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    Clinical Trial Results:
    A Phase 3, Randomized Study Investigating the Safety of CVT-301 (Levodopa Inhalation Powder) in Parkinson’s Disease Patients With Motor Response Fluctuations (OFF Phenomena) Compared to an Observational Cohort Control.

    Summary
    EudraCT number
    2014-003799-22
    Trial protocol
    HU   GB   CZ   DE   ES   BE   AT  
    Global end of trial date
    16 May 2017

    Results information
    Results version number
    v1(current)
    This version publication date
    29 Apr 2018
    First version publication date
    29 Apr 2018
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CVT-301-005
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02352363
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Acorda Therapeutics
    Sponsor organisation address
    420 Saw Mill River Road, Ardsley, United States, 10502
    Public contact
    Regulatory Affairs, INC Research, 44 127648 1000, SM_Regaffairs_eu_ap@incresearch.com
    Scientific contact
    Regulatory Affairs, INC Research, 44 127648 1000, SM_Regaffairs_eu_ap@incresearch.com
    Sponsor organisation name
    Acorda Therapeutics
    Sponsor organisation address
    420 Saw Mill River Road, Ardsley, United States, 10502
    Public contact
    Renee Rifelli, Acorda Therapeutics, 914 326-5827, rrifelli@acorda.com
    Scientific contact
    Renee Rifelli, Acorda Therapeutics, 914 326-5827, rrifelli@acorda.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    16 May 2017
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    16 May 2017
    Global end of trial reached?
    Yes
    Global end of trial date
    16 May 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To characterize the pulmonary safety, as assessed by spirometry (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], and FEV1/FVC ratio), over a 12 month period within the CVT 301 treated patients.
    Protection of trial subjects
    Conduct of the study must be approved by an appropriately constituted IRB or IEC. Approval is required for the study protocol, investigational drug brochure, protocol amendments, informed consent forms, patient information sheets, and advertising materials. For each study patient, written informed consent will be obtained prior to any protocol-related activities. As part of this procedure, the principal investigator or one of his/her associates must explain orally and in writing the nature, duration, and purpose of the study, and the action of the drug in such a manner that the patient is aware of the potential risks, inconveniences, or adverse effects that may occur. The patient should be informed that he/she may withdraw from the study at any time, and the patient will receive all information that is required by local regulations and ICH guidelines. The principal investigator will provide the Sponsor or its representative with a copy of the IRB/IEC-approved informed consent form prior to the start of the study.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    08 Apr 2015
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 93
    Country: Number of subjects enrolled
    Romania: 89
    Country: Number of subjects enrolled
    Spain: 36
    Country: Number of subjects enrolled
    United Kingdom: 9
    Country: Number of subjects enrolled
    Austria: 12
    Country: Number of subjects enrolled
    Belgium: 5
    Country: Number of subjects enrolled
    Czech Republic: 38
    Country: Number of subjects enrolled
    France: 20
    Country: Number of subjects enrolled
    Germany: 28
    Country: Number of subjects enrolled
    Hungary: 5
    Country: Number of subjects enrolled
    Israel: 21
    Country: Number of subjects enrolled
    Serbia: 15
    Country: Number of subjects enrolled
    United States: 27
    Worldwide total number of subjects
    398
    EEA total number of subjects
    335
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    196
    From 65 to 84 years
    202
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Patients participated in the study from 8-April-2015 to 16-May-2017. Most patients were from Europe (93.2%). Largest population from Poland (23.4%) and Romania (22.4%). The remaining countries each contributed less than 10% of patients.

    Pre-assignment
    Screening details
    A total of 408 (79.5%) of the 513 patients screened were randomly assigned to CVT-301(n = 278) or the observational cohort (n = 130). Of these 408 patients, 398 received at least 1 dose of inhaled CVT-301 (CVT-301 treatment group) or came in for OV1 (observational cohort) and were included in the Safety Population.

