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    Clinical Trial Results:
    A Phase 3, Long-term, Open-label Study of Istradefylline in Subjects with Moderate to Severe Parkinson’s Disease

    Summary
    EudraCT number
    2015-003887-34
    Trial protocol
    DE   CZ   PL   IT  
    Global end of trial date
    20 Dec 2017

    Results information
    Results version number
    v1(current)
    This version publication date
    03 Jan 2019
    First version publication date
    03 Jan 2019
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    6002-018
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02610231
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Kyowa Kirin Pharmaceutical Development, Inc
    Sponsor organisation address
    212 Carnegie Center, Princeton, United States, 08540
    Public contact
    Clinical Trial Help Desk, Kyowa Kirin Pharmaceutical Development, Inc., 6002014helpdesk@kyowakirin.com
    Scientific contact
    Clinical Trial Help Desk, Kyowa Kirin Pharmaceutical Development, Inc., 6002014helpdesk@kyowakirin.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
    08 Feb 2018
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    20 Dec 2017
    Global end of trial reached?
    Yes
    Global end of trial date
    20 Dec 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the long-term safety and tolerability of oral istradefylline 20 to 40 mg/d as treatment for subjects with moderate to severe Parkinson’s Disease (PD).
    Protection of trial subjects
    The Principal Investigators were responsible for the conduct and administration of the study in accordance with the protocol and ICH E6-GCP (CPMP/ICH/135/95) guidelines, for collecting, recording, and reporting the data accurately and properly as well as compliance with 21CFR Parts 11, 50,54,56 and 312 and the applicable country -specific requirements and in accordance with the ethical principles enunciated in the Declaration of Helsinki adopted by the 18th World Medical Association (WMA) General Assembly in Helsinki, Finland (June 1964); and amended most recently in 2013 (ninth revision). The Principal Investigator at each center was also responsible for contacts with study center management, the IEC/IRB, and with local non-regulatory bodies. Agreement of the Investigator to conduct and administer this study in accordance with the protocol was documented in separate study agreements with the Sponsor and other forms as required by national authorities in the country where the study center was located. The Informed Consent Form (ICF) incorporated the required elements for informed consent, including the possible treatment risks and necessary documentation as required by the Declaration of Helsinki, 21 CFR Part 50, and the ICH-GCP (CPMP/ICH/135/95) guidelines. The ICF also contained any additional information required by local laws relating to IRB/IEC review. The ICF was approved by the IRB/IEC and the Sponsor. The subject’s willingness to participate in the study was documented in writing (signed and dated by the subject [or by the subject’s legally acceptable representative] and by the person who conducted the informed consent discussion). The Investigators kept the original consent forms and copies were given to the subjects. No procedures were to take place until ICF was signed.
    Background therapy
    The study was an open-label, phase 3 continuation of study 6002-014 for the long term extension of treatment up to 52 weeks. Subjects must have completed 12 weeks of double blind treatment and a 30 day follow up period prior to enrollment in 6002-018.
    Evidence for comparator
    -
    Actual start date of recruitment
    18 Feb 2016
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 49
    Country: Number of subjects enrolled
    Germany: 12
    Country: Number of subjects enrolled
    Canada: 6
    Country: Number of subjects enrolled
    United States: 79
    Country: Number of subjects enrolled
    Serbia: 18
    Country: Number of subjects enrolled
    Israel: 16
    Country: Number of subjects enrolled
    Italy: 18
    Country: Number of subjects enrolled
    Czech Republic: 41
    Worldwide total number of subjects
    239
    EEA total number of subjects
    120
    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)
    109
    From 65 to 84 years
    129
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    Recruitment opened in February 2016 and closed 16 November 2016.

    Pre-assignment
    Screening details
    All subjects were screened for eligibility to participate in the trial. Subjects that met all the inclusion/exclusion criteria as per the protocol, were eligible for entry into the trial. A total of 243 subjects were enrolled (screened) of which 4 failed. 239 subjects were therefore enrolled into the trial.

