- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03440112
Modulation of GABA-A Receptors in Parkinson Disease-Transdermal Flumazenil Arm (GABA-A)
December 15, 2022 updated by: Nicolaas Bohnen, MD, PhD
Modulation of GABA-A Receptors and Axial Motor Impairments in Parkinson
The arm of this study evaluates possible GABA-A receptor target engagement effects of the FDA-approved medication, transdermal flumazenil (added 4/2020, replaced clarithromycin), in the setting of Parkinson's disease.
Half of the subjects will receive transdermal flumazenil for 7-10 days, and half will receive a placebo.
[11C]Flumazenil GABA-A receptor PET imaging will be used to assess target engagement effects.
Note [11C]Flumazenil GABA-A receptor PET was not performed as part of the transdermal flumazenil study because of a Covid pandemic research amendment.
Study Overview
Status
Completed
Conditions
Detailed Description
This study focuses on neurochemical changes in the brain that occur in Parkinson's disease.
In particular we will be looking a neurotransmitter called GABA.
In some Parkinson's disease patients we see too much GABA activity in the brain.
This target engagement study examines the target engagement effect of GABA-A receptor modulation by transdermal flumazenil (previously clarithromycin).
[11C]-flumazenil Positron Emission Tomography (PET) imaging results will be used to assess for possible GABA-A receptor target engagement effects of transdermal flumazenil (previously clarithromycin).
Note [11C]Flumazenil GABA-A receptor PET was not performed as part of the transdermal flumazenil study because of a Covid pandemic research amendment.
Study Type
Interventional
Enrollment (Actual)
34
Phase
- Phase 2
- Phase 1
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
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Michigan
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Ann Arbor, Michigan, United States, 48106
- University of Michigan Health System Functional Neuroimaging, Cognitive and Mobility Laboratory
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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
50 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Parkinson's disease (PD): PD diagnosis will follow the UK Parkinson's Disease Society Brain Bank Research Center (UKPDSBRC) clinical diagnostic criteria for PD.
- Hoehn and Yahr stages 2-4
- Absence of dementia confirmed by cognitive testing.
- Abnormal 11C-Dihydrotetrabenazine ([11c]-DTBZ) PET study to demonstrate nigrostriatal dopaminergic denervation
Exclusion Criteria:
- PD with Dementia (PDD) or dementia with Lewy bodies (DLB).
- Other disorders which may resemble PD, such as vascu¬lar dementia, normal pressure hydrocephalus, multiple system atrophy, corticobasal ganglionic dege¬neration, or toxic causes of parkinsonism. Prototypical cases have distincti¬ve clinical profiles, like early and severe dysautonomia or appendicular apraxia, which may differentiate them from idiopathic PD. The use of the UKPDSBRC clinical diagnostic criteria for PD will mitigate the inclusion of subjects with atypical parkinsonism.
- Subjects currently on benzodiazepine, GABAB-ergic medications (baclofen, tizanidine), modafinil, neuroleptic, anticholinergic (trihexyphenidyl, benztropine), or cholinesterase inhibitor drugs.
- Evidence of a mass lesion on structural brain imaging (MRI).
- Participants in whom MRI is contraindicated including, but not limited to, those with a pacemaker, presence of metallic fragments near the eyes or spinal cord, chest, or cochlear implant.
- Severe claustrophobia precluding MR or PET imaging.
- Subjects limited by participation in research procedures involving ionizing radiation.
- Pregnancy (urine or serum pregnancy test within 48 hours of each PET session) or breastfeeding.
- History of seizures
- Significant anxiety or history of panic disorder.
- History of recent suicide attempt or overdose of tricyclic antidepressants or other medications.
- History of transient ischemic attack (TIA) or stroke within the last year.
- History of systemic lupus erythematosis.
- Abnormal liver enzymes (AST or ALT) > 3 times upper limit of normal.
- History of atrial fibrillation.
- History of retinal branch artery occlusion.
- Active dermatitis inner forearms.
- Any other medical history determined by investigators to preclude safe participation.
Additional Exclusion Criteria for Flumazenil sub-studies:
- Allergy to flumazenil
- Significant liver disease
- History of alcohol or other substance abuse within past two years.
