Phase 2
N=57
A Study to Assess the Effect of Repeat Doses of GSK962040 on the Pharmacokinetics of L-DOPA in Subjects With Parkinson's Disease Exhibiting Delayed Gastric Emptying
Gastroparesis
Bottom Line
View on ClinicalTrials.gov: NCT01602549 ↗Enrolled (actual)
57
Serious AEs
7.0%
Results posted
Feb 2017
Primary outcome: Primary: Dose-normalized Levodopa (L-DOPA) Area Under the Plasma Concentration-time Curve From Zero to 4 Hours AUC(0-4) at Baseline — 24.13; 24.81 Nanograms*hour/milliliter/milligram
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 2
- Interventions
- GSK962040 (25 mg tablet) (Drug); Placebo (Drug)
- Age
- Adult, Older Adult · 40+ yrs
- Sex
- All
- Sponsor
- GlaxoSmithKline
- Primary completion
- May 2014
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Dose-normalized Levodopa (L-DOPA) Area Under the Plasma Concentration-time Curve From Zero to 4 Hours AUC(0-4) at Baseline |
24.13; 24.81 | — |
| PRIMARY Dose-normalized L-DOPA AUC(0-4) at Day 1 and Day 8 |
26.6; 25.7; 27.1; 24.1 | — |
| PRIMARY Dose-normalized L-DOPA Maximum Observed Concentration (Cmax) at Baseline |
12.77; 12.89 | — |
| PRIMARY Dose-normalized L-DOPA Cmax at Day 1 and Day 8 |
13.4; 11.6; 11.6; 11.8 | — |
| PRIMARY L-DOPA Time of Occurrence of Cmax (Tmax) at Baseline, Day 1,and Day 8 |
1.50; 2.00; 1.61; 1.50; 2.00; 1.55 | 0.157 |
| PRIMARY L-DOPA Terminal Phase Half-life (t1/2) at Baseline, Day 1, and Day 8 |
— | — |
| SECONDARY Gastric Half Emptying Time (GE t1/2) at Baseline (BL), Day 1, and Day 8 |
99.6; 96.9; 97.5; 91.9; 98.7; 90.6 | — |
| SECONDARY Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Scores at Baseline, Day 1, and Day 8 (Pre-levodopa Dose) |
9.1; 10.1; 10.1; 8.6; 10.0; 7.1 | — |
| SECONDARY Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III Scores at Baseline, Day 1, and Day 8 (Pre-dose; 120, 180, and 240 Minutes Post-dose) |
42.2; 38.0; 33.1; 27.7; 30.3; 27.5 | — |
| SECONDARY Period Mean Amount of Hours Spent "ON," "ON" Without Dyskinesia, "ON" With Non-troublesome Dyskinesia, "ON" With Troublesome Dyskinesia, and "OFF" at Baseline and During the Treatment Period (Days 1-8), Week 1 of Follow-up, and Week 2 of Follow-up |
11.21; 11.31; 10.11; 9.65; 1.10; 1.66 | — |
| SECONDARY Number of Times a Participant Could Alternatively Tap Two Counter Keys 30 Centimeters Apart in 1 Minute (Min) at Baseline, Day1, Day 8, and Follow-up |
92.4; 77.8; 91.2; 80.1; 89.3; 85.2 | — |
| SECONDARY Total Daily L-DOPA Equivalent Dose at Baseline and on Days 1, 2, 3, 4, 5, 6, 7, 8, and 9 |
113.2; 164.5; 353.9; 368.6; 465.8; 514.5 | — |
| SECONDARY Change From Baseline in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) at Day 1 and Day 8 |
-4.0; -2.5; -2.1; -2.8; -3.9; -3.7 | — |
| SECONDARY Change From Baseline in Heart Rate at Day 1 and Day 8 |
-2.2; 0.8; 0.5; -2.9; 0.6; 0.0 | — |
| SECONDARY Number of Participants With the Indicated Electrocardiogram (ECG) Findings at Day 1 and Day 8 |
14; 17; 18; 5; 19; 19 | — |
| SECONDARY Change From Baseline in Albumin (ALB) and Total Protein (TP) at Day 4 and Day 8 |
0.06; -0.38; -0.37; 0.11; -0.33; -0.29 | — |
| SECONDARY Change From Baseline in Alkaline Phosphatase (ALP), Alanine Amino Transferase (ALT), Aspartate Amino Transferase (AST), and Gamma Glutamyl Transferase (GGT) at Day 4 and Day 8 |
-0.8; 2.4; 2.2; -0.1; 1.4; 1.2 | — |
| SECONDARY Change From Baseline in Calcium, Chloride, Carbon Dioxide Content (CO2)/Bicarbonate (BC), Glucose, Potassium, Sodium, Urea/Blood Urea Nitrogen (BUN), and Uric Acid (UA) at Day 4 and Day 8 |
