Orally Administered ENT-01 for Parkinson's Disease-Related Constipation (KARMET)

Phase 2

Completed

Conditions: Parkinson Disease
Constipation

Interventions: Drug: Placebo Treatment
Drug: Active Investigational Treatment ENT-01

Registration Number: NCT03781791

Lead Sponsor: Enterin Inc.

Brief Summary: This study will be conducted as a multi-center, randomized, double-blind, placebo-controlled study. Approximately 72 patients will be randomized 3:1 to treatment or placebo, with approximately 54 patients allocated to receive the active investigational product and approximately 18 patients allocated to receive placebo.

- Study Update-

Amendment 3 - In this amendment, an additional 80 patients (approximately) will be randomized 1:1 to treatment or placebo (double-blind) with approximately 40 subjects allocated to each group.

Detailed Description: The study will be conducted on an out-patient basis. Each patient will have 6 visits to the clinic: a screening visit, a randomization visit, 3 follow up visits, and 1 end of study visit.

Patient randomization will be stratified based upon the baseline weekly complete spontaneous bowel movement rate (CSBM) established during the screening period. Patients will be allowed to adjust their dosing, based upon protocol specifications. Rescue medications will be provided to all patients to ensure they move their bowels on a regular basis.

Patients will also be asked to participate in up to 2 sub-studies: a pk study and/or a stool microbiome study. The first 20 patients to consent to the pk study will have additional blood samples taken at randomization and at 2 follow up visits. The first 20 patients to consent to the stool microbiome study will provide stool samples at randomization and at 2 follow up visits.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 151

Inclusion Criteria

Subjects aged 30-90 years, both genders
Subjects must provide written informed consent and be willing and able to comply with study procedures.
Subjects must be diagnosed with Parkinson's Disease defined as the presence of at least three of the following cardinal features, in the absence of alternative explanations or atypical features: rest tremor, rigidity, bradykinesia and/or akinesia, postural and gait abnormalities.
There are insufficient criteria for Irritable Bowel Syndrome (IBS)
Constipation which has been present for over 6 months and is unresponsive to first line, typically over the counter treatments such as Milk of Magnesia (1g), Miralax (17g in 8 ounces of water) or the equivalent at least once weekly with an inconsistent response over a 6-week period or the subject is dissatisfied with first line treatments.
Body mass index (BMI) of 18-40 kg/m2
Subjects must fulfill Rome IV criteria for functional constipation which includes 2 or more of the following:
1. Straining during at least 25% of defecations
2. Lumpy or hard stools in at least 25% of defecations
3. Sensation of incomplete evacuation for at least 25% of defecations
4. Sensation of anorectal obstruction/blockage for at least 25% of defecations
5. Manual maneuvers to facilitate at least 25% of defecations (e.g., digital evacuation, support of the pelvic floor)
Self-report of fewer than 3 complete spontaneous bowel movements per week
Loose stools are rarely present without the use of laxatives
Subjects must be able to read, understand, and accurately record data into the diary to guarantee full participation in the study.
Female subjects must have negative serum or urine pregnancy tests and must not be lactating. For females able to bear children, a hormonal (i.e., oral, implantable, or injectable) and single-barrier method, or a double-barrier method of birth control must be used throughout the study. A vasectomized partner will be allowed as one in conjunction with another single-barrier method.
Female subjects unable to bear children must have this documented in the CRF (i.e., tubal ligation, hysterectomy, or postmenopausal [defined as a minimum of one year since the last menstrual period]). Post-menopausal status will be confirmed by follicle stimulating hormone (FSH) in women less than 60 years of age.

Exclusion Criteria

Unable or unwilling to provide informed consent or to comply with study procedures.
Diagnosis of secondary constipation beyond that of Parkinson's Disease
Review of Screening Diaries indicates fewer than 11 days of diary completion and/or 3 or more complete spontaneous bowel movements (CSBM) per week based upon the average CSBM rate reported during the Screening Period
A compromised gastrointestinal system which includes:
1. Structural, metabolic, or functional GI diseases or disorders
2. Acute GI illness within 2 weeks of the screening visit
3. History of major GI surgery within 30 days of the screening visit (a history of cholecystectomy, polypectomy, hernia repair or appendicectomy are not exclusionary as long as they were performed more than 30 days before the screening visit)
Unable or unwilling to withdraw from laxatives, opiates, clonazepam, or any medications which may cause constipation, 2 weeks prior to the dose adjustment period and throughout the rest of the study.
Unable or unwilling to withdraw from proton pump inhibitors and antacids at the end of the screening period.
Unable or unwilling to withdraw from pimavanserin during the study.
Any clinically significant abnormalities on screening laboratories or physical examination requiring further evaluation or treatment.
Neurological disorder other than Parkinson's Disease that in the opinion of the investigator might interfere with the conduct of the study.
On treatment with intra-jejunal dopamine or carbidopa/levodopa (i.e. Duopa).
Subjects starting a new Parkinson's Disease medication or modifying an existing medication within 2 weeks prior to enrollment.
Unable to maintain a stable diet regimen.
Subjects with a cognitive impairment that preclude them from understanding the informed consent.
Subjects placed under legal guardianship.
Females who are pregnant or breastfeeding.
History of excessive alcohol use or substance abuse.
Participation in an investigational drug trial within the month prior to dosing in the present study.
Any other reason, which, in the opinion of the investigator, would confound proper interpretation of the study.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo Treatment	Placebo Treatment	Placebo tablet will be taken once daily by mouth.
Active Treatment	Active Investigational Treatment ENT-01	ENT-01 tablet will be taken once daily by mouth.

