SER-214 is a poly (2-ethyl-2oxazoline)(POZ) polymer conjugate of rotigotine, a potent dopamine agonist that has high affinity for the subclass of dopamine receptors in the brain that mediate dopamine signaling. SER-214 will be administered subcutaneously once a week via a standard 1 mL insulin syringe to determine the safety, tolerability and pharmacokinetic (PK) profile of released rotigotine and POZ-conjugate. Subjects in this study are eligible if they have early, stable or untreated Parkinson's disease and are still experiencing motor fluctuations.
Clinical evidence suggests that dopamine agonists should be considered as an initial or early symptomatic therapy for PD. Current information indicates that the early use of long-acting dopaminergic agonists may protect against the development of motor complications by stimulating dopamine receptors in a non-pulsatile manner and by delaying the introduction of levodopa. In pre-clinical primate studies, L-dopa (short-acting, pulsatile) and dopaminergic agonists (long-acting; non pulsatile) provide comparable clinical benefit but with agonists inducing significantly less dyskinesia. Chronic L-dopa treated animals develop gene changes that are associated with abnormal neuronal firing patterns and dyskinesias which are not seen with long-acting dopamine agonists. Based on pre-clinical and clinical study results, treatment of Parkinson's patients with long-acting levodopa or dopamine agonists should provide symptomatic benefit, and significantly delay the onset of motor complications. This can be accomplished with duodopa or continuous sc apomorphine but these treatments are associated with significant side effects. To date, no practical method of providing continuous drug delivery using a dopaminergic agent for therapy of patients with early PD to prevent the development of motor complications has been advanced through clinical trials. SER-214 is being developed as a weekly sc injection that provides prompt onset of dopaminergic stimulation. Continuous levels of released rotigotine within the therapeutic window for relief of motor fluctuations have been observed in MPTP-treated cynomolgus macaques. PK determinations in normal monkeys for up to 13 weeks of treatment show that weekly injections of SER-214 provide continuous drug delivery of released plasma rotigotine within a predictable therapeutic range.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
20
SER-214 is a poly(2-ethyl-oxazoline) (POZ) polymer conjugate of the potent dopamine agonist rotigotine that is designed to provide continuous drug delivery following a single weekly injection
University of Alabama Birmingham
Birmingham, Alabama, United States
MD Clinical
Hallandale, Florida, United States
Georgia Regents University
Augusta, Georgia, United States
Duke University Medical Center
Durham, North Carolina, United States
Safety - Adverse Events and Serious Adverse Events
Change from Screening in frequency of adverse events (AEs) and serious adverse events (SAEs) at the Final Safety Visit
Time frame: From initial sc dose of SER-214 up to six weeks of follow-up
Percentage of patients in each cohort who discontinued therapy due to any adverse events {Tolerability}
Percentage of patients in each cohort who discontinued therapy due to any adverse events will be used as an assessment of tolerability
Time frame: From initial sc dose of SER-214 up to six weeks of follow-up
Safety - Vital Signs
Change from Screening in assessment of vital signs (pulse, blood pressure) at each study visit and Final Safety Visit
Time frame: From initial sc dose of SER-214 up to six weeks of follow-up
Safety - Abnormal Laboratory Results
Change from Screening in number of participants with laboratory test values of potential clinical importance
Time frame: From initial sc dose of SER-214 up to six weeks of follow-up
Safety - Treatment-Emergent Adverse Events
Counts of participants who had treatment-emergent adverse events (TEAEs), defined as newly occurring or worsening after first dose. Relatedness to \[study drug\] will be assessed by the investigator (Yes/No).
Time frame: From initial sc dose of SER-214 up to six weeks of follow-up
Safety - ECG Changes
Change from Screening in assessment of electrocardiogram (ECG) parameters at each injection visit
Time frame: From initial sc dose of SER-214 up to six weeks of follow-up
Fluctuation index
On injection days plasma samples will be taken at time 0 (baseline), 1, 2, 4 and 8 hours post injection. PK samples will be used to determine (a) released plasma rotigotine and (b) total SER-214. PK data will be used to determine the Fluctuation Index
Time frame: On injection days plasma samples will be taken at time 0, 1, 2, 4 and 8 hours
Maximum plasma concentration [C(max)]
PK samples will be used to determine (a) released plasma rotigotine and (b) total SER-214. PK data will be used to determine the C(max)
Time frame: On injection days plasma samples will be taken at time 0, 1, 2, 4 and 8 hours
Time to maximum concentration [T(max)]
PK samples will be used to determine (a) released plasma rotigotine and (b) total SER-214. PK data will be used to determine the T(max)
Time frame: On injection days plasma samples will be taken at time 0, 1, 2, 4 and 8 hours
Dose-adjusted area under the curve (AUC)
PK samples will be used to determine (a) released plasma rotigotine and (b) total SER-214. PK data will be used to determine the dose-adjusted AUC
Time frame: On injection days plasma samples will be taken at time 0, 1, 2, 4 and 8 hours
Unified Parkinson's Disease Rating Scale
The UPDRS total (Parts I, II and III) will be determined at each study site visit and the Final Safety Visit
Time frame: From Screening up to six weeks of follow-up
Unified Parkinson's Disease Rating Scale - Motor Part III Only
The Motor UPDRS (Part III) will be determined as a separate outcome measure at each injection day visit
Time frame: From Screening up to six weeks of follow-up
Epworth Sleepiness Scale (ESS)
The ESS will be determined at Screening, first Follow-up visit, Final Safety Visit and any unscheduled visit to determine if escalating doses of SER-214 are associated with increase in somnolence
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Time frame: From Screening up to six weeks of follow-up
Columbia Suicide Severity Rating Scale (C-SSRS)
The C-SSRS will be determined at Screening and Final Safety Visit and any unscheduled visit. C-SSRS assessed whether participant experienced following: completed suicide (1), suicide attempt (2) (response of "Yes" on "actual attempt"), preparatory acts toward imminent suicidal behavior (3)("Yes" on "preparatory acts or behavior"), suicidal ideation (4) ("Yes" on "wish to be dead", "non-specific active suicidal thoughts", "active suicidal ideation with methods without intent to act or some intent to act, without specific plan or with specific plan and intent), any suicidal behavior or ideation, self-injurious behavior (7)("Yes" on "Has subject engaged in non-suicidal self-injurious behavior").
Time frame: From Screening up to six weeks of follow-up
Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease (QUIP)
The QUIP will be assessed at Screening and on the Final Safety Visit and any unscheduled visit to determine if there is any association between Impulsive-Compulsive behavior and SER-214 dose
Time frame: From screening up to six weeks of follow-up