When a patient with Parkinson's disease (PD) is initially treated with L-dopa or dopamine agonists, the symptoms of PD improve or disappear. After several years of taking L dopa or dopamine agonists, patients notice that their PD medications wear off sooner than when they first started taking them. This "wearing off" is characterized by the return of symptoms (i.e., tremor, slowness, and rigidity) and may occur over the course of a few minutes to an hour. When a patient's PD symptoms have returned, the patient is said to be in the "off" state. When the patient takes another dose of medication, and his/her PD symptoms improve or resolve, the patient is said to be in the "on" state. Antagonism of adenosine Type 2a receptors (A2a) may provide relief of PD symptoms. This trial will test the hypothesis that A2a receptor antagonism can lead to improvement in the function of PD participants taking a stable dose of L-dopa, as measured by a reduction in "off" time.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
778
one 2 mg tablet orally twice daily
one 5 mg tablet orally twice daily
one 10 mg tablet orally twice daily
one tablet orally twice daily
one 1 mg capsule orally in AM
one capsule orally in AM
Change From Baseline in Mean "Off" Time
The "on" state is defined as the period of time during which a patient's symptoms of PD improve or disappear following treatment with L-dopa or dopamine agonists. The "off" state is defined as the period of time characterized by the return of symptoms (i..e. tremor, slowness, and rigidity) following treatment with L-dopa or dopamine agonists. Study participants reported their symptoms at half-hour intervals as "off", "on", or "asleep" on their daily diary for 3 days before randomization (baseline) and for the 3 days immediately before their Week-12 visit. The mean change from baseline in "off" time was based on a constrained longitudinal data analysis with treatment, time, and treatment-by-time interaction as fixed effects and subject as random effect.
Time frame: Baseline and Week 12
Numberof Participants With Systolic Blood Pressure >=180 mm Hg
The number of participants with Systolic Blood Pressure \>=180 mm Hg was reported.
Time frame: Up to Week 14
Number of Participants With Diastolic Blood Pressure >=105 mm Hg
The number of participants with Diastolic Blood Pressure \>=105 mm Hg was reported.
Time frame: Up to Week 14
Number of Participants With Alanine Aminotransferase >=3 Times the Upper Limit of Normal
The number of participants with alanine aminotransferase \>=3 times the upper limit of normal and a \>=10% increase was reported.
Time frame: Up to Week 14
Number of Participants With Aspartate Aminotransferase >=3 Times the Upper Limit of Normal
The number of participants with aspartate aminotransferase \>=3 times the upper limit of normal and a \>=10% increase was reported.
Time frame: Up to Week 14
Percentage of Participants With Suicidality
The percentage of participants with suicidality using the Columbia - Suicide Severity Rating Scale (C-SSRS) was reported. The C-SSR was used in this study only for the purpose of safety monitoring by measuring the incidence of different types of suicidality categories during treatment. The assessment was done by the nature of the responses, not by a numbered scale. Participants who reported at least one occurrence of suicidal behavior or suicidal ideation were counted as having experienced suicidality. Suicidal behavior included suicide attempt, aborted attempt, interrupted attempt, or preparatory behavior. Suicidal ideation included a wish to die or active suicidal thought with or without method, intent or plan.
Time frame: Up to Week 12
Change From Baseline at Week 12 in Epworth Sleepiness Scale (ESS)
The ESS is a self-administered questionnaire providing a measure of a person's general level of daytime sleepiness, or their average sleep propensity in daily life. The scale consists of 8 situations in which the participant rates their tendency to become sleepy on a scale of 0=no chance of dozing to 3=high chance of dozing. The overall score is the sum of the scores for the 8 situations for a minimum of 0 and a maximum of 24.
Time frame: Baseline and Week 12
Percentage of Participants With >30% Change (Reduction) From Baseline at Week 12 in Mean "Off" Time
The "on" state is defined as the period of time during which a patient's symptoms of PD improve or disappear following treatment with L-dopa or dopamine agonists. The "off" state is defined as the period of time characterized by the return of symptoms (i..e. tremor, slowness, and rigidity) following treatment with L-dopa or dopamine agonists. Study participants reported their symptoms at half-hour intervals as "off", "on", or "asleep" on their daily diary for 3 days before randomization and for the 3 days immediately before their Week-12 visit.
Time frame: Baseline and Week 12
Change From Baseline at Week 12 in Mean "On" Time Without Troublesome Dyskinesia
When a participant is "on" without dyskinesias, parkinsonian symptoms have dissipated and the participant is experiencing no uncontrollable extraneous movements. Study participants reported their parkinsonian symptoms at half-hour intervals as "off", "on without dyskinesia", "on with non-troublesome dyskinesia", "on with troublesome dyskinesia", or "asleep" on their daily diary for 3 days before randomization and for the 3 days immediately before their Week-12 visit. The mean change from baseline in "on without troublesome dyskinesia" time was based on a constrained longitudinal data analysis with treatment, time, and treatment-by-time interaction as fixed effects and subject as random effect.
Time frame: Baseline and Week 12
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