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Tolerability and Efficacy of Switch From Oral Selegiline to Orally Disintegrating Selegiline (Zelapar) in Patients With Parkinson's Disease

This study is currently recruiting participants.
Verified by Baylor College of Medicine, March 2008

Sponsored by: Baylor College of Medicine
Information provided by: Baylor College of Medicine
ClinicalTrials.gov Identifier: NCT00640159
  Purpose

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.


Condition Intervention Phase
Parkinson's Disease
Drug: Zelapar
Phase IV

Genetics Home Reference related topics:   familial paroxysmal nonkinesigenic dyskinesia    Parkinson disease   

MedlinePlus related topics:   Parkinson's Disease   

Drug Information available for:   Selegiline    Selegiline hydrochloride   

U.S. FDA Resources

Study Type:   Interventional
Study Design:   Treatment, Open Label, Uncontrolled, Single Group Assignment, Safety/Efficacy Study
Official Title:   Tolerability and Efficacy of Switch From Oral Selegiline to Orally Disintegrating Selegiline (Zelapar) in Patients With Parkinson's Disease.

Further study details as provided by Baylor College of Medicine:

Primary Outcome Measures:
  • The primary efficacy point is number of subjects who prefer Zydis selegiline vs. the number who prefer oral selegiline, or have no preference. Descriptive statistics will be used to present the percentages of persons and adverse event resolutions. [ Time Frame: Baseline to End-of-study ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • The secondary endpoints will include changes in the UPDRS, PDQ-8, BDI, FSS, ESS, ratings of global improvement and change in dyskinesia. [ Time Frame: Baseline to end-of-study ] [ Designated as safety issue: Yes ]

Estimated Enrollment:   55
Study Start Date:   January 2007
Estimated Study Completion Date:   August 2008
Estimated Primary Completion Date:   June 2008 (Final data collection date for primary outcome measure)

Arms Assigned Interventions
A: Experimental
Open label switch from current oral selegiline dose to orally disintegrating selegiline (Zelapar) titrated to a dose of 2.5 mg QD.
Drug: Zelapar
Switch from oral selegiline to Zelapar 1.25 mg QD titrated to 2.5 mg QD

Detailed Description:

This is an open label, multicenter, 6 week study of the conversion from oral selegiline to orally disintegrating selegiline in PD patients with or without motor fluctuations, and currently taking levodopa. The study consists of the substitution of the oral selegiline with 1.25 mg of orally disintegrating selegiline for 10 days, and up titration of orally disintegrating selegiline to 2.5 mg per day for the next 30 days. The study will consist of 2 study visits in the clinic: Baseline and Day 40, and a telephone visit at Day 10.

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

The primary efficacy point is number of subjects who prefer Zydis selegiline vs. the number who prefer oral selegiline, or have no preference. Descriptive statistics will be used to present the percentages of persons and adverse event resolutions. The secondary endpoints will include changes in the UPDRS, PDQ-8, BDI, FSS, ESS, ratings of global improvement and change in dyskinesia from Baseline to the Day 40 visit. Appropriate parametric (t-tests) and non-parametric analyses (Wilcoxon signed rank comparisons) will be conducted based on the scale being analyzed. An intent to treat approach will be used in which all subjects receiving at least one dose of study medication will be included in the analyses.

  Eligibility
Ages Eligible for Study:   30 Years to 90 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

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
  Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00640159

Locations
United States, California
Dee Silver, MD at Coastal Neurological Medical Group, Inc     Recruiting
      La Jolla, California, United States, 92037
      Contact: Kelly Vandever     858-453-3842 ext 15     kelly_coastal@hotmail.com    
James Tetrud, MD at The Parkinson's Institute     Recruiting
      Sunnyvale, California, United States, 94085
      Contact: Julie Bergman, MSN, RN     408-542-5626     jbergman@thepi.org    
United States, Florida
Stuart Isaacson, MD at Parkinson's Disease and Movement Disorder Center of Boca Raton     Recruiting
      Boca Raton, Florida, United States, 33486
      Contact: Jorge Riveros     561-392-1818     research@parkinsonscenter.org    
United States, Texas
PDCMDC 6550 Fannin, Suite 1801     Recruiting
      Houston, Texas, United States, 77030
      Contact: Christine B Hunter, RN     713-798-3951     chunter@bcm.edu    
      Principal Investigator: William G Ondo, MD            
      Sub-Investigator: Joseph Jankovic, MD            
      Sub-Investigator: Joohi Jimenez-Shahed, MD            
R. Malcolm Stewart, MD at Neurology Specialists of Dallas     Recruiting
      Dallas, Texas, United States, 75231
      Contact: Pam Turnbull     214-345-1262     pamturnbull@yahoo.com    

Sponsors and Collaborators
Baylor College of Medicine
  More Information


Responsible Party:   Baylor College of Medicine ( William G. Ondo, MD )
Study ID Numbers:   H-20709
First Received:   March 18, 2008
Last Updated:   March 20, 2008
ClinicalTrials.gov Identifier:   NCT00640159
Health Authority:   United States: Food and Drug Administration;   United States: Institutional Review Board

Keywords provided by Baylor College of Medicine:
Parkinson's disease  
selegiline to Zelapar switch  
orally disintegrating formulation  

Study placed in the following topic categories:
Selegiline
Ganglion Cysts
Movement Disorders
Parkinson Disease
Basal Ganglia Diseases
Central Nervous System Diseases
Parkinsonian Disorders
Neurodegenerative Diseases
Brain Diseases

Additional relevant MeSH terms:
Molecular Mechanisms of Pharmacological Action
Anti-Dyskinesia Agents
Therapeutic Uses
Physiological Effects of Drugs
Nervous System Diseases
Monoamine Oxidase Inhibitors
Antiparkinson Agents
Enzyme Inhibitors
Central Nervous System Agents
Protective Agents
Neuroprotective Agents
Pharmacologic Actions

ClinicalTrials.gov processed this record on November 20, 2008




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