Clinical Study to Test the Safety of CDNF by Brain Infusion in Patients With Parkinson's Disease

• ClinicalTrials.gov Identifier: NCT03295786
• Recruitment Status: Completed
• First Posted: September 28, 2017
• Last Update Posted: January 13, 2020
• Sponsor: Herantis Pharma Plc.
• Collaborator: Renishaw plc.
• Information provided by (Responsible Party): Herantis Pharma Plc.

Study Description

Brief Summary:

This study evaluates the safety and tolerability of CDNF in patients with Parkinson's disease, when dosed directly into the brain using an implanted investigational drug delivery system (DDS). Safety and accuracy of the DDS is also being evaluated. One-third of the patients will receive monthly infusions with placebo and two-third of the patients will receive monthly infusions with either mid- or high-doses of CDNF for a period of 6 months.

Condition or disease	Intervention/treatment	Phase
Parkinson Disease; Movement Disorders; Neurodegenerative Diseases; Nervous System Diseases; Brain Diseases	Drug: Cerebral Dopamine Neurotrophic Factor; Device: Renishaw Drug Delivery System	Phase 1; Phase 2

Detailed Description:

A patient's participation in the study will last for ten months and will include sixteen to seventeen visits:

• Screening (2 visits)
• Planning of surgery - Surgery: implantation of drug delivery system - Post-surgery follow-up (3 visits)
• Test infusions with vehicle (1-2 visits)
• Positron emission tomography (PET) examinations before the first and after the last dose (2 visits)
• Baseline and randomisation to CDNF or placebo group (1 visit)
• Dosing visits: CDNF or placebo (6 visits)
• End-of-study visit (1 visit)

Study examinations and assessments

- Physical examination: pulse rate, blood pressure, temperature, body weight and height

• ECG (electrocardiography) and blood and urine tests
• HIV, hepatitis B and C blood tests (on first visit)
• Pregnancy tests for women of childbearing age
• Completion of a patient diary to record mobility and time asleep
• Parkinson's Kinetigraph (PKGTM) Data Logger: a watch-type device worn on the wrist for certain periods during the study to record movements
• Questionnaires, rating scales and forms: quality of life, mood, memory, impulse control, mental health
• Assessment of the port and the skin around the port
• Cerebrospinal fluid sampling by lumbar puncture
• Magnetic resonance imaging (MRI)
• Positron emission tomography scans (PET)
• Computed tomography (CT)

For more information: https://treater.eu/clinical-study/

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 17 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: Randomised, Double-Blind, Placebo Controlled
• Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Masking Description: Double-Blind
• Primary Purpose: Treatment
• Official Title: Phase 1-2, Randomised, Double-Blind, Placebo Controlled, Safety and Tolerability Study of Intraputamenal Cerebral Dopamine Neurotrophic Factor (CDNF) Infusions Via an Investigational Drug Delivery System to Patients With Parkinson's Disease
• Actual Study Start Date: September 26, 2017
• Actual Primary Completion Date: December 19, 2019
• Actual Study Completion Date: December 19, 2019

Arms and Interventions

Arm	Intervention/treatment
Placebo Comparator: Placebo; Patients randomized to this group will receive 6 monthly infusions of placebo/vehicle	Drug: Cerebral Dopamine Neurotrophic Factor; Repeated intracerebral infusions; Other Name: CDNF; Device: Renishaw Drug Delivery System; Stereotactically implanted device; Other Name: DDS
Experimental: CDNF mid-dose; Patients randomized to this group will receive 6 doses of CDNF titrated to mid-dose	Drug: Cerebral Dopamine Neurotrophic Factor; Repeated intracerebral infusions; Other Name: CDNF; Device: Renishaw Drug Delivery System; Stereotactically implanted device; Other Name: DDS
Experimental: CDNF high-dose; Patients randomized to this group will receive 6 doses of CDNF titrated to high-dose	Drug: Cerebral Dopamine Neurotrophic Factor; Repeated intracerebral infusions; Other Name: CDNF; Device: Renishaw Drug Delivery System; Stereotactically implanted device; Other Name: DDS

