A Clinical Study of Mesdopetam in Patients With Parkinson's Disease Experiencing Levodopa Induced Dyskinesia

Study Overview
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Brief Summary
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This is a Phase 2b study investigating the efficacy and safety of mesdopetam as adjunct therapy on daily ON-time without troublesome dyskinesia in patients with Parkinson disease. Mesdopetam is taken for 84 days.

Detailed Description
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At the screening visit consenting patients will be screened for eligibility according to study specific inclusion/exclusion criteria within 8 weeks before start of Investigational Medicinal Product (IMP) administration. A diary concordance training will be performed and following the screening visit the patient will be asked to self-administer three 24-hour home diaries and to bring the completed diaries to the baseline visit for assessment prior randomization. At the baseline visit, patients will be randomized to receive one of three doses of mesdopetam (dose 1, dose 2 and dose 3) or placebo b.i.d. During the first week a dose run-in phase will take place, where all patients allocated to mesdopetam will receive a run-in dose of mesdopetam twice daily and patients allocated to placebo will receive placebo twice daily. At Visit 2, patients will receive mesdopetam dose 1, dose 2 or dose 3 or placebo b.i.d., as randomized and continue the same dose for the rest of the treatment period until EOT. Dose reductions are restricted and the dose can only be reduced once. Dose reductions are permitted from visit 2 (day 9) until visit 3 (day 28), where after the dose should be kept stable until EOT. The treatment allocation will be double-blind, i.e. it will not be disclosed to the patients, the site staff or the Sponsor. During the treatment period, changes in disease state and ON phase dyskinesia will be assessed using the MDS-UPDRS, the modified UDysRS (i.e. parts 1, 3 and 4), and Clinician's Global Impression of Severity (CGI-S). Furthermore, patients will self-administer three 24-hour home diaries prior to visit 3 (week 4), visit 4 (week 8) and visit 5 (week 12) to assess daily motor function. Blood samples for pharmacokinetic (PK) analysis will be collected at visit 4 (week 8) and visit 5 (week 12). Visit 6 (follow-up) will be performed for all patients, including any patients that discontinue the IMP early, 5-8 days after last administration of IMP.

Official Title
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A Randomized, Double-blind, Placebo-controlled Phase IIB Study Evaluating the Efficacy of Mesdopetam on Daily ON-time Without Troublesome Dyskinesia in Patients With Parkinson's Disease

Conditions
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Parkinson Disease

Intervention / Treatment
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* Drug: Mesdopetam
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or female ≥30 and ≤79 years of age at the time of screening. Signed a current Ethics Committee approved informed consent form (ICF). PD, per UK Parkinson's Disease Society (UKPDS) Brain Bank Clinical Diagnostic Criteria. Minimal amount of 2 hours of levodopa-induced daily ON-time with troublesome dyskinesia during waking hours Functional impact of dyskinesias determined as a score of ≥2 as per Question 4.2 of the MDS-UPDRS. On a stable regimen of antiparkinson medications for at least 30 days prior to first home diary completion which must include a levodopa preparation administered 3-8 times/day (excluding nighttime levodopa) and willing to continue the same doses and regimens during study participation. Rescue medications such as Madopar dispersable and Apomorphine injections are allowed if prescribed PRN prior to study entry. Any other current and allowed prescription/non-prescription medications and/or nutritional supplements taken regularly must have been at a stable dose and regimen for at least 30 days prior to first home diary completion and the patient must be willing to continue the same doses and regimens during study participation (this criterion does not apply to medications that are being taken pre-study only on an as-needed basis). Able to complete 24-hour patient home diaries of which two valid diaries must be presented at visit 1. Exclusion Criteria: History of neurosurgical intervention related to PD (e.g. deep brain stimulation). Treatment with pump delivered antiparkinsonian therapy (i.e. subcutaneous apomorphine or levodopa/carbidopa intestinal infusion). History of seizures within two years prior to screening. History of stroke or transient ischemic attack (TIA) within two years prior to screening. History of cancer within five years prior to screening, with the following exceptions: adequately treated non-melanomatous skin cancers, localized bladder cancer, non metastatic prostate cancer or in situ cervical cancer. Presence of cognitive impairment, as evidenced by a Mini-Mental State Examination (MMSE) score of less than 24 during screening. A Hoehn and Yahr stage of 5. Ongoing treatment with amantadine at time of screening or within 6 weeks prior first home diary completion. Treatment with Inbrija (levodopa inhalation powder) at time of screening or within 4 weeks prior first home diary completion. Any history of a significant heart condition or cardiac arrhythmias within the past 5 years, any repolarisation deficits or any other clinically significant abnormal ECG as judged by the Investigator. Severe or ongoing unstable medical condition including a history of poorly controlled diabetes; obesity associated with metabolic syndrome; uncontrolled hypertension; cerebrovascular disease, or any form of clinically significant cardiac disease, clinically significant symptomatic orthostatic hypotension (a fall and/or a discomfort); clinically significant hepatic disease, severe renal impairment, i.e. creatinine clearance <30 mL/min (stage IV or V). Any history of a neurological disorder other than PD or a psychiatric disorder, including history of Diagnostic and Statistical Manual of Mental Disorders (DSM) IV diagnosed major depression or psychosis. Patients with illusions or hallucinations with no loss of insight will be eligible. Patients with mild depression who are well controlled on a stable dose of an antidepressant medication for at least 4 weeks before screening will be eligible. Enrolment in any other clinical study involving medication, medical devices or surgical procedures, current or within three months prior to screening visit, or previous participation in the present study. Patients enrolled in non-interventional clinical trials will be eligible. Drug and/or alcohol abuse. History of severe drug allergy or hypersensitivity. If female, is pregnant or lactating, or has a positive pregnancy test result pre-dose. Patients unwilling to use two forms of contraception (one of which being a barrier method (see Section 8.1) during the treatment period and 90 days for men and 30 days for women after last IMP dose. Any planned major surgery within the duration of the study. Any other condition or symptoms preventing the patient from entering the study, according to the Investigator's judgement.

