- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03229174
Brain Perfusion & Oxygenation in Parkinson's Disease With NOH
September 1, 2022 updated by: William Ondo, MD
Evaluation of Brain Perfusion and Oxygenation in PD Patients With Neurogenic Orthostatic Hypotension: 4 Week Comparison of Droxidopa Versus Placebo
This is a double blind placebo controlled trial in Parkinson's disease (PD) patients with neurogenic orthostatic hypotension (NOH).
Investigators hypothesize that the study drug (droxidopa) may improve cerebral perfusion more robustly than systemic BP, possibly by direct action within the CNS vasculature.
This study is designed to determine if droxidopa improves cerebral perfusion measures in PD patients with NOH, in addition to peripheral BP measures and subjective responses.
Study Overview
Status
Completed
Intervention / Treatment
Detailed Description
- This is a double blind placebo controlled trial in PD patients with NOH. The controlled portion consists of two visits (baseline and week 4) and a phone call (week 2). An open label extension will include a phone call (week 6) and a final visit (week 8). Subjects will undergo a baseline assessment including continuous tilt table (10 minutes supine / 30 minutes at 70o / 10 minute supine) measurements of arteriole BP. Assessment will be done in the "on" state 1-3 hours after last dose and 1-3 hours after last meal. During both supine and standing positions, subjects will undergo a quantified transcranial cerebral ultrasound of the middle cerebral artery. A secondary analysis of the posterior circulation (basilar artery) will also be done when technically possible. An experienced technician will use a Spencer ST-3 Transcranial Doppler and MHz frequency probes (Spencer Technologies, Redmond WA), with ability to display all data in real time with M-mode and spectral waveform, depth of sample volume, size of sample volume, peak systolic and end diastolic velocities, pulsatility index and frequency of transducer. Cerebral oxygenation will be assessed throughout the tilt table with an FORE-SIGHT ELITE Oximetry System (CASMED) with FORE-SIGHT ELITE large advanced sensor. Mean/Max/Min vales will be analyzed. The tilt table BP and HR monitor with autonomic function will be recorded with a Task Force monitor from CNsystem. Subjective assessments will be done prior to the tilt table and will include demographics, general medical history, UPDRS, and the orthostatic hypotension questionnaire, and some gait analysis. We will also query their subjective "light headedness" throughout the tilt table test to determine for objective correlates.
- Subjects will be titrated with droxidopa or matching placebo over two weeks using current guidelines. The dose will be held constant for the final two weeks and taken on the day of the week 4 visit. After a safety and dose determination call at two weeks, subjects will return at 4 weeks for an identical evaluation, along with clinical global impressions of change.
- All subjects will be allowed into a 4 week open label extension. They will start titration at 100 mg droxidopa TID but can titrate up daily if preferred. After a safety call (week 6) they will return for a final tilt table/ultrasound perfusion study/oximetry study and subjective questionnaires. The patients will be provided two additional weeks medication to ensure a safe transition to purchased droxidopa if desired.
Study Type
Interventional
Enrollment (Actual)
17
Phase
- Phase 4
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Texas
-
Houston, Texas, United States, 77030
- Houston Methodist Hospital
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 85 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Idiopathic Parkinson's disease patients with orthostatic hypotension (Systolic Blood Pressure drop of > 20 mm hg or Diastolic Blood Pressure drop of >10 mm hg measured at some point) within a month of inclusion.
Exclusion Criteria:
- Age >85
- Concurrent use of Midodrine
- Medical conditions that in the opinion of the investigator, might not allow for same completion of the study i.e. unstable angina, neoplasm, etc
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intervention phase
Droxidopa unforced titration dose (starting at 100mg by mouth TID) or matching placebo and titrated over 2 weeks up to maximum of 600 TID.
Efficacy evaluation of given dose at week 4
|
Placebo (sugar pill)
Other Names:
Droxidopa initial dose 100mg TID, titrated in increments of 100mg every 24-48 hours to symptomatic response.
Other Names:
|
Other: Open label extension phase
All subjects allowed into a 4 week open label extension.
Similar titration will start at 100mg Droxidopa three times a day (TID), but can be titrated up daily using the same dose escalation scale.
|
Droxidopa initial dose 100mg TID, titrated in increments of 100mg every 24-48 hours to symptomatic response.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cerebral perfusion
Time Frame: 8 weeks
|
Cerebral perfusion measured by trans-cranial ultrasound of middle cerebral artery "supine and standing" delta.
|
8 weeks
|
Brain oxygenation
Time Frame: 8 weeks
|
Brain oxygenation as measured by cerebral pulse oximetry device, delta between supine and standing
|
8 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Arteriole Blood Pressure
Time Frame: 8 weeks
|
Change in arteriole BP (supine/standing) via tilt table
|
8 weeks
|
R-R variability
Time Frame: 8 weeks
|
changes in autonomic influence on heart rate placebo vs drug
|
8 weeks
|
Orthostatic hypotension
Time Frame: 8 weeks
|
Orthostatic hypotension scale
|
8 weeks
|
Assessment of Parkinson's disease symptoms
Time Frame: 8 weeks
|
Movement disorder society- Unified parkinson disease rating scale (MDS-UPDRS)
|
8 weeks
|
Assessment of gait and falls
Time Frame: 8 weeks
|
Timed Up and Go test
|
8 weeks
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Assessment of depressive symptoms
Time Frame: 8 weeks
|
Beck Depression Inventory
|
8 weeks
|
Assessment of sleepiness
Time Frame: 8 weeks
|
Epworth sleepiness scale (ESS)
|
8 weeks
|
Assessment of cognitive changes
Time Frame: 8 weeks
|
Montreal cognitive assessment (MOCA)
|
8 weeks
|
Assessment of fatigue
Time Frame: 8 weeks
|
Fatigue severity scale (FSS)
|
8 weeks
|
Participant impression of light-headedness
Time Frame: 8 weeks
|
Subjective assessment of "light-headedness"
|
8 weeks
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: William Ondo, MD, The Methodist Hospital Research Institute
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
August 23, 2018
Primary Completion (Actual)
February 2, 2022
Study Completion (Actual)
February 2, 2022
Study Registration Dates
First Submitted
April 21, 2017
First Submitted That Met QC Criteria
July 21, 2017
First Posted (Actual)
July 25, 2017
Study Record Updates
Last Update Posted (Actual)
September 6, 2022
Last Update Submitted That Met QC Criteria
September 1, 2022
Last Verified
September 1, 2022
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Parkinsonian Disorders
- Basal Ganglia Diseases
- Movement Disorders
- Synucleinopathies
- Neurodegenerative Diseases
- Autonomic Nervous System Diseases
- Primary Dysautonomias
- Orthostatic Intolerance
- Parkinson Disease
- Hypotension
- Hypotension, Orthostatic
- Antiparkinson Agents
- Anti-Dyskinesia Agents
- Droxidopa
Other Study ID Numbers
- PRO00013931
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
Yes
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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