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Overall Trial
    Arm description
    Open label study therefore all subjects were treated with istradefylline at a starting dose of 20 mg/d with an option for a dose adjustment to 40 mg/d at week 12 based on the Investigator's judgement of each subject's response and tolerability.
    Arm type
    Experimental

    Investigational medicinal product name
    Istradefylline
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects were treated with istradefylline at a starting dose of 20 mg/d with an option for a dose adjustment to 40 mg/d at week 12 based on the Investigator's judgement of each subject's response and tolerability. If deemed necessary, one unscheduled dose adjustment dose adjustment visit between weeks 2 and 12 was allowed in accordance with the Investigator's clinical judgement. Subject's who had a dose adjustment to 40mg/d could have their their dose decreased to 20mg/d by the investigator at a second unscheduled dose adjustment visit if there were tolerability issues. The istradefylline dose was to remain fixed between weeks 26 and 52. Consultation with the Sponsors Medical Monitor was required prior to any unscheduled dose adjustment visits. Study drug was to be taken in the morning for the duration of study participation on an outpatient basis. Study drug could be taken with or without food.

    Number of subjects in period 1
    Overall Trial
    Started
    239
    Week 12
    219
    Week 26
    198
    Completed
    179
    Not completed
    60
         Adverse event, serious fatal
    5
         Consent withdrawn by subject
    27
         Physician decision
    1
         Adverse event, non-fatal
    20
         Unknown
    3
         Non-compliance
    2
         Surgery
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall Trial
    Reporting group description
    -

    Reporting group values
    Overall Trial Total
    Number of subjects
    239 239
    Age categorical
    Due to change in German Privacy Law the age for two subjects was not entered. The age of these subjects were estimated in the enrolled reporting table but have been added as unknown to the age categorical table.
    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)
    108 108
        From 65-84 years
    128 128
        85 years and over
    1 1
        Unknown (age not collected)
    2 2
    Age continuous
    Due to change in German Privacy Law the age for two subjects was not entered. The age of these subjects were estimated in the enrolled reporting table but have been added as unknown to the age continuous table.
    Units: years
        arithmetic mean (standard deviation)
    65.0 ( 8.95 ) -
    Gender categorical
    Units: Subjects
        Female
    87 87
        Male
    152 152
    Subject analysis sets

    Subject analysis set title
    Efficacy analysis
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Efficacy analyses were based on the Intent to treat population, defined as all subjects who had both a valid baseline and at least one valid post-baseline efficacy assessment.

    Subject analysis set title
    Safety Evaluation
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Safety analysis was based on the safety analysis set. All continuous safety data that was collected in the study was summarized using descriptive statistics at each assessment time based on actual values and change from baseline values.

    Subject analysis sets values
    Efficacy analysis Safety Evaluation
    Number of subjects
    238
    239
    Age categorical
    Due to change in German Privacy Law the age for two subjects was not entered. The age of these subjects were estimated in the enrolled reporting table but have been added as unknown to the age categorical table.
    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)
    107
    108
        From 65-84 years
    128
    128
        85 years and over
    1
    1
        Unknown (age not collected)
    2
    2
    Age continuous
    Due to change in German Privacy Law the age for two subjects was not entered. The age of these subjects were estimated in the enrolled reporting table but have been added as unknown to the age continuous table.
    Units: years
        arithmetic mean (standard deviation)
    65 ( 8.96 )
    65 ( 8.95 )
    Gender categorical
    Units: Subjects
        Female
    86
    87
        Male
    152
    152

    End points

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    End points reporting groups
    Reporting group title
    Overall Trial
    Reporting group description
    Open label study therefore all subjects were treated with istradefylline at a starting dose of 20 mg/d with an option for a dose adjustment to 40 mg/d at week 12 based on the Investigator's judgement of each subject's response and tolerability.

    Subject analysis set title
    Efficacy analysis
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    Efficacy analyses were based on the Intent to treat population, defined as all subjects who had both a valid baseline and at least one valid post-baseline efficacy assessment.

    Subject analysis set title
    Safety Evaluation
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Safety analysis was based on the safety analysis set. All continuous safety data that was collected in the study was summarized using descriptive statistics at each assessment time based on actual values and change from baseline values.

    Primary: Safety Analysis based on the Safety Analysis Set.

