E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Dyskinesia in advanced Parkinson's disease |
Discinesia in Soggetti con Malattia di Parkinson in Fase Avanzata |
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E.1.1.1 | Medical condition in easily understood language |
Advanced Parkinson's disease |
Malattia di Parkinson in Fase Avanzata |
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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 | 21.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10013113 |
E.1.2 | Term | Disease Parkinson's |
E.1.2 | System Organ Class | 100000004852 |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective of this interventional study is to examine the effect of LCIG treatment relative to that of Optimized Medical Treatment (OMT) on dyskinesia as measured by the Unified Dyskinesia Rating Scale (UDysRS) Total Score. |
L’obiettivo primario di questa sperimentazione interventistica è quello di studiare l’effetto del trattamento con LCIG rispetto all’effetto del trattamento medico ottimizzato (OMT) sulla discinesia, misurato in base alla variazione del punteggio totale UDysRS (Unified Dyskinesia Rating Scale). |
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E.2.2 | Secondary objectives of the trial |
The Secondary objective is to assess the effect of LCIG treatment relative to that of OMT on dyskinesia as measured by PD Diaries, motor symptoms, motor complications, safety, tolerability and health-related outcome measures. |
L’obiettivo secondario è quello di valutare gli effetti del trattamento con LCIG rispetto all’effetto del trattamento medico ottimizzato (OMT) sulla discinesia, misurati in base ai Diari della Malattia di Parkinson, sintomi motori e non-motori, complicanze motorie, sicurezza, tollerabilità ed esiti relativi alla salute. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Male or female subjects of at least 30 years old at the time of Visit 3. 2. Subject must have a diagnosis of idiopathic Parkinson's disease according to the United Kingdom Parkinson's Disease Society (UKPDS) Brain Bank Criteria 3. Patients with advanced levodopa-responsive Parkinson's disease and persistent motor fluctuations who have not been controlled with optimized medical treatment. "Optimized medical treatment" is defined as the maximum therapeutic effect obtained with pharmacological antiparkinsonian therapies when no further improvement is expected regardless of any additional manipulations of levodopa and/or other antiparkinsonian medication. This will be based on the Investigator's clinical judgment. 4. UDysRS Total score = 30 at Visit 3 based on Central Blinded Rater's score. 5. Subject (or subject's proxy/caregiver) must be able to complete both the Subject Dosing Diary and the PD Diary and must be able to demonstrate the ability to operate, manipulate, and care for the pump and tubing. 6. Subject must demonstrate at least 75% concordance with the Investigator's or qualified designee's assessment of symptoms on the Parkinson's Disease Diary following training at Screening Visit 1 with concordance on at least 1 time interval of "Off," concordance on at least 1 time interval of "ON regardless of dyskinesia" and at least 1 time interval of "ON with dyskinesia" irrespective of whether the dyskinesia are troublesome or not troublesome. 7. Subject is eligible to transfer to commercial treatment of Duodopa after completing the study based on local country requirements. |
1.Soggetti di ambo i sessi e di età pari o superiore a 30 anni al momento della Visita 3. 2.Soggetto con diagnosi di malattia di Parkinson idiopatica secondo i criteri Brain Bank UKPDS (United Kingdom Parkinson’s Diseases Society) 3.Pazienti con malattia di Parkinson in fase avanzata responsiva alla levodopa, con persistenti fluttuazioni motorie non controllate in maniera adeguata con il trattamento medico ottimizzato. Per “trattamento medico ottimizzato” si intende l’effetto terapeutico massimo ottenuto con le terapie farmacologiche antiparkinson, dove non sia atteso alcun ulteriore miglioramento da qualsiasi ulteriore aggiustamento della levodopa e/o di altri farmaci antiparkinson. Tale valutazione si baserà sul giudizio clinico dello sperimentatore. 4.Punteggio totale UDysRS = 30 alla Visita 3, secondo il punteggio del Rater centralizzato in cieco. 