Outcome Measures

Primary Outcome Measures :

1. Adverse events (AEs) [ Time Frame: Week 15 to Week 40 ]
   Number and severity of adverse events
2. Electrocardiogram (ECG) [ Time Frame: Week 15 to Week 40 ]
   Changes in electrical activity of heartbeat measured by electrocardiogram
3. Beck Depression Inventory (BDI) score [ Time Frame: Week 15 to Week 40 ]
   Assessment of change in depression using Beck Depression Inventory (BDI) score
4. Questionnaire for impulsive-compulsive disorder in Parkinson's disease rating scale (QUIP_RS) [ Time Frame: Week 15 to Week 40 ]
   Assessment of changes in impulsive-compulsive disorders using QUIP_RS
5. Montreal cognitive assessment (MoCA) [ Time Frame: Week 15 to Week 40 ]
   Assessment of change in cognitive domains using MoCA test
6. Physical examination [ Time Frame: Week 15 to Week 40 ]
   Changes in anatomic findings found in physical examination
7. Vital signs [ Time Frame: Week 15 to Week 40 ]
   Changes in vital signs
8. Clinical laboratory safety screen [ Time Frame: Week 15 to Week 40 ]
   Changes in clinical laboratory variables (chemistry, haematology, urinanalysis)
9. Formation of anti-CDNF antibodies [ Time Frame: Week 15 to Week 40 ]
   Change in anti-CDNF antibody concentration
10. Device related changes in safety measures [ Time Frame: Week 8 to Week 40 ]
    Occurrence of adverse device effects (ADE), for either the whole system or the individual sub systems (guide tubes/catheters, subcutaneous components, port), serious adverse device effect (SADE) including long term effects, neurological deficit (seizures), infection (local to components, in CNS), severe skin breakdown or necrosis requiring component removal life threatening or major (requiring intervention) intracerebral haemorrhage.
11. Device related accuracy of implantation [ Time Frame: Week 8 ]
    The accuracy of implantation of the Drug Delivery System (DDS) will be measured comparing the tip of each individual catheters defined in the plan of the surgical procedure with the position of those measured by the post-operative CT scan.

Secondary Outcome Measures :

1. UPDRS (Unified Parkinson's Disease Rating Scale) Part III motor score [ Time Frame: Week 15 to Week 40 ]
   Changes in severity of PD (Parkinson's disease) motor symptoms assessed by UPDRS Part III motor scores
2. TUG (Timed Up and Go) test [ Time Frame: Week 15 to Week 40 ]
   Changes in mobility assessed by TUG test
3. UPDRS Total score (Part I-IV) [ Time Frame: Week 15 to Week 40 ]
   Change in severity of PD non-motor and motor symptoms assessed by UPDRS Part I-IV total scores (Parts I, II and IV in ON-state; Part III in OFF-state).
4. Home diary score [ Time Frame: Week 16 to Week 24 ]
   Change in functional status assessed by home diary score
5. PDQ-39 (Parkinson's Disease Questionnaire) score [ Time Frame: Week 15 to Week 40 ]
   Changes in health and daily activity assessed by PDQ-39 questionnaire score
6. change in CGI (Clinical Global Impressions) scale [ Time Frame: Week 16 to Week 40 ]
   • Change from baseline until end of treatment evaluation in mental status as measured by CGI scale.
7. Occurrence of blockage [ Time Frame: Week 11 to Week 36 ]
   Occurrence of blockage of implanted catheter preventing or limiting infusion assessed by measuring catheter pressure
8. Cessation of infusions [ Time Frame: Week 11 to Week 36 ]
   Cessation of infusions in an individual patient

Other Outcome Measures:

1. DAT (dopamine transporter)-PET imaging [ Time Frame: Week 14 to Week 38 ]
   Change in caudate and putamen DAT availability using PET imaging.
2. alpha-synuclein levels [ Time Frame: Week 15 to Week 40 ]
   Changes in serum and CSF (cerebrospinal fluid) concentrations of various α-synuclein species
3. Distribution of CDNF [ Time Frame: Week 24 and Week 36 ]
   Level of distribution of CDNF in serum and Cmax of CDNF in CSF
4. Daily activity measurement [ Time Frame: Week 16 to Week 40 ]
   Change in daily activity measured by Parkinson's KinetiGraph™ (PKG™) Data Logger
5. Coverage of infusate [ Time Frame: Week 11 to Week 36 ]
   Coverage of the infusate in target anatomy assessed by MRI (Magnetic resonance imaging)

