Clinical trial NCT03292016: A Study That Compares the Extent to Which Apomorphine Becomes Available in the Body After Taking Either an Investigational Drug Containing Apomorphine or Apomorphine That is Injected Under the Skin in People With PD Complicated by "OFF" Episodes
Official title: A Comparative Bioavailability Study to Evaluate the Single Dose Pharmacokinetic Properties of APL-130277 With Two Different Formulations of Subcutaneous Apomorphine in a Randomized, 3-Period Crossover Design in Subjects With Parkinson's Disease Complicated by Motor Fluctuations ("OFF" Episodes)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Parkinson Disease
Keywords: Off Episodes
Parkinson Disease
Lead sponsor: Sumitomo Pharma America, Inc.
Sponsor class: INDUSTRY
First posted: 2017-09-25
Enrollment: 8
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Primary purpose: TREATMENT

Brief summary: A study that compares the extent to which apomorphine becomes available in the body after taking either an investigational drug containing apomorphine or apomorphine that is injected under the skin in people with PD complicated by "OFF" episodes.

Detailed description: This multi-center study will aim to evaluate the pharmacokinetics (PK) and comparative bioavailability of a single dose of APL-130277 sublingual thin film with subcutaneous (s.c.) APO-go® and s.c. APOKYN® in subjects with Parkinson's disease (PD). The dose of APOKYN® (≤ 5 mg) will be based on the subjects' current prescribed dose. The study is designed as an open-label, randomized, three-way crossover. Subjects will receive all three treatment arms with a minimum 1-day wash-out between each visit (excluding the screening visit) and will be randomly assigned to one of the six sequences

Eligibility criteria: Inclusion Criteria:

1. Male or female ≥ 18 years of age.
2. Clinical diagnosis of Idiopathic PD, consistent with UK Brain Bank Criteria (excluding the "more than one affected relative" criterion).
3. Clinically meaningful response to Levodopa (L-Dopa) with well-defined "OFF" episodes, as determined by the Investigator.
4. Receiving APOKYN® of ≤ 5 mg per dose for at least 4 weeks before the Screening Visit.
5. Receiving stable doses of L-Dopa/carbidopa (immediate or sustained release) administered at least 4 times per day OR Rytary™ administered 3 times per day, for at least 4 weeks before the Screening Visit. Adjunctive PD medication regimens must be maintained at a stable dose for at least 4 weeks prior to the Screening Visit with the exception that MAOB inhibitors must be maintained at a stable level for at least 8 weeks prior to the Screening Visit.
6. No planned medication change(s) or surgical intervention anticipated during the course of study.
7. Patients must experience a well-defined "OFF" episode in the morning if they do not take their morning PD medications on schedule, and must be willing to delay morning doses on the 3 study dosing days
8. Stage III or less on the modified Hoehn and Yahr scale in the "ON" state.
9. Mini-Mental State Examination (MMSE) score \> 23.
10. If female and of childbearing potential, must agree to use one of the following methods of birth control:

    * Oral contraceptive;
    * Contraceptive patch;
    * Barrier (diaphragm, sponge or condom) plus spermicidal preparations;
    * Intrauterine contraceptive system;
    * Levonorgestrel implant;
    * Medroxyprogesterone acetate contraceptive injection;
    * Complete abstinence from sexual intercourse;
    * Hormonal vaginal contraceptive ring; or
    * Surgical sterilization or partner sterile (must have documented proof).
11. Male patients must be either surgically sterile, agree to be sexually abstinent or use a barrier method of birth control (e.g., condom) or maintain a monogamous relationship with a person who is not of child-bearing potential from first study drug administration until 30days after final drug administration.
12. Willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study-related procedures to complete the study.
13. Able to understand the consent form, and to provide written informed consent

Exclusion Criteria:

