Parkinson's Disease
Conditions
Keywords
Parkinson, PD, Wearing-off, Levodopa/DDCI
Brief summary
Parkinson's disease (PD) is a neurodegenerative disorder of unknown aetiology with an estimated incidence of 4.5-16/100,000 persons/year. BIA 9-1067 is currently being developed by BIAL (Portela & Cª,S.A.) to be used in addition to L-DOPA (Levodopa) /carbidopa or L-DOPA (Levodopa) / preparations in PD patients. Promising results have been obtained for BIA 9-1067 in previous studies.
Detailed description
This study aims to demonstrate the efficacy and safety of BIA 9-1067 used in addition to L-DOPA/DDCI to control the wearing-off phenomenon in patients with PD. DDCI (DOPA decarboxylase inhibitors): benserazide and carbidopa
Interventions
DRUGBIA 9-1067
Capsules will be used.
DRUGPlacebo
comparator
DRUGLevodopa
DRUGCarbidopa
DOPA decarboxylase inhibitor (DDCI)
DRUGBenserazide
DOPA decarboxylase inhibitor
Sponsors
Bial - Portela C S.A.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
30 Years to 83 Years
Healthy volunteers
No
Inclusion criteria
1. Able to comprehend and willing to sign an informed consent form. 2. Male and female subjects between 30 and 83 years old, inclusive. 3. Diagnosed with idiopathic PD according to the UK Parkinson's Disease Society Brain Bank Clinical Diagnostic Criteria for at least 3 years. 4. Disease severity Stages I-III (modified Hoehn &Yahr staging) at ON. 5. Treated with L-DOPA/DDCI for at least 1 year with clear clinical improvement. 6. Treated with 3 to 8 daily doses of L-DOPA/DDCI, which can include a slow-release formulation. 7. On a stable regimen of L-DOPA/DDCI and other anti-PD drugs for at least 4 weeks before screening. 8. Signs of wearing-off phenomenon (end-of-dose deterioration) for a minimum of 4 weeks before screening with average total daily OFF time while awake of at least 1.5 hours, excluding the early morning pre-first dose OFF, despite optimal anti-PD therapy (based on the investigator's judgment.
Exclusion criteria
1. Non-idiopathic PD (atypical parkinsonism, secondary \[acquired or symptomatic\] parkinsonism, Parkinson-plus syndrome). 2. Dyskinesia disability score \>3 in the Unified Parkinson's Disease Rating Scale UPDRS) Sub-section IV A, item 33. 3. Severe and/or unpredictable OFF periods. 4. Treatment with prohibited medication: entacapone, tolcapone, neuroleptics, venlafaxine, MAO inhibitors (except selegiline up to 10 mg/day in oral formulation or 1.25 mg/day in buccal absorption formulation or rasagiline up to 1mg/day), or antiemetics with antidopaminergic action (except domperidone) within the month before screening. 5. Treatment with apomorphine within the month before screening or likely to be needed at any time during the study. 6. Dosage change of concomitant anti-PD medication within 4 weeks of screening. 7. Previous or planned (during the entire study duration, including the OL period)deep brain stimulation. 8. Previous stereotactic surgery (e.g. pallidotomy, thalamotomy) for PD or with planned stereotactic surgery during the study period. 9. Any investigational medicinal product within the 3 months (or within 5 half-lives, whichever is longer) before screening. 10. Any medical condition that might place the subject at increased risk or interfere with assessments.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Efficacy of 2 BIA 9-1067 (25 mg, and 50 mg) Compared With Placebo, When Administered With the Existing Treatment of L-DOPA Plus a DDCI (DOPA Decarboxylase Inhibitor) | 14-15 weeks | Efficacy of 2 BIA 9-1067 (25 mg, and 50 mg) compared with placebo, when administered with the existing treatment of L-DOPA plus a DDCI (DOPA decarboxylase inhibitor), in patients with PD and end-of-dose motor fluctuations. The primary efficacy variable will be the change from baseline in absolute OFF-time at the end of the DB period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| UPDRS (Unified Parkinson's Disease Rating Scale) Sections I (ON), II (ON and OFF), and III (ON) | 14-15 weeks | Total UPDRS SCORE (I, II (ON), and III) Change from Baseline to Endpoint * UPDRS I evaluation of mentation, behavior, and mood * UPDRS II self-evaluation of the activities of daily life (ADLs) including speech, swallowing, handwriting, dressing, hygiene, falling, salivating, turning in bed, walking, and cutting food * UPDRS III clinician-scored monitored motor evaluation The UPDRS I, II and III scores and subscores are calculated as the sum of all individual items. If one or two items in a scale are missing, they will be imputed with the mean of the non-missing items of that scale. Subscale has 0-4 ratings, where 0 = normal, 1 = slight, 2 = mild, 3 = moderate, and 4 = severe The final cumulative score will range from 0 (no disability) to 199 (total disability). |
| Parkinson's Disease Sleep Scale (PDSS) | 14-15 weeks | The Parkinson's disease Sleep Scale (PDSS) is a specific scale for the assessment of sleep disturbances in subjects with PD. The PDSS score is calculated as the sum of all single items. If one or two items are missing, they will be imputed with the mean of the non-missing items. If three or more items are missing, no imputation will be done and the score will be set to missing. Subscale has 0-10 ratings, where 0 = severe and 10 = normal The PDSS total score is a sum score of all 15 questions and ranges from 0 to 150, with lower scores meaning more disability. |
| Non-motor Symptoms Scale (NMSS) | 14-15 weeks | The Non-motor Symptoms Scale (NMSS) consists of 30 questions, covering 9 dimensions, whereby each item is scored for severity and frequency: Severity None 0 Mild (symptoms present but causes little distress) 1 Moderate (some distress or disturbance to subject) 2 Severe (major source of distress or disturbance to subject) 3 Frequency Rarely (\<1/wk) 1 Often (1/wk) 2 Frequent (several times per week) 3 Very Frequent (daily or all the time) 4 The product of frequency and severity is calculated for each item and each dimension score is defined as the sum of the frequency\*severity of the respective items. If frequency or severity of a single item is missing, the domain score will not be calculated. The NMSS total score is defined as the sum of all domain scores. The NMSS total score is calculated by adding all domain scores (0-360), and lower scores mean less disability. |
Countries
Portugal
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| BIA 9-1067 25 mg BIA 9-1067 once daily (QD). | 125 |
| BIA 9-1067 50 mg BIA 9-1067 once daily (QD). | 147 |
| Placebo Placebo: comparator | 135 |
| Total | 407 |
Baseline characteristics
| Characteristic | BIA 9-1067 25 mg | BIA 9-1067 50 mg | Placebo | Total |
|---|---|---|---|---|
| Age, Customized <70 years | 96 participants | 96 participants | 107 participants | 299 participants |
| Age, Customized ≥70 years | 29 participants | 51 participants | 28 participants | 108 participants |
| Sex: Female, Male Female | 82 Participants | 89 Participants | 71 Participants | 242 Participants |
| Sex: Female, Male Male | 43 Participants | 58 Participants | 64 Participants | 165 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 87 / 125 | 108 / 150 | 68 / 136 |
| serious Total, serious adverse events | 4 / 125 | 9 / 150 | 5 / 136 |
Outcome results
Primary
Efficacy of 2 BIA 9-1067 (25 mg, and 50 mg) Compared With Placebo, When Administered With the Existing Treatment of L-DOPA Plus a DDCI (DOPA Decarboxylase Inhibitor)
Efficacy of 2 BIA 9-1067 (25 mg, and 50 mg) compared with placebo, when administered with the existing treatment of L-DOPA plus a DDCI (DOPA decarboxylase inhibitor), in patients with PD and end-of-dose motor fluctuations. The primary efficacy variable will be the change from baseline in absolute OFF-time at the end of the DB period.
