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    Summary
    EudraCT Number:2016-003456-70
    Sponsor's Protocol Code Number:CTH-302
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2021-02-02
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2016-003456-70
    A.3Full title of the trial
    An Open-Label Randomized Crossover Trial, utilizing a Single-Blinded Rater to evaluate APL- 130277 compared to S.C. Apomorphine in Levodopa Responsive Subjects with Parkinson¿s Disease Complicated by Motor Fluctuations
    Studio di crossover randomizzato in aperto con valutatore in singolo cieco, volto a valutare APL-130277 rispetto ad apomorfina sottocutanea (SC) in soggetti con il morbo di Parkinson complicato da fluttuazioni motorie che rispondono a levodopa
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A clinical trial to compare APL-130277 sublingual film to Subcutaneous Apomorphine in Parkinson¿s Disease patients
    Uno studio clinico per confrontare la pellicola sublinguale di APL-130277 rispetto ad apomorfina per via sottocutanea nei pazienti con malattia di Parkinson
    A.3.2Name or abbreviated title of the trial where available
    A clinical trial to compare APL-130277 sublingual film to Subcutaneous Apomorphine in Parkinson¿s Di
    Uno studio clinico per confrontare la pellicola sublinguale di APL-130277 rispetto ad apomorfina per
    A.4.1Sponsor's protocol code numberCTH-302
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorSUNOVION PHARMACEUTICALS INC
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportSunovion Pharmaceuticals Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationSyneos Health/INC Research Hungary Kft
    B.5.2Functional name of contact pointEniko Dalanics
    B.5.3 Address:
    B.5.3.1Street AddressKiralyhago ter 8-9/v.
    B.5.3.2Town/ cityBudapest
    B.5.3.3Post codeH-1126
    B.5.3.4CountryHungary
    B.5.4Telephone number003614578307
    B.5.5Fax number00360000
    B.5.6E-maileniko.dalanics@syneoshealth.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameApomorphine hydrochloride
    D.3.2Product code APL-130277
    D.3.4Pharmaceutical form Sublingual film
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSublingual use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAPOMORFINA CLORIDRATO
    D.3.9.1CAS number 41372-20-7
    D.3.9.2Current sponsor codeAPL-130277
    D.3.9.3Other descriptive nameAPOMORPHINE HYDROCHLORIDE
    D.3.9.4EV Substance CodeSUB12924MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name APO-go
    D.2.1.1.2Name of the Marketing Authorisation holderBRITANNIA PHARMACEUTICALS LIMITED
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product names.c. apomorphine
    D.3.2Product code n/a
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAPOMORFINA CLORIDRATO
    D.3.9.1CAS number 41372-20-7
    D.3.9.2Current sponsor coden/a
    D.3.9.3Other descriptive nameAPOMORPHINE HYDROCHLORIDE
    D.3.9.4EV Substance CodeSUB12924MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number2
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameApomorphine hydrochloride
    D.3.2Product code APL-130277
    D.3.4Pharmaceutical form Sublingual film
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSublingual use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAPOMORFINA CLORIDRATO
    D.3.9.1CAS number 41372-20-7
    D.3.9.2Current sponsor codeAPL-130277
    D.3.9.3Other descriptive nameAPOMORPHINE HYDROCHLORIDE
    D.3.9.4EV Substance CodeSUB12924MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number15
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameApomorphine hydrochloride
    D.3.2Product code APL-130277
    D.3.4Pharmaceutical form Sublingual film
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSublingual use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAPOMORFINA CLORIDRATO
    D.3.9.1CAS number 41372-20-7
    D.3.9.2Current sponsor codeAPL-130277
    D.3.9.3Other descriptive nameAPOMORPHINE HYDROCHLORIDE
    D.3.9.4EV Substance CodeSUB12924MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 5
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameApomorphine hydrochloride
    D.3.2Product code APL-130277
    D.3.4Pharmaceutical form Sublingual film
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSublingual use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAPOMORFINA CLORIDRATO
