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Effects of Carbidopa/Levodopa/Entacapone on Motor Function and Quality of Life in Patients With Parkinson's Disease

A Prospective, Multi-center, Randomized, Open-label Study With Blinded Raters to Evaluate the Effects of Immediate Versus Delayed Switch to Carbidopa/Levodopa/Entacapone on Motor Function and Quality of Life in Patients With Parkinson's Disease With End-of-dose Wearing Off

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00219284
Enrollment
359
Registered
2005-09-22
Start date
2005-01-31
Completion date
2008-07-31
Last updated
2017-03-30

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Parkinson's Disease With End of Dose Wearing Off

Keywords

Parkinson's disease, tremor

Brief summary

To assess motor function and quality of life (QoL) in Parkinson's disease (PD) subjects with end-of-dose wearing off, comparing immediate and delayed switch to carbidopa/levodopa and entacapone.

Detailed description

This was a prospective, multi-center, randomized, open-label study with blinded raters to evaluate the effects of immediate versus delayed switch to carbidopa/levodopa/entacapone on motor function and quality of life in patients with Parkinson's disease with end-of-dose wearing off.

Interventions

Carbidopa/levodopa/entacapone was administered in 1 of 3 dose combinations: 12.5/50/200 mg, 25/100/200 mg, or 37.5/150/200 mg. The selected combination dose contained the same doses of carbidopa and levodopa the patient was receiving prior to switching to carbidopa/levodopa/entacapone.

Sponsors

Novartis Pharmaceuticals
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
30 Years to 85 Years
Healthy volunteers
No

Inclusion criteria

* Males or females 30-80 years of age (inclusive). Patients aged 81-85 years were eligible to participate if the principal investigator considered the patient to be in otherwise good health. * Clinical diagnosis of Parkinson's disease exhibiting two of three symptoms (rigidity, resting tremor, bradykinesia). * All patients were required to have end-of dose wearing off (EODWO, re-emergence of PD symptoms at the end of at least two daily doses of levodopa during waking hours). * Taking regular doses of immediate release carbidopa/levodopa

Exclusion criteria

* Unstable Parkinson's Disease requiring booster doses or treatment with as needed dose regimens of levodopa * Female subjects who are pregnant, trying to become pregnant or nursing an infant Other protocol-defined inclusion/

Design outcomes

Primary

MeasureTime frameDescription
Change in Unified Parkinson's Disease Rating Scale (UPDRS) Part III Score From Baseline to Week 4Baseline to Week 4Motor function was assessed with the UPDRS part III. There are 14 items in the instrument, each measured on a 5 point scale (0-4): Speech, facial expression, tremor at rest, action tremor, rigidity, finger taps, hand movements, hand pronation and supination, leg agility, arising from chair, posture, gait, postural stability, and body bradykinesia. The sum of scores can range from 0 to 56; a higher score indicates greater disability. A negative change score indicates improvement.