Time frame: 14-15 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| BIA 9-1067 25 mg | Efficacy of 2 BIA 9-1067 (25 mg, and 50 mg) Compared With Placebo, When Administered With the Existing Treatment of L-DOPA Plus a DDCI (DOPA Decarboxylase Inhibitor) | -102.8 minutes | Standard Deviation 159.42 |
| BIA 9-1067 50 mg | Efficacy of 2 BIA 9-1067 (25 mg, and 50 mg) Compared With Placebo, When Administered With the Existing Treatment of L-DOPA Plus a DDCI (DOPA Decarboxylase Inhibitor) | -124.0 minutes | Standard Deviation 178.23 |
| Placebo | Efficacy of 2 BIA 9-1067 (25 mg, and 50 mg) Compared With Placebo, When Administered With the Existing Treatment of L-DOPA Plus a DDCI (DOPA Decarboxylase Inhibitor) | -64.5 minutes | Standard Deviation 155.35 |
Secondary
Non-motor Symptoms Scale (NMSS)
The Non-motor Symptoms Scale (NMSS) consists of 30 questions, covering 9 dimensions, whereby each item is scored for severity and frequency: Severity None 0 Mild (symptoms present but causes little distress) 1 Moderate (some distress or disturbance to subject) 2 Severe (major source of distress or disturbance to subject) 3 Frequency Rarely (\<1/wk) 1 Often (1/wk) 2 Frequent (several times per week) 3 Very Frequent (daily or all the time) 4 The product of frequency and severity is calculated for each item and each dimension score is defined as the sum of the frequency\*severity of the respective items. If frequency or severity of a single item is missing, the domain score will not be calculated. The NMSS total score is defined as the sum of all domain scores. The NMSS total score is calculated by adding all domain scores (0-360), and lower scores mean less disability.
Time frame: 14-15 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BIA 9-1067 25 mg | Non-motor Symptoms Scale (NMSS) | Visit 5 | 33.7 units on a scale | Standard Deviation 26.3 |
| BIA 9-1067 25 mg | Non-motor Symptoms Scale (NMSS) | Baseline | 38.2 units on a scale | Standard Deviation 29.4 |
| BIA 9-1067 25 mg | Non-motor Symptoms Scale (NMSS) | Visit 7 | 35.0 units on a scale | Standard Deviation 29.88 |
| BIA 9-1067 50 mg | Non-motor Symptoms Scale (NMSS) | Visit 5 | 33.2 units on a scale | Standard Deviation 27.95 |
| BIA 9-1067 50 mg | Non-motor Symptoms Scale (NMSS) | Baseline | 36.7 units on a scale | Standard Deviation 30.88 |
| BIA 9-1067 50 mg | Non-motor Symptoms Scale (NMSS) | Visit 7 | 31.5 units on a scale | Standard Deviation 28.47 |
| Placebo | Non-motor Symptoms Scale (NMSS) | Baseline | 38.2 units on a scale | Standard Deviation 33.37 |
| Placebo | Non-motor Symptoms Scale (NMSS) | Visit 7 | 31.6 units on a scale | Standard Deviation 29.88 |
| Placebo | Non-motor Symptoms Scale (NMSS) | Visit 5 | 33.5 units on a scale | Standard Deviation 31.18 |
Secondary
Parkinson's Disease Sleep Scale (PDSS)
The Parkinson's disease Sleep Scale (PDSS) is a specific scale for the assessment of sleep disturbances in subjects with PD. The PDSS score is calculated as the sum of all single items. If one or two items are missing, they will be imputed with the mean of the non-missing items. If three or more items are missing, no imputation will be done and the score will be set to missing. Subscale has 0-10 ratings, where 0 = severe and 10 = normal The PDSS total score is a sum score of all 15 questions and ranges from 0 to 150, with lower scores meaning more disability.
