A Placebo- and Ropinirole-Controlled Study for SPM 962 in Advanced Parkinson's Disease Patients

A Double-Blind, 3-Arm, Parallel Group, Placebo- and Ropinirole-Controlled Study for SPM 962 in Advanced Parkinson's Disease Patients With Concomitant Treatment of L-dopa

Status

Completed

Phases

Phase 3

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT01628926

Enrollment

420

Registered

2012-06-27

Start date

2009-06-30

Completion date

2011-05-31

Last updated

2014-05-23

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

Conditions

Parkinson's Disease

Brief summary

* To demonstrate the non-inferiority of SPM 962 to ropinirole in terms of efficacy in order to confirm clinical value of SPM 962. * To demonstrate the superiority of SPM 962 to placebo in terms of efficacy. * To investigate the tolerability and safety of SPM 962 up to 36.0 mg/day.

Interventions

DRUGSPM 962

SPM 962 transdermal patch once a daily up to 36.0 mg/day

DRUGRopinirole

Ropinirole oral administration TID up to 15.0 mg/day

DRUGPlacebo

SPM962-placebo patch and Ropinirole-placebo tab

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender

ALL

Age

30 Years to 79 Years

Healthy volunteers

Inclusion criteria

* Subject diagnosed as having Parkinson's disease in accordance with Diagnostic Criteria established by the Research Committee of MHLW-specified Intractable Neurodegenerative Diseases (1995). * Subject is 30 and more and less than 80 years of age at the time of informed consent. * Hoehn & Yahr stage 2-4 (on time). * Total UPDRS Part 3 score is over 10 at screening test (on time). * Subject is on a stable dose of L-dopa with no change in daily dose or dosing regimen for at least 28 days prior to the initial treatment of SPM 962. * Subject has any of the following problematic symptoms; 1) Wearing off phenomenon (including frozen gait at off time and dystonia at off time) 2) On and off phenomenon 3) Delayed-on and/or No-on phenomenon 4) Dyskinesia 5) Not well controlled with L-dopa.

Exclusion criteria

* Subject who has previously participated in a clinical trial of SPM962 and taken the investigational product (IP). * Subject has psychiatric symptoms, e.g. confusion, hallucination, delusion, excitation, delirium, abnormal behavior at screening test or baseline. * Subject whose SBP declines by at least 30 mmHg from supine to standing position based on the orthostatic hypotension assessment, or subject who develops orthostatic hypotension at baseline. * Subject has a history of epilepsy, convulsion and other. * Subject who has complications or a history of serious cardiac diseases or arrhythmia (eg, congestive heart failure of class 3 or 4 in the NYHA classification, second or third degree atrioventricular block, complete left bundle branch block, sick sinus syndrome, ventricular fibrillation, myocardial infarction within 12 months prior to the screening test, or a complication of angina pectoris). * Subjects has QTc-interval \>450 msec twice at screening. Subject has a the average QTc-interval from two ECGs \>450 msec in males and \>470 msec in females at baseline. * Subject has congenital long QT syndrome. * Subject whose serum potassium level is \< 3.5mEq/L at the screening test. * Subject has a total bilirubin \>= 3.0 mg/dL or AST(GOT) or ALT(GPT) greater than 2.5 times of the upper limit of the reference range (or \>= 100 IU/L) at screening test, or suffers complications of active phase of chronic hepatitis or liver cirrhosis. * Subject has BUN \>= 30 mg/dL or serum creatinine \>= 2.0 mg/dl at screening test. * Subject has a history of allergic reaction to topical agents such as transdermal patch. * Subject has a history of known intolerance/hypersensitivity to ropinirole and/or adverse drug reactions that prevent subject from receiving treatment. * Subject is pregnant or nursing or woman who plans pregnancy during the trial. * Subject is receiving therapy with prohibited drug specified in the study protocol. * Subject has a history of pallidotomy, thalamotomy, deep brain stimulation or fetal tissue transplant. * Subject has dementia, including DLB and PDD (MMSE score \<= 24 at screening). * Subject who has a complication or history of malignant neoplastic disease, or received treatment for the disease within 12 months prior to the screening test. * Subject is unable to give consent. * Subject who is unable to properly record information in a diary. * Subject is participating in another trial of IPs or received other IPs within 12 weeks prior to commencement of study treatment. * Investigator judges that subject is inappropriate as a study subject with other reasons.

