Clinical Trial Results:
ADS-5102 (Amantadine HCl) Extended Release Efficacy and Safety Study in Parkinson's Disease Patients with Levodopa-Induced Dyskinesia
Summary
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EudraCT number |
2014-003738-24 |
Trial protocol |
DE ES AT |
Global end of trial date |
10 Mar 2016
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Results information
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Results version number |
v1(current) |
This version publication date |
25 Mar 2017
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First version publication date |
25 Mar 2017
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Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
ADS-AMT-PD304
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT02136914 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Adamas Pharmaceuticals, Inc
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Sponsor organisation address |
1900 Powell Street, Suite 750, Emeryville, United States, CA94608
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Public contact |
Clinical Trials Information, Adamas Pharmaceuticals, Inc., +1 5104503500, RegistroEspanolDeEstudiosClinicos@druginfo.com
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Scientific contact |
Clinical Trials Information, Adamas Pharmaceuticals, Inc., +1 5104503500, RegistroEspanolDeEstudiosClinicos@druginfo.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
12 Jul 2016
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
10 Mar 2016
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Global end of trial reached? |
Yes
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Global end of trial date |
10 Mar 2016
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
To evaluate the efficacy of ADS-5102 oral capsules, an extended release formulation of amantadine, at a dose level of 340 mg, dosed once nightly at bedtime for 13 weeks, for the treatment of levodopa-induced dyskinesia (LID) in subjects with Parkinson's disease (PD).
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Protection of trial subjects |
This study was conducted in accordance with the ethical principles of Good Clinical Practice, according to International Council for Harmonisation Guidelines.
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Background therapy |
For at least 30 days prior to Screening and throughout participation in the study, subjects were to receive stable doses and regimens of antiparkinson medications, including any levodopa preparation administered at least 3 times daily. | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
23 Oct 2014
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
No
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Spain: 9
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Country: Number of subjects enrolled |
United States: 25
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Country: Number of subjects enrolled |
Austria: 3
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Country: Number of subjects enrolled |
France: 16
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Country: Number of subjects enrolled |
Germany: 24
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Worldwide total number of subjects |
77
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EEA total number of subjects |
52
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
31
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From 65 to 84 years |
46
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85 years and over |
0
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Recruitment
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Recruitment details |
Subjects who provided written informed consent and met all eligibility criteria were randomly assigned in a 1:1 ratio to receive either placebo or ADS-5102 (340mg). | |||||||||||||||||||||
Pre-assignment
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Screening details |
Male and female subjects between 30 and 85 years of age, inclusive; had PD per the UK Parkinson's Disease Society Brain Bank Clinical Diagnostic Criteria; were ambulatory or ambulatory aided (walker or cane) while ON (the time during which PD symptoms were adequately controlled) and could complete study assignments were selected per protocol. | |||||||||||||||||||||
Period 1
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Period 1 title |
Overall Trial (overall period)
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Is this the baseline period? |
Yes | |||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | |||||||||||||||||||||
Roles blinded |
Subject, Investigator, Monitor, Data analyst, Assessor | |||||||||||||||||||||
Blinding implementation details |
Study drug was administered in a double blind fashion. Placebo capsules were indistinguishable in size and appearance from ADS-5102 capsules. A subject's treatment assignment was only to be unblinded when knowledge of the treatment was essential to the safety of the patient. The investigator was responsible for ensuring that instructions for unblinding were stored safely, the location known and readily available to the relevant staff if required. No emergency unblinding was performed.
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Arms
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Are arms mutually exclusive |
Yes
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Arm title
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ADS-5102 | |||||||||||||||||||||
Arm description |
Active treatment group | |||||||||||||||||||||
Arm type |
Experimental | |||||||||||||||||||||
Investigational medicinal product name |
ADS-5102
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Investigational medicinal product code |
ADS-5102
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Other name |
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Pharmaceutical forms |
Capsule, hard
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Routes of administration |
Oral use
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Dosage and administration details |
ADS-5102 was taken once daily at bedtime (if possible, no earlier than 9pm). The ADS-5102 dose was 170 mg during week 1 (1 ADS-5102 capsule and 1 placebo capsule), 340 mg during Weeks 2 through 12 (2 ADS-5102 capsules) and 170 mg during Week 13 (1 ADS-5102 capsule and 1 placebo capsule). Capsules were to be swallowed intact with any non-alcoholic beverage with or without food.
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Arm title
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Placebo | |||||||||||||||||||||
Arm description |
Placebo group | |||||||||||||||||||||
Arm type |
Placebo | |||||||||||||||||||||
Investigational medicinal product name |
Placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Capsule, hard
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Routes of administration |
Oral use
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Dosage and administration details |
Placebo was taken once daily at bedtime (if possible, no earlier than 9pm) and consisted of 2 placebo capsules Weeks 1 through 13. Capsules were to be swallowed intact with any non-alcoholic beverage with or without food.
