A Study of Suvecaltamide in Adults With Moderate to Severe Residual Tremor in Parkinson's Disease

Parkinson Disease Clinical Trial

Official title:

A 17-week, Phase 2, Randomized, Double-blind, Placebo-controlled, Flexible-dosing, Parallel-group, Multicenter Study of the Efficacy and Safety of Suvecaltamide in the Treatment of Moderate to Severe Residual Tremor in Participants With Parkinson's Disease

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05642442
• Other study ID #: JZP385-202
• Secondary ID: 2022-001063-27
• Status: Recruiting
• Phase: Phase 2
• Start date: December 1, 2022
• Est. completion date: December 31, 2024

Study information

• Verified date: April 2024
• Source: Jazz Pharmaceuticals
• Contact: Clinical Trial Disclosure & Transparency
• Phone: 215-832-3750
• Email: ClinicalTrialDisclosure[@]JazzPharma.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a 17-week double-blind, placebo-controlled, randomized, flexible-dosing, parallel-group, multicenter study designed to evaluate the efficacy and safety of suvecaltamide for the treatment of moderate to severe residual tremor in adult participants with Parkinson's disease (PD). The target population represents participants who have tremor that is not adequately controlled by PD medications and that interferes with their activities of daily living (ADL) and/or with their performance of tasks.

Description:

Participants will be randomized 1:1 to receive suvecaltamide or placebo and stratified by the Essential Tremor Rating Scale (TETRAS) composite outcome score (≤ 17 or > 17) as assessed at baseline. The maximum total duration of the study for each participant will be 23 weeks, with a maximum treatment duration of 17 weeks. For each participant, the study consists of a Screening Period (up to 4 weeks), a 5-week Dose Titration and Optimization Period, a 12-week Maintenance Period, and a 2-week Safety Follow-up Period.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 160
• Est. completion date: December 31, 2024
• Est. primary completion date: December 31, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 40 Years to 85 Years

Eligibility

KEY Inclusion Criteria:

• Diagnosis of clinically probable or clinically established Parkinson's disease (PD) meeting the Movement Disorder Society (MDS) 2015 criteria.

• Participants must be individually optimized on PD medications for the treatment of other cardinal signs of PD (bradykinesia, rigidity) per the judgment of the investigator.

• Participants must be on a stable dosing regimen of their permitted PD and/or other tremor (eg, propranolol) medications for the treatment of motor symptoms for at least 6 weeks prior to screening and do not anticipate the need to make any changes for the duration of the study. A lack of use of medications used to treat motor symptoms also must be stable for 6 weeks prior to screening and remain stable for the duration of the study.

• Participants have moderate to severe impairment associated with tremor at both the screening and baseline visits, as determined by all the following:

1. A score of > 21 on The Essential Tremor Assessment Rating Scale, Activities of Daily Living (TETRAS-ADL) subscale; and

2. Clinician Global Impression of Severity (CGI-S) rating of tremor severity of > 2 (at least moderate for participant's ability to function).

KEY Exclusion Criteria:

Medical Conditions

• Female participants who are pregnant, nursing, or lactating or plan to become pregnant during the study or within 90 days of study completion.

• Known history or current evidence of other medical or neurological conditions that may cause or explain the participant's tremor in the opinion of the investigator. Note: Participants with a history of essential tremor are eligible.

• Hoehn & Yahr stage 5 (confinement to bed or wheelchair unless aided).

• Participants who only experience tremor during their "OFF" periods.

• Severity of motor fluctuations or medication-induced dyskinesia that would interfere with the assessment of tremor and/or "ON"/"OFF" periods that are unpredictable per the opinion of the investigator.

• Clinically significant symptomatic orthostatic hypotension in the opinion of the investigator.

• Has evidence at screening of cognitive impairment as defined by a Montreal Cognitive Assessment (MoCA) score < 22 or has a cognitive impairment that, in the investigator's opinion, would prevent completion of study procedures or the ability to provide informed consent.

• History or presence of gastrointestinal disease (including prior bariatric bypass surgery), hepatic (including ALT or AST = 2 × ULN or total bilirubin = 1.5 ULN), or severe renal impairment or end-stage renal disease, or any other condition that, in the opinion of the investigator, may interfere with the absorption, distribution, metabolism, or excretion of suvecaltamide.