Secondary

MeasureTime frameDescription
Change in Parkinson's Disease Quality of Life Score From Baseline to Week 8Baseline to Week 8Quality of life was assessed with the Parkinson's Disease Quality of Life Instrument (PDQUALIF), a 33-item self-reported questionnaire which includes seven domains: Social/role function, self-imaging/sexuality, sleep, outlook, physical function, independence, and urinary function. Questions are scored on a 5-point Likert scale ranging from 1 (never) to 3 (sometimes) to 5 (always). The 1 to 5 range was recoded to 0 to 4 for the analysis. The total score can range from 0 to 132. A lower score indicates better quality of life. A negative change score indicates improvement.
Change in Unified Parkinson's Disease Rating Scale (UPDRS) Part III Score From Baseline to Week 8Baseline to Week 8Motor function was assessed with the UPDRS part III. There are 14 items in the instrument, each measured on a 5-point scale (0-4): Speech, facial expression, tremor at rest, action tremor, rigidity, finger taps, hand movements, hand pronation and supination, leg agility, arising from chair, posture, gait, postural stability, and body bradykinesia. The sum of scores can range from 0 to 56; a higher score indicates greater disability. A negative change score indicates improvement.
Change in the 39-item Parkinson's Disease Questionnaire (PDQ-39) Total Score From Baseline to Week 4Baseline to Week 4The PDQ-39 is another instrument used to assess quality of life in individuals with Parkinson's disease. The questionnaire provides scores on eight scales: Mobility, activities of daily living, emotions, stigma, social support, cognition, communication, and bodily discomfort. Questions are scored on a 5-point Likert scale ranging from 1 (never) to 3 (sometimes) to 5 (always). The 1 to 5 range was recoded to 0 to 4 for the analysis. The total score can range from 0 to 156. A lower score indicates better quality of life. A negative change score indicates an improvement.
Change in Parkinson's Disease Quality of Life Score From Baseline to Week 4Baseline to Week 4Quality of life was assessed with the Parkinson's Disease Quality of Life Instrument (PDQUALIF), a 33-item self-reported questionnaire which includes seven domains: Social/role function, self-imaging/sexuality, sleep, outlook, physical function, independence, and urinary function. Questions are scored on a 5-point Likert scale ranging from 1 (never) to 3 (sometimes) to 5 (always). The 1 to 5 range was recoded to 0 to 4 for the analysis. The total score can range from 0 to 132. A lower score indicates better quality of life. A negative change score indicates improvement.
Change in Unified Parkinson's Disease Rating Scale (UPDRS) Part III Score From Baseline to End of TreatmentBaseline to end of treatment (Week 16 in the Immediate Switch group, Week 20 in the Delayed Switch group)Motor function was assessed with the UPDRS part III. There are 14 items in the instrument, each measured on a 5 point scale (0-4): Speech, facial expression, tremor at rest, action tremor, rigidity, finger taps, hand movements, hand pronation and supination, leg agility, arising from chair, posture, gait, postural stability, and body bradykinesia. The sum of scores can range from 0 to 56; a higher score indicates greater disability. A negative change score indicates improvement.
Change in Parkinson's Disease Quality of Life Score From Baseline to End of TreatmentBaseline to end of treatment (Week 16 in the Immediate Switch group, Week 20 in the Delayed Switch group)Quality of life was assessed with the Parkinson's Disease Quality of Life Instrument (PDQUALIF), a 33-item self-reported questionnaire which includes seven domains: Social/role function, self-imaging/sexuality, sleep, outlook, physical function, independence, and urinary function. Questions are scored on a 5-point Likert scale ranging from 1 (never) to 3 (sometimes) to 5 (always). The 1 to 5 range was recoded to 0 to 4 for the analysis. The total score can range from 0 to 132. A lower score indicates better quality of life. A negative change score indicates improvement.
Change in the 39-item Parkinson's Disease Questionnaire (PDQ-39) Total Score From Baseline to End of TreatmentBaseline to end of treatment (Week 16 in the Immediate Switch group, Week 20 in the Delayed Switch group)The PDQ-39 is another instrument used to assess quality of life in individuals with Parkinson's disease. The questionnaire provides scores on eight scales: Mobility, activities of daily living, emotions, stigma, social support, cognition, communication, and bodily discomfort. Questions are scored on a 5-point Likert scale ranging from 1 (never) to 3 (sometimes) to 5 (always). The 1 to 5 range was recoded to 0 to 4 for the analysis. The total score can range from 0 to 156. A lower score indicates better quality of life. A negative change score indicates an improvement.
Change in the 39-item Parkinson's Disease Questionnaire (PDQ-39) Total Score From Baseline to Week 8Baseline to Week 8The PDQ-39 is another instrument used to assess quality of life in individuals with Parkinson's disease. The questionnaire provides scores on eight scales: Mobility, activities of daily living, emotions, stigma, social support, cognition, communication, and bodily discomfort. Questions are scored on a 5-point Likert scale ranging from 1 (never) to 3 (sometimes) to 5 (always). The 1 to 5 range was recoded to 0 to 4 for the analysis. The total score can range from 0 to 156. A lower score indicates better quality of life. A negative change score indicates an improvement.

