E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
Degenerative disease of the nervous system |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nervous System Diseases [C10] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10061536 |
E.1.2 | Term | Parkinson's disease |
E.1.2 | System Organ Class | 10029205 - Nervous system disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess the effects of Rotigotine over placebo on improvement of Parkinson’s disease associated chronic pain in subjects with advanced-stage Parkinson’s disease experiencing Parkinson’s disease associated chronic pain. |
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E.2.2 | Secondary objectives of the trial |
To demonstrate that Rotigotine is effective on Parkinson’s disease associated chronic pain intensity and characterization, quality of life, depression, anxiety, and motor function in subjects with advanced-stage Parkinson’s disease. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. An Institutional Review Board (IRB)/Independent Ethics Committee (IEC) approved written Informed Consent form is signed and dated by the subject.
2. Subject is considered reliable and capable of adhering to the protocol, visit schedule, completion of the diary, and medication application according to the judgment of the investigator.
3. Subject is male or female and ≥18 years of age at the Screening Visit.
4. Subject has idiopathic Parkinson’s disease, defined by the cardinal sign, bradykinesia, plus the presence of at least 1 of the following: resting tremor, rigidity, or impairment of postural reflexes, and without any other known or suspected cause of Parkinsonism.
5. Subject is taking levodopa (either immediate or sustained release, in combination either with benserazide or carbidopa) with a stable daily dose of at least 200mg for at least 21 days prior to starting the documentation in the diary. The dose is expected to be maintained for the duration of the study.
6. Subject has a Hoehn and Yahr stage score of II to IV in the “on” state at the Screening Visit.
7. Subject is experiencing chronic pain associated with Parkinson’s disease for at least 3 months and of at least 4 points on an 11-point Likert Pain Scale (average pain experienced during last 7 days) at the Screening Visit. Pain characteristics with at least 1 kind of Parkinson’s disease pain to be included:
Dystonia
Musculoskeletal pain
Central neuropathic pain
Other pains worsened by Parkinson’s disease (except dyskinesia)
8. Subject has a Mini-Mental State Examination (MMSE) score ≥25 at the Screening Visit.
9. If the subject is taking a monoamine oxidase (MAO)-B inhibitor, an anticholinergic agent, the catechol-O-methyl transferase (COMT) inhibitor entacapone or the N-methyl-D aspartate (NMDA) antagonist amantadine, he/she must have been on a stable dose for at least 21 days prior to starting the documentation in the diary, and the dose is expected to be maintained for the duration of the study.
10. If the subject is taking an antidepressant drug such as a selective serotonin reuptake inhibitor, serotonin norepinephrine reuptake inhibitor, bupropion, or tricyclic antidepressants, he/she must have been on a stable dose for at least 21 days prior to starting the documentation in the diary, and the dose is expected to be maintained for the duration of the study.
11. Female subjects must be either postmenopausal for at least 1 year, surgically incapable of childbearing, or effectively practicing an acceptable method of contraception (either oral/parenteral/implantable hormonal contraceptives, intrauterine device, or barrier and spermicide). Abstinence only is not an acceptable method. Subjects must agree to use adequate contraception during the study and for 4 weeks after their final dose of rotigotine (or longer, if required by local regulations).
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E.4 | Principal exclusion criteria |
1. Subject has previously participated in this study or subject has previously been assigned to treatment in a study of the medication under investigation in this study.
2. Subject has participated in another study of an investigational medicinal product (IMP) (or a medical device) within the last 28 days prior to the Screening Visit or is currently participating in another study of an IMP or a medical device.
3. Subject has had therapy with a dopamine agonist within 21 days prior to starting the documentation in the diary.
4. Subject discontinued from previous therapy with a dopamine agonist after an adequate length of treatment, at an adequate dose, due to lack of efficacy as assessed by the investigator.
5. Subject is receiving therapy with any of the following medications within 21 days prior to starting the documentation in the diary: dopamine modulating substances (eg, reserpine), dopamine releasing substances (eg, methylphenidate, amphetamine), alpha-methyldopa, metoclopramide, budipine, tolcapone, Duodopa®, neuroleptics (including atypical neuroleptics), MAO-A inhibitors, opioids, and opiates.