    D.3.9.1CAS number 41372-20-7
    D.3.9.2Current sponsor codeAPL-130277
    D.3.9.3Other descriptive nameAPOMORPHINE HYDROCHLORIDE
    D.3.9.4EV Substance CodeSUB12924MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 6
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameApomorphine hydrochloride
    D.3.2Product code APL-130277
    D.3.4Pharmaceutical form Sublingual film
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSublingual use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAPOMORFINA CLORIDRATO
    D.3.9.1CAS number 41372-20-7
    D.3.9.2Current sponsor codeAPL-130277
    D.3.9.3Other descriptive nameAPOMORPHINE HYDROCHLORIDE
    D.3.9.4EV Substance CodeSUB12924MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number30
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboSublingual tablet
    D.8.4Route of administration of the placeboSublingual use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Levodopa Responsive Patients with Parkinson¿s Disease Complicated by Motor Fluctuations ("OFF episodes")
    Pazienti responsivi a Levodopa con malattia di Parkinson complicata da fluttuazioni motorie ("episodi OFF")
    E.1.1.1Medical condition in easily understood language
    Central nervous system disease affecting the movement
    Malattia del sistema nervoso centrale che colpisce il movimento
    E.1.1.2Therapeutic area Diseases [C] - Nervous System Diseases [C10]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 22.1
    E.1.2Level LLT
    E.1.2Classification code 10034006
    E.1.2Term Parkinson's disease aggravated
    E.1.2System Organ Class 100000004852
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective is to demonstrate the preference of APL 130277 as a therapy for the acute and intermittent management of ¿OFF¿ episodes in subjects with Parkinson¿s Disease (PD) in the titration period and in an open label crossover period compared to subcutaneous (s.c.) apomorphine (PART A and B).
    L'obiettivo primario ¿ quello di dimostrare la preferenza di APL 130277 come terapia per la gestione acuta e intermittente di episodi "OFF" in soggetti con malattia di Parkinson (PD) in un periodo di titolazione e in un periodo crossover in aperto, rispetto ad apomorfina sottocutanea (s.c.) (parte A e B).
    E.2.2Secondary objectives of the trial
    The key secondary objective is to demonstrate the superiority efficacy of APL 130277 as a therapy for the acute and intermittent management of ¿OFF¿ episodes in subjects with PD compared to s.c. apomorphine (in PART B).
    L'obiettivo secondario principale ¿ quello di dimostrare la superiorit¿ in efficacia di APL 130277 come terapia per la gestione acuta e intermittente di episodi "OFF" in soggetti con malattia di Parkinson rispetto ad apomorfina sottocutanea (Parte B).
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives

    Other types of substudies
    Specify title, date and version of each substudy with relative objectives: Optional Pharmacokinetic (PK) evaluation : Blood draws for APL-130277 and s.c. apomorphine PK analyses will occur during PART B at V2, V3, V5, and V6 at selected sites (dependent on feasibility). Blood draws will occur at t = 0 (just prior to dosing) and at t = 10, 20, 30, 60, 90, 120, 180 and 240 minutes post-dose. Sampling should occur as close as possible to the target time. Subjects must consent in order to participate in optional PK sub-study

    Altre tipologie di sottostudi
    specificare il titolo, la data e la versione di ogni sottostudio con i relativi obiettivi: Valutazione opzionale di Farmacocinetica (PK): Saranno effettuati prelievi ematici per le analisi di farmacocinetica per APL-130277 ed apomorfina s.c. durante la Parte B alle visite V2, V3, V5 e V6 presso centri selezionati (a seconda della feasibility). I prelievi ematici saranno raccolti al tempo t=0 (prima del dosaggio) ed ai tempi t= 10, 20, 30, 60, 90, 120, 180 e 240 minuti post-dose. La raccolta dovr¿ avvenire il pi¿ vicino possibile ai tempi target. I soggetti devono dare il proprio consenso per partecipare al sottostudio opzionale di Farmacocinetica
    E.3Principal inclusion criteria
    1) Male or female = 18 years of age.
    2) Clinical diagnosis of Idiopathic PD, consistent with UK Brain Bank Criteria.1
    3) Clinically meaningful response to L Dopa as determined by the Investigator.
