A Phase 2 study to evaluate the safety, tolerability and initial efficacy of pramipexole ER, given with aprepitant in patients with parkinsonian type disorders
Methodology: This is an initial Phase 2, rising-dose, single-blind, out-patient, sequential-treatment study in up to 24 patients with idiopathic Parkinson's disease of about 5 months duration. All participants will have idiopathic Parkinson's disease (PD). Subjects will sign a consent form prior to any study related procedure and will complete baseline screening assessments. The study will be conducted in three parts: Part 1: All eligible patients switch from their dopaminergic treatment to the equivalent dose of pramipexole ER in the judgement of the investigator. Then, pramipexole ER is titrated alone up to the patients' optimal dose or to the protocol maximum allowed dose for Part 1 of 4.5 mg/day. Part 2: Add-on aprepitant and continue the titration of pramipexole ER from the optimal dose (or 4.5 mg/day) determined in Part 1 to the optimal dose not to exceed the protocol limit of 9.0mg/day, given in combination with aprepitant. Part 3: Maintain the dose of pramipexole ER found in Part 2 given in combination with aprepitant for 3 months with periodic safety and efficacy checks. During Parts 1 and 2, subjects will be evaluated at in-clinic visits for safety and tolerability at intervals not to exceed once weekly ± 2 days and additionally by telephone or in-clinic visits, as considered clinically appropriate, at each dose change. During Part 3, this optimal pramipexole ER/aprepitant regimen will be stably maintained for 3 months in association with monthly in-clinic laboratory and clinical evaluations. Safety and tolerability will continue to be evaluated by telephone or in-clinic visits, as deemed clinically appropriate. Pramipexole ER tablets will be administered with or without aprepitant, orally once daily in the morning. Subjects will take 1-3 pramipexole ER tablets daily. Aprepitant will be administered orally in a fixed daily dose by means of a single capsule containing 80 mg. At study completion (or at other times in accordance with Stopping Rules given below), study medications will be discontinued, and participants will be returned to their pre-admission therapeutic regimen as considered medically appropriate. Investigators will always have the option of making necessary and appropriate changes to protocol dose optimization schedules in consultation with the Sponsor. An independent DSMB will be appointed to have responsibility for safeguarding the interests of the trial subjects and assessing the safety and tolerability of the study treatments during the trial. The DSMB will meet when 10 patients complete the study and when all patients complete the study.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
24
pramipexole ER, given with aprepitant
Quest Research
Farmington Hills, Michigan, United States
Number of participants with adverse events -Safety by Incidence of Treatment-Emergent Adverse Events
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0" . Incidence and nature of adverse events; vital signs;
Time frame: multiple times for the duration of the study (baseline through Month 3)
Number of participants with change in weight
Number of participants with a change in weight (either by pounds or kilograms) from baseline
Time frame: mulitple times from baseline through Month 3
Number of participants with change in in physical examine
physical examination changes General appearance,Head, eyes, ears, nose, and throat, Respiratory, Cardiovascular, Musculoskeletal, Abdomen, Neurologic, Extremities, Dermatologic, Lymphatic)
Time frame: multiple times for the duration of the study (baseline through Month 3)
Number of participants with change in in clinical laboratory evaluations
changes in clinical laboratory evaluations (Creatinine, Potassium(K+),Sodium (Na+) , Chloride (Cl-), Magnesium (Mg++), Calcium, Inorganic phosphate, Glucose, Urea,Bilirubin (Total) ,Bilirubin (direct), AST, ALT, GGT, Alkaline phosphatase, Total Protein Albumin,
Time frame: multiple times for the duration of the study (baseline through Month 3)
Number of participants with change in Electrocardiography (ECG)
ECG (standard digital 12-lead in singlicate).
Time frame: multiple times for the duration of the study (baseline through Month 3)
Unified Parkinson's Disease Rating Scale (MDS-UPDRS)
Change from baseline in the MDS-UPDRS Part 4 for motor fluctuations and dyskinesia severity will be assessed hourly x3 on assessment days.motor complications (six items). Subscale has 0-4 ratings, where 0 = normal, 1 = slight, 2 = mild, 3 = moderate, and 4 = severe. Total score 0-24.
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Time frame: multiple times from baseline through Month 3
modified Columbia-Suicide Severity Rating Scale
3 question scale to to gage is the subject is having suicidal tendencies. If the response is "YES" to Question 1 or 2, or if the response to Question 3 reveals a concern about a significant level of suicidality, the subject would undergo a more detailed assessment by a qualified clinician who has experience in the evaluation of suicidal ideation and behavior, either at the site or by referral to an outside clinician. In either case, appropriate documentation of the clinical issues and management plan will be required in a narrative that would be placed in the subject's study record. Questions are 'yes' or 'no'
Time frame: multiple times from baseline through Month 3
Pharmacokinetics of pramipexole and aprepitant
Plasma concentrations of pramipexole and aprepitant will be measured
Time frame: multiple times from baseline through Month 3