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A Study to Evaluate the Safety and Efficacy of IPX203 in Parkinson's Disease Patients With Motor Fluctuations

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ClinicalTrials.gov Identifier: NCT03670953
Recruitment Status : Completed
First Posted : September 14, 2018
Last Update Posted : July 26, 2021
Sponsor:
Information provided by (Responsible Party):
Impax Laboratories, LLC

Study Description
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Brief Summary:
To evaluate the safety and efficacy of IPX203 (carbidopa and levodopa) extended-release capsules (IPX203 ER CD-LD) in comparison to immediate release (IR) CD-LD in the treatment of CD-LD-experienced subjects with Parkinson's disease (PD) who have motor fluctuations.

Condition or disease Intervention/treatment Phase
Parkinson's Disease (Disorder) Drug: IR CD-LD Drug: IPX203 ER CD-LD Other: IPX203 placebo Other: IR CD-LD placebo Phase 3

Detailed Description:
This is a multicenter, randomized, double-blind, double-dummy, active-controlled, parallel-group study. The study will consist of a 3-week, open-label IR CD-LD dose adjustment period; a 4-week, open-label period for conversion to IPX203; followed by a 13-week double-blind treatment period with subjects randomized in a 1:1 ratio, stratified by center, to receive either IPX203 (with matching IR CD-LD placebo) or IR CD-LD (with matching IPX203 placebo). Approximately 510 subjects will be enrolled to randomize 420 subjects.
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 631 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Multicenter, randomized, double-blind, double-dummy, active-controlled, parallel-group study.
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description: Double dummy, blinded drug
Primary Purpose: Treatment
Official Title: A Randomized Controlled Study to Compare the Safety and Efficacy of IPX203 With Immediate-Release Carbidopa-Levodopa in Parkinson's Disease Patients With Motor Fluctuations
Actual Study Start Date : November 6, 2018
Actual Primary Completion Date : June 15, 2021
Actual Study Completion Date : June 15, 2021

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Arms and Interventions
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Arm Intervention/treatment
Experimental: IPX203 ER CD-LD

Following IR CD-LD dose adjustment and conversion to IPX203 ER CD-LD, subjects will be randomized to investigational product IPX203 ER CD-LD and IR CD-LD placebo.

IR CD-LD active and placebo are tablets and IPX203 ER CD-LD active is capsules. Dosage and frequency is patient specific.

 Drug: IR CD-LD
Active comparator - IR CD-LD
Other Name: Generic for Sinemet tablets

Drug: IPX203 ER CD-LD
Investigational formulation - ER CD-LD
Other Name: IPX203 extended-release capsules

Other: IR CD-LD placebo
Double dummy placebo tablets
Other Name: IR CD-LD placebo tablets
Active Comparator: IR CD-LD

Following IR CD-LD dose adjustment and conversion to IPX203 ER CD-LD, subjects will be randomized to IPX203 placebo and IR CD-LD active comparator.

IR CD-LD active is tablets and IPX203 active and placebo are capsules. Dosage and frequency is patient specific.

 Drug: IR CD-LD
Active comparator - IR CD-LD
Other Name: Generic for Sinemet tablets

Drug: IPX203 ER CD-LD
Investigational formulation - ER CD-LD
Other Name: IPX203 extended-release capsules

Other: IPX203 placebo
Double dummy placebo capsules
Other Name: IPX203 placebo capsules


Outcome Measures
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Primary Outcome Measures :
  1. Change in "Good on" time [ Time Frame: 13 weeks ]
    Change from baseline in "Good on" time in hours per day, at the end of double-blind treatment period. "Good on" time is defined as the sum of "On" time without dyskinesia and "On" time with nontroublesome dyskinesia.


Secondary Outcome Measures :
  1. Change in "Off" time [ Time Frame: 13 weeks ]
    Change from baseline in "Off" time in hours per day, at the end of double-blind treatment period.

  2. Patients with "much improved" or "very much improved" on PGI-C [ Time Frame: 13 weeks ]
    Proportion of subjects with either "much improved" or "very much improved" in Patient Global Impression of Change (PGI-C) scores at the end of double-blind treatment period.

  3. Change in MDS-UPDRS Part III [ Time Frame: 13 weeks ]
    Change from baseline in the MDS-UPDRS Part III at the end of double-blind treatment period.

  4. Change in MDS-UPDRS Parts II and III [ Time Frame: 13 weeks ]
    Change from baseline in the sum of MDS-UPDRS Parts II and III at the end of double-blind treatment period.


