E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Idiopathic Parkinson's Disease patients who have motor fluctuations with recognisable motor “off” periods |
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MedDRA Classification |
E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
•To explore the efficacy of VR040 in controlling “off” periods as measured by the primary and secondary efficacy criteria in patients with idiopathic PD who have motor fluctuations with recognisable motor “off” periods. •To compare the efficacy of VR040 with that of placebo. •To explore the safety/tolerability profile of VR040 as measured by the incidence and severity of spontaneously reported adverse events (AEs), vital signs, electrocardiograms (ECGs), lung function, and laboratory test results. •To explore the PK profile of VR040. •To verify that patients with idiopathic PD have sufficient dexterity and inspiratory effort to operate the Aspirair® inhaler satisfactorily.
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E.2.2 | Secondary objectives of the trial | |
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
In order to be eligible to enter the study, patients must meet all of the following criteria: 1.Male and female patients between 30 and 90 years of age with a clinical diagnosis of idiopathic PD for at least 5 years duration 2.Provides voluntary written informed consent 3.Is willing and able to comply with study procedures 4.Fulfils steps 1 & 2 of the UK Brain Bank Criteria (Appendix 3) 5.Classifies as Hoehn & Yahr Stage II-IV in “on” state (Appendix 4) 6.Experiences motor fluctuations with recognisable “off” periods in control of motor symptoms, as assessed by the Motor Fluctuation Questionnaire. Patients should report at least 1 “Yes” response to the questions in the Motor Fluctuation Questionnaire (Appendix 5) 7.Has received optimised oral therapy including LD 300-1500 mg per day (in combination with decarboxylase inhibitors) for at least the 30 days before Screening. For patients receiving controlled-release (CR) formulations, the dose range is based on a 70% bioavailability adjustment (ie, 100 mg CR = 70 mg non-CR) 8.Shows dopaminergic responsiveness as defined by ≥30% improvement (reduction) in UPDRS III score compared to pre-dose value
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E.4 | Principal exclusion criteria |
Patients will be excluded from the study if they meet any of the following criteria: 1.Participation in a trial with an investigational product within 3 months prior to Visit 1 2.Serious uncontrolled disease, including serious psychological disorders likely to interfere with the study and/or likely to cause death within 6 months of the study completion 3.Previous intolerance to apomorphine 4.Previous significant complication from oral dopamine agonist therapy including hospitalisation following dopamine agonist introduction and/or the development of hallucinations or other adverse neuropsychiatric features. Specific severe mental side effects include compulsive behaviour, psychosis, or hallucination that led to withdrawal of oral dopamine agonist therapy. 5.Women during the lactation period, pregnancy or of childbearing potential not using a reliable contraceptive method (eg, barrier, intrauterine device, abstinence) 6.Known human immunodeficiency virus or active chronic hepatitis B or C infection 7.Any clinically significant abnormality following review of screening laboratory data, previous medical history/intercurrent illness, and full physical examination, which may compromise the safety of the patient in the study 8.In the investigator’s opinion, the patient is unsuitable for the study for any reason. 9.ECG abnormalities that, in the opinion of the investigator, would preclude study entry. 10.FEV1 ≤ 65% predicted 11.A postural decrease in systolic blood pressure of ≥20 mmHg, or showing significant clinical symptoms associated with orthostatic hypotension 12.Persistent arterial hypotension, with average systolic readings of ≤110 mmHg 13.Persistent elevation of blood pressure, with average systolic readings of ≥160 mmHg or average diastolic readings of ≥100 mmHg 14.Taking prohibited concomitant medications (Section 7.2) 15.Consumption of anabolic steroids or antipsychotics. Administration of the following low dose atypical antipsychotics is permitted: • Quetiapine (up to and including 50 mg per day) • Risperidone (up to and including 1 mg per day) • Olanzipine (up to and including 2.5 mg per day) 16.Consumption of the 5HT3 antagonist class including ondansetron, granisetron, dolasetron, palonosetron, and alosetron 17.Existing cancer and those in remission for less than 5 years 18.Evidence as ascertained from examination, tests or history to indicate cardiovascular, gastrointestinal tract, liver, kidneys, central nervous system, pulmonary system or bone marrow disorders that, in the investigator’s opinion, compromises patient safety 19.Known non-responders to apomorphine treatment for “off” episodes, eg, in previous challenge tests or trials 20.History of drug or alcohol abuse in the 12 months prior to entry 21.A history of clinically significant allergies to VR040 formulation constituents (including lactose and opioids) or domperidone 22.Signs or symptoms suggestive of psychosis, dementia, “Parkinson-plus” syndromes, or unstable systemic disease 23.History of stroke, seizure, or other neurological conditions 24.Patients with dyskinesia rated 4 in Item 32 of UPDRS IV assessment at Screening (dyskinesia present ≥76% of a waking day)
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary efficacy endpoint is calculated for each patient as the maximum change in the UPDRS III score from pre-dose to post-dose score. This relates to the highest dose received by an individual patient. The UPDRS III data will be collected during Screening and Visits 1 and 2. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Information not present in EudraCT |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 8 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 6 |