Nilotinib in Cognitively Impaired Parkinson Disease Patients 001

Parkinson's Disease Clinical Trial

Official title:

Open Label Dose Escalation of Nilotinib in Cognitively Impaired Parkinson Disease Patients With Elevated Cerebrospinal Fluid and Blood α-Synuclein

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02281474
• Other study ID #: IIT-2014-001
• Status: Completed
• Phase: Phase 1
• First received: October 27, 2014
• Last updated: December 15, 2015
• Start date: November 2014

Study information

• Verified date: December 2015
• Source: Georgetown University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This pilot study will test Nilotinib's ability to alter the abnormal protein build up in Parkinson disease and Diffuse Lewey Body Disease patients . Patients will receive Nilotinib at different doses for 6 months. Patients will then be tested to see if there is change in three areas: 1) has the disease symptoms changed. 2) has levels of a specific misfolded protein changed in the fluid around their brain and spine. 3) Have inflammatory markers changed in the patient's blood and fluid around their brain and spine. If successful, this drug could be used to slow down or stop the progression of disorders that involve abnormal collection of misfolded proteins. However, the main purpose of this pilot study is to check for the safety of using this medication at this level.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 12
• Est. primary completion date: May 2015
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 40 Years to 90 Years

Eligibility

Inclusion Criteria:

1. Patients aged 40 to 90 with Idiopathic Parkinson's Disease (Significant Sinemet response) on a stable medication drug regimen L-dopa and/or Dopamine agonist (at least 1 month before enrollment with no new medication change) and with moderate to severe cognitive impairment (MOCA =24).

Inclusions criteria:

1. Written informed consent

2. Capability and willingness to comply with the study related criteria

3. Patients between the age of 40-90 y

4. Diagnosis of PD according to the UK Brain Bank Diagnostic Criteria

5. Early PD subjects with MMSE between 23-30.

6. Hoehn and Yahr stage <2

7. Stable treatment (>4 weeks) with MAO-B inhibitor (Selegeline up to 10mg/d or rasagiline up to 1 mg/d) allowable

8. Patients not needing dopamine agonist or levodopa therapy presently or at least for the next 6 months

9. Idiopathic PD with NO genetic mutations (autosomal recessive or dominant)

10. Detectable levels of CSF for blood and CSF Alpha-Synuclein

Exclusion Criteria:

1. Patients with a known genetic form of PD that does not involve alpha-synuclein.

2. Unwillingness to undergo lumbar punctures

3. Immeasurable CSF a-synuclein.

4. Presence of dementia or severe cognitive impairment that would not permit the patient to give adequate feedback for potential side effects.

5. Unwilling to be in an off state for UPDRS assessment.

6. Pre-menopausal women

7. Patients with autosomal recessive (PARKIN, PINK1 or DJ1) or dominant mutations (LRRK2)

8. Patients with hypokalemia, hypomagnesaemia, or long QT syndrome.

9. Concomitant drugs known to prolong the QT interval

10. Strong CYP3A4 inhibitors

11. Any drugs or foods that may interact with Nilotinib as stated in the Package Insert (PI).

12. Medical history of liver and pancreatic diseases.

13. Clinical signs indicating syndromes other than idiopathic PD, including supranucelar gaze palsy, signs of frontal dementia, history of stroke, head injury or encephalitis, cerebellar sings, early severe autonomic involvement, Babinski's signs.

14. History of any cardiovascular disease, including hypertension, myocardial infraction or cardiac failure, angina, arrhythmia.

Related Conditions & MeSH terms

• Dementia
• Diffuse Lewy Body Disease
• Lewy Body Disease
• Parkinson Disease
• Parkinson's Disease
• Parkinson's Disease Dementia

Intervention

Drug:
• Nilotinib

Locations

Country	Name	City	State
United States	MedStar Georgetown University Hospital	Washington	District of Columbia

Sponsors (1)

Lead Sponsor	Collaborator
Georgetown University

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in a-synuclein and Tau concentrations in the CSF and serum of patients	Working Hypothesis: PD patients have been shown to have elevated levels of a-synuclein in their CSF. Nilotinib has been shown to reduce a-synuclein and Tau in the gastrointestinal tract and central nervous system in animal models, and similarly, we propose will show changes in CSF and serum a-synuclein concentrations in nilotinib treated PD patients.	6 months
Secondary	Determine nilotinib's efficacy by improvement in motor and non-motor symptoms	Working Hypothesis: By following strict safety guidelines, monitoring patients through physical examinations, self-examinations, laboratory and neurological examinations, nilotinib will be a safe drug to use in patients with PD and PD related patients.; Determine if any clinical benefit is observed in this small, short, limited clinical trial.; Working Hypothesis: In cell culture and animal models of PD, dopaminergic neurons have shown increased cell death with accumulating a-synuclein. Therefore, PD patients treated with nilotinib, which lowers a-synuclein and Tau in vivo and in vitro studies, will have improvement or stabilization of their motor UPDRS and cognition.	6 months
Secondary	Safety and tolerability, as measured by number of Participants with Adverse Events	Working Hypothesis: By following strict safety guidelines, monitoring patients through physical examinations, self-examinations, laboratory and neurological examinations, nilotinib will be a safe drug to use in patients with PD and PD related patients.; Determine if any clinical benefit is observed in this small, short, limited clinical trial.; Working Hypothesis: In cell culture and animal models of PD, dopaminergic neurons have shown increased cell death with accumulating a-synuclein. Therefore, PD patients treated with nilotinib, which lowers a-synuclein and Tau in vivo and in vitro studies, will have improvement or stabilization of their motor UPDRS and cognition.	6 months