1. Atypical or secondary parkinsonism.
2. Previous treatment with any of the following: continuous subcutaneous (s.c.) apomorphine infusion; or Duodopa/Duopa.
3. Contraindications to APO-go® or APOKYN® or hypersensitivity to apomorphine hydrochloride or any marcrolide antibiotic or any of the ingredients APO-go® or APOKYN® (notably sodium metabisulfite).
4. Female who is pregnant or lactating.
5. Participation in a clinical trial within 30 days prior to the Screening Visit.
6. Receipt of any investigational (ie, unapproved) medication within 30 days prior to the Screening Visit.
7. Any selective 5HT3 antagonists (ie, ondansetron, granisetron, dolasetron, palonosetron, alosetron), dopamine antagonists (excluding quetiapine and clozapine) or dopamine depleting agents within 30 days prior to the Screening Visit.
8. Drug or alcohol dependency in the past 12 months.
9. History of malignant melanoma.
10. Clinically significant medical, surgical, or laboratory abnormality in the opinion of the Investigator.
11. Major psychiatric disorder including, but not limited to, dementia, bipolar disorder, psychosis, or any disorder that, in the opinion of the Investigator, requires ongoing treatment that would make study participation unsafe or make treatment compliance difficult.
12. History of clinically significant hallucinations during the past 6 months.
13. History of clinically significant impulse control disorder(s).
14. Dementia that precludes providing informed consent or would interfere with participation in the study.
15. Current suicidal ideation within one year prior to the Screening Visit as evidenced by answering "yes" to Questions 4 or 5 on the suicidal ideation portion of the Columbia-Suicide Severity Rating Scale (C-SSRS) or attempted suicide within the last 5 years.
16. Donation of blood plasma in the 30 days prior to first dosing.
17. Cankers or mouth sores within 30 days prior to the Screening Visit, or other clinically significant oral pathology in the opinion of the Investigator. The Investigator should follow-up with an appropriate specialist on any finding, if indicated, before enrolling a patient into the study.

Primary outcomes:
measure: Maximum Observed Plasma Concentration (Cmax)
timeFrame: Day 1
measure: Observed Time of the Maximum Concentration (Tmax)
timeFrame: Day 1
measure: Area Under the Concentration- Time Curve (AUC Last)
timeFrame: Day 1
measure: Area Under the Concentration- Time Curve (AUC Inf)
timeFrame: Day 1
measure: Mean Residence Time (MRT)
timeFrame: Day 1
measure: Metabolite/Parent (M/P) Drug Concentration Ratio -Cmax
timeFrame: Day 1
measure: Apparent Total Clearance of the Drug From Plasma After Oral Administration (CL/F)
timeFrame: Day 1
measure: Apparent Volume of Distribution After Non-intravenous Administration (V/F)
timeFrame: Day 1
measure: Terminal-phase Half-life (t½)
timeFrame: Day 1
measure: Terminal-phase Rate Constant ( λz)
timeFrame: Day 1
measure: Metabolite/Parent (M/P) Drug Concentration Ratio -AUC Last
timeFrame: Day 1
Secondary outcomes:
Other outcomes:
Locations:
city: Boca Raton
country: United States
facility: Parkinson's Disease and Movement Disorders Center of Boca Raton
state: Florida
city: Port Charlotte
country: United States
facility: Parkinson's Disese Treatment Center of SW Florida
state: Florida
city: Farmington Hills
country: United States
facility: QUEST Research Institute
state: Michigan
Study officials:
affiliation: Sunovion Pharmacetuicals Inc.
name: CNS Mecdical Director
role: STUDY_CHAIR
References:
citation: Agbo F, Isaacson SH, Gil R, Chiu YY, Brantley SJ, Bhargava P, Navia B. Pharmacokinetics and Comparative Bioavailability of Apomorphine Sublingual Film and Subcutaneous Apomorphine Formulations in Patients with Parkinson's Disease and "OFF" Episodes: Results of a Randomized, Three-Way Crossover, Open-Label Study. Neurol Ther. 2021 Dec;10(2):693-709. doi: 10.1007/s40120-021-00251-6. Epub 2021 May 15.