This is a randomized, placebo-controlled, double-blind, 2-period study evaluating the safety and pharmacokinetics (PK) of ND0612 in Parkinson's disease (PD) patients on an optimized oral levodopa (LD) regimen and experiencing ≥2 h/day of OFF time. Safety and tolerability, PK profile, pump usability, and the potential clinical effect of ND0612 will be explored in subjects with PD and motor fluctuations.
During Period 1, patients continued on their current standard of care (SoC) levodopa/carbidopa (LD/CD) and were randomized at 2:1 ratio to 14 days of adjunct treatment with ND0612 (daily LD/CD dose of 270/63 mg) or placebo infusion. During Period 2, patients were randomized to receive 7 days open-label treatment with ND0612 or ND0612 plus oral entacapone. Patients then entered a 4-week safety follow-up period.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
30
Subcutaneous infusion via CRONO ND pump
Subcutaneous infusion via CRONO ND pump
200 mg oral tablet
Hadassah Medical Center
Jerusalem, Israel
Rabin Medical Center
Petah Tikva, Israel
Tel Aviv Medical Center
Tel Aviv, Israel
Maximum Dermal Rating Score: Draize Score
Local safety of the infusion sites was comprehensively assessed approximately one hour after removal of the SC pump. Draize score is the sum of the erythema and eschar formation plus edema scores with 0 meaning no and 8 indicating the most severe erythema, eschar, and edema formation. The maximum dermal rating score was assessed in Period 1.
Time frame: 14 days (Period 1)
Maximum Dermal Rating Score: Erythema and Eschar Formation
Local safety of the infusion sites was comprehensively assessed approximately one hour after removal of the SC pump. Erythema was evaluated via the Draize score on a scale of 0 to 4, with 0 meaning no erythema to a maximum score of 4 representing the most severe erythema (beet redness to eschar formation). The maximum dermal rating score was assessed in Period 1.
Time frame: 14 days (Period 1)
Maximum Dermal Rating Score: Edema
Local safety of the infusion sites was comprehensively assessed approximately one hour after removal of the SC pump. Edema was evaluated via the Draize score on a scale of 0 to 4, with 0 meaning no edema to a maximum score of 4 representing the most severe edema (raised more than 1 mm and extending beyond the area of exposure). The maximum dermal rating score was assessed in Period 1.
Time frame: 14 days (Period 1)
Maximum Dermal Rating Score: Presence of Nodules
Local safety of the infusion sites was comprehensively assessed approximately one hour after removal of the SC pump. Evaluated via a scale of 0 to 3, with 0 meaning no nodule to a score of 3 representing severe (\> 1 cm). The maximum dermal rating score was assessed in Period 1.
Time frame: 14 days (Period 1)
Maximum Dermal Rating Score: Pruritus
Local safety of the infusion sites was comprehensively assessed approximately one hour after removal of the SC pump. Evaluated on a scale of 0 to 3, with 0 meaning no pruritus to a maximum score of 3 representing severe pruritus. The maximum dermal rating score was assessed in Period 1.
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Time frame: 14 days (Period 1)
Maximum Dermal Rating Score: Staining
Local safety of the infusion sites was comprehensively assessed approximately one hour after removal of the SC pump. The presence of staining at the infusion site was evaluated via a scale of 0 to 3, with 0 meaning none to a score of 3 representing severe. The maximum dermal rating score was assessed in Period 1.
Time frame: 14 days (Period 1)
Maximum Dermal Rating Score: Pain
Local safety of the infusion sites was comprehensively assessed approximately one hour after removal of the SC pump. Pain score was evaluated with a visual analog scale (VAS). The VAS was a horizontal line, 100 mm in length, anchored by word descriptors at each end; "no pain" = 0 mm to "very severe pain" = 100 mm. The patient marked on the line the point that they felt represented their current state. The maximum dermal rating score was assessed in Period 1.
Time frame: 14 days (Period 1)
Total Oral LD Dose
Total oral levodopa dose during PK sampling day
Time frame: Day 15 (Period 1) and Day 22 (Period 2)
LD Cmin
The lowest plasma concentration (Cmin) measured during a sampling period. Samples collected at 2 h and 1 h prior to the first morning oral LD dose, and every 30 min for 2 h then hourly until 10 h.
Time frame: Day 15 (Period 1) and Day 22 (Period 2)
LD Cmax
Maximum observed levodopa plasma concentration (Cmax). Samples collected at 2 h and 1 h prior to the first morning oral LD dose, and every 30 min for 2 h then hourly until 10 h.
Time frame: Day 15 (Period 1) and Day 22 (Period 2)
LD AUC (0-10h)
Area under the concentration-time curve (AUC) until 10 h. Samples collected at 2 h and 1 h prior to the first morning oral LD dose, and every 30 min for 2 h then hourly until 10 h.
Time frame: Day 15 (Period 1) and Day 22 (Period 2)
Time LD Concentration >1000 ng/mL
Time LD plasma concentrations were maintained above 1000 ng/mL. Samples collected at 2 h and 1 h prior to the first morning oral LD dose, and every 30 min for 2 h then hourly until 10 h.
Time frame: Day 15 (Period 1) and Day 22 (Period 2)
LD Concentration FI
LD plasma concentration Fluctuation index (FI) is a pharmacokinetic parameter defined as \[Cmax-Cmin\]/Caverage. Samples collected at 2 h and 1 h prior to the first morning oral LD dose, and every 30 min for 2 h then hourly until 10 h. Lower values are considered better to maintain the clinical response.
Time frame: Day 15 (Period 1) and Day 22 (Period 2)