Selegiline to Zelapar Switch Study in Parkinson Disease Patients
Condition: Parkinson's Disease
MeSH terms: Parkinson Disease
Intervention: Zelapar
Intervention description: Switch from oral selegiline to Zelapar 1.25 mg QD titrated to 2.5 mg QD
Intervention MeSH terms: Selegiline
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 48.0
Sex: All
Minimum age: 30 Years
Maximum age: 90 Years
Healthy volunteers: No
Keywords: Parkinson's disease; selegiline to Zelapar switch; orally disintegrating formulation

Summary:

      Parkinson's disease (PD) is a progressive neurodegenerative disease. Symptomatic therapy is
      primarily aimed at restoring dopamine function in the brain. Oral selegiline in conjunction
      with L-dopa has been a mainstay of therapy for PD patients experiencing motor fluctuations
      for many years. The mechanisms accounting for selegiline's beneficial adjunctive action in
      the treatment of PD are not fully understood. Inhibition of monoamine oxidase (MAO) type B
      (MAO-B) activity is generally considered to be of primary importance.

      Oral selegiline has low bio-availability and is typically dosed BID, for a total of 5-10 mg
      daily. Recently, the FDA approved a new orally disintegration tablet (ODT) formulation of
      selegiline, called ZelaparTM. This new formulation utilizes Zydis technology to dissolve in
      the mouth, with absorption through the oral mucosa, thereby largely bypassing the gut and
      avoiding first pass hepatic metabolism. This allows more active drug to be delivered at a
      lower dose. Consequently, Zelapar is dosed once-daily, up to 2.5 mg per day. There are no
      empirical data indicating whether the use of the new approved formulation of selegiline ODT
      (Zelapar) is superior or preferred by patients compared to traditional oral selegiline. It is
      believed that clinical efficacy will be preserved or enhanced, by delivering more active
      drug, with improved patient preference for the ODT formulation due to the once-daily dosing .

      The effectiveness of orally disintegrating selegiline as an adjunct to carbidopa/levodopa in
      the treatment of PD was established in a multicenter randomized placebo-controlled trial
      (n=140; 94 received orally disintegrating selegiline, 46 received placebo) of three months'
      duration. Patients randomized to orally disintegrating selegiline received a daily dose of
      1.25 mg for the first 6 weeks and a daily dose of 2.5 mg for the last 6 weeks. Patients were
      all treated with levodopa and could additionally have been on dopamine agonists,
      anticholinergics, amantadine, or any combination of these during the trial. At 12 weeks,
      orally disintegrating selegiline-treated patients had an average of 2.2 hours per day less
      "OFF" time compared to baseline. Placebo treated patients had 0.6 hours per day less "OFF"
      time compared to baseline. These differences were significant (p < 0.001). Adverse events
      were very similar between drug and placebo.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Idiopathic PD confirmed by at least two of the following signs: resting tremor,
             bradykinesia, rigidity

          2. Male or female outpatients

          3. Age 30-90 years

          4. Current use of levodopa and oral selegiline (5-10 mg /day), stable for at least 1
             month and well tolerated

          5. Positive treatment response to current anti-parkinsonian medications in the opinion of
             the investigator

          6. Acceptable contraception for females of child bearing potential

          7. Willing and able to comply with study procedures.

          8. Willing and able to give written informed consent prior to beginning any study
             procedures.

        Exclusion Criteria:

          1. Atypical parkinsonism due to drugs, metabolic disorders, encephalitis, trauma, or
             other neurodegenerative diseases.

          2. Significant cognitive or psychiatric impairment which, in the opinion of the
             investigator, would interfere with the ability to complete all the tests required in
             the protocol.

          3. Participation in another clinical drug trial within the previous four weeks.

          4. Patients on any medications contraindicated with Zelapar (including
             meperidine/Demerol, tramadol, methadone, propoxyphene, dextromethorphan, other
             selegiline products)

          5. Patients with a known hypersensitivity to any formulation of selegiline or any of the
             inactive ingredients of Zelapar, or previous exposure to orally disintegrating
             selegiline

          6. History of melanoma

          7. Unstable/uncontrolled medical problems

          8. History of drug/alcohol abuse

          9. Patients currently taking rasagiline