SR-Exenatide (PT320) to Eveluate Efficacy and Safety in Patients With Early Parkinson's Disease

Phase 2

• Conditions: Early Parkinson's Disease
• Interventions: Drug: PT320 2.0 mg; Drug: PT320 2.0mg Placebo; Drug: PT320 2.5 mg

• Registration Number: NCT04269642
• Lead Sponsor: Peptron, Inc.

Brief Summary

This study is to evaluate the safety and efficacy of sustained release (SR)-Exenatide (PT320, Q1W and Q2W) in the treatment of patients with early Parkinson's disease (PD).

Detailed Description

This study is a multicenter, randomized, double-blind, placebo-controlled, parallel comparison, phase IIa clinical study to evaluate the efficacy and safety of sustained release (SR)-Exenatide (PT320) in the treatment of patients with early Parkinson's disease (PD).

Exenatide (GLP-1) has been approved by the Food and Drug Administration (FDA) to treat patients with Type 2 Diabetes (T2D) and obesity. In addition, several research groups have confirmed that Exenatide has beneficial aspects due to the neuroprotective effects in neuronal cells in patients with PD. Peptron has developed a sustained-release (SR)-Exenatide, (PT320, Q1W and Q2W), which has shown a higher Blood-Brain Barrier (BBB) penetration rate and better patient compliance.

Thus, the objective of this study is to evaluate the effect of PT320 on symptom improvement and the inhibition of disease progression in the treatment of patients with early Parkinson's disease. Also, pharmacokinetic analysis of PT320 in blood cerebrospinal fluid (CSF) and exosome analysis of biomarkers related to Exenatide will be being tested, as exploratory measurements.

Study Timeline

• Study First Submitted: 2020-01-13
• Study First Submitted QC: 2020-02-11
• Study First Posted: 2020-02-17
• Study Start: 2020-03-19
• Status Verified: 2021-04
• Last Update Submitted: 2021-04-07
• Last Update Posted: 2021-04-12
• Primary Completion: 2021-09-29
• Study Completion: 2021-12-31

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 99

Inclusion Criteria

1. Patient who is male or female aged 40-75 and is diagnosed with Parkinson's Disease (using Queen Square Brain Bank criteria)
2. Patient who is diagnosed of Parkinson's Disease less than 24 months prior to the screening
3. Patient who has a modified Hoehn and Yahr stage ≤ 2. 5
4. Patient who has been taking L-dopa stable-dose less than 600 mg/day or who has not previously taken any medication for the treatment of Parkinson's Disease from 4 weeks prior to the screening.
5. Patient who is able to inject an Investigational Product by himself/herself or a his/her guardian.
6. Patient or legally acceptable representative who signs the informed consent form voluntarily and is able to comply with all study procedures

Exclusion Criteria

1. Patient who is diagnosed or suspected to have Parkinson-plus syndromes (e.g., Multiple System Atrophy, Progressive Supranuclear Palsy, Corticobasal Degeneration, Diffuse Lewy Body Disease, and etc.)

2. Patient who has a BMI < 18.5 at the screening

3. Patient who has known abnormalities on CT or MRI brain imaging that may have an impact on the protocol compliance and/or PET scan

4. Patient who has dementia with MoCA-K ≤ 22

5. Patient who has a history of severe heart failure (NYHA class III to IV), stroke, cerebral ischemic attack, or seizure within 1 year prior to screening; or a history myocardial infarction or unstable angina within 6 months prior to screening.

6. Patient who has severe liver disease or has AST or ALT level 3 times more than ULN at the screening

7. Patient who has clinically significant depression [> 18 of Korean Beck Depression Inventory II score (K-BDI-II)]

8. Patient who has a history of brain surgery for any treatment of Parkinson's disease

9. Patient who has participated in any clinical trials for the treatment of Parkinson's Disease within 3 months prior to screening

10. Patient who took exenatide within 90 days prior to randomization

11. Patient who has a history of gastroduodenal ulcer or gastroparesis within 3 months prior to administration of investigational product or is currently on medication for acute or chronic gastritis

12. Patient who has severe kidney function injury (creatinine clearance < 30 ml/min)

13. Patient who has a history of pancreatitis

14. Patient who has type 1 or type 2 diabetes or HbA1c ≥ 6.5% at screening

15. Patient who has a history or suspected to thyroid cancer or multiple endocrine adenomatosis

16. Patient who has known or suspected intolerance in PET scan or fluoropropyl-CIT (18F)

17. Woman childbearing potential who doesn't agree to use the medically acceptable methods of contraception* during this study and up to 24 weeks after the last injection of investigational product

    *Medically acceptable methods of contraception: oral contraceptives, intrauterine contraceptive devices, vasectomy for male partner, barrier method [condom, spermicidal foam/gel/film/cream/suppository with sealed cap (diaphragm or cervix/bolt cap)].

18. Woman who is pregnant or breastfeeding

19. Patient who has a history of hypersensitivity reactions to any ingredients of investigational product

20. Patient who is not eligible for the study at the discretion of the investigator

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
PT320 2.0mg treatment 1	PT320 2.0 mg	will be injected subcutaneously once a week for 48 weeks
PT320 2.0mg Placebo	PT320 2.0mg Placebo	will be injected subcutaneously once a week for 48 weeks
PT320 2.5mg treatment2	PT320 2.5 mg	will be injected subcutaneously every two weeks for 48 weeks. (Actually, patients will be injected PT320 2.5 mg and placebo alternately once a week.)