Countries

Puerto Rico, United States

Participant flow

Participants by arm

ArmCount
Immediate Switch
Carbidopa/levodopa/entacapone was administered in 1 of 3 dose combinations: 12.5/50/200 mg, 25/100/200 mg, or 37.5/150/200 mg. The selected combination dose contained the same doses of carbidopa and levodopa the patient was receiving prior to switching to carbidopa/levodopa/entacapone. Patients were switched the day after randomization from combined carbidopa/levodopa to combined carbidopa/levodopa/entacapone. Patients received the same doses of carbidopa (12.5, 25.0, or 37.5 mg) and levodopa (50, 100, or 150 mg) they were receiving prior to the switch, combined with 200 mg of entacapone. The frequency of doses per day prior to the switch remained the same after the switch.
180
Delayed Switch
Carbidopa/levodopa/entacapone was administered in 1 of 3 dose combinations: 12.5/50/200 mg, 25/100/200 mg, or 37.5/150/200 mg. The selected combination dose contained the same doses of carbidopa and levodopa the patient was receiving prior to switching to carbidopa/levodopa/entacapone. Patients were switched 4 weeks after randomization from combined carbidopa/levodopa to combined carbidopa/levodopa/entacapone. Patients received the same doses of carbidopa (12.5, 25.0, or 37.5 mg) and levodopa (50, 100, or 150 mg) they were receiving prior to the switch, combined with 200 mg of entacapone. The frequency of doses per day prior to the switch remained the same after the switch.
179
Total359

Withdrawals & dropouts

PeriodReasonFG000FG001
Extension Phase - 8 WeeksAdverse Event23
Extension Phase - 8 WeeksLost to Follow-up02
Extension Phase - 8 WeeksWithdrawal by Subject02
Treatment Phase - 16 WeeksAbnormal laboratory value(s)01
Treatment Phase - 16 WeeksAdverse Event2624
Treatment Phase - 16 WeeksLack of Efficacy310
Treatment Phase - 16 WeeksLost to Follow-up12
Treatment Phase - 16 WeeksProtocol Violation95
Treatment Phase - 16 WeeksWithdrawal by Subject59

Baseline characteristics

CharacteristicImmediate SwitchDelayed SwitchTotal
Age, Continuous68.7 years
STANDARD_DEVIATION 9.18
68.3 years
STANDARD_DEVIATION 10.38
68.5 years
STANDARD_DEVIATION 9.78
Sex: Female, Male
Female
74 Participants71 Participants145 Participants
Sex: Female, Male
Male
106 Participants108 Participants214 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
100 / 18066 / 179
serious
Total, serious adverse events
8 / 18012 / 179

Outcome results

Primary

Change in Unified Parkinson's Disease Rating Scale (UPDRS) Part III Score From Baseline to Week 4

Motor function was assessed with the UPDRS part III. There are 14 items in the instrument, each measured on a 5 point scale (0-4): Speech, facial expression, tremor at rest, action tremor, rigidity, finger taps, hand movements, hand pronation and supination, leg agility, arising from chair, posture, gait, postural stability, and body bradykinesia. The sum of scores can range from 0 to 56; a higher score indicates greater disability. A negative change score indicates improvement.

Time frame: Baseline to Week 4

Population: Intent-to-treat (ITT) population: All randomized patients who received at least one dose of study drug and had at least one post-baseline assessment of the primary efficacy variable. Only patients with baseline and Week 4 UPDRS part III scores were included in the analysis.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Immediate SwitchChange in Unified Parkinson's Disease Rating Scale (UPDRS) Part III Score From Baseline to Week 4-3.7 Units on a scaleStandard Error 0.66
Delayed SwitchChange in Unified Parkinson's Disease Rating Scale (UPDRS) Part III Score From Baseline to Week 4-1.8 Units on a scaleStandard Error 0.58
Secondary

Change in Parkinson's Disease Quality of Life Score From Baseline to End of Treatment

Quality of life was assessed with the Parkinson's Disease Quality of Life Instrument (PDQUALIF), a 33-item self-reported questionnaire which includes seven domains: Social/role function, self-imaging/sexuality, sleep, outlook, physical function, independence, and urinary function. Questions are scored on a 5-point Likert scale ranging from 1 (never) to 3 (sometimes) to 5 (always). The 1 to 5 range was recoded to 0 to 4 for the analysis. The total score can range from 0 to 132. A lower score indicates better quality of life. A negative change score indicates improvement.

