Rotigotine Versus Placebo, A Study To Evaluate The Efficacy In Advanced Stage Idiopathic Parkinson's Disease Patients

Phase 3

Completed

Conditions: Idiopathic Parkinson's Disease

Interventions: Drug: Placebo Patch
Drug: Rotigotine
Drug: L-dopa

Registration Number: NCT01646255

Lead Sponsor: UCB Pharma

Brief Summary: The primary objective of this study was to demonstrate that Rotigotine transdermal patch is efficacious in Chinese subjects with advanced-stage Idiopathic Parkinson's Disease as an adjuvant therapy.

Detailed Description: The study included a maximum 4-week Screening Period, a maximum 7-week Titration Period for advanced-stage Parkinson's disease, 12-week Maintenance Period, a maximum 12-day De-escalation Period for advanced-stage Parkinson's Disease and 30-day Safety Follow-Up Period. The maximum study duration for an individual subject with advanced-stage Parkinson's disease was 27 weeks.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 346

Inclusion Criteria

Inclusion Criteria:

An Independent Ethics Committee (IEC)-approved written informed consent is signed and dated by the subject or by the legal representative
Subject/legal representative is considered reliable and capable of adhering to the protocol (eg, able to understand and complete diaries), visit schedule, and medication application according to the judgment of the investigator
Subject has Idiopathic Parkinson's Disease of more than 3 years' duration, defined by the cardinal sign, Bradykinesia, plus the presence of at least 1 of the following: resting tremor, rigidity, or impairment of postural reflexes, and without any other known or suspected cause of Parkinsonism
The investigator must observe the subject in both the 'on' and 'off' state and determine that the subject is Hoehn & Yahr stage 2 through 4 in both the 'on' and 'off' state
Subject is male or female and aged ≥30 years at Screening (Visit 1)
Subject has a Mini Mental State Examination (MMSE) score of ≥25 at Screening (Visit 1)
Subject must be on a stable dose of L-dopa (either short-acting or sustained release [in combination with Benserazide or Carbidopa]) of at least 200 mg/day, administered in at least 2 intakes, for at least 28 days prior to Baseline (Visit 2)
Subject is not adequately controlled on a L-dopa dose (in combination with Benserazide or Carbidopa) which was judged by the treating physician to be optimal
Subject must be willing and able to accurately complete a subject diary on designated days (with assistance from caregivers, if required), recording periods when they are 'on without troublesome Dyskinesia', 'on with troublesome Dyskinesia', 'off', and sleeping
As part of the Screening (pretreatment) assessments, the subject must complete a diary over a period of 6 days, with 4 of the 6 diaries being 'valid' as determined by the investigator (see Section 9.1.1)
It must be clear to the investigator that the subject is able to differentiate between the 'on' and 'off' state and the 'valid' diaries confirm that the subject has an average of ≥2.5 h/day spent in the 'off' state
If the subject is receiving an Anticholinergic agent (eg, Benztropine, Trihexyphenidyl, Parsitan, Procyclidine, Biperiden), a monoamine oxidase (MAO)-B inhibitor (eg, Selegiline), and/or an N-methyl-d-aspartate (NMDA) antagonist (eg, Amantadine), he/she must have been on a stable dose for at least 28 days prior to Baseline (Visit 2) and be maintained on that dose for the duration of the study
Subject must be on a stable dose of all anti-Parkinsonian medications for at least 20 days prior to completing the 6 Baseline diaries

Exclusion Criteria

Subject has previously participated in this study or subject has previously received the study medication under investigation in this study
Subject is participating in another study of an investigational drug or has done so within 28 days prior to the Baseline Visit (Visit 2)
Subject has a history of significant skin hypersensitivity to adhesive or other transdermal preparations, or recent unresolved contact dermatitis
Subject has a lifetime history of suicide attempt (including an actual attempt, interrupted attempt, or aborted attempt), or has suicidal ideation in the past 6 months as indicated by a positive response ('Yes') to either Question 4 or Question 5 of the Columbia-Suicide Severity Rating Scale (C-SSRS) at Screening (Visit 1)
Subject has atypical Parkinson's syndrome(s) due to drugs (eg, Metoclopramide, Flunarizine), Metabolic Neurogenetic Disorders (eg, Wilson's Disease), Encephalitis, Cerebrovascular Disease, or Degenerative Disease (eg, Progressive Supranuclear Palsy)
Subject has a history of Pallidotomy, Thalamotomy, deep brain stimulation, or fetal tissue transplant
Subject has dementia, active psychosis or hallucinations, or severe depression
Subject is receiving therapy with a Dopamine agonist either concurrently or has done so within 28 days prior to the Baseline Visit (Visit 2)
Subject is receiving therapy with 1 of the following drugs either concurrently or within 28 days prior to Baseline (Visit 2): Alpha-methyl dopa, Metoclopramide, Reserpine, Neuroleptics (except specific atypical neuroleptics: Olanzapine, Ziprasidone, Aripiprazole, Clozapine, quetiapine), MAO-A inhibitors, Methylphenidate, or Amphetamine
Subject is currently receiving central nervous system (CNS) active therapy (eg, sedatives, hypnotics, antidepressants, anxiolytics), unless the dose has been stable for at least 28 days prior to Baseline (Visit 2) and is likely to remain stable for the duration of the study
Subject has a current diagnosis of Epilepsy, has a history of seizures as an adult, has a history of stroke, or has had a transient ischemic attack within 1 year prior to Screening (Visit 1)
Subject has clinically relevant hepatic dysfunction (as defined as a total bilirubin >2.0 mg/dL, or Alanine Aminotransferase (ALT) and/or Aspartate Aminotransferase (AST) >2 times the upper limit of the reference range)
Subject has clinically relevant renal dysfunction (serum creatinine >2.0 mg/dL [>178 μmol/L])
Subject has clinically relevant cardiac dysfunction (any cardiac disorder which in the opinion of the investigator would put the subject at risk of clinically relevant arrhythmia) and/or myocardial infarction within the last 12 months
Subject has a QT interval corrected for heart rate according to Bazett's formula (QTcB) of ≥500 ms at Screening (Visit 1)
Subject has a history of only symptomatic (not asymptomatic) orthostatic hypotension, with a decrease of systolic blood pressure (SBP) from supine to standing position of ≥2 0 mmHg or of ≥10 mmHg in DBP after 1 or 3 minutes within 28 days prior to Baseline (Visit 2), or SBP <105 mmHg at study entry 17. Subject has evidence of an impulse control disorder (ICD) at Screening (Visit 1)
Subject has a history of known intolerance/hypersensitivity to the following Antiemetics: Domperidone, Trimethobenzamide, Ondansetron, Tropisetron, Granisetron, and Glycopyrrolate
Subject has a history of chronic alcohol or drug abuse within the last 5 years
Subject is pregnant or nursing, or is of childbearing potential but (i) not surgically sterile or (ii) not using adequate birth control methods (including at least a double barrier method) or (iii) not sexually abstinent or (iv) not at least 2 years post-menopausal
Subject has any other clinically relevant medical condition, psychiatric condition, or laboratory abnormality which would, in the judgment of the investigator, interfere with the subject's ability to participate in the study

Exclusion Criteria:

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo Patch	Placebo, daily doses, placebo group
Placebo	L-dopa	Placebo, daily doses, placebo group
Rotigotine	Rotigotine	Rotigotine, daily doses, treatment group
Rotigotine	L-dopa	Rotigotine, daily doses, treatment group

Primary Outcome Measures

Name	Time	Method
Absolute Change in Absolute Time Spent 'Off' From Baseline to the End of Double-blind Maintenance Period	From Baseline (Week 0) to end of Maintenance Period (up to Week 12)	A subject has been considered "off" when he/she began to lose the optimum effects of anti-Parkinson's medication. A negative mean indicates a reduction of the time off during the conduct of the study