• Presence of significant cardiovascular disease at Screening

• History or presence of bipolar and related mood disorders, schizophrenia, schizophrenia spectrum disorders, or other psychotic disorders according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria.

Prior/Concomitant Therapy

• Treatment-naïve patients (ie, those who have never tried PD medication) are excluded from participating in the study.

• Use of PRN medication/substance(s) that might produce or interfere with the evaluation of tremor on study visit days prior to discharge

• Prior or planned surgical intervention to treat PD, including but not limited to magnetic resonance-guided focused ultrasound thalamotomy, deep brain stimulation, ablative thalamotomy, and gamma knife thalamotomy.

• Use of PRN medications to treat tremor or continuous infusion of PD medications. Note:

Use of dopaminergic rescue medications (eg, PRN use of carbidopa/levodopa, including levodopa inhalation powder) for non-tremor PD symptoms (eg, rigidity or bradykinesia) is permitted.

• Botulinum toxin injection in the 6 months before screening or planned use at any time during the study. Note: Use of botulinum toxin for other reasons (eg, cosmetic, excessive salivation, dystonia) is permitted as long as the location of use is anatomically distinct from the region with tremor.

• Use of prescription or nonprescription drugs or other products (eg, St. John's Wort) known to be inducers of cytochrome 3A4 (CYP3A4) (cause > 30% reduction of sensitive substrates area under the plasma concentration-time curve [AUC]), which cannot be discontinued at least 4 weeks before baseline, or planned use at any time during the study.

• Use of prescription or nonprescription drugs or other products (eg, grapefruit) known to be strong or moderate inhibitors of CYP3A4, which cannot be discontinued 2 weeks or 5 half-lives, whichever is longer, before baseline, or planned use at any time during the study.

• Use of proton pump inhibitors, which cannot be discontinued at least 2 weeks before baseline, or planned use at any time during the study. (Occasional use of antacids or histamine receptor type 2 [H2] receptor antagonists will be permitted, but antacids should be taken at least 4 hours apart from study intervention; H2 receptor antagonists should be taken at least 4 hours after and/or 12 hours before study intervention).

Diagnostic Assessments

• Known use of recreational drugs, inclusive of the following: phencyclidine, cocaine, opioids, barbiturates, amphetamines, or 3,4-methylenedioxymethamphetamine [ecstasy].

• Opioid use at stable doses, either regularly or PRN, for pain management, as prescribed, is permitted. Use of cannabinoids (including cannabidiol) is permitted if there is no impact on tremor symptoms per the judgment of the investigator.

Other protocol-defined inclusion and exclusion criteria may apply.

Related Conditions & MeSH terms

• Parkinson Disease
• Tremor

Intervention

Drug:
• Placebo
Matching placebo capsule(s) administered every day (QD) orally. Titration may proceed at a rate of 1 matching placebo capsule per day every 7 days as required for optimal efficacy and tolerability up to a maximum number of 3 matching placebo capsules per day.
• Suvecaltamide
Suvecaltamide capsule administered every day (QD) orally. Titration may proceed at a rate of 10 mg suvecaltamide per day every 7 days as required for optimal efficacy and tolerability up to a maximum dose of 30 mg suvecaltamide per day.