0.010; -0.009; -0.011; 0.026; -0.018; -0.017 | — |
| SECONDARY Change From Baseline in Basophils, Eosinophils, Lymphocytes, Monocytes, Total Absolute Neutrophil Count (ANC), and Platelet Count (PC) at Day 4 and Day 8 |
-0.003; -0.006; -0.006; -0.006; -0.001; -0.001 | — |
| SECONDARY Change From Baseline in Hemoglobin and Mean Corpuscle Hemoglobin Concentration (MCHC) at Day 4 and Day 8 |
-2.3; -2.0; -2.3; -2.4; -2.3; -2.2 | — |
| SECONDARY Change From Baseline in Hematocrit at Day 4 and Day 8 |
-0.0059; -0.0059; -0.0067; -0.0044; -0.0037; -0.0039 | — |
| SECONDARY Change From Baseline in Mean Corpuscle Hemoglobin (MCH) at Day 4 and Day 8 |
-0.12; -0.06; 0.07; 0.03; -0.20; 0.19 | — |
| SECONDARY Change From Baseline in Mean Corpuscle Volume (MCV) at Day 4 and Day 8 |
-0.13; -0.14; -0.17; 0.72; -0.05; -0.06 | — |
| SECONDARY Change From Baseline in Red Blood Cell Count (RBC) and White Blood Cell Count (WBC) at Day 4 and Day 8 |
-0.055; 0.068; -0.074; -0.073; 0.041; -0.043 | — |
| SECONDARY Change From Baseline in Reticulocytes (RET) at Day 4 and Day 8 |
0.000; 0.002; 0.001; 0.004; 0.001; 0.001 | — |
| SECONDARY Number of Participants With Any Adverse Event (AE) or Serious Adverse Event (SAE) |
17; 23; 24; 2; 2; 2 | — |
| SECONDARY GSK962040 Area Under the Plasma Concentration-time Curve From Zero to 5.5 Hours (AUC[0-5.5] and Area Under the Plasma Concentration-time Curve From Zero to Infinity (AUC[0-inf]) at Days 1 and 8 |
1632.5; 3036.9; 2972.8 | — |
| SECONDARY GSK962040 Percentage of AUC(0-inf) Obtained by Extrapolation (%AUCex) at Day 1 |
41.64 | — |
| SECONDARY GSK962040 Cmax at Day1 and Day 8 |
501.0; 788.3 | — |
| SECONDARY GSK962040 Tmax at Day1 and Day 8 |
0.750; 1.000 | — |
Summary
Gastric emptying is the end-result of a complex and carefully regulated series of events which follow the ingestion of a meal, each of which is dependent on the other and subject to neurohormonal control. Motilin is an endogenous peptide, produced mainly in the duodenum, whose physiological action is mediated by motilin receptors located on enteric neurons, peripheral terminals of the vagus, and on the smooth muscle of the gut. Motilin and non-peptide agonists at motilin receptors increases the gastric emptying rate and therefore provide a potential approach to the treatment of a range of clinical conditions in which delayed gastric emptying is thought to be part of the physiopathology and may be contributory to symptoms. Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by degeneration of nigrostriatal dopaminergic neurones. It affects 1.5% of the global population over 65 years of age. Cardinal symptoms comprise bradykinesia, rigidity, resting tremors and postural instability. Gastrointestinal dysfunction, including gastroparesis, is a frequent feature of PD affecting approximately 90% of patients, and is caused by autonomic dysfunction as well as an adverse effect of antiparkinsonian drug therapy. The therapeutic mainstay for PD treatment is the neutral amino acid L-3,4-dihydroxyphenylalanine (L-DOPA), a dopamine prodrug, as it provides the most rapid and effective symptomatic control of motor impairment in PD. The primary determinant of L-DOPA bioavailability is gastric emptying (GE); delays in GE slow delivery of L-DOPA to its proximal small intestinal absorption sites, increasing the extent of presystemic metabolism, and leading to slowed and diminished absorption.