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Notes [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same. Justification: 77 Subjects were enrolled worldwide but 2 Subjects were randomized in error and did not receive study medication. One Subject was randomized to placebo and one was randomized to active. Results are reported for the 75 Subjects who received at least one dose of study medication. |
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Baseline characteristics reporting groups
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Reporting group title |
Overall Trial (overall period)
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Reporting group description |
- | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Subject analysis sets
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Subject analysis set title |
Modified Intent to Treat (MITT) ADS-5102
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Subject analysis set type |
Modified intention-to-treat | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
The MITT population included all randomized subjects who were dosed and provided at least 1 post-baseline assessment of UDysRS (Unified Dyskinesia Rating Scale). The MITT population was used for the primary analysis, as well as for all secondary efficacy analyses. In all analyses and summaries based on the MITT population, subjects were included in the treatment group to which they were randomized.
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Subject analysis set title |
Modified Intent to Treat (MITT) Placebo
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Subject analysis set type |
Modified intention-to-treat | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
The MITT population included all randomized subjects who were dosed and provided at least 1 post-baseline assessment of UDysRS (Unified Dyskinesia Rating Scale). The MITT population was used for the primary analysis, as well as for all secondary efficacy analyses. In all analyses and summaries based on the MITT population, subjects were included in the treatment group to which they were randomized.
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Subject analysis set title |
Safety Population ADS-5102
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Subject analysis set type |
Safety analysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
The safety population included all randomized subjects who received at least 1 dose of study drug. The safety population was used for safety analyses. In these analyses, subjects were analysed according to the treatment received most often.
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Subject analysis set title |
Safety population - placebo
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Subject analysis set type |
Safety analysis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
The safety population included all randomized subjects who received at least 1 dose of study drug. The safety population was used for safety analyses. In these analyses, subjects were analysed according to the treatment received most often.
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End points reporting groups
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Reporting group title |
ADS-5102
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Reporting group description |
Active treatment group | ||
Reporting group title |
Placebo
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Reporting group description |
Placebo group | ||
Subject analysis set title |
Modified Intent to Treat (MITT) ADS-5102
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Subject analysis set type |
Modified intention-to-treat | ||
Subject analysis set description |
The MITT population included all randomized subjects who were dosed and provided at least 1 post-baseline assessment of UDysRS (Unified Dyskinesia Rating Scale). The MITT population was used for the primary analysis, as well as for all secondary efficacy analyses. In all analyses and summaries based on the MITT population, subjects were included in the treatment group to which they were randomized.
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Subject analysis set title |
Modified Intent to Treat (MITT) Placebo
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Subject analysis set type |
Modified intention-to-treat | ||
Subject analysis set description |
The MITT population included all randomized subjects who were dosed and provided at least 1 post-baseline assessment of UDysRS (Unified Dyskinesia Rating Scale). The MITT population was used for the primary analysis, as well as for all secondary efficacy analyses. In all analyses and summaries based on the MITT population, subjects were included in the treatment group to which they were randomized.
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Subject analysis set title |
Safety Population ADS-5102
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Subject analysis set type |
Safety analysis | ||
Subject analysis set description |
The safety population included all randomized subjects who received at least 1 dose of study drug. The safety population was used for safety analyses. In these analyses, subjects were analysed according to the treatment received most often.
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Subject analysis set title |
Safety population - placebo
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Subject analysis set type |
Safety analysis | ||
Subject analysis set description |
The safety population included all randomized subjects who received at least 1 dose of study drug. The safety population was used for safety analyses. In these analyses, subjects were analysed according to the treatment received most often.
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End point title |
Change from Baseline in UDysRS Total Score at Week 12 (MITT population) | |||||||||||||||||||||
End point description |
The UDysRS is a 26-item rating scale which evaluates involuntary movements often associated with treated Parkinson's Disease. The scale has four parts with a total possible score of 104.
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End point type |
Primary
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End point timeframe |
Week 12
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Statistical analysis title |
MMRM Treatment Difference (Active-Placebo) | |||||||||||||||||||||
Statistical analysis description |
The mixed model with repeat measures (MMRM) included all categorical effects for treatment group, visit (Weeks 2, 4, 8, and 12), and the interaction between treatment group and visit; the baseline value was included as a continuous covariate. The dependent variable was the change from baseline.
MMRM Least squares (standard error) mean change from baseline at Week 12 were calculated.
Summary statistics were computed using data for subjects who had values at both baseline and Week 12.