    4) Receiving stable doses of L Dopa/carbidopa and/or L Dopa/benserazide and/or L Dopa/carbidopa/entacapone (immediate or CR) administered at least 4 times per day OR Rytary™ administered at least 3 times per day, and on stable doses for at least 4 weeks before the initial Screening Visit (SV1). Adjunctive PD medication regimens are permitted but must be maintained at a stable dose for at least 4 weeks prior to the initial Screening Visit (SV1) with the exception that MAO B inhibitors must be maintained at a stable level for at least 8 weeks prior to the initial Screening Visit (SV1).
    5) No planned medication change(s) or surgical intervention anticipated during the course of study.
    6) Subjects must experience at least one well defined “OFF” episode per day with a total daily “OFF” time duration of > 2 hours during the waking day, based on judgment of physician and subject self assessment.
    7) Subject must have predictable morning “OFF” periods.
    8) Subject and where appropriate, caregiver, must be trained in completing the home dosing diary and able to recognize “ON” and “OFF” states.
    9) Stage III or less on the modified Hoehn and Yahr scale in the "ON" state.
    10) Mini–Mental State Examination (MMSE) score >25.
    11) Female subject of childbearing potential and male subject with female partner of childbearing potential, must agree to use an effective
    and medically acceptable form of birth control throughout the study period. Note: Continued use of an effective and medically acceptable form of birth control is recommended through 30 days after study completion.
    12) Willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study related procedures to complete the study.
    13) Able to understand the consent form, and to provide written informed consent.
    14) Must be approved as a satisfactory candidate by the Enrollment Adjudication Committee (EAC).
    1) Pazienti di sesso maschile o femminile di età pari o superiore a 18 anni.
    2)Diagnosi clinica di morbo di Parkinson idiopatico, in linea con i criteri della Banca inglese del cervello (UK Brain Bank Criteria)1
    3)Risposta clinicamente significativa a L-Dopa, come determinato dallo Sperimentatore.
    4) Pazienti che ricevono dosi stabili di L-Dopa/carbidopa e/o L-Dopa/benserazide e/o L-Dopa/carbidopa/entacapone (a rilascio immediato o cronico) somministrate almeno 4 volte al giorno OPPURE Rytary™ somministrato almeno 3 volte al giorno e che abbiano ricevuto dosi stabili per almeno le 4 settimane antecedenti la visita iniziale di screening (SV1). Sono consentiti regimi terapeutici aggiuntivi con farmaci anti-Parkinson (anti-PD) ma questi devono essere stati mantenuti a una dose stabile per almeno le 4 settimane antecedenti la SV1, fatta eccezione per gli inibitori della monoamminoossidasi B (MAO B) che devono essere stati mantenuti a un livello stabile per almeno le 8 settimane antecedenti la SV1.
    5) Durante il corso dello studio non deve esserci alcuna modifica programmata di farmaci o alcun intervento chirurgico pianificato.
    6) I soggetti devono manifestare almeno un episodio “OFF” ben definito al giorno con una durata complessiva quotidiana dell’episodio “OFF” >2 ore durante la veglia, sulla base del giudizio del medico e dell’auto-valutazione da parte del soggetto.
    7) I soggetti devono manifestare periodi “OFF” mattutini prevedibili.
    8)I soggetti, e ove applicabile chi si prende cura di loro, devono aver ricevuto istruzioni su come completare il diario relativo alla somministrazione del farmaco a casa ed essere in grado di riconoscere gli stati “ON” e “OFF”.
    9)Allo stato “ON”, rientrare nello stadio III o inferiore della Scala modificata di Hoehn e Yahr.
    10) Punteggio per il Mini-Mental State Examination (MMSE) >25.
    11) I soggetti di sesso femminile in grado di procreare e i soggetti di sesso maschile con partner di sesso femminile in grado di procreare devono accettare di utilizzare un metodo contraccettivo efficace e clinicamente accettabile per l’intero periodo dello studio. Nota: si raccomanda l’uso continuo di un metodo contraccettivo efficace e clinicamente accettabile per i 30 giorni successivi al completamento dello studio.
    12) Il soggetto deve essere disposto e in grado di sottoporsi alle visite programmate, al programma di trattamento, agli esami di laboratorio e ad altre procedure correlate allo studio per completare lo studio.
    13) Il soggetto deve essere in grado di comprendere il modulo di consenso e fornire il consenso informato scritto.