6. Subject is receiving analgesics for the treatment for pain, unless the dose has been stable for at least 21 days prior to starting the documentation in the diary and the dose is likely to remain stable for the duration of the study.
7. Subject has a history of chronic alcohol or drug abuse within the last 6 months.
8. Subject has any medical or psychiatric condition (eg, bipolar disorder, dementia, hallucinations, or psychosis) that, in the opinion of the investigator, could jeopardize or would compromise the subject’s ability to participate in this study.
9. Subject has a known hypersensitivity to any components of the IMP or comparative drugs as stated in the protocol.
10. Subject has a lifetime history of suicide attempt (including an actual attempt, interrupted attempt, or aborted attempt), or has suicidal ideation in the past 6 months as indicated by a positive response (“Yes”) to either Question 4 or Question 5 of the Columbia-Suicide Severity Rating Scale (C-SSRS) at the Screening Visit.
11. Subject has an atypical Parkinson’s disease syndrome due to drugs (eg, neuroleptics, metoclopramide, flunarizine), metabolic neurogenetic disorders (eg, Wilson Disease), encephalitis, cerebrovascular disease, or degenerative diseases (progressive supranuclear palsy).
12. Subject has a history of deep brain stimulation.
13. Subject has a significant skin disease that would make transdermal drug use inappropriate, including a history of skin sensitivity to adhesives or transdermal medications.
14. Subject has received electroconvulsive therapy within 12 weeks prior to the Screening Visit.
15. Subject has evidence of an Impulse Control Disorder (ICD) according to the modified Minnesota Impulse Disorders Inventory (mMIDI) at the Screening Visit confirmed by a positive structured clinical interview.
16. Subject has a previous diagnosis of severe restless legs syndrome.
17. Subject has chronic migraine (>15 days per month).
18. Subject currently has severe depression.
19. Subject is currently lactating or pregnant or planning to become pregnant during the duration of the study.
20. Subject has symptomatic orthostatic hypotension at the Screening Visit.
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E.5 End points |
E.5.1 | Primary end point(s) |
Change from Baseline to the end of the Maintenance Period in pain severity “average pain experienced in the last 7 days” assessed by an 11-point Likert Pain Scale. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Following titration (7 weeks) and maintainance (12 weeks) periods, 19 weeks total |
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E.5.2 | Secondary end point(s) |
• Percentage of responders at the end of the Maintenance Period, with responders defined as “2 point reduction on an 11-point Likert Pain Scale”
• Change from Baseline to the end of the Maintenance Period in the sum score of the 8-item Parkinson’s Disease Questionnaire (PDQ-8)
• Change from Baseline to the end of the Maintenance Period of the 7-item depression subscore of the Hospital Anxiety and Depression Scale (HADS)
• Change from Baseline to the end of the Maintenance Period of the 7-item anxiety subscore of the HADS
• Change from Baseline to the end of the Maintenance Period in the combined score of the Unified Parkinson’s Disease Rating Scale (UPDRS) Parts II (Activities of Daily Living [ADL] subscale) and III (motor subscale)
• Change from Baseline to the end of the Maintenance Period in the total score of classification of pain in Parkinson’s disease <<TBC if algorithm is available to calculate total score>>
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Following titration (7 weeks) and maintainance (12 weeks) periods, 19 weeks total |
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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 | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
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) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
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.8.2.4 | Number of treatment arms in the trial | 2 |
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 | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 48 |
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 | No |
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 |
Argentina |
France |
Germany |
Hungary |
Korea, Republic of |
Mexico |
Poland |
Russian Federation |
Slovakia |
Ukraine |
United Kingdom |
United States |
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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 | 2 |
E.8.9.1 | In the Member State concerned months | 5 |
E.8.9.1 | In the Member State concerned days | 20 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 5 |
E.8.9.2 | In all countries concerned by the trial days | 20 |