Eligibility Criteria

• Ages Eligible for Study: 35 Years to 75 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Idiopathic Parkinson's disease based on UK brain bank criteria
2. Duration of PD motor symptoms 5-15 years (inclusive)
3. Age 35-75 years (inclusive)
4. Presence of motor fluctuations.
5. At least 5 daily doses of levodopa
6. Ability to reliably distinguish motor states and accurately complete fluctuation diaries
7. UPDRS motor score (part III) in a practically defined OFF-state between 25-50 (inclusive)
8. Hoehn and Yahr ≤ stage III in the OFF-state
9. Responsiveness to levodopa
10. No change in anti-parkinsonian medication for 6 weeks before screening
11. Provision of Informed Consent

Exclusion Criteria:

1. Diagnosed with atypical parkinsonism or any known secondary parkinsonian syndrome.
2. Signs or symptoms suggestive of atypical parkinsonian syndrome.
3. Drug-resistant rest tremor.
4. Prior neurosurgical treatment for PD, including lesioning or deep brain stimulation
5. Significant neurological disorder other than PD including clinically significant head trauma, cerebrovascular disease, epilepsia, CSF shunt or other implanted CNS device
6. Presence of significant depression as defined as a BDI score ≥ 20
7. Current psychosis requiring therapy.
8. Presence of clinically significant impulse control disorder ((QUIP-RS) score > 20), or, presence of dopamine dysregulation syndrome.
9. MoCA score < 24.
10. Use within 3 months of planned catheter insertion of concomitant medications known to affect PD symptoms other than prescribed PD therapy.
11. Any medical condition, which might impair outcome measure assessments or safety measures including ability to undergo MRI or DAT-PET.
12. Hypersensitivity or allergy to gadolinium or to any of excipients of macrocyclic GBCA used for the surgical planning MRI.
13. Screening and/or planning MRI demonstrating any abnormality, which would suggest an alternative cause for patient's parkinsonism or preclude neurosurgery.
14. Any medical condition that would put the patient at undue risk from surgical treatment or chronic implants including but not limited to bleeding disorders, chronic infections, or immunosuppressive illness
15. History within the last 5 years of cancer with the exception of basal cell carcinoma of the skin
16. History of drug or alcohol abuse within 2 years of screening
17. Use of any investigational drug or device within 90 days of screening
18. Active breastfeeding

Contacts and Locations

Locations

Finland

Helsinki University Hospital

Helsinki, Finland, 00029

Sweden

Skåne University Hospital

Lund, Sweden, 221 85

Karolinska University Hospital, Huddinge

Stockholm, Sweden, 141 86

Sponsors and Collaborators

Herantis Pharma Plc.

Renishaw plc.

Investigators

• Principal Investigator: Per Svenningsson, MD; Karolinska University Hospital

More Information

• Responsible Party: Herantis Pharma Plc.
• ClinicalTrials.gov Identifier: NCT03295786
• Other Study ID Numbers: HP-CD-CL-2002; 2015-004175-73 ( EudraCT Number )
• First Posted: September 28, 2017
• Last Update Posted: January 13, 2020
• Last Verified: January 2020

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Herantis Pharma Plc.:

Parkinson; CDNF; Drug Delivery System; Intracerebral

Additional relevant MeSH terms:

Parkinson Disease; Nervous System Diseases; Movement Disorders; Neurodegenerative Diseases; Brain Diseases; Parkinsonian Disorders; Basal Ganglia Diseases; Central Nervous System Diseases; Synucleinopathies; Dopamine; Cardiotonic Agents; Sympathomimetics; Autonomic Agents; Peripheral Nervous System Agents; Physiological Effects of Drugs; Dopamine Agents; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Protective Agents