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    End point title
    Safety Analysis based on the Safety Analysis Set. [1]
    End point description
    All continuous safety data collected in this study was categorised using descriptive statistics at each assessment time based on actual values and change from baseline values.
    End point type
    Primary
    End point timeframe
    From the time ICF was signed through to 30 days post last dose administration.
    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: Statistical Analysis was performed using descriptive statistics (number of subjects, mean, standard deviation, median, minimum and maximum) for continuous variables and frequency distributions and percentages for discrete (or any categorical) variables were utilized.
    End point values
    Overall Trial Safety Evaluation
    Number of subjects analysed
    239
    239
    Units: Adverse events
        Subjects with any TEAE
    141
    141
        Subjects with any serious TEAE
    30
    30
        Subjects with any TEAE leading to discontinuation
    25
    25
        Subjects with any related TEAE
    78
    78
        Subjects with any severe TEAE
    27
    27
        Subjects who died
    5
    5
    No statistical analyses for this end point

    Secondary: Efficacy Analysis based on the PGI-I scores at end of study (Week 52) as a percentage

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    End point title
    Efficacy Analysis based on the PGI-I scores at end of study (Week 52) as a percentage
    End point description
    The percentage of subjects showing improvement (moderate and mild) at week 52.
    End point type
    Secondary
    End point timeframe
    From baseline to week 52 (end of study)
    End point values
    Efficacy analysis
    Number of subjects analysed
    187
    Units: percentage
    number (not applicable)
        Overall Condition
    40.7
        Fatigue
    21.4
        Sleep
    19.8
        Motivation to get things done
    24.1
        Key Symptom
    39
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From the time the subject signs the ICF and until 30 days after last dose of study drug.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    16.1
    Reporting groups
    Reporting group title
    Safety Evaluation
    Reporting group description
    All safety analyses was based on the safety analyses set. All continuous safety data collected in this study was summarized using descriptive statistics at each assessment time based on actual values and changes from baseline values. Baseline was defined as the last non missing value obtained prior to first treatment. Continuous variables were summarized using n, mean, SD, median,minimum, and maximum values. Categorical variables were summarized using the number and percentage of subjects in each category. All out of normal range results and clinically significant changes in any safety variable were flagged in the subject data listings.

    Serious adverse events
    Safety Evaluation
    Total subjects affected by serious adverse events
         subjects affected / exposed
    30 / 239 (12.55%)
         number of deaths (all causes)
    5
         number of deaths resulting from adverse events
    5
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Breast cancer
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Circulatory collapse
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Acute respiratory failure
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    1 / 1
    Acute pulmonary oedema
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Psychiatric disorders
    Panic attack
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Confusional state
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Investigations
    Protein total decreased
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood creatinine increased
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Limb amputation
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Procedural pain
         subjects affected / exposed
    2 / 239 (0.84%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Pubis fracture
         subjects affected / exposed
    2 / 239 (0.84%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Incorrect dose administered
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Fall
         subjects affected / exposed
    3 / 239 (1.26%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Femur fracture
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Coronary artery disease
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac arrest
         subjects affected / exposed
    2 / 239 (0.84%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 2
    Atrial fibrillation
         subjects affected / exposed
    2 / 239 (0.84%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Atrioventricular block complete
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac failure congestive
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Angina pectoris
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Bradycardia
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac failure
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    Nervous system disorders
    On and off phenomenon
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Syncope
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Parkinson's disease
         subjects affected / exposed
    3 / 239 (1.26%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Convulsion
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Transient ischaemic attack
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Cerebrovascular accident
         subjects affected / exposed
    2 / 239 (0.84%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Sciatica
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Multiple sclerosis
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Carotid artery stenosis
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Dyskinesia
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Eye disorders
    Glaucoma
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Diplopia
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Gastritis erosive
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Inguinal hernia
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Drug-induced liver injury
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Urinary retention
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Intervertebral disc protrusion
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Spinal column stenosis
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Osteoarthritis
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Urinary tract infection
         subjects affected / exposed
    2 / 239 (0.84%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Bronchitis
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonia
         subjects affected / exposed
    2 / 239 (0.84%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Sepsis
         subjects affected / exposed
    2 / 239 (0.84%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 2
    Gas gangrene
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Necrotising fasciitis
         subjects affected / exposed
    1 / 239 (0.42%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Safety Evaluation
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    87 / 239 (36.40%)
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    27 / 239 (11.30%)
         occurrences all number
    37
    Nervous system disorders
    Dyskinesia
         subjects affected / exposed
    42 / 239 (17.57%)
         occurrences all number
    50
    Parkinson's disease
         subjects affected / exposed
    18 / 239 (7.53%)
         occurrences all number
    21

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    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
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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