    Period 1
    Period 1 title
    12-month period (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded
    Blinding implementation details
    This study was a 12-month, open-label, randomized, multicenter study that evaluated the safety and effects of inhaled CVT-301 84 mg for the treatment of up to 5 OFF periods per day in patients with PD experiencing motor fluctuations (OFF periods) and included a concurrent observational cohort of patients with PD managed using standard-of-care treatments.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    CVT-301
    Arm description
    CVT-301 is an investigational during and device combination that delivers levodopa to the lungs by oral inhalation via a breath-actuated inhaler.
    Arm type
    Experimental

    Investigational medicinal product name
    CVT-301
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder, hard capsule
    Routes of administration
    Inhalation use
    Dosage and administration details
    Inhalation of two capsules up to 5 times daily.

    Arm title
    Observational Cohort
    Arm description
    Patients who were randomly assigned to the observational cohort (CVT-301-naïve patients) and who completed all study visits per protocol without any safety issues were allowed to enroll in a long-term safety extension study (CVT-301-004E) if they met that study’s eligibility criteria.
    Arm type
    Observational

    Investigational medicinal product name
    No investigational medicinal product assigned in this arm
    Number of subjects in period 1
    CVT-301 Observational Cohort
    Started
    271
    127
    Completed
    204
    106
    Not completed
    67
    21
         Consent withdrawn by subject
    30
    21
         Adverse event, non-fatal
    26
    -
         Lost to follow-up
    2
    -
         Lack of efficacy
    8
    -
         Protocol deviation
    1
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    12-month period
    Reporting group description
    -

    Reporting group values
    12-month period Total
    Number of subjects
    398 398
    Age categorical
    In the Safety Population, mean age was 63.8 years. Race was White for 390 patients (98.0%) and ethnicity was non-Hispanic for 391 patients (98.2%). There were 239 male patients (60.1%) and 159 female patients (39.9%).
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    196 196
        From 65-84 years
    202 202
        85 years and over
    0 0
    Age continuous
    Units: years
        arithmetic mean (full range (min-max))
    63.8 (37 to 80) -
    Gender categorical
    Units: Subjects
        Female
    159 159
        Male
    239 239
    Subject analysis sets

    Subject analysis set title
    Safety Population
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    A total of 408 (79.5%) of the 513 patients screened were randomly assigned to CVT-301 (n = 278) or the observational cohort (n = 130). Of these 408 patients, 398 received at least 1 dose of inhaled CVT-301 (CVT-301 treatment group) or came in for OV1 (observational cohort) and were included in the Safety Population.

    Subject analysis sets values
    Safety Population
    Number of subjects
    398
    Age categorical
    In the Safety Population, mean age was 63.8 years. Race was White for 390 patients (98.0%) and ethnicity was non-Hispanic for 391 patients (98.2%). There were 239 male patients (60.1%) and 159 female patients (39.9%).
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
        Newborns (0-27 days)
    0
        Infants and toddlers (28 days-23 months)
    0
        Children (2-11 years)
    0
        Adolescents (12-17 years)
    0
        Adults (18-64 years)
    196
        From 65-84 years
    202
        85 years and over
    0
    Age continuous
    Units: years
        arithmetic mean (full range (min-max))
    63.8 (37 to 80)
    Gender categorical
    Units: Subjects
        Female
    159
        Male
    239

    End points

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    End points reporting groups
    Reporting group title
    CVT-301
    Reporting group description
    CVT-301 is an investigational during and device combination that delivers levodopa to the lungs by oral inhalation via a breath-actuated inhaler.

    Reporting group title
    Observational Cohort
    Reporting group description
    Patients who were randomly assigned to the observational cohort (CVT-301-naïve patients) and who completed all study visits per protocol without any safety issues were allowed to enroll in a long-term safety extension study (CVT-301-004E) if they met that study’s eligibility criteria.

    Subject analysis set title
    Safety Population
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    A total of 408 (79.5%) of the 513 patients screened were randomly assigned to CVT-301 (n = 278) or the observational cohort (n = 130). Of these 408 patients, 398 received at least 1 dose of inhaled CVT-301 (CVT-301 treatment group) or came in for OV1 (observational cohort) and were included in the Safety Population.

