A Study of an Investigational Drug to See How it Affects the People With Parkinson's Disease Complicated by Motor Fluctuations ("OFF" Episodes) Compared to an Approved Drug Used to Treat People With Parkinson's Disease Complicated by Motor Fluctuations ("OFF" Episodes)

An Open-Label, Randomized, Crossover Trial Utilizing a Single-Blinded Rater to Evaluate APL-130277 Compared to Subcutaneous Apomorphine in Levodopa Responsive Subjects With Parkinson's Disease Complicated by Motor Fluctuations

A study of an investigational drug to see how it affects the people with Parkinson's Disease complicated by motor fluctuations ("OFF" Episodes) compared to an approved drug used to treat people with Parkinson's Disease complicated by motor fluctuations ("OFF" Episodes)

Study Overview

• Status: Completed
• Conditions: Motor OFF Episodes Associated With Parkinson's Disease
• Intervention / Treatment: Drug: APL-130277; Drug: subcutaneous apomorphine

Detailed Description

An Open-Label, Randomized, Crossover Trial utilizing a Single-Blinded Rater to evaluate APL-130277 compared to s.c. Apomorphine in Levodopa Responsive Subjects with Parkinson's Disease Complicated by Motor Fluctuations.

PART A consists of an open label, crossover titration phase where eligible subjects will be randomized to 1 of 2 treatment sequences in a 1:1 ratio to Sublingual APL 130277 followed by subcutaneous apomorphine or subcutaneous apomorphine followed by sublingual APL 130277. Subjects will undergo dose titration with the first study treatment (APL 130277 or sc apomorphine) to tolerance and effect, ie, the tolerable dose that turns the subject from the practically defined "OFF" state to the full "ON" state as determined by both the Investigator and subject. The subject will then be crossed over to the other study treatment (APL 130277 or subcutaneous apomorphine) and similarly titrated to tolerance and effect. These determined doses of APL 130277 and subcutaneous apomorphine will be used during PART B.

PART B consists of an open-label, crossover treatment period where subjects will be randomized to one of the study treatment for 4 weeks, then be crossed over to the other study treatment (APL-130277 or sc apomorphine) for additional 4-weeks of open-label treatment. Subjects return to the clinic for safety and efficacy assessments throughout the treatment period.

This study is designed to test the superiority of sublingually administered APL-130277 against subcutaneously injected apomorphine (APO-go) for the treatment of "OFF" episodes in patients with Parkinson's Disease, as measured by the change from pre-dose to 90 minutes post-dose in MDS UPDRS Part III score in Part B after 4 weeks of dosing in each crossover period.