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Comparison groups |
Modified Intent to Treat (MITT) ADS-5102 v Modified Intent to Treat (MITT) Placebo
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Number of subjects included in analysis |
75
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Analysis specification |
Pre-specified
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Analysis type |
superiority | |||||||||||||||||||||
P-value |
< 0.0001 | |||||||||||||||||||||
Method |
MMRM | |||||||||||||||||||||
Parameter type |
LS mean treatment difference | |||||||||||||||||||||
Point estimate |
-14.4
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Confidence interval |
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level |
95% | |||||||||||||||||||||
sides |
2-sided
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lower limit |
-20.4 | |||||||||||||||||||||
upper limit |
-8.3 | |||||||||||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
3.03
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End point title |
Change from Baseline in PD Diary ON Time Without Troublesome Dyskinesia at Week 12 (MITT Population) | ||||||||||||
End point description |
Patient reported diary state where ON time without troublesome dyskinesia is the duration of time that a patient is free from troublesome dyskinesia.
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End point type |
Secondary
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End point timeframe |
Week 12
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Statistical analysis title |
MMRM Treatment Difference (Active - Placebo) | ||||||||||||
Statistical analysis description |
The MMRM results were from a model that used all available data at each time point. In this model, the dependent variable was the change from baseline. The model included categorical effects for treatment group, visit (weeks 2, 4, 8, and 12), and the interaction between treatment group and visit; the baseline value was included as a continuous covariate. Summary statistics were computed using data from subjects who had values at both baseline and Week 12.
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Comparison groups |
Modified Intent to Treat (MITT) ADS-5102 v Modified Intent to Treat (MITT) Placebo
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Number of subjects included in analysis |
75
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
= 0.0168 | ||||||||||||
Method |
MMRM | ||||||||||||
Parameter type |
LS mean treatment difference | ||||||||||||
Point estimate |
1.9
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
0.35 | ||||||||||||
upper limit |
3.45 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
0.775
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End point title |
Change from Baseline to Week 12 in PD Diary OFF time | ||||||||||||
End point description |
OFF time refers to the duration of time when a patient is not benefiting from medication.
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End point type |
Secondary
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End point timeframe |
Week 12
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Statistical analysis title |
MMRM Treatment Difference (Active - Placebo) | ||||||||||||
Statistical analysis description |
The MMRM results were from a model that used all available data at each time point. In this model, the dependent variable was the change from baseline. The model included categorical effects for treatment group, visit (weeks 2, 4, 8, and 12), and the interaction between treatment group and visit; the baseline value was included as a continuous covariate. Summary statistics were computed using data from subjects who had values at both baseline and Week 12.
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Comparison groups |
Modified Intent to Treat (MITT) ADS-5102 v Modified Intent to Treat (MITT) Placebo
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Number of subjects included in analysis |
75
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
= 0.0199 | ||||||||||||
Method |
MMRM | ||||||||||||
Parameter type |
LS mean treatment difference | ||||||||||||
Point estimate |
-1.1
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-2.02 | ||||||||||||
upper limit |
-0.18 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
0.461
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End point title |
Overview of Adverse Events | |||||||||||||||||||||||||||||||||||||||||||||
End point description |
Overview of Adverse Events (Safety Population)
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End point type |
Secondary
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End point timeframe |
From start of study medication (all AEs collected were treatment-emergent) to final follow-up assessment.
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
Any adverse event with an onset date after study drug administration up to and including the designated Safety Follow-up Visit.
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Adverse event reporting additional description |
Adverse events are reported as one occurrence for each event reported.
Non-serious adverse events:
Most common AEs (at least 5% of subjects in the active treatment group) are reported.
Total subjects affected by non-serious AEs refers to the number of subjects with any AEs experienced by >=5% of subjects in the active treatment group.
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Assessment type |
Systematic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
17
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Reporting groups
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Reporting group title |
Safety Population ADS-5102
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Reporting group description |
- | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Safety Population Placebo
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Reporting group description |
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Frequency threshold for reporting non-serious adverse events: 5% | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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22 Dec 2014 |
Amendment 1.
To the exclusion criterion regarding sexually active females, simplified the wording regarding acceptable contraception and specified that a hormonal method was to used in combination with a barrier method.
Added that subjects with untreated angle closure glaucoma would be excluded from the study.
Added that subjects with suicidal ideation and subjects with a history of suicidal ideation or suicide attempt during amantadine treatment would be excluded from the study.
Added that use of medications that prolonged the QT interval and had a known risk of torsades de pointes would exclude a subject from the study unless the medication was discontinued at least 60 days prior to Screening. Added (to the appendix of prohibited medications) a list of agents that prolong the QT interval and had a known risk of torsades de pointes.
Added urine pregnancy testing for female subjects of childbearing potential at the end of Weeks 4, 8, 12 and 18; modified the schedule of assessments accordingly.
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
None reported |