    14) Il soggetto deve essere approvato come candidato adeguato da parte della Commissione giudicatrice dell’arruolamento (Enrollment Adjudication Committee, EAC).
    E.4Principal exclusion criteria
    1) Atypical or secondary parkinsonism.
    2) Previous treatment with any of the following: a neurosurgical procedure for PD; continuous subcutaneous (s.c.) apomorphine infusion;
    subcutaneous (s.c.) apomorphine injection; Duodopa/Duopa; or APL-130277.
    3) Contraindications to domperidone, subcutaneous apomorphine, or hypersensitivity to apomorphine hydrochloride or any of the ingredients
    of subcutaneous apomorphine (notably sodium metabisulfite).
    4) Female who is pregnant or lactating.
    5) Participation in a clinical trial within 30 days prior to SV1.
    6) Receipt of any investigational (ie, unapproved) medication within 30 days prior to SV1.
    7) Currently taking selective 5HT3 antagonists (ie, ondansetron, granisetron, dolasetron, palonosetron, alosetron), dopamine antagonists (excluding quetiapine or clozapine) or dopamine depleting agents. Subjects receiving anti-depressants must be on a stable daily dose for at least 8 weeks before SV1.
    8) The subject has a current diagnosis or history of substance abuse (excluding cannabinoids, nicotine, and caffeine) or alcohol abuse (in the opinion of the investigator) < 6 months prior to SV1.
    9) Subject has a history of malignancy within 5 years prior to SV1, except for adequately treated basal cell or squamous cell skin cancer or in situ cervical cancer. Pituitary tumors of any duration are excluded.
    10) Subject has a clinically significant abnormality on screening evaluation including physical examination, vital signs, ECG, or laboratory
    tests that the Investigator considers to be inappropriate to allow participation in the study.
    11) Subject has screening laboratory test results of: blood urea nitrogen (BUN) value = 1.5 times the upper limit of normal (ULN) for the reference range; serum creatinine > 1.5 times the ULN for the reference range; or alanine aminotransferase (ALT) or aspartate aminotransferase (AST) value = 2 times the ULN for the reference laboratory.
    12) Subject is on injectable medication for the treatment of Type 2 diabetes. A subject with Type 2 diabetes is eligible for study inclusion if
    considered clinically stable.
    13) The subject's screening ECG at SV1 or SV2 shows a corrected QT interval using Fridericia's formula (QTcF) of = 450 msec for male subjects or = 470 msec for female subjects. Eligibility will be based on the core laboratory ECG interpretation report.
    14) Subject has a positive screening laboratory test result for human immunodeficiency virus (HIV).
    15) Subject has a positive screening laboratory test result for hepatitis B surface antigen or hepatitis C antibodies and has liver function test results at screening above the ULN for the reference laboratory.
    16) Subject has major psychiatric disorder, including but not limited to in the last 12 months: bipolar disorder, psychosis (including hallucinations), major depressive episode, or any disorder that, in the
    opinion of the Investigator, requires new or ongoing treatment that would make study participation unsafe or make treatment compliance difficult.
    17) Subject has Parkinson's disease psychosis (PDP) that precludes providing informed consent or would interfere with participation in the study. Symptoms of PDP commonly include visual hallucinations, delusions (paranoia) and illusions (misperception of objects).
    18) History of clinically significant impulse control disorder(s).
    19) Orthostatic hypotension (requiring medication).
    20) Dementia that precludes providing informed consent or would interfere with participation in the study.
    21) Current suicidal ideation within one year prior to Screening Visit 2 (SV2) or attempted suicide within the last 5 years.
    22) Presence of canker or mouth sores in the 30 days prior to SV1, or other clinically significant oral pathology in the opinion of the Investigator. The Investigator should follow-up with an appropriate specialist on any finding, if indicated, before enrolling a subject into the study.
    1)Parkinsonismo atipico o secondario
    2) Trattamento precedente con uno dei seguenti: procedura neurochirurgica per il morbo di Parkinson, infusione (SC) continua di apomorfina, iniezione (SC) di apomorfina, Duodopa/Duopa oppure APL-130277.
    3) Presenza di controindicazioni per domperidone, per apomorfina SC o ipersensibilità ad apomorfina cloridrato o a uno qualunque degli eccipienti dell’apomorfina SC (in particolare metabisolfito di sodio).