Primary Outcome Measures

Name	Time	Method
Change of MDS-UPDRS part 3 score	48 week	Change of MDS-UPDRS (Movement Disorder Society -Unified Parkinson's Disease Rating Scale ) part 3 score from baseline at 48 weeks.; The MDS-UPDRS has four parts: Part I (non-motor experiences of daily living), Part II (motor experiences of daily living), Part III (motor examination) and Part IV (motor complications). The MDS-UPDRS consists of five measures, 0(normal) to 4(severe), according to each item, and is evaluated as the total score per part of Part 1 to 4. A 0 means there is no disability, and the higher the score, the more the disability is reflected.

Secondary Outcome Measures

Name	Time	Method
MDS-UPDRS part 1, 2 and 4 scores	0, 24, 48 and 60 weeks	Changes of MDS-UPDRS (Movement Disorder Society -Unified Parkinson's Disease Rating Scale ) part 1, 2 and 4 scores from baseline at 24, 48 and 60 weeks.; The MDS-UPDRS has four parts: Part I (non-motor experiences of daily living), Part II (motor experiences of daily living), Part III (motor examination) and Part IV (motor complications). The MDS-UPDRS consists of five measures, 0(normal) to 4(severe), according to each item, and is evaluated as the total score per part of Part 1 to 4. A 0 means there is no disability, and the higher the score, the more the disability is reflected.
K-PDQ-39 score	0, 48 and 60 weeks	Change of K-PDQ-39 (korean-The Parkinson's Disease Questionnaires-39) score from baseline at 48 and 60 weeks. PDQ-39 is an assessment of Parkinson's disease and comprises a total of 39 questions. Based on the past month's experience, each item consists of a five-point scale of 0(never) to 4 (always) and is checked by the test subjects themselves. The total score of PDQ-39 is evaluated as a percentage of 0-100%, and as the score increases, the symptom becomes more severe.
MoCA-K score	0, 24, 48 and 60 weeks	Change of MoCA-K (Montreal Cognitive Assessment-Korean) score from baseline at 24, 48 and 60 weeks.; MoCA-K is designed to evaluate mild cognitive disorders. The raters evaluate cognitive functions such as attention and concentration, memory, language, conceptual thinking, calculations, and orientation. The execution time takes about 10 minutes and is evaluated by the sum of the scores of each item. A perfect score of 30 points or more is considered normal.
MDS-UPDRS part 3 score	0, 24 and 60 weeks	Change of MDS-UPDRS (Movement Disorder Society -Unified Parkinson's Disease Rating Scale ) part 3 scores from baseline at 24 and 60 weeks.; The MDS-UPDRS has four parts: Part I (non-motor experiences of daily living), Part II (motor experiences of daily living), Part III (motor examination) and Part IV (motor complications). The MDS-UPDRS consists of five measures, 0(normal) to 4(severe), according to each item, and is evaluated as the total score per part of Part 1 to 4. A 0 means there is no disability, and the higher the score, the more the disability is reflected.
K-NMSS score	0, 24, 48 and 60 weeks	Change of K-NMSS (Korean-Non Motor Symptoms Scale) score from baseline at 24, 48 and 60 weeks.; K-NMSS evaluates non-motorative symptoms of Parkinson's disease. It consists of a total of 30 questions, separated by nine aspects: cardiovascular function, sleep/ fatigue, sexual function, and other non-motor symptoms. The evaluation period is evaluated based on the experience of the last month.; For each aspect, the grade point is evaluated as the degree of severity (level 0-3) and frequency (1-4), and the evaluation score is obtained by multiplying the degree and frequency of severity.; The K-NMSS has a range of 0-360 points, and the higher the score, the more severe the symptoms are judged.
Change of the L-dopa dosage of subjects	0, 2, 4, 8, 12, 24, 36, 48 and 60 weeks	Starting time of L-dopa treatment and percentage of subjects who have L-dopa treatment at each visit.
Each percentage of subjects and changing patterns in modified Hoehn and Yahr stage	0, 24, 48 and 60 weeks	Percentage of subjects per modified Hoehn and Yahr stage and the changing patterns from baseline at 24, 48 and 60 weeks
SNBR (specific to non-specific binding ratio) confirmed by PET scan	0 and 48 weeks	Change of SNBR (specific to non-specific binding ratio) from baseline at 48 weeks, confirmed by PET scan

Trial Locations

Locations (5)

Seoul National University Hospital; 🇰🇷 Seoul, Korea, Republic of

Samsung Medical Center; 🇰🇷 Seoul, Korea, Republic of

Seoul Metropolitan Government Seoul National University Boramae Medical Center; 🇰🇷 Seoul, Korea, Republic of

Seoul National University Bundang Hospital; 🇰🇷 Seongnam-si, Korea, Republic of

Asan Medical Center; 🇰🇷 Seoul, Korea, Republic of