5.Soggetto (o rappresentante o caregiver del soggetto) in grado di compilare sia il Diario di Somministrazione per il Soggetto sia il Diario della Malattia di Parkinson e di dimostrare la propria capacità di utilizzare, gestire ed avere cura della pompa per infusione e del sistema di tubi. 6.Soggetto per cui viene dimostrata, dopo opportuno training alla Visita 1 di Screening, una concordanza di almeno il 75% fra la valutazione dei sintomi, eseguita dallo Sperimentatore o da un suo incaricato qualificato ed il Diario della Malattia di Parkinson; con concordanza riguardo almeno un periodo di “OFF”, almeno un periodo “ON a prescindere dalla discinesia” e almeno un periodo “ON con discinesia”, a prescindere dal grado di disturbo associato alla discinesia. 7.Soggetto idoneo a passare al trattamento con Duodopa commerciale dopo aver concluso la sperimentazione, nel rispetto della normativa nazionale. |
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E.4 | Principal exclusion criteria |
1. Predominantly di-phasic dyskinesia, as per Investigator discretion. 2. Patients who were treated with LCIG before 3. Patients who have had previous surgery for PD including, but not limited to deep brain stimulation (DBS) or cell transplantation. 4. A Mini-Mental State Examination (MMSE) score of < 24 at Visit 1 or significant cognitive impairment that, in the opinion of the Investigator, could impact the subject's ability to participate in the trial 5. Current primary psychiatric diagnosis of uncontrolled acute psychotic disorder or primary psychiatric diagnoses of bipolar disorder, schizophrenia, obsessive compulsive disorder or currently experiencing a major depressive episode with psychotic features per Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, Text Revision (DSM-V-TR). 6. Subject experiencing clinically significant sleep attacks or clinically significant impulsive behavior (e.g., pathological gambling, hypersexuality) at any point during the three months prior to the Screening evaluation as judged by the Investigator. 7. Current diagnosis or history of drug or alcohol abuse (DSM-V-TR criteria) within 12 months prior to screening visit. 8. Participation in a concurrent interventional or observational study. 9. Lack of motivation or insufficient language skills to complete the study questionnaires. 10. Subject's PD diagnosis is unclear or there is a suspicion that the subject has a parkinsonian syndrome such as secondary parkinsonism(e.g., caused by drugs, toxins, infectious agents, vascular disease, trauma, brain neoplasm), atypical Parkinson Syndrome (e.g., Multiple System Atrophy, Progressive supranuclear Palsy, Diffuse Lewy Body disease) or other neurodegenerative disease that might mimic the symptoms of PD. |
1.Discinesia prevalentemente bifasica, in base al giudizio dello sperimentatore. 2.Pazienti trattati in precedenza con LCIG. 3.Pazienti sottoposti a pregresso intervento chirurgico per la malattia di Parkinson tra cui, a titolo esemplificativo ma non esaustivo, la stimolazione cerebrale profonda (deep brain stimulation, DBS) oppure il trapianto di cellule. 4.Punteggio alla scala MMSE (Mini-Mental State Examination) < 24 in occasione della Visita 1 oppure significativa compromissione cognitiva che, a giudizio dello Sperimentatore, possa interferire con la capacità del soggetto di partecipare alla sperimentazione 5.Attuale diagnosi psichiatrica primaria di disturbo psicotico acuto non controllato o diagnosi psichiatrica primaria di sindrome bipolare, schizofrenia, disturbo ossessivo-compulsivo o soggetti che al momento soffrono di un episodio depressivo maggiore con elementi psicotici in base ai criteri Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, Text Revision (DMSIV-TR). 6.Soggetti che presentano colpi di sonno oppure comportamento impulsivo (es., gioco d’azzardo patologico, ipersessualità) considerati clinicamente significativi dallo Sperimentatore, in qualsiasi momento nei tre mesi precedenti le valutazioni dello Screening. 7.Diagnosi in atto o storia di abuso di stupefacenti o alcolici (in base ai criteri DSM-IV-TR) nei 12 mesi precedenti la visita di screening 8.Partecipazione simultanea ad una sperimentazione interventistica o ad uno studio osservazionale. 9.Scarsa motivazione oppure capacità linguistiche insufficienti a completare i questionari previsti dalla sperimentazione 10.Soggetto la cui diagnosi di Malattia di Parkinson non è chiara o per cui si sospetti una sindrome parkinsoniana quale il parkinsonismo secondario (es., indotto da farmaci, tossine, agenti infettivi, vasculopatia, trauma, neoplasie cerebrali), sindrome parkinsoniana atipica (es, Atrofia Sistemica Multipla, Paralisi Sopranucleare Progressiva, Malattia a Corpi di Lewy Diffusi) o altre patologie neurodegenerative che mimano i sintomi del Parkinson. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Change from baseline to week 12 in Unified Dyskinesia Rating Scale (UDysRS) Total Score |