    4) Paziente donna gestante o in allattamento
    5) Partecipazione a uno studio clinico nei 30 giorni antecedenti la SV1
    6) Assunzione di un farmaco sperimentale nei 30 giorni antecedenti la SV1.
    7) Attuale assunzione di antagonisti selettivi di 5HT 3 (ondansetron, granisetron, dolasetron, palonosetron, alosetron), antagonisti della dopamina (tranne quetiapina o clozapina) o agenti depletori della dopamine. I soggetti che assumono anti-depressivi devono averli assunti a dosi stabili per almeno 8 settimane antecedenti la SV1.
    8) Il soggetto ha ricevuto una diagnosi attuale o ha avuto episodi pregressi di abuso di sostanze (tranne cannabinoidi, nicotina e caffeina) o abuso di alcool nei <6 mesi antecedenti la SV1
    9) Il soggetto ha una anamnesi di tumore maligno sviluppato nei 5 anni antecedenti la SV1, tranne carcinoma cutaneo basocellulare o a cellule squamose o carcinoma della cervice in situ adeguatamente trattati. Tumori pituitari di qualunque durata sono esclusi.
    10) Il soggetto ha un’anomalia clinicamente significativa alla valutazione di screening, compreso esame obiettivo, parametri vitali, ECG o esami di laboratorio che lo Sperimentatore ritiene inappropriata per la partecipazione del soggetto allo studio.
    11) Il soggetto presenta i seguenti valori per gli esami di laboratorio di screening: indice di azoto ureico ematico (BUN) =1,5 volte limite superiore di normalità (ULN) per l’intervallo di riferimento;, creatinina sierica >1,5 volte (ULN) per l’intervallo di riferimento oppure alanina aminotransferasi (ALT) o aspartato aminotransferasi (AST) =2 volte (ULN)
    12) Il soggetto è in trattamento con farmaci iniettabili per il diabete di tipo 2. Un soggetto con diabete di tipo 2 è idoneo ad essere incluso nello studio, se è considerato clinicamente stabile
    13) L’ECG di screening del soggetto in occasione della SV1 o SV2 mostra un intervallo QT corretto, utilizzando la formula di Fridericia (QTcF) =450 msec per i soggetti di sesso maschile o =470 msec per i soggetti di sesso femminile.
    14) Il soggetto risulta positivo all’esame di laboratorio allo screening per il virus dell’immunodeficienza umana (HIV).
    15) Il soggetto risulta positivo allo screening per l’antigene di superficie per l’epatite B o agli anticorpi per l’epatite C e i risultati del test di funzionalità epatica allo screening risultano superiori all’ULN
    16) Il soggetto presenta disturbi psichiatrici maggiori negli ultimi 12 mesi tra cui disturbo bipolare, psicosi (comprese allucinazioni), episodi importanti di depressione o qualsiasi altro disturbo che necessiti di un attuale trattamento che renderebbe la partecipazione del soggetto allo studio non sicura.
    17) Il soggetto presenta psicosi correlata a morbo di Parkinson (PDP) che preclude al soggetto di fornire il consenso informato o che potrebbe interferire con la partecipazione allo studio. Sintomi di PDP normalmente includono allucinazioni visive, deliri (paranoia) e illusioni (percezione errata degli oggetti).
    18) Trascorsi di disturbo/i del controllo degli impulsi clinicamente significativi
    19) Ipotensione ortostatica (richiedente trattamento).
    20) Demenza che preclude al soggetto di fornire il consenso informato o che potrebbe interferire con la partecipazione allo studio.
    21) Ideazione suicidaria attuale, nell’anno antecedente la visita di screening 2 oppure tentativo di suicidio negli ultimi 5 anni.
    22) Presenza di ulcerazione o afta della bocca nei 30 giorni antecedenti la SV1, o altre patologie orali clinicamente significative secondo il parere dello Sperimentatore.