    Primary: Pulmonary safety by FEV1

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    End point title
    Pulmonary safety by FEV1 [1]
    End point description
    End point type
    Primary
    End point timeframe
    12 months
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: This is an open labeled safety study evaluating the pulmonary safety assessed by spirometry. Formal statistical testing was not specified for the primary endpoint of pulmonary safety.
    End point values
    CVT-301 Observational Cohort
    Number of subjects analysed
    271
    127
    Units: FEV1
        arithmetic mean (standard deviation)
    2.665 ± 0.6977
    2.645 ± 0.8233
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    52 Week treatment period.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.1
    Reporting groups
    Reporting group title
    Observational Cohort
    Reporting group description
    -

    Reporting group title
    CVT-301
    Reporting group description
    -

    Serious adverse events
    Observational Cohort CVT-301
    Total subjects affected by serious adverse events
         subjects affected / exposed
    13 / 127 (10.24%)
    42 / 271 (15.50%)
         number of deaths (all causes)
    0
    1
         number of deaths resulting from adverse events
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Benign ovarian tumor
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metastases to central nervous system
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Prostatic adenoma
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Uterine cancer
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    1 / 127 (0.79%)
    0 / 271 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gait disturbance
         subjects affected / exposed
    1 / 127 (0.79%)
    0 / 271 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pyrexia
         subjects affected / exposed
    1 / 127 (0.79%)
    0 / 271 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Anoxia
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bronhcial hyperreactivity
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    Pulmonary embolism
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory failure
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Restrictive pulmonary disease
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psychiatric disorders
    Depressed mood
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dopamine dysregulation syndrome
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Suicidal ideation
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Investigations
    Blood pressure increased
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Femoral neck fracture
         subjects affected / exposed
    0 / 127 (0.00%)
    2 / 271 (0.74%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abdominal wound dehiscence
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ankle fracture
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hand fracture
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Head injury
         subjects affected / exposed
    1 / 127 (0.79%)
    0 / 271 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hip fracture
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Joint dislocation
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Post procedural haemorrhage
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    Rib fracture
         subjects affected / exposed
    1 / 127 (0.79%)
    0 / 271 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Road traffic accident
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Thoracic vertebral fracture
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Angina pectoris
         subjects affected / exposed
    1 / 127 (0.79%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Parkinson's disease
         subjects affected / exposed
    2 / 127 (1.57%)
    2 / 271 (0.74%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cerebrovascular accident
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dyskinesia
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ischaemic stroke
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Loss of consciousness
         subjects affected / exposed
    1 / 127 (0.79%)
    0 / 271 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Occipital neuralgia
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Syncope
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 127 (0.79%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    2 / 127 (1.57%)
    0 / 271 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Inguinal hernia
         subjects affected / exposed
    0 / 127 (0.00%)
    2 / 271 (0.74%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastritis
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pancreatitis acute
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Bile duct stone
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cholecystitis
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cholethiasis
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Skin ulcer
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Nephrolithiasis
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Osteoarthritis
         subjects affected / exposed
    0 / 127 (0.00%)
    3 / 271 (1.11%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Back pain
         subjects affected / exposed
    0 / 127 (0.00%)
    2 / 271 (0.74%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intervertebral disc protrusion
         subjects affected / exposed
    1 / 127 (0.79%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lunar spinal stenosis
         subjects affected / exposed
    1 / 127 (0.79%)
    0 / 271 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Rhabdomyolysis
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Spondylitis
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vertebral formalin stenosis
         subjects affected / exposed
    1 / 127 (0.79%)
    0 / 271 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Urinary tract infection
         subjects affected / exposed
    0 / 127 (0.00%)
    4 / 271 (1.48%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bronchitis
         subjects affected / exposed
    1 / 127 (0.79%)
    0 / 271 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cellulitis
         subjects affected / exposed
    1 / 127 (0.79%)
    0 / 271 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Escherichia urinary tract infection
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    1 / 127 (0.79%)
    0 / 271 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Postoperative wound
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory tract infection
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Dehydration
         subjects affected / exposed
    0 / 127 (0.00%)
    2 / 271 (0.74%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hyponatraemia
         subjects affected / exposed
    0 / 127 (0.00%)
    1 / 271 (0.37%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0.03%
    Non-serious adverse events
    Observational Cohort CVT-301
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    73 / 127 (57.48%)
    192 / 271 (70.85%)
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    7 / 127 (5.51%)
    22 / 271 (8.12%)
         occurrences all number
    8
    28
    Vascular disorders
    Hypertension
         subjects affected / exposed
    4 / 127 (3.15%)
    9 / 271 (3.32%)
         occurrences all number
    4
    9
    Nervous system disorders
    Dyskinesia
         subjects affected / exposed
    5 / 127 (3.94%)
    17 / 271 (6.27%)
         occurrences all number
    5
    18
    Parkinson's disease
         subjects affected / exposed
    4 / 127 (3.15%)
    8 / 271 (2.95%)
         occurrences all number
    4
    8
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    0 / 127 (0.00%)
    10 / 271 (3.69%)
         occurrences all number
    0
    12
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    0 / 127 (0.00%)
    36 / 271 (13.28%)
         occurrences all number
    0
    43
    Sputum discoloured
         subjects affected / exposed
    0 / 127 (0.00%)
    9 / 271 (3.32%)
         occurrences all number
    0
    11
    Throat Irritation
         subjects affected / exposed
    0 / 127 (0.00%)
    9 / 271 (3.32%)
         occurrences all number
    0
    10
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    5 / 127 (3.94%)
    0 / 271 (0.00%)
         occurrences all number
    5
    0
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    4 / 127 (3.15%)
    12 / 271 (4.43%)
         occurrences all number
    4
    19
    Arthralgia
         subjects affected / exposed
    0 / 127 (0.00%)
    8 / 271 (2.95%)
         occurrences all number
    0
    8
    Musculoskeletal pain
         subjects affected / exposed
    4 / 127 (3.15%)
    0 / 271 (0.00%)
         occurrences all number
    4
    0
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    7 / 127 (5.51%)
    18 / 271 (6.64%)
         occurrences all number
    8
    20
    Upper respiratory tract infection
         subjects affected / exposed
    0 / 127 (0.00%)
    13 / 271 (4.80%)
         occurrences all number
    0
    16
    Bronchitis
         subjects affected / exposed
    4 / 127 (3.15%)
    0 / 271 (0.00%)
         occurrences all number
    6
    0
    Influenza
         subjects affected / exposed
    4 / 127 (3.15%)
    0 / 271 (0.00%)
         occurrences all number
    4
    0

