angelis
State/Province
California
ZIP/Postal Code
90033
Country
United States
Facility Name
Pacific Neuroscience Medical Group
City
Oxnard
State/Province
California
ZIP/Postal Code
93030
Country
United States
Facility Name
Colorado Neurological Institute
City
Englewood
State/Province
Colorado
ZIP/Postal Code
80113
Country
United States
Facility Name
Parkinson's Disease & Movement Disorders Ctr of Boca Raton
City
Boca Raton
State/Province
Florida
ZIP/Postal Code
33486
Country
United States
Facility Name
Collier Neurologic Specialists, LLC
City
Naples
State/Province
Florida
ZIP/Postal Code
34102
Country
United States
Facility Name
Strurers Parkinson's Center
City
Golden Valley
State/Province
Minnesota
ZIP/Postal Code
55427
Country
United States
Facility Name
David L. Kreitzman, M.D., P.C.
City
Commack
State/Province
New York
ZIP/Postal Code
11725
Country
United States
Facility Name
108-14 72nd Ave, Second floor
City
Forest Hills
State/Province
New York
ZIP/Postal Code
11375
Country
United States
Facility Name
Duke University Medical Center, Department of Neurology
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27705
Country
United States
Facility Name
The Movement Disordedr Clinic of Oklahoma
City
Tusla
State/Province
Oklahoma
ZIP/Postal Code
74137
Country
United States
Facility Name
Parkinson's Disease and Movement Center, Penn Comprehensive Neuroscience Center
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19107
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
31133957
Citation
Lieberman A, Lockhart TE, Olson MC, Smith Hussain VA, Frames CW, Sadreddin A, McCauley M, Ludington E. Nicotine Bitartrate Reduces Falls and Freezing of Gait in Parkinson Disease: A Reanalysis. Front Neurol. 2019 May 7;10:424. doi: 10.3389/fneur.2019.00424. eCollection 2019.
Results Reference
derived

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Study of NP002 in Subjects With Idiopathic Parkinson's Disease to Treat Dyskinesias Due to Levodopa Therapy

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