• Study Type: Interventional
• Enrollment (Actual): 113
• Phase: Phase 3

Contacts and Locations

Study Locations

• Austria
  • Innsbruck, Austria, A-6020
    • Medical University Innsbruck, Neurolgy Dept
  • Vienna, Austria, A-1160
    • Wilhelminenspital, Department of Neurology
• France
  • Nimes, France, 30029
    • CHU Caremeau, Service de Neurologie
  • Toulouse, France, 31059
    • Centre d'Investigation Clinique, CIC 43, CHU Purpan, Hopital Pierre-Paul Riquet, place du Dr. Baylac, Hall D, 2 eme etage -TSA
• Germany
  • Beelitz-Heilstatten, Germany, 14547
    • Klinken Beelitz GmbH Neurologisches Fachkrankenhaus fur Bewegungsstorungen/Parkinson
  • Berlin, Germany, 10117
    • Charite-University Medicine Berlin, Department of Neurology, Campus charite Mitte
  • Berlin, Germany, 13088
    • St. Joseph Krankenhaus Berlin - Weissensee, Abteilung fur Neurologie
  • Bochum, Germany, 44791
    • St. Josef Hospital, Klnikum der Ruhr-Universitat-Bochum, Neurologische Klinik
  • Dresden, Germany, 01307
    • Universitatsklinikum Carol Gustav Carus an der TU dDresden, Klinik umd Poliklinik fur Neurologie
  • Haag In Oberbayern, Germany, 83527
    • Klinik Haag i.OB
  • Munchen, Germany, 81675
    • Klinikum Rechts Der Isar Der Technischen Universität München
  • Munich, Germany, 80331
    • Curiositas ad sanum GmbH
  • Ulm, Germany, D-89081
    • Universitaets-und Rehabillitatinskliniken Ulm
• Italy
  • Cassino, Italy, 03043
    • San Raffaele Cassino
  • Catania, Italy
    • University Hospital Policlinico-Vittorio Emanuele, Department "G.F. Ingrassia", Section of Neurosciences
  • Napoli, Italy, 80138
    • A.O.U. Universita degli Studi della Campania "Luigi Vanvitelli" Dipartamento di Scienze Mediche e Chirurgiche Avanzate
  • Rome, Italy, 00163
    • IRCCS San Raffaele Pisana-Clinical Trial Center
  • Rozzano, Italy, 20089
    • Istituto Clinico Humanitas, Dipartmento di Neurologia 1
  • Salerno, Italy, 84131
    • AOU San Giovanni di Dio e Ruggid'Aragona-CEMAND
• Spain
  • Barakaldo, Spain
    • Hospital Universitario de Cruces, Neurology
  • Barcelona, Spain, 08036
    • Hospital Clinic de Barcelona
  • Barcelona, Spain, 08041
    • Hospital de la Santa Creu i Sant Pau c/Mas de Casanovas 90
  • Burgos, Spain, 09006
    • Hospital Universitario de Burgos
  • Madrid, Spain, 28006
    • Hospital Universitario de la Princesa
  • Mostoles, Spain, 28938
    • CINAC, Hospital Universitario HB Pueta del Sur
  • Sant Cugat del Valles, Spain, 08195
    • Hospital General de Catalunya
• United Kingdom
  • London, United Kingdom, SE5 9RS
    • King's College Hospital NHS Foundation Trust
  • London, United Kingdom, W6 8RF
    • 10W, Imperial Memory/PD Research Unit, Imperial College Healthcare NHS Trust
  • Manchester, United Kingdom, Bl9 7TD
    • NHS Forth Valley, Pennine Actue NHS Trust, Fairfield General Hospital
  • Nottingham, United Kingdom, NG7 2UH
    • Academic Neuroscience Department, C Floor, South Block, Nottingham University Hospitals NHS Trust Queens Medical Centre
  • Plymouth, United Kingdom, PL6 8DH
    • University Hospitals Plymouth NHS Trust-Derriford Hospital-The Lind Research Center, Level 5, Terence Lewis Building

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. The subject (and caregiver, if applicable) must be fully informed of and understand the objectives, procedures, and possible benefits and risks of the study, and give written informed consent prior to performing any study related activities.
2. Male or female ≥ 18 years of age.
3. Clinical diagnosis of Idiopathic PD, consistent with UK Brain Bank Criteria (excluding the "more than one affected relative" criterion).
4. Clinically meaningful response to levodopa (L-Dopa), as determined by the Investigator.
5. Subjects at screening must demonstrate an adequate L-Dopa response on the MDS UPDRS Part III in the "ON" state compared to the MDS UPDRS Part III in the "OFF" state and on the Hoehn and Yahr, as determined during the review by Enrollment Adjudication Committee (EAC), Sponsor, and Medical Monitor.
6. Receiving stable doses of L Dopa/carbidopa and/or L Dopa/benserazide and/or L Dopa/carbidopa/entacapone (immediate or chronic release) administered at least 4 times per day OR Rytary™ administered at least 3 times per day for at least 4 weeks before the initial screening Visit (SV1). Adjunctive PD medication regimens are permitted but must be maintained at a stable dose for at least 4 weeks prior to SV1 with the exception of monoamine oxidase B (MAO B) inhibitors, which must be maintained at a stable level for at least 8 weeks prior to SV1.
7. No planned medication change(s) or surgical intervention anticipated during the course of study.
8. Subjects must experience at least one well defined "OFF" episode per day and have a total daily "OFF" time duration of > 2 hours during the waking day, based on judgment of physician and subject self assessment.
9. Subject must have predictable morning "OFF" periods, based on judgment of physician and subject self assessment.
10. Subject, and where appropriate caregiver, must be trained in completing the home dosing diaries and able to recognize "ON" and "OFF" states.
11. Stage III or less on the modified Hoehn and Yahr scale in the "ON" state.
12. Mini-Mental State Examination (MMSE) score > 25.
13. Female subject of childbearing potential and male subject with female partner of childbearing potential must agree to either remain abstinent or use adequate and reliable contraception throughout the study and for at least 7 days after the last dose of study drug has been taken. Note: Continued use of adequate and reliable contraception is recommended through 30 days after study completion.
14. Willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study related procedures to complete the study.
15. Must be approved as a satisfactory candidate by the Enrollment Adjudication Committee (EAC), Medical Monitor, and Sponsor.