- Subjects currently taking benzodiazepines
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: Other
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Clarithromycin (Not used anymore as of 4/2020; study aborted)
Clarithromycin 250mg (1 capsule) will be taken orally twice a day for 3 days and if tolerated will be increased to 500mg (2 capsules) orally twice a day for 4-6 days.
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Clarithromycin (generic) capsule 250mg each
Other Names:
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Placebo Comparator: Placebo (Not used anymore as of 4/2020; study aborted)
Placebo will be taken exactly as the clarithromycin arm: 1 capsule orally twice a day for 3 days and if tolerated will be increased to 2 capsules orally twice a day for 4-6 days.
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Lactose in a gel capsule
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Active Comparator: Transdermal flumazenil (added 4/2020 as safer alternative for clarithromycin)
Added in April 2020.
Subjects will take 18mg transdermal application every 3-4 hrs dispensed as 3 dispenser bottle clicks of 0.25 ml each, while awake for 3 days then if no side-effects subjects will increase to 36mg transdermal application every 3-4 hrs dispensed as 6 dispenser bottle clicks of 0.25 ml each, while awake.
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Transdermal flumazenil 24mg/mL
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Placebo Comparator: Placebo cream (added 4/2020)
Added in April 2020.
Placebo will be taken exactly as the transdermal flumazenil arm: Subjects will take 18mg transdermal application every 3-4 hrs dispensed as 3 dispenser bottle clicks of 0.25 ml each, while awake for 3 days then if no side-effects subjects will increase to 36mg transdermal application every 3-4 hrs dispensed as 6 dispenser bottle clicks of 0.25 ml each, while awake.
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Transdermal placebo
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Quantitative Biomechanics 1 (Clinical Motor Ratings MDS-UPDRS)
Time Frame: Day 1 (before treatment administration), day 7 (after 7 days of treatment), and day 14 (7 days of treatment discontinuation).
|
We will use the total Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III - motor scale rating scores to assess motor function.
Scale from 0-132, higher scores indicate worse motor outcomes.
Outcome measure was collected during dopaminergic medication ON state.
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Day 1 (before treatment administration), day 7 (after 7 days of treatment), and day 14 (7 days of treatment discontinuation).
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Quantitative Biomechanics 2 (MiniBESTest Dynamic Balance Scale Sensory Subscore)
Time Frame: Day 1 (before treatment administration), day 7 (after 7 days of treatment), and day 14 (7 days of treatment discontinuation).
|
MiniBEST sensory subscore measures an individual's ability to maintain balance under conditions of sensory constrain and unstable/inclined standing surface.
It is is computed as a sum of MiniBEST items 7, 8, and 9.The score ranges from 0 to 6, with 0 indicating inability to balance under all of the condition, and 6 indicating no difficulty in maintaining balance under any of the conditions (lower score indicates worse balance).
Outcome measure was collected during dopaminergic medication ON state.
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Day 1 (before treatment administration), day 7 (after 7 days of treatment), and day 14 (7 days of treatment discontinuation).
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Nicolaas I Bohnen, MD, PhD, University of Michigan
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)
January 29, 2018
Primary Completion (Actual)
December 8, 2021
Study Completion (Actual)
December 8, 2021
Study Registration Dates
First Submitted
January 26, 2018
First Submitted That Met QC Criteria
February 13, 2018
First Posted (Actual)
February 20, 2018
Study Record Updates
Last Update Posted (Estimate)
January 10, 2023
Last Update Submitted That Met QC Criteria
December 15, 2022
Last Verified
December 1, 2022
More Information
Terms related to this study
Keywords
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
- Anti-Infective Agents
- Enzyme Inhibitors
- Protective Agents
- Anti-Bacterial Agents
- GABA Modulators
- GABA Agents
- Cytochrome P-450 CYP3A Inhibitors
- Cytochrome P-450 Enzyme Inhibitors
- Protein Synthesis Inhibitors
- Antidotes
- Clarithromycin
- Flumazenil
Other Study ID Numbers
- HUM00360361-A
- R01NS099535 (U.S. NIH Grant/Contract)
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
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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