Locations

Country	Name	City	State
Germany	Zentrum f. klinische Forschung Dr. I. Schöll	Bad Homburg
Germany	Pharmakologisches Studienzentrum Chemnitz GmbH	Chemnitz
Germany	Department of Neurology- University Hospital Duesseldorf	Duesseldorf	Nordrhein-Westfalen
Germany	Curiositas-ad-sanum Beratungs-und Studien GmbH	Haag in Oberbayern
Germany	Medizinische Hochsule Hannover, Klinik für Neurologie	Hanover	Lower Saxony
Germany	Deutsche Klinik fur Diagnostik Helios Klinik Wiesbaden	Hessen
Germany	Universitätsklinikum Ulm	Ulm
Germany	Velocity Clinical Research Germany GmbH, Location Wiesbaden	Wiesbaden
Poland	NZOZ Wielospecjalistyczna Poradnia Lekarska SYNAPSIS	Katowice
Poland	Centrum Medyczne Plejady	Kraków
Poland	Maxxmed Centrum Zdrowia i Urody w Lublinie	Lublin
Poland	Niepubliczny Zaklad Opieki Zdrowotnej Neuromed M.i M. Nastaj Spólka Partnerska	Lublin
Poland	Neurologiczny Niepubliczny ZOZ Centrum Leczenia SM Osrodek Badan Klinicznych im. dr. n.med Hanki Hertmanowskiej	Plewiska
Poland	Gabinety Lekarskie Rivermed Sp. z o.o.	Poznan
Poland	Singua Sp. z o.o.	Warszawa
Spain	Hospital Universitario Cruces	Barakaldo
Spain	Hospital de la Santa Creu i Sant Pau	Barcelona
Spain	Hospital Ramón y Cajal	Madrid
Spain	Hospital Universitario de La Princesa	Madrid
Spain	Policlínica Gipuzkoa	San Sebastián
Spain	Hospital Universitario Virgen Macarena	Sevilla
United States	Albany Medical College	Albany	New York
United States	The Nene and Jamie Koch Comprehensive Movement Disorders Center	Albuquerque	New Mexico
United States	Inova Parkinson's and Movement Disorders Center - Alexandria	Alexandria	Virginia
United States	Neurology of Central Florida Research Center LLC	Altamonte Springs	Florida
United States	Dent Neurologic Institute	Amherst	New York
United States	NeuroTrials Research Inc.	Atlanta	Georgia
United States	University of Colorado Hospital Anschutz Outpatient Pavilion	Aurora	Colorado
United States	Parkinson's Disease and Movement Disorder Center of Boca Raton	Boca Raton	Florida
United States	Northwestern Medical Group, Department of Neurology	Chicago	Illinois
United States	University of Cincinnati Gardner Neuroscience Institute (UCGNI)	Cincinnati	Ohio
United States	Inova Neurology	Fairfax	Virginia
United States	Texas Movement Disorder Specialist, PLLC	Georgetown	Texas
United States	Hawaii Pacific Health	Honolulu	Hawaii
United States	Baylor College of Medicine	Houston	Texas
United States	Clinical Neuroscience Solutions, Inc.	Jacksonville	Florida
United States	University of Kansas Medical Center	Kansas City	Kansas
United States	EverGreenHealth Neuroscience Institute	Kirkland	Washington
United States	University of Kentucky, College of Medicine, Department of Neurology	Lexington	Kentucky
United States	Keck School of Medicine of University of Southern California (USC)	Los Angeles	California
United States	Veracity Neuroscience LLC	Memphis	Tennessee
United States	Columbia University Irving Medical Center	New York	New York
United States	South Shore Neurologic Associates PC	Patchogue	New York
United States	Woodland Research Northwest	Rogers	Arkansas
United States	Central Texas Neurology Consultants	Round Rock	Texas
United States	Movement Disorders Center of Arizona	Scottsdale	Arizona
United States	USF Parkinson's Disease and Movement Disorders Center	Tampa	Florida

Sponsors (1)