Exclusion Criteria:

1. Atypical or secondary parkinsonism.
2. Major focal brain disorders including malignancy or stroke.
3. Prior treatment with any of the following: a neurosurgical procedure for PD; continuous subcutaneous (subcutaneous) apomorphine infusion; subcutaneous (subcutaneous) apomorphine injection; Duodopa/Duopa; or APL-130277.
4. Contraindications to domperidone, subcutaneous apomorphine, or hypersensitivity to apomorphine hydrochloride or any of the ingredients of subcutaneous apomorphine (notably sodium metabisulfite).
5. Female who is pregnant or lactating.
6. Participation in an interventional clinical study and/or receipt of any investigational (ie, unapproved) medication within 30 days prior to SV1.
7. Currently taking selective 5HT3 antagonists (ie, ondansetron, granisetron, dolasetron, palonosetron, alosetron), dopamine antagonists (excluding quetiapine or clozapine) or dopamine depleting agents. Subjects receiving anti depressants must be on a stable daily dose for at least 8 weeks prior to SV1.
8. The subject has a current diagnosis or history of substance abuse (excluding nicotine and caffeine) or alcohol abuse (in the opinion of the investigator) < 6 months prior to SV1.
9. The recreational use of cannabinoids and hallucinogenic are excluded, as well any use of a sublingual formulation of any drug.
10. Subject has a history of malignancy within 5 years prior to SV1, except for adequately treated basal cell or squamous cell skin cancer or in situ cervical cancer.
11. Subject has a clinically significant abnormality on screening evaluation including physical examination, vital signs, electrocardiogram (ECG), or laboratory tests that the Investigator considers to be inappropriate to allow participation in the study.
12. Subject has screening laboratory test results of: blood urea nitrogen (BUN) value ≥ 1.5 times the upper limit of normal (ULN) for the reference range; serum creatinine > 1.5 times the ULN for the reference range; or alanine aminotransferase (ALT) or aspartate aminotransferase (AST) value ≥ 2 times the ULN for the reference laboratory.
13. Subject has random (non-fasting) screening glucose of ≥ 200 mg/dL (11.1 mmol/L) or HbA1c > 7.0%.

14. Subjects with type 1 diabetes, or insulin dependent diabetics are excluded. Subjects with type 2 diabetes are eligible for study inclusion if the following conditions are met:

    • Subject's screening glucose is < 200 mg/dL (11.1 mmol/L). Note: Subjects with random (non fasting) blood glucose at screening ≥ 200 mg/dL (11.1 mmol/L) must be retested in a fasted state; and
    • Subject's hemoglobin A1c (HbA1c) ≤ 7.0%; and
    • If the subject is currently being treated with oral anti-diabetic medication(s), the dose must have been stable for at least 4 weeks prior to SV1. Such medication may be adjusted or discontinued during the study, as clinically indicated.
15. The subject's screening ECG results of corrected QT interval using Fridericia's formula (QTcF) ≥ 450 msec for male subjects or ≥ 470 msec for female subjects. Eligibility will be based on the core laboratory ECG interpretation report.
16. Subject has a positive screening laboratory test result for human immunodeficiency virus (HIV).
17. Subject has a positive screening laboratory test result for hepatitis B surface antigen or hepatitis C antibodies and has liver function test results at screening above the ULN for the reference laboratory.
18. Subject has any other medical disorder that, in the opinion of the Investigator, could interfere with the subject's participation in the study.
19. Subject has major psychiatric disorder(s), including but not limited to: bipolar disorder, psychosis (eg, Parkinson's Disease Psychosis), major depressive episode, or any disorder that, in the opinion of the Investigator, would require treatment that could make study participation unsafe or make treatment compliance difficult.
20. History of clinically significant impulse control disorder(s).
21. History of symptomatic orthostatic hypotension requiring medication.
22. History of severe dyskinesia based on a score of 4 on the MDS-UPDRS Part IV.
23. Dementia that precludes providing informed consent or would interfere with participation in the study.
24. Current/recent suicidal ideation as evidenced by answering "yes" to "Suicidal Ideation" item 4 (active suicidal ideation with some intent to act, without specific plan) or item 5 (active suicidal ideation with specific plan and intent) on the C-SSRS assessment at screening (using the "screening /Baseline Version" scale, in the past 12 months) or attempted suicide within the last 5 years.
25. Presence of canker or mouth sores in the 30 days prior to SV1, or other clinically significant oral pathology in the opinion of the Investigator. The Investigator should follow-up with an appropriate specialist on any finding, if indicated, before enrolling a subject into the study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: APL-130277; APL-130277: Part A- determine the dose; Part B- 28-day repeat dosing at the dose determined in Part A	Drug: APL-130277; APL-130277: Part A- determine the dose; Part B- 28-day repeat dosing at the dose determined in Part A; Other Names: Apomorphine Hydrochloride
Active Comparator: subcutaneous apomorphine; subcutaneous apomorphine , Part A- determine the dose; Part B- 28-day repeat dosing at the dose determined in Part A	Drug: subcutaneous apomorphine; subcutaneous apomorphine Part A- determine the dose; Part B- 28-day repeat dosing at the dose determined in Part A; Other Names: APO-go®