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    22 Sep 2015
    Protocol CVT-301-005, Version 1.0 was never activated nor implemented at any study sites in the US or outside of the US except for Spain and the UK. Protocol CVT-301-005, Version 2.0 was submitted to the US Food and Drug Administration (FDA) and to Health Authorities outside of the US and was implemented at all study sites. Protocol Version 2.0 incorporated changes that clarified spirometry inclusion criteria, excluded patients treated with an investigational drug within 4 weeks or 5 half-lives before Screening, and removed the requirement that the onset time of dyskinesia be recorded during the 60-minute post-dose period. Protocol Version 2.1 reflected the local regulatory requirements in Belgium and Germany to include more stringent pregnancy contraception inclusion criteria and to require at-home monthly pregnancy tests for women of childbearing age in the CVT-301 treatment group. Protocol CVT-301-005, Version 3.0 was submitted to the US FDA and to Health Authorities outside of the US and was implemented at all study sites. Protocol Version 3.0 and Version 3.1 incorporated changes to allow an unscheduled visit to occur between SV1 and SV2 for the purpose of repeating concordance testing, the reordering of secondary and exploratory endpoints, and administrative clarifications. Additional changes, including those made to the inclusion and exclusion criteria, are documented in the summary of changes in Protocol CVT-301-005, Version 4.0 was submitted to the US FDA but not to Health Authorities outside of the US and was not implemented at any study sites because enrollment of additional patients was deemed unnecessary. A summary of the protocols and protocol amendments that were implemented at sites in the US, 11 countries in Europe (Austria, Belgium, Czech Republic, France, Germany, Hungary, Poland, Romania, Serbia, Spain, and the UK), and Israel. Only the protocols and protocol amendments (including summaries of changes between protocol versions that were

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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