Eligibility Criteria
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Ages Eligible for Study:   40 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Male or female subjects diagnosed at age ≥ 40 years with PD, consistent with the United Kingdom Parkinson's Disease Society Brain Bank Diagnostic Criteria and who are being treated with stable regimens of CD-LD but experiencing motor fluctuations.
  • Able to provide written informed consent prior to the conduct of any study-specific procedures.
  • Female subjects of childbearing potential must have a negative urine pregnancy test at Screening Visit.
  • Negative urine screen for drugs of abuse and negative alcohol breath test at Screening.
  • Hoehn and Yahr Stages 1, 2, 3, or 4 in the "On" state (part of Movement Disorders Society version of the Unified Parkinson's Disease Rating Scale [MDS-UPDRS] Part III)
  • Agrees to use a medically acceptable method of contraception throughout the study and for 6 weeks after completing the study. Medically acceptable methods of contraception that may be used by the subject and/or partner include but are not limited to: abstinence, oral contraception, NuvaRing or transdermal systems, diaphragm with vaginal spermicide, intrauterine device, condom and partner using vaginal spermicide, surgical sterilization (6 months), progestin implant or injection, or postmenopausal female (no menstrual period for ˃ 2 years) or vasectomy (˃ 6 months).
  • Montreal Cognitive Assessment (MoCA) score ≥ 24 at Screening Visit in "On" state.
  • Able to differentiate "On" state from "Off" state as determined by at least 75% concordance with a trained rater in "On/Off" ratings for 8 ratings over a 4-hour training period. The concordance must include at least 1 "On" and 1 "Off" rating and must be achieved within two 4-hour training sessions.
  • Able and willing to comply with the protocol, including completion of diaries and availability for all study visits.
  • Responsive to CD-LD therapy and currently being treated on a stable regimen with CD-LD for at least 4 weeks prior to Visit 1.
  • At Screening, the subject has predictable "Off" periods.

Exclusion Criteria:

  • Received any investigational medications within 30 days or 5 times the half-life, whichever is longer, prior to Visit 1.
  • Female subjects who are currently breastfeeding or lactating.
  • Had prior neurosurgical treatment for PD or if such procedure is planned or anticipated during the study period.
  • Allergic to any excipient in the study drugs.
  • History of medical conditions or of a prior surgical procedure that would interfere with LD absorption, such as gastrectomy, proximal small-bowel resection, or bariatric surgery.
  • History of upper gastrointestinal hemorrhage in patients with peptic ulcer disease within the past 5 years.
  • History of glaucoma with intraocular pressures that are elevated despite appropriate medical management.
  • History of seizure or epilepsy and experienced at least 1 seizure during the past 12 months or has not been compliant with medically recommended therapy or visits.
  • History of myocardial infarction with residual atrial, nodal, or ventricular arrhythmias that are not controlled with medical and/or surgical interventions. A recent (≤ 12 months) history of myocardial infarction with secondary arrhythmias is exclusionary regardless of the therapeutic control.
  • History of neuroleptic malignant syndrome or of nontraumatic rhabdomyolysis.
  • Liver enzyme values ≥ 2.5 times the upper limit of normal; or history of severe hepatic impairment.
  • Serum creatinine level ≥ 1.75 times the upper limit of normal; or requires dialysis at the time of Screening.
  • Subject with a history of malignant melanoma or with a suspicious undiagnosed skin lesion which in the opinion of the investigator could be melanoma.
  • History of drug or alcohol abuse within the 12 months prior to Screening.
  • Received within 4 weeks of Screening or planning to take during participation in the clinical study:
  • Any doses of a CR CD-LD apart from a single daily bedtime dose, any doses of Rytary, additional CD (eg, Lodosyn) or benserazide (eg, Serazide), or catechol-O-methyl transferase inhibitors (entacapone or tolcapone) or medications containing these inhibitors (Stalevo),
  • Nonselective monoamine oxidase inhibitors (MAOI), apomorphine, or antidopaminergic agents, including antiemetics.
  • Employees or family members of the investigator, study site, or sponsor.
  • Subjects who have previously participated in an IPX203 study.
  • Subjects who, in the opinion of the clinical investigator, should not participate in the study.
  • Based on clinical assessment, subject does not adequately comprehend the terminology needed to complete the PD diary.
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03670953


Locations
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Sponsors and Collaborators
Impax Laboratories, LLC
Investigators
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Study Director: Impax Study Director Impax Laboratories, LLC
More Information
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Responsible Party: Impax Laboratories, LLC
ClinicalTrials.gov Identifier: NCT03670953    
Other Study ID Numbers: IPX203-B16-02
2018-002233-37 ( EudraCT Number )
First Posted: September 14, 2018    Key Record Dates
Last Update Posted: July 26, 2021
Last Verified: May 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Impax Laboratories, LLC:
Idiopathic Parkinson's Disease
Lewy Body Parkinson's Disease
Paralysis Agitans
Primary Parkinsonism
Additional relevant MeSH terms:
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Parkinson Disease
Disease
Parkinsonian Disorders
Basal Ganglia Diseases
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Movement Disorders
Synucleinopathies
Neurodegenerative Diseases
Pathologic Processes
 Carbidopa, levodopa drug combination
Adjuvants, Immunologic
Immunologic Factors
Physiological Effects of Drugs
Antiparkinson Agents
Anti-Dyskinesia Agents
Dopamine Agonists
Dopamine Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action