    E.5 End points
    E.5.1Primary end point(s)
    The primary endpoint is the percentage of subjects preferring APL-130277 over s.c. apomorphine. The overall subject preference will be based on
    preference of method of dose titration (PART A) and method of treatment (PART B). The subjects who prefer APL-130277 dose titration / treatment in
    both PART A and PART B will be defined as preferring APL-130277. The subjects who prefer s.c. apomorphine dose titration/treatment both in PART A and PART B will be defined as preferring s.c. apomorphine. For subjects who prefer different dose titration / treatment in PART A and PART B, the preference of PART B will be used for the primary endpoint.
    For subjects who only provide preference data from one of the two periods (PART A or PART B), the available preference will be used for the primary endpoint.
    L'endpoint primario è la percentuale di soggetti che preferiscono APL-130277 alla'apomorfina s.c. La preferenza globale del soggetti sarà basata sulla preferenza del metodo di titolazione della dose (Parte A) e del metodo di trattamento (Parte B). I soggetti che preferiscono APL-130277 nella titolazione della dose / trattamento nelle Parti A e B saranno definiti come quelli che preferiscono APL-130277. I soggetti che preferiscono apomorfina s.c. nella titolazione della dose / trattamento nelle Parti A e B saranno definiti come quelli che preferiscono l'apomorfina s.c. Per I soggetti che preferiscono una titolazione della dose differente / trattament nelle Parti A e B, la preferenza della Parte B sarà usata per l'endpoint primario. Per I soggetti che forniscono solamente la preferenza di uno dei due periodi (Parte A o Parte B), la stessa preferenza disponibilt sarà usata per l'endpoint primario
    E.5.1.1Timepoint(s) of evaluation of this end point
    For PART A, Subject Preference question should be completed at the last titration visit once the subject has completed titration to both treatment regimens immediately prior to being scheduled for PART B. For PART B, Subject Preference question should be completed at V6
    Per la Parte A, la domanda sulla preferenza del soggetto dovrà essere completata all'ultima visita della titolazione una volta che il soggetto ha completato la titolazione per entrambi I trattamenti, subito prima di essere inserito nella Parte B. Per la Parte B, la domanda sulla preferenza del soggetto dovrà essere completata alla Visita V6
    E.5.2Secondary end point(s)
    1 Durability of effect, defined as an Investigator confirmed full "ON" within 30 minutes post-dose and at 90 minutes post-dose, after 4 weeks of dosing in each crossover period (assessed by the blinded-rater inclinic at V3 and V6 of PART B).
    2 Subject preference for APL-130277 treatment (either somewhat or definitely prefer APL-130277) after the subject has completed both APL-130277 and s.c. apomorphine treatment regimens (assessed in-clinic at V6 of PART B).
    3 Subject confirmed durability of effect, defined as subject confirmed full "ON" within 30 minutes post-dose and at 90 minutes post-dose, after 4 weeks of dosing in each crossover period (assessed in-clinic at V3 and V6 of PART B).
    4 Patient Global Impression of Change (PGI-C): Subject improvement of "OFF" episodes, defined as very much better, much better or a little better after 4 weeks of dosing in each crossover period (assessed inclinic at V3 and V6 of PART B).; Other Efficacy Endpoints (PART B):
    Other efficacy variables will include analysis of: Clinical Global Impression of Improvement (CGI-I), MDS-UPDRS – Parts I, II, III and
    IV Score, Time to Full and Partial "ON", Expanded Home Dosing Diaries including percent of "ON" episodes without troublesome dyskinesia based on the 3 consecutive days prior to V2, V3, V5, and V6, dyskinesia questionnaire, Parkinson's Disease Questionnaire-39 (PDQ-39) Total Index Score and subscale scores, European Quality of Life – 5 Dimensions (EQ-5D-5L) ), and Ease of Use questionnaire. Methodology concerning the analysis of these variables will be provided in the Statistical Analysis Plan (SAP).; Evaluation of safety and tolerability of APL-130277 compared to sc apomorphine as measured by AEs, physical examination including assessment of oropharyngeal AEs and injection-site related AEs, 12-lead ECGs, vital signs including OH, clinical laboratory tests, and C-SSRS and QUIP-RS assessments.; Pharmacokinetic Endpoints:
    Pharmacokinetic concentration-time data for apomorphine and metabolites (apomorphine sulfate, norapomorphine, and others as
    deemed necessary) will be evaluated and PK parameters (including but not limited to Cmax, tmax, AUCt, parent-to-metabolite ratios of Cmax and AUCt) will be estimated by noncompartmental methods from plasma samples using actual elapsed time from dosing. Details and methodology concerning the analysis of these variables will be provided in a separate PK analysis plan. A separate and stand-alone PK report will be provided.
