This study evaluates the safety and tolerability of CDNF in patients with Parkinson's disease, when dosed directly into the brain using an implanted investigational drug delivery system (DDS). Safety and accuracy of the DDS is also being evaluated. One-third of the patients will receive monthly infusions with placebo and two-third of the patients will receive monthly infusions with either mid- or high-doses of CDNF for a period of 6 months.
A patient's participation in the study will last for ten months and will include sixteen to seventeen visits: * Screening (2 visits) * Planning of surgery - Surgery: implantation of drug delivery system - Post-surgery follow-up (3 visits) * Test infusions with vehicle (1-2 visits) * Positron emission tomography (PET) examinations before the first and after the last dose (2 visits) * Baseline and randomisation to CDNF or placebo group (1 visit) * Dosing visits: CDNF or placebo (6 visits) * End-of-study visit (1 visit) Study examinations and assessments \- Physical examination: pulse rate, blood pressure, temperature, body weight and height * ECG (electrocardiography) and blood and urine tests * HIV, hepatitis B and C blood tests (on first visit) * Pregnancy tests for women of childbearing age * Completion of a patient diary to record mobility and time asleep * Parkinson's Kinetigraph (PKGTM) Data Logger: a watch-type device worn on the wrist for certain periods during the study to record movements * Questionnaires, rating scales and forms: quality of life, mood, memory, impulse control, mental health * Assessment of the port and the skin around the port * Cerebrospinal fluid sampling by lumbar puncture * Magnetic resonance imaging (MRI) * Positron emission tomography scans (PET) * Computed tomography (CT) For more information: https://treater.eu/clinical-study/
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
17
Repeated intracerebral infusions
Stereotactically implanted device
Helsinki University Hospital
Helsinki, Finland
Skåne University Hospital
Lund, Sweden
Karolinska University Hospital, Huddinge
Stockholm, Sweden
Adverse events (AEs)
Number and severity of adverse events
Time frame: Week 15 to Week 40
Electrocardiogram (ECG)
Changes in electrical activity of heartbeat measured by electrocardiogram
Time frame: Week 15 to Week 40
Beck Depression Inventory (BDI) score
Assessment of change in depression using Beck Depression Inventory (BDI) score
Time frame: Week 15 to Week 40
Questionnaire for impulsive-compulsive disorder in Parkinson's disease rating scale (QUIP_RS)
Assessment of changes in impulsive-compulsive disorders using QUIP\_RS
Time frame: Week 15 to Week 40
Montreal cognitive assessment (MoCA)
Assessment of change in cognitive domains using MoCA test
Time frame: Week 15 to Week 40
Physical examination
Changes in anatomic findings found in physical examination
Time frame: Week 15 to Week 40
Vital signs
Changes in vital signs
Time frame: Week 15 to Week 40
Clinical laboratory safety screen
Changes in clinical laboratory variables (chemistry, haematology, urinanalysis)
Time frame: Week 15 to Week 40
Formation of anti-CDNF antibodies
Change in anti-CDNF antibody concentration
Time frame: Week 15 to Week 40
Device related changes in safety measures
Occurrence of adverse device effects (ADE), for either the whole system or the individual sub systems (guide tubes/catheters, subcutaneous components, port), serious adverse device effect (SADE) including long term effects, neurological deficit (seizures), infection (local to components, in CNS), severe skin breakdown or necrosis requiring component removal life threatening or major (requiring intervention) intracerebral haemorrhage.
Time frame: Week 8 to Week 40
Device related accuracy of implantation
The accuracy of implantation of the Drug Delivery System (DDS) will be measured comparing the tip of each individual catheters defined in the plan of the surgical procedure with the position of those measured by the post-operative CT scan.
Time frame: Week 8
UPDRS (Unified Parkinson's Disease Rating Scale) Part III motor score
Changes in severity of PD (Parkinson's disease) motor symptoms assessed by UPDRS Part III motor scores
Time frame: Week 15 to Week 40
TUG (Timed Up and Go) test
Changes in mobility assessed by TUG test
Time frame: Week 15 to Week 40
UPDRS Total score (Part I-IV)
Change in severity of PD non-motor and motor symptoms assessed by UPDRS Part I-IV total scores (Parts I, II and IV in ON-state; Part III in OFF-state).
Time frame: Week 15 to Week 40
Home diary score
Change in functional status assessed by home diary score
Time frame: Week 16 to Week 24
PDQ-39 (Parkinson's Disease Questionnaire) score
Changes in health and daily activity assessed by PDQ-39 questionnaire score
Time frame: Week 15 to Week 40
change in CGI (Clinical Global Impressions) scale
• Change from baseline until end of treatment evaluation in mental status as measured by CGI scale.
Time frame: Week 16 to Week 40
Occurrence of blockage
Occurrence of blockage of implanted catheter preventing or limiting infusion assessed by measuring catheter pressure
Time frame: Week 11 to Week 36
Cessation of infusions
Cessation of infusions in an individual patient
Time frame: Week 11 to Week 36
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