Lead Sponsor	Collaborator
Jazz Pharmaceuticals

Countries where clinical trial is conducted

United States,  Germany,  Poland,  Spain, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change from Baseline to Week 17 on the Essential Tremor Rating Scale (TETRAS) Composite Outcome Score	The TETRAS composite outcome score is the sum of modified items 1 - 11 of the TETRAS-ADL subscale and modified items 6 - 7 of the TETRAS-PS. The TETRAS-ADL subscale is a patient-rated scale administered by a trained interviewer that assesses the impact of tremor on day-to-day functioning, such as eating, drinking, dressing, and other fine motor skills. The TETRAS-PS is a clinical rating scale that quantifies tremor in the head, face voice, limbs and trunk. Items 6 (drawing an Archimedes spiral using left and right hands) and 7 (handwriting) of the TETRAS-PS evaluate the impact of upper limb tremor on performance. Each item from the modified subscales ranges from 0 - 3, with 0 representing normal or slightly abnormal and 3 representing severely abnormal. The sum of the 14 items provides the TETRAS composite outcome score, which ranges from 0 - 42, with higher scores representing more severe tremor.	Baseline to Week 17 post-dose.
Secondary	Proportion of Participants Who Improved (= 1-point improvement) from Baseline to Week 17 on the Clinical Global Impression of Severity (CGI-S)	The CGI-S is a 5-point Likert-type rating scale assessed by qualified personnel to assess the severity of the impact of tremor in PD on the participants' ability to function. The responses to this investigator-completed scale range from 1 (no limitations) to 5 (severe), with higher scores indicating a worse outcome.	Baseline to Week 17 post-dose.
Secondary	Change from Baseline to Week 17 on The Essential Tremor Rating Scale, Activities of Daily Living Subscale (TETRAS-ADL)	The TETRAS-ADL subscale is a patient-rated scale of the impact of tremor on day-to-day functioning administered by a trained interviewer. The TETRAS-ADL subscale directly measures how a patient functions by assessing activities impacted by tremor, such as eating and drinking, dressing and personal hygiene, carrying items, and fine motor skills. The TETRAS-ADL has 12 items and each item is rated on a 0 (normal) to 4 (severe) scale, with higher scores representing more severe tremor.	Baseline to Week 17 post-dose.
Secondary	Proportion of participants who improved (= 1 point) from Baseline to Week 17 on the Patient's Global Impression of Severity (PGI-S)	The PGI-S is a 5-point Likert-type rating scale, with response options ranging from 1 (no limitations) to 5 (severe), with higher scores indicating a worse outcome. The participant will rate his/her impression of the severity of the impact of their tremor in PD on their current ability to function.	Baseline to Week 17 post-dose.
Secondary	Proportion of participants who were much improved on the Patient's Global Impression of Change (PGI-C) at Week 17	The PGI-C is a 5-point Likert-type rating scale that participants use to rate the change in severity of their ability to function due to tremor since baseline. The responses to this scale range from 1 (Much improved) to 5 (Much worse), with higher scores indicating a worse outcome.	Week 17 post-dose.
Secondary	Proportion of Participants who were Much Improved on the Clinician's Global Impression of Change (CGI-C) at Week 17	The CGI-C is a 5-point Likert-type rating scale that a qualified medical personnel will use to rate the change in severity of the participants' ability to function due to their tremor since baseline. The responses to this scale range from 1 (Much improved) to 5 (Much worse), with higher scores indicating a worse outcome.	Week 17 post-dose.
Secondary	Change from Baseline to Week 17 on The Essential Tremor Rating Scale, Performance Subscale (TETRAS-PS)	The TETRAS-PS is a clinical rating scale performed by a blinded rater that quantifies tremor in the head, face, voice, limbs, and trunk. Each item will be rated on a scale of 0 (normal) to 4 (severe). The sum of the individual scores provides the overall score, ranging from 0 to 64, with higher scores representing more severe tremor.	Baseline to Week 17 post-dose.
Secondary	Change from Baseline to Week 17 on TETRAS total score (TETRAS-ADL + TETRAS-PS)	The TETRAS total score is the sum of the scores of the full TETRAS-ADL and TETRAS-PS subscales. Each item is rated on a 0 (normal) to 4 (severe) scale, and total scores range from 0 to 112, with higher scores representing more severe tremor. The TETRAS-PS is performed by a blinded rater.	Baseline to Week 17 post-dose.
Secondary	Change from Baseline to Week 17 on the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Tremor Score	The tremor items from the MDS-UPDRS consist of 1 item from Part II (Item 2.10) and 10 items from Part III (Items 3.15a,b, 3.16a,b, 3.17a-e, and 3.18). These items are graded on a severity score of 0 to 4 (normal, slight, mild, moderate, severe). Item 2.10 assesses the patient report of the presence of tremor and impact on daily activities. Items 3.15, 3.16, and 3.17 are clinician assessments of the amplitude of distinct types of tremor (resting, postural, and kinetic respectively)in the right and left upper extremities separately. Item 3.17 also includes separate clinician assessments for both lower extremities and for the lip/jaw. Item 3.18 provides a clinician assessment of the constancy of rest tremor without regard to anatomical location. For the 11 individual assessments the maximum possible total score of these tremor items is 44, with higher scores indicating more	Baseline to Week 17 post-dose.