E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Parkinson's Disease With Motor Response Fluctuations (OFF Phenomena) |
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E.1.1.1 | Medical condition in easily understood language |
Parkinson's Disease With Periods of Prolonged Immobility or Freezing |
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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 | 17.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10034007 |
E.1.2 | Term | Parkinson's disease NOS |
E.1.2 | System Organ Class | 100000004852 |
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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 characterize the pulmonary safety, as assessed by spirometry (forced expiratory volume in 1 second [FEV1] and FEV1/forced vital capacity [FVC] ratio), over a 12 month period within the CVT 301 treated patients. |
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E.2.2 | Secondary objectives of the trial |
To characterize the pulmonary safety.
To estimate the difference between the CVT 301 treated patients and the observational cohort on measures of pulmonary safety.
To characterize the effects of CVT 301 on safety over a 12 month period
To describe the effects of CVT-301, Time course of effect and onset of effect, Magnitude of effect
To characterize the occurrence and severity of examiner rated dyskinesia following treatment of patients experiencing an OFF episode after the initiation of CVT 301 treatment.
To characterize the proportion of patients achieving resolution of an OFF to an ON state within 60 minutes after study drug is administered in the clinic
To characterize the proportion of patients with an ON state at the end of the 60-minute observation period following treatment in the clinic
To evaluate the ability of carbon monoxide diffusing capacity (DLco) maneuver.
To describe the effects of CVT 301 on DLco over a 12 month period.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Has signed and dated an IRB/IEC-approved informed consent form before any protocol-specific screening procedures are performed.
Is a male or female aged 30 to 80 years, inclusive. Women of child-bearing potential must use protocol-defined contraceptive measures (see Section 11.1.5) and must have a negative serum human chorionic gonadotropin (hCG) test at screening. These patients must be willing to remain on their current form of contraception for the duration of the study.
Patients who have idiopathic PD (i.e., not induced by drugs or other diseases) as defined by fulfilling Steps 1 and 2 of the UK Brain Bank criteria, diagnosed after the age of 30 years.
Patients who are classified as Stage 1 to 3 (in the ON state) on the modified Hoehn and Yahr scale for staging of PD severity.
Patients who have experienced motor fluctuations for a minimum of 2 hours of average daily OFF time per waking day (excluding early morning OFF time) by self-report and confirmed by the PD Diary (on 3 consecutive days) during the screening period.
Patients must be stable on oral LD-containing therapy for at least 2 weeks prior to SV1 with a LD/dopamine decarboxylase inhibitor (DDI) containing regimen, which must include doses at least 4 times during the waking day and a total daily LD dose of ≤1600 mg (exclusive of PRN LD-containing medications).
Patients should be stable on other PD medications for at least 4 weeks prior to SV1.
Patients must have a ≥25% difference between UPDRS Part 3 scores recorded in their ON and OFF states at screening.
Patients must have normal cognition as confirmed by a score of ≥25 on the MMSE.
Patients must be able to perform a spirometry maneuver in the ON and OFF states, and must have a screening FEV1 ≥50% of predicted and an FEV1/FVC ratio >60% in the ON state at screening. (A pulmonologist will review the spirometry tracings/morphology of any patient with an FEV1 that is ≥50% to <60% of predicted or an FEV1/FVC ratio that is >60% to <70% in order to determine potential eligibility. All CVT 301 naïve patients with an FEV1/FVC ratio of >60% to <70% will be required to undergo a bronchodilator challenge and the results must be reviewed prior to entry into the study. Patients with an FEV1/FVC ratio that is >60% to <70% will complete spirometry before and after the administration of a bronchodilator in a pulmonary function laboratory. Testing will be performed in accordance with the 2005 ATS/European Respiratory Society [ERS] criteria prior to randomization. The results of the bronchodilator challenge will be reviewed by a pulmonologist prior to potential randomization.)
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E.4 | Principal exclusion criteria |
Patients who have dyskinesia of a severity that would significantly interfere with their ability to participate or perform study procedures.
Pregnant or lactating females or females wishing to become pregnant.
Patients who have any known contraindication to the use of LD, including a history of malignant melanoma or a history of narrow-angle glaucoma.
Patients who have had previous surgery for PD (including but not limited to deep brain stimulation [DBS] or cell transplantation).
Patients with a history of psychotic symptoms requiring treatment, or suicide ideation or attempt within the prior 12 months (stable regimens [for at least 4 weeks prior to SV1] of anti-depressant and certain low-dose atypical antipsychotic medications are permitted).
Patients who have cancer with the exception of the following: basal cell carcinoma or successfully treated squamous cell carcinoma of the skin; cervical carcinoma in situ; prostatic carcinoma in situ; or other malignancies curatively treated and with no evidence of disease recurrence for at least 3 years.
Patients taking certain prohibited medications (see Section 9.4.2).
Patients with a history of drug or alcohol abuse within the prior 12 months.
Patients with chronic obstructive pulmonary disease (COPD), asthma, or other chronic respiratory disease within the last 5 years (or if a patient is receiving treatment for any of these conditions).
Patients with any contraindication to performing routine spirometry or who are unable to perform a spirometry maneuver (see Appendix 20 for a list of contraindications).
Patients with a current history of symptomatic orthostatic hypotension despite adequate treatment.