Secondary Outcome Measures

Name	Time	Method
Percentage of Responders From Baseline to the End of the Doubleblind Maintenance Period	From Baseline (Week 0) to end of Maintenance Period (up to Week 12)	A Responder is defined as a subject with an ≥ 30 % decrease in absolute time spent 'off'
Percent Change in Absolute Time Spent "Off" From Baseline to the End of Double-blind Maintenance Period	From Baseline (Week 0) to end of Maintenance Period (up to Week 12)	A subject has been considered "off" when he/she began to lose the optimum effects of anti-Parkinson's medication. Absolute time "off" is defined as the mean number of hours marked "off" during a 24-hour period from all valid daily diary cards.
Change in Absolute Time Spent "on" From Baseline to the End of Double-blind Maintenance Period	From Baseline (Week 0) to end of Maintenance Period (up to Week 12)	A subject has been considered "on" when he/she felt the effects of L-dopa. The subject recorded the exact time of L-dopa intake and his/her status at the time of the L-dopa dose. In instances when the subject was 'off' when taking his/her L-dopa, he/she recorded the exact time their status changed to 'on'. Absolute time "on" is defined as the mean number of hours marked "on" during a 24-hour period from all valid daily diary cards.
Change in Relative Time Spent "on" From Baseline to the End of Double-blind Maintenance Period	From Baseline (Week 0) to end of Maintenance Period (up to Week 12)	A subject has been considered "on" when he/she felt the effects of L-dopa. The subject recorded the exact time of L-dopa intake and his/her status at the time of the L-dopa dose. In instances when the subject was "off" when taking his/her L-dopa, he/she recorded the exact time their status changed to "on". Relative time spent "on" will be calculated in two stages. Each valid daily diary will have an associated relative time "on" calculated as relative time "on" for day = 100\*\[total absolute time "on" for day/ absolute time awake for day\]. Relative time spent "on" is then calculated by averaging the daily relative time "on" for the valid days of that visit.
Percent Change in Relative Time Spent "Off" From Baseline to the End of Double-blind Maintenance Period	From Baseline (Week 0) to end of Maintenance Period (up to Week 12)	A subject has been considered "off" when he/she began to lose the optimum effects of anti-Parkinson's medication. Relative time spent "off" will be calculated in two stages. Each valid daily diary will have an associated relative time "off" calculated as relative time "off" for day = 100\*\[total absolute time "off" for day/ absolute time awake for day\]. Relative time spent "off" is then calculated by averaging the daily relative time "off" for the valid days of that visit.
Percent Change in Absolute Time Spent "on" From Baseline to the End of Double-blind Maintenance Period	From Baseline (Week 0) to end of Maintenance Period (up to Week 12)	A subject has been considered "on" when he/she felt the effects of L-dopa. The subject recorded the exact time of L-dopa intake and his/her status at the time of the L-dopa dose. In instances when the subject was 'off' when taking his/her L-dopa, he/she recorded the exact time their status changed to 'on'. Note for percent change calculations: when absolute time at Baseline was 0 hours, the absolute Baseline value was assumed to be 1 minute for calculation purposes.
Percent Change in Relative Time Spent "on" From Baseline to the End of Double-blind Maintenance Period	From Baseline (Week 0) to end of Maintenance Period (up to Week 12)	A subject has been considered "on" when he/she felt the effects of L-dopa. The subject recorded the exact time of L-dopa intake and his/her status at the time of the L-dopa dose. In instances when the subject was "off" when taking his/her L-dopa, he/she recorded the exact time their status changed to "on". Note for percent change calculations: when relative time at Baseline was 0%, the relative Baseline value was assumed to be 0.1 for calculation purposes. Relative time spent "on" will be calculated in two stages. Each valid daily diary will have an associated relative time "on" calculated as relative time "on" for day = 100\*\[total absolute time "on" for day/ absolute time awake for day\]. Relative time spent "on" is then calculated by averaging the daily relative time "on" for the valid days of that visit.
Change in the Number of "Off" Periods From Baseline to the End of Double-blind Maintenance Period	From Baseline (Week 0) to end of Maintenance Period (up to Week 12)	A subject has been considered "off" when he/she began to lose the optimum effects of anti-Parkinson's medication.