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
change from pre-dose to 90 minutes post-dose in MDS UPDRS Part III score after 4 weeks of dosing in each crossover period (assessed by the blinded-rater in-clinic at Visit 3 and Visit 6 of PART B).	Week 4

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Durability of effect, defined as an Investigator confirmed full "ON" within 30 minutes post dose and at 90 minutes post-dose, after 4 weeks of dosing in each crossover period (assessed by the blinded-rater in-clinic at Visit 3 and Visit 6 of PART B).		Week 4
Subject preference for treatment regimen as measured by the Subject Preference Visual Analog Scale (VAS) after the subject has completed both APL 130277 and sc apomorphine treatment regimens (assessed in-clinic at Visit 6 of PART B).	with a recorded range of -50 to 50. Negative values indicate preference for SC treatment, and the more negative the value, the stronger is the preference for SC compared to APL treatment. Positive values indicate preference for APL treatment, and the more positive the value, the stronger is the preference for APL compared to SC treatment. A value of 0 indicates no preference of one treatment over the other.	Week 4
Per the Expanded Home Dosing Diary, percent of "ON" episodes without troublesome dyskinesia based on the 3 consecutive days prior to Visit 2, Visit 3, Visit 5, and Visit 6.		Week 4
Subject confirmed durability of effect, defined as subject confirmed full "ON" within 30 minutes post-dose and at 90 minutes post-dose, after 4 weeks of dosing in each crossover period (assessed in-clinic at Visit 3 and Visit 6 of PART B).		Week 4
Patient Global Impression of Change (PGI-C): Subject improvement of "OFF" episodes, defined as very much better, much better or a little better after 4 weeks of dosing in each crossover period (assessed in-clinic at Visit 3 and Visit 6 of PART B).		Week 4

Collaborators and Investigators

• Sponsor: Sunovion

Study record dates

Study Major Dates

• Study Start (Actual): December 19, 2018
• Primary Completion (Actual): August 11, 2021
• Study Completion (Actual): August 11, 2021

Study Registration Dates

• First Submitted: January 2, 2018
• First Submitted That Met QC Criteria: January 2, 2018
• First Posted (Actual): January 5, 2018

Study Record Updates

• Last Update Posted (Actual): January 12, 2022
• Last Update Submitted That Met QC Criteria: January 11, 2022
• Last Verified: January 1, 2022

More Information

Terms related to this study

• Keywords: Parkinson's Disease; "Off" Episodes; motor fluctuations associated with Parkinson's Disease
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Parkinsonian Disorders; Basal Ganglia Diseases; Movement Disorders; Synucleinopathies; Neurodegenerative Diseases; Parkinson Disease; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Autonomic Agents; Peripheral Nervous System Agents; Gastrointestinal Agents; Dopamine Agonists; Dopamine Agents; Emetics; Apomorphine
• Other Study ID Numbers: CTH-302; 2016-003456-70 (EudraCT Number)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Plan Description: IPD for this study may be made available upon request via the Clinical Study Data Request site.
• IPD Sharing Time Frame: IPD will be made available upon request within 12 months of posting the study results on ct.gov.
• IPD Sharing Access Criteria: Access is provided after a research proposal is submitted and has received approval from the Independent Review Panel and after a Data Sharing Agreement is in place. Access is provided for an initial period of 12 months but an extension can be granted, when justified, for up to another 12 months.
• IPD Sharing Supporting Information Type: Study Protocol; Statistical Analysis Plan (SAP); Clinical Study Report (CSR)

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