Patients with any condition that in the investigator’s opinion would make patients unsuitable or interfere with their participation in the study. Potential issues of concern should be raised to the medical monitor during eligibility review.
Patients who have any clinically significant abnormality or finding from examination, tests, or history that may compromise patient safety.
Patients who have been treated with an investigational drug within 4 weeks or 5 half-lives (whichever is longer) prior to the beginning of the screening period (this includes investigational formulations of marketed products).
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E.5 End points |
E.5.1 | Primary end point(s) |
Spirometry forced expiratory volume in 1 second [FEV1] and FEV1/forced vital capacity [FVC] ratio
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
At each patient visit throughout the study |
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E.5.2 | Secondary end point(s) |
Mean change from pre-dose in average Unified Parkinson’s Disease Rating Scale (UPDRS) Part 3 motor score at 10 to 60 minutes following treatment of patients experiencing an OFF episode in the clinic at 1, 3, 6, 9, and 12 months after the initiation of CVT-301 treatment.
Time-course of the change in UPDRS Part 3 motor score from pre-dose to 10, 20, 30, and 60 minutes following treatment in the clinic at 1, 3, 6, 9, and 12 months after the initiation of CVT-301 treatment.
Mean change from pre-dose in average UPDRS Part 3 motor score at 10 to 20 minutes following treatment of patients experiencing an OFF episode in the clinic at 1, 3, 6, 9, and 12 months after the initiation of CVT-301 treatment.
Mean best change and best percent change in the UPDRS Part 3 motor score from pre-dose at 10 to 60 minutes following treatment of patients experiencing an OFF episode in the clinic at 1, 3, 6, 9, and 12 months after the initiation of CVT-301 treatment.
Mean change in the UPDRS item 23 (Finger Taps) from pre dose to 10 minutes following treatment of patients experiencing an OFF episode in the clinic at 1, 3, 6, 9 and 12 months after the initiation of CVT-301 treatment.
Mean change in the UPDRS item 31 (Body Bradykinesia and Hypokinesia) from pre-dose to 10 minutes following treatment of patients experiencing an OFF episode in the clinic at 1, 3, 6, 9 and 12 months after the initiation of CVT-301 treatment.
Proportion of patients with a ≥3 point, ≥6 point, and ≥11 point reduction in the UPDRS Part 3 motor score from pre dose to post dose, by assessing the number and proportion of patients achieving on objective motor response overall and at 10, 20, 30, and 60 minutes following treatment in the clinic at 1, 3, 6, 9, and 12 months after the initiation of CVT 301 treatment.
Occurrence and severity of examiner rated dyskinesia following treatment of patients experiencing an OFF episode in the clinic at 1, 3, 6, 9, and 12 months after the initiation of CVT 301 treatment.
Proportion of patients achieving resolution of an OFF to an ON state within 60 minutes after study drug is administered in the clinic (per the examiner’s subjective assessment) at 1, 3, 6, 9, and 12 months after the initiation of CVT 301 treatment.
Proportion of patients with an ON state at the end of the 60-minute observation period (per the examiner’s subjective assessment) following treatment in the clinic at 1, 3, 6, 9, and 12 months after the initiation of CVT 301 treatment.
Patient reported total daily OFF time, total daily ON time without dyskinesia, total daily ON time with non troublesome dyskinesia, and total daily ON time with troublesome dyskinesia, assessed by the patient and recorded in the patient diary for the 3 consecutive days immediately prior to visits at 1, 3, 6, 9, and 12 months after the initiation of CVT-301 treatment.
Mean change from baseline in the 39-Item Parkinson’s Disease Questionnaire (PDQ-39) quality of life instrument measured pre dose at 3, 6, and 12 months after the initiation of CVT 301 treatment.
Patient Global Impression of Change (PGI-C) rating scale measured pre dose at 3, 6, and 12 months after the initiation of CVT 301 treatment.
Mean change from baseline in the Schwab and England (S&E) Activities of Daily Living (ADL) score measured pre dose at 3, 6, and 12 months after the initiation of CVT-301 treatment.
Mean change from baseline in the UPDRS Part 2 score measured pre dose at 3, 6, and 12 months after the initiation of CVT-301 treatment.
Mean change from baseline in the UPDRS Part 4 measures of motor fluctuations (dyskinesias [Q32-35] and wearing off [Q36 39]) measured pre dose at 3, 6, and 12 months after the initiation of CVT-301 treatment.
The ability of Parkinson’s disease (PD) patients to perform American Thoracic Society (ATS) quality carbon monoxide diffusing capacity (DLco) maneuver.
DLco over a 12 month period.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
These will be repeated throughout the study where necessary as indicated above |
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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 | No |
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 | 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) | Yes |
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 | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
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 | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
Standard of Care Treatment |
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E.8.2.4 | Number of treatment arms in the trial | 1 |
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 | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 59 |
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 |
Austria |
Belgium |
Czech Republic |
France |
Germany |
Hungary |
Israel |
Italy |
Poland |
Romania |
Serbia |
Spain |
United Kingdom |
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E.8.7 | Trial has a data monitoring committee | Yes |
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 | 3 |
E.8.9.1 | In the Member State concerned days | 7 |
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 | 3 |
E.8.9.2 | In all countries concerned by the trial days | 7 |