Primary Outcome Measures

Name	Time	Method
The Number of Participants Who Experience Treatment Related Adverse Events-Safety Endpoint	Through Study treatment up to 10 weeks	The number of treatment related adverse events as reported and assessed by NCI CTCAE v.4.3.
The Number of Participants Who Experience Dose Limiting Toxicity Adverse Events	Through Study treatment Dosing Period up to 10 weeks	The number of participants who experience dose limiting toxicity adverse events as reported and assessed by NCI CTCAE v.4.3. Per protocol, dose limiting toxicity adverse events are vomiting, diarrhea, abdominal pain and dizziness.
Change in Baseline Weekly CSBM-Primary Efficacy Endpoint	25 day treatment period, part of which is at a fixed dose.	Change from participant's weekly CSBM baseline rate during treatment fixed Dose period. The fixed dose period begins on the first day or the subject's highest dose at which the subject did not experience a dose limiting toxicity (nausea, vomiting, diarrhea or dizziness) The fixed dose period will not be a specific time period for all subjects since each subject will start the fixed dose period based on their tolerability to ENT-01 dosing.

Secondary Outcome Measures

Name	Time	Method

Trial Locations

Locations (51): Cleveland Clinic
🇺🇸
Cleveland, Ohio, United States
The NeuroMedical Center, P.C.
🇺🇸
Baton Rouge, Louisiana, United States
Neuroscience Researc Institute of NJ
🇺🇸
Toms River, New Jersey, United States
BTC Network - Community Clinical Research Center
🇺🇸
Anderson, Indiana, United States
Raleigh Neurology Associates
🇺🇸
Raleigh, North Carolina, United States
Parkinson's and Movement Disorders Center of Maryland
🇺🇸
Elkridge, Maryland, United States
North Texas Movement Disorders Institute
🇺🇸
Bedford, Texas, United States
Clinical Trial Network
🇺🇸
Houston, Texas, United States
University of Toledo Medical Center
🇺🇸
Toledo, Ohio, United States
The Movement Disorder Clinic of Oklahoma
🇺🇸
Tulsa, Oklahoma, United States
Wake Forest Baptist Medical Center
🇺🇸
Wake Forest, North Carolina, United States
Elias Research - Floridian Research Institute
🇺🇸
Miami, Florida, United States
Interspond - Neurology Center of Las Vegas
🇺🇸
Las Vegas, Nevada, United States
University of Cincinnati
🇺🇸
Cincinnati, Ohio, United States
Banner Sun Health Research Institute
🇺🇸
Sun City, Arizona, United States
Clinical Trials, Inc.
🇺🇸
Little Rock, Arkansas, United States
The Parkinson's and Movement Disorder Institute
🇺🇸
Fountain Valley, California, United States
Neuro Pain Medical Center
🇺🇸
Fresno, California, United States
Pacific Neuroscience Medical Group
🇺🇸
Oxnard, California, United States
SC3 Research - Pasadena
🇺🇸
Pasadena, California, United States
Trial Connections - Care Access Research, Santa Clarita
🇺🇸
Santa Clarita, California, United States
Associated Neurologist of Southern CT
🇺🇸
Fairfield, Connecticut, United States
Georgetown University Hospital
🇺🇸
Washington, District of Columbia, United States
Care Access Research, Norwich
🇺🇸
Norwich, Connecticut, United States
JEM Research Institute
🇺🇸
Atlantis, Florida, United States
Parkinson's Disease and Movement Disorders Center of Boca Raton
🇺🇸
Boca Raton, Florida, United States
Elias Research - Allied Biomedical Research Institute
🇺🇸
Miami, Florida, United States
Pharmax Research of South Florida
🇺🇸
Miami, Florida, United States
MEDSOL Clinical Research
🇺🇸
Port Charlotte, Florida, United States
Parkinson's Disease Treatment Center of SWFL
🇺🇸
Port Charlotte, Florida, United States
Intercoastal Medical Group
🇺🇸
Sarasota, Florida, United States
University of South Florida
🇺🇸
Tampa, Florida, United States
Palm Beach Neurology and Premier Research Institute
🇺🇸
West Palm Beach, Florida, United States
Atlanta Center for Medical Research
🇺🇸
Atlanta, Georgia, United States
Elias Research - Neurology Diagnostics Research
🇺🇸
Dayton, Ohio, United States
Sentara Neuroscience Institute
🇺🇸
Norfolk, Virginia, United States
Rocky Mountain Movement Disorders Center
🇺🇸
Englewood, Colorado, United States
Icahn School of Medicine at Mount Sinai
🇺🇸
New York, New York, United States
Penn State University
🇺🇸
Hershey, Pennsylvania, United States
BTC Network - Neurological Associates of North Texas
🇺🇸
Dallas, Texas, United States
Evergreen Health - Booth Gardner Parkinson's Care Center
🇺🇸
Kirkland, Washington, United States
Interspond - Metrolina Neurological Associates
🇺🇸
Indian Land, South Carolina, United States
Albany Medical College
🇺🇸
Albany, New York, United States
Henry Ford West Bloomfield Hospital
🇺🇸
West Bloomfield, Michigan, United States
Dartmouth Hitchcock Medical Center
🇺🇸
Lebanon, New Hampshire, United States
Interspond - The Neuromedical Clinic of Central Louisiana
🇺🇸
Alexandria, Louisiana, United States
Neurology Associates Clinical Research
🇺🇸
Lincoln, Nebraska, United States
Evolution Research Group - Neuroscience Research Institution
🇺🇸
Toms River, New Jersey, United States
University Physicians & Surgeons, Inc. dba Marshall Health
🇺🇸
Huntington, West Virginia, United States
Dayton Center for Neurological Disorders
🇺🇸
Centerville, Ohio, United States
Interspond - Premier Neurology
🇺🇸
Greer, South Carolina, United States