Design outcomes

Primary

Measure	Time frame	Description
Unified Parkinson's Disease Rating Score (UPDRS) Part 3 Sum Score	baseline, 16 weeks after dosing	Mean change (LOCF) from baseline in UPDRS Part 3 sum score (on state) at 16 weeks after dosing. UPDRS is a scale for monitoring Parkinson's Disease-related disability and impairment. The UPDRS consists of the following four sub-scales. Part 1: Mentation, Part 2: Activities of Daily Living, Part 3: Motor, Part 4: Complications. Part 3 assesses 14 items. Each item is scored from 0 (normal) to 4 (severe). The sum score serves as the sub-scale score. A higher score indicates a greater severity of symptoms. Thus a decrease in the scores means improvement.

Secondary

Measure	Time frame	Description
UPDRS Part 2 Sum Score	Baseline, 16 weeks after dosing	Mean change (LOCF) from baseline in UPDRS Part 2 sum score (average scores of on state and off state) at 16 weeks after dosing. UPDRS 2 assesses 13 items. Each item is scored from 0 (normal) to 4 (severe). The sum score serves as the sub-scale score. A higher score indicates a greater severity of symptoms. Thus a decrease in the scores means improvement.
Off Time	Baseline, 16 weeks after dosing	Mean change (LOCF) from baseline in off time at 16 weeks after dosing. Off-time is a state where L-Dopa becomes ineffective. Off-time was measured by patient diary in hours/day.
Parkinson's Disease Sleep Scale-2 (PDSS-2)	Baseline, 16 weeks after dosing	Mean change (LOCF) from baseline in PDSS-2 sum score at 16 weeks after dosing. PDSS-2 is a scale for assessing sleep disorders in Parkinson's disease. PDSS consists of 15 questions about sleep and nocturnal disturbances. The score of each question ranges from 0 (never) to 4 (very frequent). The sum of each question serves as the scale score. Thus a decrease in the scores means improvement.
On Time	Baseline, 16 weeks after dosing	Mean change (LOCF) from baseline in on time at 16 weeks after dosing. On-time is a state where L-Dopa is effective. On-time was measured by patient diary in hours/day.
On Time Without Dyskinesia Disturbing Daily Activities	Baseline, 16 weeks after dosing	Mean change (LOCF) from baseline in on time without dyskinesia disturbing daily activities at 16 weeks after dosing. On-time is a state where L-Dopa is effective. On-time was measured by patient diary in hours/day.
On Time With Dyskinesia Disturbing Daily Activities	Baseline, 16 weeks after dosing	Mean change (LOCF) from baseline in on time with dyskinesia disturbing daily activities at 16 weeks after dosing (rate against on time).
UPDRS Part 3 Sum Score	baseline, 8 and 10 weeks after dosing	Mean change (LOCF) from baseline in UPDRS Part 3 sum score (on state) at 8 and 10 weeks after dosing. UPDRS Part 3 assesses 14 items. Each item is scored from 0 (normal) to 4 (severe). The sum score serves as the sub-scale score. A higher score indicates a greater severity of symptoms. Thus a decrease in the scores means improvement.
Effective Rate in UPDRS Part 2 Sum Score	Baseline, 16 weeks after dosing	Effective rate (percentage of subjects with 20% or 30% decrease) (LOCF) in UPDRS Part 2 sum score (average scores of on state and off state) at 16 weeks after dosing.
Effective Rate in Off Time	Baseline, 16 weeks after dosing	Effective rate (percentage of subjects with 20% or 30% decrease) (LOCF) in off time at 16 weeks after dosing. On-time is a state where L-Dopa is effective. On-time was measured by patient diary in hours/day.
Clinical Global Impression (CGI)	Baseline, 16 weeks after dosing	Change (LOCF) from baseline in CGI score. CGI improvement is a clinician-reported scale for assessing how much the patient's illness has improved or worsened from baseline. The scale scoring criteria are 1: very much improved, 2: much improved, 3: minimally improved, 4: no change, 5: minimally worse, 6: much worse, 7: very much worse. A decrease in the scores means improvement.
Dystonia (at an Early Hour)	Baseline, 16 weeks after dosing	Change (LOCF) from baseline in occurrence of Dystonia (at an early hour).
Dystonia (in the Daytime)	Baseline, 16 weeks after dosing	Change (LOCF) from baseline in occurrence of Dystonia (in the daytime).
Effective Rate in UPDRS Part 3 Sum Score	Baseline, 16 weeks after dosing	Effective rate (percentage of subjects with 20% or 30% decrease) (LOCF) in UPDRS Part 3 sum score (on state) at 16 weeks after dosing.