Time frame: 14-15 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BIA 9-1067 25 mg | Parkinson's Disease Sleep Scale (PDSS) | Visit 7 | 98.79 units on a scale | Standard Deviation 25.28 |
| BIA 9-1067 25 mg | Parkinson's Disease Sleep Scale (PDSS) | Visit 5 | 97.99 units on a scale | Standard Deviation 26.196 |
| BIA 9-1067 25 mg | Parkinson's Disease Sleep Scale (PDSS) | Baseline | 95.75 units on a scale | Standard Deviation 28.026 |
| BIA 9-1067 50 mg | Parkinson's Disease Sleep Scale (PDSS) | Visit 7 | 103.25 units on a scale | Standard Deviation 26.752 |
| BIA 9-1067 50 mg | Parkinson's Disease Sleep Scale (PDSS) | Baseline | 102.62 units on a scale | Standard Deviation 25.116 |
| BIA 9-1067 50 mg | Parkinson's Disease Sleep Scale (PDSS) | Visit 5 | 103.05 units on a scale | Standard Deviation 26.437 |
| Placebo | Parkinson's Disease Sleep Scale (PDSS) | Visit 5 | 107.11 units on a scale | Standard Deviation 26.987 |
| Placebo | Parkinson's Disease Sleep Scale (PDSS) | Baseline | 101.76 units on a scale | Standard Deviation 26.729 |
| Placebo | Parkinson's Disease Sleep Scale (PDSS) | Visit 7 | 105.39 units on a scale | Standard Deviation 28.643 |
Secondary
UPDRS (Unified Parkinson's Disease Rating Scale) Sections I (ON), II (ON and OFF), and III (ON)
Total UPDRS SCORE (I, II (ON), and III) Change from Baseline to Endpoint * UPDRS I evaluation of mentation, behavior, and mood * UPDRS II self-evaluation of the activities of daily life (ADLs) including speech, swallowing, handwriting, dressing, hygiene, falling, salivating, turning in bed, walking, and cutting food * UPDRS III clinician-scored monitored motor evaluation The UPDRS I, II and III scores and subscores are calculated as the sum of all individual items. If one or two items in a scale are missing, they will be imputed with the mean of the non-missing items of that scale. Subscale has 0-4 ratings, where 0 = normal, 1 = slight, 2 = mild, 3 = moderate, and 4 = severe The final cumulative score will range from 0 (no disability) to 199 (total disability).
Time frame: 14-15 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BIA 9-1067 25 mg | UPDRS (Unified Parkinson's Disease Rating Scale) Sections I (ON), II (ON and OFF), and III (ON) | Baseline | 30.8 units on a scale | Standard Deviation 16.88 |
| BIA 9-1067 25 mg | UPDRS (Unified Parkinson's Disease Rating Scale) Sections I (ON), II (ON and OFF), and III (ON) | Endpoint | 26.6 units on a scale | Standard Deviation 16.4 |
| BIA 9-1067 50 mg | UPDRS (Unified Parkinson's Disease Rating Scale) Sections I (ON), II (ON and OFF), and III (ON) | Baseline | 31.7 units on a scale | Standard Deviation 17.55 |
| BIA 9-1067 50 mg | UPDRS (Unified Parkinson's Disease Rating Scale) Sections I (ON), II (ON and OFF), and III (ON) | Endpoint | 28.7 units on a scale | Standard Deviation 18.11 |
| Placebo | UPDRS (Unified Parkinson's Disease Rating Scale) Sections I (ON), II (ON and OFF), and III (ON) | Baseline | 31.5 units on a scale | Standard Deviation 17 |
| Placebo | UPDRS (Unified Parkinson's Disease Rating Scale) Sections I (ON), II (ON and OFF), and III (ON) | Endpoint | 28.1 units on a scale | Standard Deviation 16.78 |