Time frame: Baseline to end of treatment (Week 16 in the Immediate Switch group, Week 20 in the Delayed Switch group)

Population: ITT population - For each patient, the last post-baseline measurement during the treatment phase was used as the end-of-treatment measurement. Only patients with baseline and end-of-treatment PDQUALIF scores were included in the analysis.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Immediate SwitchChange in Parkinson's Disease Quality of Life Score From Baseline to End of Treatment-1.3 Units on a scaleStandard Error 0.97
Delayed SwitchChange in Parkinson's Disease Quality of Life Score From Baseline to End of Treatment0.2 Units on a scaleStandard Error 0.89
Secondary

Change in Parkinson's Disease Quality of Life Score From Baseline to Week 4

Quality of life was assessed with the Parkinson's Disease Quality of Life Instrument (PDQUALIF), a 33-item self-reported questionnaire which includes seven domains: Social/role function, self-imaging/sexuality, sleep, outlook, physical function, independence, and urinary function. Questions are scored on a 5-point Likert scale ranging from 1 (never) to 3 (sometimes) to 5 (always). The 1 to 5 range was recoded to 0 to 4 for the analysis. The total score can range from 0 to 132. A lower score indicates better quality of life. A negative change score indicates improvement.

Time frame: Baseline to Week 4

Population: Intent-to-treat (ITT) population: All randomized patients who received at least one dose of study drug and had at least one post-baseline assessment of the primary efficacy variable. Only patients with baseline and Week 4 PDQUALIF scores were included in the analysis.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Immediate SwitchChange in Parkinson's Disease Quality of Life Score From Baseline to Week 4-0.4 Units on a scaleStandard Error 0.88
Delayed SwitchChange in Parkinson's Disease Quality of Life Score From Baseline to Week 41.1 Units on a scaleStandard Error 0.77
Secondary

Change in Parkinson's Disease Quality of Life Score From Baseline to Week 8

Quality of life was assessed with the Parkinson's Disease Quality of Life Instrument (PDQUALIF), a 33-item self-reported questionnaire which includes seven domains: Social/role function, self-imaging/sexuality, sleep, outlook, physical function, independence, and urinary function. Questions are scored on a 5-point Likert scale ranging from 1 (never) to 3 (sometimes) to 5 (always). The 1 to 5 range was recoded to 0 to 4 for the analysis. The total score can range from 0 to 132. A lower score indicates better quality of life. A negative change score indicates improvement.

Time frame: Baseline to Week 8

Population: Intent-to-treat (ITT) population: All randomized patients who received at least one dose of study drug and had at least one post-baseline assessment of the primary efficacy variable. Only patients with baseline and Week 8 PDQUALIF scores were included in the analysis.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Immediate SwitchChange in Parkinson's Disease Quality of Life Score From Baseline to Week 8-2.5 Units on a scaleStandard Error 1.01
Delayed SwitchChange in Parkinson's Disease Quality of Life Score From Baseline to Week 8-1.1 Units on a scaleStandard Error 0.89
Secondary

Change in the 39-item Parkinson's Disease Questionnaire (PDQ-39) Total Score From Baseline to End of Treatment

The PDQ-39 is another instrument used to assess quality of life in individuals with Parkinson's disease. The questionnaire provides scores on eight scales: Mobility, activities of daily living, emotions, stigma, social support, cognition, communication, and bodily discomfort. Questions are scored on a 5-point Likert scale ranging from 1 (never) to 3 (sometimes) to 5 (always). The 1 to 5 range was recoded to 0 to 4 for the analysis. The total score can range from 0 to 156. A lower score indicates better quality of life. A negative change score indicates an improvement.

Time frame: Baseline to end of treatment (Week 16 in the Immediate Switch group, Week 20 in the Delayed Switch group)

Population: ITT population - For each patient, the last post-baseline measurement during the treatment phase was used as the end-of-treatment measurement. Only patients with baseline and end-of-treatment PDQ-39 scores were included in the analysis.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Immediate SwitchChange in the 39-item Parkinson's Disease Questionnaire (PDQ-39) Total Score From Baseline to End of Treatment-2.8 Units on a scaleStandard Error 1.6
Delayed SwitchChange in the 39-item Parkinson's Disease Questionnaire (PDQ-39) Total Score From Baseline to End of Treatment0.4 Units on a scaleStandard Error 1.47
Secondary

Change in the 39-item Parkinson's Disease Questionnaire (PDQ-39) Total Score From Baseline to Week 4

The PDQ-39 is another instrument used to assess quality of life in individuals with Parkinson's disease. The questionnaire provides scores on eight scales: Mobility, activities of daily living, emotions, stigma, social support, cognition, communication, and bodily discomfort. Questions are scored on a 5-point Likert scale ranging from 1 (never) to 3 (sometimes) to 5 (always). The 1 to 5 range was recoded to 0 to 4 for the analysis. The total score can range from 0 to 156. A lower score indicates better quality of life. A negative change score indicates an improvement.