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 79 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mesdopetam dose 1<br>Mesdopetam capsule (mg), dose 1, 1 capsule b.i.d. for 84 days. | Drug: Mesdopetam<br>* Oral use<br>* Other names: IRL790;|
| Experimental: Mesdopetam dose 2<br>Mesdopetam capsule (mg), dose 2, 1 capsule b.i.d. for 84 days. | Drug: Mesdopetam<br>* Oral use<br>* Other names: IRL790;|
| Experimental: Mesdopetam dose 3<br>Mesdopetam capsule (mg), dose 3, 1 capsule b.i.d. for 84 days. | Drug: Mesdopetam<br>* Oral use<br>* Other names: IRL790;|
| Placebo Comparator: Placebo<br>Placebo capsule, 1 capsule b.i.d. for 84 days | Drug: Placebo<br>* Oral use<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in average daily hours of ON-time without troublesome dyskinesia with mesdopetam compared to Placebo as assessed with 24-hour patient home diaries from baseline to end of treatment. | This is a self administered diary where patients assess their motor state every half hour during 24 hours. The different motor states assessed: ON, ON with troublesome dyskinesia, OFF and asleep. | Baseline to end of treatment (week 12) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline in mean score of ON-phase dyskinesia assessed with the sum score of the modified UDysRS (parts 1, 3 and 4) (with mesdopetam compared to placebo). | The scoring range is 0-88, where higher score means more dyskinesia. | Baseline to end of treatment (week 12) | 
| Change from baseline in mean score of disability associated with ON-phase dyskinesia assessed with the sum score of parts 1b and 4 of the UDysRS (with mesdopetam compared to placebo). | The scoring range is 0-60, where higher score means more dyskinesia. | Baseline to end of treatment (week 12) | 
| Change from baseline in mean score of ON-phase dyskinesia assessed by MDS-UPDRS part 4 questions 4.1 (Time spent with dyskinesias) and 4.2 (Functional impact of dyskinesias) (with mesdopetam compared to placebo). | Minimum score is 0 and maximum score is 8. A higher score means more dyskinesia. | Baseline to end of treatment (week 12) | 
| Change from baseline in mean score of motor symptoms of PD assessed with MDS-UPDRS total score of part 2 (M-EDL) (with mesdopetam compared to placebo) | Minimum score is 0 and maximum score is 52. A higher score means more motor symptoms. | Baseline to end of treatment (week 12) | 
| Change from baseline in average daily hours of OFF-time, daily ON-time with troublesome dyskinesia and daily total ON-time (defined as the sum of ON-time with and without troublesome dyskinesia) (with mesdopetam compared to placebo). | This is a self administered diary where patients assess their motor state every half hour during 24 hours. The different motor states assessed: ON, ON with troublesome dyskinesia, OFF and asleep. | Baseline to end of treatment (week 12) |