This trial will the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA.
This is a randomized, double-blind, placebo-controlled phase II trial. This trial will be performed in two part: Main study and Ancillary study. Main Study: Following a 4-week screening period, subjects will be stratified by MSA subtype (MSA-P, -C \[MSA-Parkinsonian type, MSA-cerebellar ataxia\]) and randomly assigned in a 1:1 ratio either to KM-819 or Placebo groups. During a treatment period of 36 weeks, subjects will receive pills of either KM-819 or Placebo for oral administration every day from baseline visit. Following this, there will be a safety follow-up period at Week 40. Ancillary Study: This ancillary study will provide additional information on the continuing efficacy and safety of KM-819. Subjects in either treatment group in the main study who complete the study are eligible to participate in a follow-up, all-subjects-on-treatment (KM-819), open-label ancillary study. All subjects in the ancillary study will receive KM-819 for additional 36 weeks regardless of their treatment allocation during the main study. During a treatment period of 36 weeks, subjects will receive pills of KM-819 for oral administration every day from visit at Weeks 40.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
68
CHA Bundang Medical Center, CHA University
Seongnam-si, Gyeonggi-do, South Korea
Percentage change from baseline in putaminal [18F]FP-CIT (18F-FP-CIT Positron Emission Tomography for Correlating Motor and Cognitive Symptoms of Parkinson's Disease) binding
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA. The putaminal \[18F\]FP-CIT binding will allow quantification of MSA progression during 36 weeks.
Time frame: From Baseline to Week 36
Change from baseline in the Unified Multiple System Atrophy Rating Scale (UMSARS) scores (UMSARS I + II)
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA. The Unified Multiple System Atrophy Rating Scale (UMSARS) was developed to provide a surrogate measure of disease progression in multiple system atrophy. It is composed of four subscales: UMSARS-I (12 items) rates patient-reported functional disability (Historical Review), UMSARS-II (14 items) assesses motor impairment based on a clinical examination. Each item scores 0-4. UMSARS-I total score is 48 and UMSARS-II total score is 56. Higher scores on the UMSARS indicate greater disability.
Time frame: From Baseline to Week 36
Change from baseline in the UMSARS I scores
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA. The Unified Multiple System Atrophy Rating Scale (UMSARS) was developed to provide a surrogate measure of disease progression in multiple system atrophy. It is composed of four subscales: UMSARS-I (12 items) rates patient-reported functional disability (Historical Review), UMSARS-II (14 items) assesses motor impairment based on a clinical examination. Each item scores 0-4. UMSARS-I total score is 48. Higher scores on the UMSARS indicate greater disability.
Time frame: From Baseline to Week 36
Change from baseline in the UMSARS II scores
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA. The Unified Multiple System Atrophy Rating Scale (UMSARS) was developed to provide a surrogate measure of disease progression in multiple system atrophy. It is composed of four subscales: UMSARS-I (12 items) rates patient-reported functional disability (Historical Review), UMSARS-II (14 items) assesses motor impairment based on a clinical examination. Each item scores 0-4. UMSARS-II total score is 56. Higher scores on the UMSARS indicate greater disability.
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Time frame: From Baseline to Week 36
Percentage change from baseline in putaminal glucose metabolism
To evaluate the efficacy of KM-819 compared to placebo for slowing the putaminal of MSA, as measured by \[18F\]FDG PET (fluorodeoxyglucose (FDG)-positron emission tomography (PET)).
Time frame: From Baseline to Week 36
Percentage change from baseline in cerebellar glucose metabolism
To further evaluate the efficacy of KM-819 compared to placebo for slowing the cerebellar progression of MSA, as measured by \[18F\]FDG PET.
Time frame: From Baseline to Week 36
Change from baseline in the Unified Parkinson Disease Rating Scale (UPDRS) III score
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA, measured by clinical scales. The UPDRS is the most widely applied rating instrument for PD. The Total UPDRS III scale includes 18 items. Each item scores 0-4. UPDRS III total score is 72. The highest score refers to the most severe level of disability due to Parkinson's disease.
Time frame: From Baseline to Week 36
Change from baseline in the Scale for the Assessment and Rating of Ataxia (SARA) score
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA, measured by clinical scales. The SARA is a tool for assessing ataxia. It has eight categories with an accumulative scores ranging from 0 (no ataxia) to 40 (most severe ataxia). The eight categories were: Gait (0-8 score); Stance (0-6 score); Sitting (0-4 score); Speech disturbance (0-6 score); Finger chase(0-4 score); Nose-finger test (0-4 score); Fast alternating hand movements (0-4 score); Heel-shin slide (0-4 score). Mild dependence: 5.5 or lower, Moderate dependence: 14.25 or lower, Maximal dependence: 23 of higher.
Time frame: From Baseline to Week 36
Change from baseline in the Montreal Cognitive Assessment (MoCA) score
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA, measured by clinical scales. MoCA can be used to detect dementia in a clinical setting. A total score of 30 with over 26 is normal. The lower score refers the severe cognitive impairment.
Time frame: From Baseline to Week 36
Change from baseline in the Beck's Depression Inventory (BDI-II) score
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA, measured by clinical scales. The BDI-II is scored by summing the ratings for the 21 items. Each item is rated on a 4-point scale ranging from 0 to 3. The maximum total score is 63. Measures of 0-13: Minimal, 14-19: Mild, 20-28: Moderate, 29-63: Severe.
Time frame: From Baseline to Week 36
Number of subjects with adverse events (AEs) and serious AEs (SAEs)
To evaluate the safety of KM-819 in subjects with MSA.
Time frame: From Screening (Day -4) to Week 40
Maximum observed concentration (Cmax)
To describe the pharmacokinetics parameter (Cmax) of KM-819 using sparse PK sampling.
Time frame: From Baseline to Week 36
Area under the concentration-time curve (AUC)
To describe the pharmacokinetics parameter (AUC) of KM-819 using sparse PK sampling.
Time frame: From Baseline to Week 36
Time of maximum observed concentration (Tmax)
To describe the pharmacokinetics parameter (Tmax) of KM-819 using sparse PK sampling.
Time frame: From Baseline to Week 36