Time frame: Baseline to Week 4

Population: Intent-to-treat (ITT) population: All randomized patients who received at least one dose of study drug and had at least one post-baseline assessment of the primary efficacy variable. Only patients with baseline and Week 4 PDQ-39 scores were included in the analysis.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Immediate SwitchChange in the 39-item Parkinson's Disease Questionnaire (PDQ-39) Total Score From Baseline to Week 4-1.7 Units on a scaleStandard Error 1.34
Delayed SwitchChange in the 39-item Parkinson's Disease Questionnaire (PDQ-39) Total Score From Baseline to Week 40.8 Units on a scaleStandard Error 1.17
Secondary

Change in the 39-item Parkinson's Disease Questionnaire (PDQ-39) Total Score From Baseline to Week 8

The PDQ-39 is another instrument used to assess quality of life in individuals with Parkinson's disease. The questionnaire provides scores on eight scales: Mobility, activities of daily living, emotions, stigma, social support, cognition, communication, and bodily discomfort. Questions are scored on a 5-point Likert scale ranging from 1 (never) to 3 (sometimes) to 5 (always). The 1 to 5 range was recoded to 0 to 4 for the analysis. The total score can range from 0 to 156. A lower score indicates better quality of life. A negative change score indicates an improvement.

Time frame: Baseline to Week 8

Population: Intent-to-treat (ITT) population: All randomized patients who received at least one dose of study drug and had at least one post-baseline assessment of the primary efficacy variable. Only patients with baseline and Week 8 PDQ-39 scores were included in the analysis.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Immediate SwitchChange in the 39-item Parkinson's Disease Questionnaire (PDQ-39) Total Score From Baseline to Week 8-5.8 Units on a scaleStandard Error 1.48
Delayed SwitchChange in the 39-item Parkinson's Disease Questionnaire (PDQ-39) Total Score From Baseline to Week 8-1.9 Units on a scaleStandard Error 1.31
Secondary

Change in Unified Parkinson's Disease Rating Scale (UPDRS) Part III Score From Baseline to End of Treatment

Motor function was assessed with the UPDRS part III. There are 14 items in the instrument, each measured on a 5 point scale (0-4): Speech, facial expression, tremor at rest, action tremor, rigidity, finger taps, hand movements, hand pronation and supination, leg agility, arising from chair, posture, gait, postural stability, and body bradykinesia. The sum of scores can range from 0 to 56; a higher score indicates greater disability. A negative change score indicates improvement.

Time frame: Baseline to end of treatment (Week 16 in the Immediate Switch group, Week 20 in the Delayed Switch group)

Population: ITT population - For each patient, the last post-baseline measurement during the treatment phase was used as the end-of-treatment measurement. Only patients with baseline and end-of-treatment UPDRS part III scores were included in the analysis.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Immediate SwitchChange in Unified Parkinson's Disease Rating Scale (UPDRS) Part III Score From Baseline to End of Treatment-3.6 Units on a scaleStandard Error 0.69
Delayed SwitchChange in Unified Parkinson's Disease Rating Scale (UPDRS) Part III Score From Baseline to End of Treatment-3.3 Units on a scaleStandard Error 0.64
Secondary

Change in Unified Parkinson's Disease Rating Scale (UPDRS) Part III Score From Baseline to Week 8

Motor function was assessed with the UPDRS part III. There are 14 items in the instrument, each measured on a 5-point scale (0-4): Speech, facial expression, tremor at rest, action tremor, rigidity, finger taps, hand movements, hand pronation and supination, leg agility, arising from chair, posture, gait, postural stability, and body bradykinesia. The sum of scores can range from 0 to 56; a higher score indicates greater disability. A negative change score indicates improvement.

Time frame: Baseline to Week 8

Population: Intent-to-treat (ITT) population: All randomized patients who received at least one dose of study drug and had at least one post-baseline assessment of the primary efficacy variable. Only patients with baseline and Week 8 UPDRS part III scores were included in the analysis.

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Immediate SwitchChange in Unified Parkinson's Disease Rating Scale (UPDRS) Part III Score From Baseline to Week 8-3.6 Units on a scaleStandard Error 0.71
Delayed SwitchChange in Unified Parkinson's Disease Rating Scale (UPDRS) Part III Score From Baseline to Week 8-3.7 Units on a scaleStandard Error 0.62

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026