Variazione media del punteggio totale UDysRS, rispetto al baseline, rilevato alla Settimana 12. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Baseline, Week 2, Week 4, Week 8, Week 12/Early termination visit |
Baseline, Settimana 2, 4, 8, 12/visita di conclusione anticipata |
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E.5.2 | Secondary end point(s) |
Secondary endpoints (with hierarchical analysis) • ON time without troublesome dyskinesia as measured by the PD Diary • PDQ-8 Summary Index • CGI-C • UPDRS Part II Score • OFF time as measured by PD Diary • UPDRS Part III Score Additional Efficacy Endpoints are: ¿ UDysRS Historical Score, Objective Score and Parts 1 through 4 Scores ¿ ON time with troublesome dyskinesia and ON time without dyskinesia as measured by PD Diary ¿ mAIMS Additional Health Outcome Endpoints: ¿ King's PD Pain Scale |
Endpoint Secondari (con analisi gerarchica): • Durata del periodo ON senza discinesie fastidiose, misurata in base al Diario PD • Punteggio PDQ-8 Summary Index • Valutazione CGI-C • Punteggio UPDRS Parte II • Durata del periodo OFF misurata in base al Diario PD • Punteggio UPDRS Parte III Ulteriori Endpoint di Efficacia: • Punteggio Storico UDysRS, Punteggio Obiettivo e Punteggi relativi alle Parti 1, 2, 3 e 4 • Durata del periodo ON con discinesia fastidiosa e del periodo ON senza discinesie, misurata in base al Diario PD • Punteggio mAISM Ulteriori Endpoint relativi agli Esiti di Salute: • Punteggio King’s PD Pain Scale
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1. Baseline, Week 2, Week 4, Week 8, Week 12/Early termination visit 2. Baseline, Week 8, Week 12/Early termination visit 3. Week 2, Week 4, Week 8, Week 12/Early termination visit 4. Screening, Baseline, Week 2, Week 4, Week 8, Week 12/Early termination visit 5. Baseline, Week 2, Week 4, Week 8, Week 12/Early termination visit 6. Screening, Baseline, Week 2, Week 4, Week 8, Week 12/Early termination visit 7. Baseline, Week 2, Week 4, Week 8, Week 12/Early termination visit 8. Baseline, Week 2, Week 4, Week 8, Week 12/Early termination visit 9. Baseline, Week 2, Week 4, Week 8, Week 12/Early termination visit 10. Baseline, Week 4, Week 8, Week 12/Early termination visit |
1. Baseline, Settimana 2, 4, 8, 12/Visita di conclusione Anticipata 2. Baseline, Settimana 8, 12/Visita di conclusione Anticipata 3. Settimana 2, 4, 8, 12/Visita di conclusione Anticipata 4. Screening, Baseline, Settimana 2, 4, 8, 12/Visita di conclusione Anticipata 5. Baseline, Settimana 2, 4, 8, 12/Visita di conclusione Anticipata 6. Screening, Baseline, Settimana 2, 4, 8, 12/Visita di conclusione Anticipata 7. Baseline, Settimana 2, 4, 8, 12/Visita di conclusione Anticipata 8. Baseline, Settimana 2, 4, 8, 12/Visita di conclusione Anticipata 9. Baseline, Settimana 2, 4, 8, 12/Visita di conclusione Anticipata 10. Baseline, Settimana 4, 8, 12/Visita di conclusione Anticipata |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | 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 | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
Trattamento Medico Ottimizzato |
Optimized medical treatment |
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E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 6 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 20 |
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 | Information not present in EudraCT |
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 |
United States |
European Union |
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E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
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 | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |