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Study of NP002 in Subjects With Idiopathic Parkinson's Disease to Treat Dyskinesias Due to Levodopa Therapy

This study has been completed.
Information provided by (Responsible Party):
Neuraltus Pharmaceuticals, Inc. Identifier:
First received: August 11, 2009
Last updated: September 26, 2011
Last verified: September 2011
The study is designed to answer the question: will nicotine at doses that do not cause serious side effects, show feasibility in treatment of levodopa-induced dyskinesia in patients with Parkinson's disease?

Condition Intervention Phase
Parkinson's Disease
Drug: nicotine
Other: placebo comparator
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Randomized, Double-Blind, Parallel Group, Placebo Controlled Safety, Tolerability and Efficacy Study of NP002 in Subjects With Idiopathic Parkinson's Disease With Dyskinesias Due to Levodopa Therapy

Resource links provided by NLM:

Further study details as provided by Neuraltus Pharmaceuticals, Inc.:

Primary Outcome Measures:
  • frequency and severity of adverse events, active vs placebo [ Time Frame: Every two weeks during dosing (week 0 to week 12) and weekly thereafter for 2 weeks following cessation of dosing ]
  • measure of impulse control (rMIDI), active vs placebo [ Time Frame: at screening and 4 weeks, 10 weeks, 12 weeks and 14 weeks ]

Secondary Outcome Measures:
  • measure of frequency and severity of dyskinesia (USDysRS), active vs placebo [ Time Frame: At screen and every two weeks through week 10 ]
  • Parkinson's disease severity (UPDRS part II,III,IV), active vs placebo [ Time Frame: At screen and every two weeks through week 10 ]

Enrollment: 65
Study Start Date: October 2009
Study Completion Date: September 2010
Primary Completion Date: September 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Nicotine
Active drug is nicotine dihydrate bitartrate, provided as an oral capsule at escalating doses, 1 mg to 6 mg, once every 6 hours
Drug: nicotine
Oral capsule self administered in escalating doses from 1 mg to 6 mg, 4 times a day. Each dose is is taken for two weeks, except the highest dose, which is taken for 4 weeks. At the end of 10 weeks, the dose is tapered down over 9 days. Subject is continued on study through week 14.
Other Name: NP002
Placebo Comparator: placebo
Subjects in this arm receive placebo capsules orally
Other: placebo comparator
oral capsules containing only excipient will be self-administered with the same regimen as the active drug, 4 times a day, approximately every 6 hours for 10 weeks and nine days. Study is continued through week 14.

Detailed Description:
Nicotine will be employed at daily doses lower than those available OTC as smoking-cessation patches, in parkinsonian patients experiencing disabling dyskinesias due to their levodopa treatment. The principal adverse effect from this dose level of nicotine is expected to be nausea on acute administration to nicotine-naive patients. Because tolerance to the effects of nicotine is achieved by repeated dose, the study is designed to gradually escalate from 6 to 24 mg per day, taken in 6 separate oral doses of 6 mg each. The study is designed to see if doses which can be tolerated by parkinsonian patients will also reduce the severity and frequency of the dyskinesias experienced following administration of levodopa, the gold standard medication for Parkinson's disease.

Ages Eligible for Study:   30 Years to 83 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • clinical diagnosis of probable idiopathic Parkinson's disease
  • in stable health
  • male and female aged 30-83 yrs
  • Hoehn and Yahr stage II through IV inclusive
  • levodopa-induced dyskinesias present greater than 25% of waking day; rating equal or greater than 2 on item 32 of UPDRS
  • dyskinesias moderately or severely disabling as determined by a rating of equal or greater than 2 on item 33 of UPDRS
  • Mini-Mental state (MMSE) score of equal or greater than 26
  • on a stable dose of levodopa for at least 30 days
  • if subjects are taking dopamine antagonists, amantadine, MAO-B inhibitors (rasagiline only) or COMT inhibitors, doses must have been stable for at least 30 days

Exclusion Criteria:

  • Secondary or non-idiopathic Parkinson's disease
  • Subjects with parkinsonian symptoms who do not respond to levodopa therapy
  • history of schizophrenia, or other DSM-IV TR axis 1 diagnosis sufficient to interfere with or affect study conduct or interpretation of results
  • any history (past 5 years) of suicide or suicide attempt or thoughts or urges of suicide on direct questioning
  • subjects who score 2 or higher on a single module of the Jay MIDI scale
  • moderate or severe hallucinations, psychoses or delusions
  • any medical condition or lab abnormality presenting an unwarranted risk in the opinion of the Investigator
  • history of HIV positivity, AIDS, or active hepatitis determined by subject report
  • female who is pregnant or breastfeeding
  • female of childbearing potential not using double barrier method of birth control throughout the duration of the study
  • receipt of a neurosurgical intervention (e.g. brain surgery)related to Parkinson's disease or any neurosurgical procedure sufficient to interfere with study conduct or interpretation of results
  • must not have systolic blood pressure ≥150; diastolic ≥95.
  • must not have ECG at screening judged clinically significantly abnormal by investigator
  • must not have QTc > 450 msec at ECG screen
  • must not have current angina pectoris, history of ventricular arrhythmias, uncontrolled hyperthyroidism, known or suspected pheochromocytoma, symptomatic vasospastic disease, or active peptic ulcer
  • must not have a history of stroke, transient ischemic attack (TIA) or myocardial infarction within the last 2 years
  • must not have current drug or alcohol abuse within the last two years. Acceptable alcohol use is no more than 3 ounces of alcohol, 3 beers or 2 glasses of wine per day.
  • must not be participating in another drug trial or have participated in another drug study in the last 30 days. Observational trials with no intervention are acceptable provided permission is obtained from the other study sponsor in writing.
  • must not be unwilling or unable to swallow capsules
  • must not have a positive urine test for cotinine at screening
  • must not be a smoker, previous (less than 5 years since cessation) smoker or have regular exposure to second hand smoke
  • must not be allergic to capsule excipients
  • must not be allergic to ondansetron. If allergic, they may participate provided they understand there is no rescue medication for potential nausea or vomiting during the study
  • must not have known sensitivity to nicotine or nicotine-containing products
  • must not be taking any of the following medications or substances within a minimum of 30 days: nicotine, any form; CYP2A6 inducers or inhibitors during the course of the study or within 30 days of the planned initial dose (your investigator will have a full list of these drugs); Monoamine oxidase inhibitors (with the exception of rasagiline, which is allowed)(your investigator will have a full list of these drugs); apokyn (apomorphine), due to its contraindication with ondansetron); warfarin.
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Please refer to this study by its identifier: NCT00957918

United States, Arizona
Barrow Neurology Clinics at St. Joseph's Hospital and Medical Center
Phoenix, Arizona, United States, 85013
United States, California
Keck/USC School of Medicine -Department of Neurology
Los Angelis, California, United States, 90033
Pacific Neuroscience Medical Group
Oxnard, California, United States, 93030
United States, Colorado
Colorado Neurological Institute
Englewood, Colorado, United States, 80113
United States, Florida
Parkinson's Disease & Movement Disorders Ctr of Boca Raton
Boca Raton, Florida, United States, 33486
Collier Neurologic Specialists, LLC
Naples, Florida, United States, 34102
United States, Minnesota
Strurers Parkinson's Center
Golden Valley, Minnesota, United States, 55427
United States, New York
David L. Kreitzman, M.D., P.C.
Commack, New York, United States, 11725
108-14 72nd Ave, Second floor
Forest Hills, New York, United States, 11375
United States, North Carolina
Duke University Medical Center, Department of Neurology
Durham, North Carolina, United States, 27705
United States, Oklahoma
The Movement Disordedr Clinic of Oklahoma
Tusla, Oklahoma, United States, 74137
United States, Pennsylvania
Parkinson's Disease and Movement Center, Penn Comprehensive Neuroscience Center
Philadelphia, Pennsylvania, United States, 19107
Sponsors and Collaborators
Neuraltus Pharmaceuticals, Inc.
Principal Investigator: Abrahan N Lieberman, MD St. Joseph's Hospital and Medical Center, Barrow Neurology Clinics
  More Information

Responsible Party: Neuraltus Pharmaceuticals, Inc. Identifier: NCT00957918     History of Changes
Other Study ID Numbers: NP002-09-001
Study First Received: August 11, 2009
Last Updated: September 26, 2011

Keywords provided by Neuraltus Pharmaceuticals, Inc.:
levodopa-induced dyskinesia
Parkinson's disease
levodopa-induced dyskinesias in Parkinson's disease

Additional relevant MeSH terms:
Parkinson Disease
Parkinsonian Disorders
Basal Ganglia Diseases
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Movement Disorders
Neurodegenerative Diseases
Neurologic Manifestations
Signs and Symptoms
Ganglionic Stimulants
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Nicotinic Agonists
Cholinergic Agonists
Cholinergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Antiparkinson Agents
Anti-Dyskinesia Agents
Dopamine Agents processed this record on April 27, 2017