    1. Durata dell’effetto confermata dal soggetto, definita come stato “ON” completo confermato dal soggetto 30 minuti dopo la somministrazione della dose e 90 minuti dopo la somministrazione della dose, dopo 4 settimane di somministrazione della dose in ciascun periodo di crossover (valutata in ospedale alla V3 e V6 della PARTE B).
    2. Preferenza del soggetto per il trattamento con APL-130277 (preferenza moderata o netta per APL) dopo che il soggetto avrà completato i regimi di trattamento sia con APL-130277 che con apomorfina sc (valutati in ospedale alla V6 della PARTE B).
    3. Conferma del soggetto della durabilità dell'effetto, definito come uno stato ON confermato entro 30 minuti post-dose e a 90 minuti post-dose, dopo 4 settimane di dosaggio in ciascun periodo di crossover (valutata in ospedale alla V3 e V6 della PARTE B).
    4. Impressione globale di cambiamento da parte del paziente (PGI-C): miglioramento degli episodi “OFF” del soggetto, definito come episodi migliorati moltissimo, migliorati molto o migliorati un po’ dopo 4 settimane di somministrazione della dose in ciascun periodo di crossover (valutato in ospedale alle V3 e V6 della PARTE B).; Altri Endpoint di efficacia parte B:
    Altre variabili di efficacia includono l'analisi di: Clinical Global Impression of Improvement (CGI-I), punteggio di MDS-UPDRS - Parte I, II, III e IV, Tempo di stato ON pieno o parziale, Diari di dosaggio a domicilio estesi compresa la percentuale di episodi ON senza problemi di discinesia nei 3 giorni consecutivi prima delle visite V2, V3, V5, e V6, questionario sulla discinesia, PDQ-39, EQ-5D-5L e questionario sulla facilità di utilizzo. I metodi di analisi delle variabili saranno forniti nel piano di analisi statistiva (SAP).; Endpoint di sicurezza:
    Valutazione della sicurezza e della tollerabilità di AP-130277 rispetto ad apomorfina sc secondo quanto misurato da eventi avversi, esame obiettivo (inclusa valutazione degli AE orofaringei e degli AE correlati al sito di iniezione), ECG a 12 derivazioni, segni vitali, test clinici di laboratorio e valutazioni C-SSRS e QUIP-RS; Endpoint di farmacocinetica:
    Utilizzando metodi non compartimentali, saranno valutati da campioni di plasma i dati farmacocinetici della concentrazione nel tempo per l’apomorfina e i suoi metaboliti (apomorfina solfato, norapomorfina e altri, se ritenuto necessario) e si stimeranno i
    parametri PK (inclusi, ma non limitati a, Cmax, tmax, AUCt, rapporti farmaco originale-metaboliti di Cmax e AUCt) usando il tempo effettivamente trascorso dalla somministrazione della dose. I dettagli e la metodologia relativi all’analisi di queste variabili saranno forniti in un piano di analisi PK. Un report separato di PK sarà fornito
    E.5.2.1Timepoint(s) of evaluation of this end point
    Refer to section E.5.2; Refer to section E.5.2; Refer to section E.5.2; Refer to section E.5.2
    si faccia riferimento alla sezione E.5.2; fare riferimento alla sezione E.5.2; Si faccia riferimento alla sezione E.5.2; si faccia riferimento alla sezione E.5.2
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Ease of use and Tolerability
    Facilit¿ d'uso e tollerabilit¿
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over Yes
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    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.8.4.1Number of sites anticipated in Member State concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA33
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.7Trial 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
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years0
    E.8.9.1In the Member State concerned months24
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years0
    E.8.9.2In all countries concerned by the trial months24
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 64
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 42
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state40
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 106
    F.4.2.2In the whole clinical trial 106
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None
    nessuno
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2018-05-04
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2017-12-20
    P. End of Trial
    P.End of Trial StatusCompleted
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