Countries

Japan

Participant flow

Participants by arm

Arm	Count
SPM 962 SPM 962 transdermal patch	164
Ropinirole Ropinirole tablet	166
Placebo SPM962 placebo patch and Ropinirole placebo tab	84
Total	414

Withdrawals & dropouts

Period	Reason	FG000	FG001	FG002
Overall Study	Adverse Event	13	11	9
Overall Study	Discontinuation criteria	3	4	0
Overall Study	Lack of Efficacy	2	1	5
Overall Study	Physician Decision	2	2	1
Overall Study	Protocol Violation	0	1	0
Overall Study	Withdrawal by Subject	6	4	2

Baseline characteristics

Characteristic	Ropinirole	Placebo	SPM 962	Total
Age, Categorical <=18 years	0 Participants	0 Participants	0 Participants	0 Participants
Age, Categorical >=65 years	114 Participants	56 Participants	93 Participants	263 Participants
Age, Categorical Between 18 and 65 years	52 Participants	28 Participants	71 Participants	151 Participants
Age, Continuous	67.0 years STANDARD_DEVIATION 7.9	65.3 years STANDARD_DEVIATION 7.9	64.8 years STANDARD_DEVIATION 8.8	65.8 years STANDARD_DEVIATION 8.3
Region of Enrollment Japan	166 participants	84 participants	164 participants	414 participants
Sex: Female, Male Female	98 Participants	42 Participants	103 Participants	243 Participants
Sex: Female, Male Male	68 Participants	42 Participants	61 Participants	171 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	140 / 168	99 / 167	40 / 85
serious Total, serious adverse events	7 / 168	5 / 167	6 / 85

Outcome results

Primary

Unified Parkinson's Disease Rating Score (UPDRS) Part 3 Sum Score

Mean change (LOCF) from baseline in UPDRS Part 3 sum score (on state) at 16 weeks after dosing. UPDRS is a scale for monitoring Parkinson's Disease-related disability and impairment. The UPDRS consists of the following four sub-scales. Part 1: Mentation, Part 2: Activities of Daily Living, Part 3: Motor, Part 4: Complications. Part 3 assesses 14 items. Each item is scored from 0 (normal) to 4 (severe). The sum score serves as the sub-scale score. A higher score indicates a greater severity of symptoms. Thus a decrease in the scores means improvement.

Time frame: baseline, 16 weeks after dosing

Population: Full analysis set (FAS), last observation carried forward (LOCF)

Arm	Measure	Value (MEAN)	Dispersion
SPM 962	Unified Parkinson's Disease Rating Score (UPDRS) Part 3 Sum Score	-10.9 Scores on a scale	Standard Deviation 8.1
Ropinirole	Unified Parkinson's Disease Rating Score (UPDRS) Part 3 Sum Score	-9.5 Scores on a scale	Standard Deviation 8.7
Placebo	Unified Parkinson's Disease Rating Score (UPDRS) Part 3 Sum Score	-4.5 Scores on a scale	Standard Deviation 9.7

Secondary

Clinical Global Impression (CGI)

Change (LOCF) from baseline in CGI score. CGI improvement is a clinician-reported scale for assessing how much the patient's illness has improved or worsened from baseline. The scale scoring criteria are 1: very much improved, 2: much improved, 3: minimally improved, 4: no change, 5: minimally worse, 6: much worse, 7: very much worse. A decrease in the scores means improvement.