Change in Status of the Subject (on) After Wake-up With Troublesome Dyskinesia From Baseline to the End of Double-blind Maintenance Period	From Baseline (Week 0) to end of Maintenance Period (up to Week 12)	A subject has been considered "on" when he/she felt the effects of L-dopa. The subject recorded the exact time of L-dopa intake and his/her status at the time of the L-dopa dose. In instances when the subject was 'off' when taking his/her L-dopa, he/she recorded the exact time their status changed to 'on'. The percentage of days from Baseline to the end of the double-blind Maintenance Period in which the subject woke in the "on with troublesome dyskinesia" state is presented below.
Change in Status of the Subject (on) After Wake-up Without Troublesome Dyskinesia From Baseline to the End of Double-blind Maintenance Period	From Baseline (Week 0) to end of Maintenance Period (up to Week 12)	A subject has been considered "on" when he/she felt the effects of L-dopa. The subject recorded the exact time of L-dopa intake and his/her status at the time of the L-dopa dose. In instances when the subject was 'off' when taking his/her L-dopa, he/she recorded the exact time their status changed to 'on'. The percentage of days from Baseline to the end of the double-blind Maintenance Period in which the subject woke in the "on without troublesome dyskinesia" state is presented below.
Change in Status of the Subject (Off) After Wake-up From Baseline to the End of Double-blind Maintenance Period	From Baseline (Week 0) to end of Maintenance Period (up to Week 12)	A subject has been considered "off" when he/she began to lose the optimum effects of anti-Parkinson's medication. The percentage of days from Baseline to the end of the double-blind Maintenance Period in which the subject woke in the "off" state is presented below.
Change in Unified Parkinson's Disease Rating Scale (UPDRS Part III Motor Examination) During "on" Periods From Baseline to the End of Double-blind Maintenance Period	From Baseline (Week 0) to end of Maintenance Period (up to Week 12)	The UPDRS Part III (motor subscale) assessment consists of 27 questions, measured on a 5-Point scale (0 to 4). The sum score is calculated as sum of these 27 individual questions. This score ranges from 0 to 108, higher scores denote greater disability. A subject has been considered "on" when he/she felt the effects of L-dopa. The subject recorded the exact time of L-dopa intake and his/her status at the time of the L-dopa dose. In instances when the subject was 'off' when taking his/her L-dopa, he/she recorded the exact time their status changed to 'on'.

Trial Locations

Locations (24): Sp1037 006
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Wuhan, China
Sp1037 001
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Beijing, China
Sp1037 002
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Beijing, China
Sp1037 019
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Beijing, China
Sp1037 025
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Beijing, China
Sp1037 017
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Changchun, China
Sp1037 007
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Chengdu, China
Sp1037 027
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Chengdu, China
Sp1037 011
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Guangzhou, China
Sp1037 013
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Hangzhou, China
Sp1037 021
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Fuzhou, China
Sp1037 010
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Guangzhou, China
Sp1037 015
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Guangzhou, China
Sp1037 014
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Guangzhou, China
Sp1037 005
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Hangzhou, China
Sp1037 018
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Hangzhou, China
Sp1037 023
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Jinan, China
Sp1037 004
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Shanghai, China
Sp1037 003
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Shanghai, China
Sp1037 009
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Shanghai, China
Sp1037 008
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Suzhou, China
Sp1037 016
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Tianjin, China
Sp1037 022
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Wuhan, China
Sp1037 024
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Wuhan, China