Eligibility Criteria
Inclusion Criteria
- Diagnosis of idiopathic Parkinson's Disease (according to modified Hoehn & Yahr criteria Stages II-IV) and with suboptimal motor control on L-DOPA or L-DOPA combination therapy (i.e. wearing off, peak dose dyskinesias, delayed on or no-on effects)
- Subjects receiving a stable regimen of L-DOPA for at least four weeks prior to screening
- Patient has gastric half-time of emptying > or = 70 min as determined by 13C oral breath test
- Between 40 and 80 years of age, inclusive.
- Patient has never had a gastrectomy, nor major gastric surgical procedure or any evidence of bowel obstruction or strictures within the previous 12 months
- Dosage of any concomitant medications has been stable for at least 4 weeks
- A female subject is eligible to participate if she is of: Non-childbearing potential defined as pre-menopausal females with a documented tubal ligation or hysterectomy; or postmenopausal defined as 12 months of spontaneous amenorrhea [in questionable cases a blood sample with simultaneous follicle stimulating hormone (FSH) > 40 MlU/ml and estradiol 1.5xULN is acceptable if bilirubin is fractionated and direct bilirubin <35%).
- Single or Average QTc, QTcB or QTcF< 450 msec; or QTc < 480 msec in subjects with Bundle Branch Block.
Exclusion Criteria
- Late stage advanced subjects with incapacitating peak dose or biphasic dyskinesia ona stable L-DOPA regime.
- Presence, or history within the previous 3 months, of significant and/or uncontrolled psychiatric, neurological (other than Parkinson's disease), gastro-intestinal, hematological, endocrinologic, neurological (other than Parkinson's disease), cardiovascular disease, active malignancy (other than basal cell cancer) or other condition that would in the opinion of the investigator or medical monitor make the subject unsuitable for inclusion in this clinical study.
- A positive pre-study Hepatitis B surface antigen or positive Hepatitis C antibody result within 3 months of screening
- Patient has a gastric pacemaker
- Patient is on chronic enteral (e.g., feeding tube) or parenteral feeding
- Patient has evidence of severe cardiovascular autonomic neuropathy (e.g. history of recurrent syncope in the last 6 months)
- Current or chronic history of liver disease, or known hepatic or biliary abnormalities (with the exception of Gilbert's syndrome or asymptomatic gallstones).
- Pregnant females as determined by positive serum or urine hCG test at screening or prior to dosing.
- Lactating females.
- Unable to refrain from consumption of red wine, Seville oranges, grapefruit or grapefruit juice from 7 days prior to the first dose of study medication until followup.
- Use of medications potentially influencing upper gastrointestinal motility or appetite within one week of the study (e.g., prokinetic drugs, macrolide antibiotics (erythromycin), GLP-1 mimetics)
- Unable to refrain from use of prohibited medications listed in Section 9 within the restricted timeframe relative to the first dose of study medication.
- The patient has participated in a clinical trial and has received an investigational product within the following time period prior to the first dosing day in the current study: 30 days, 5 half-lives or twice the duration of the biological effect of the investigational product (whichever is longer).
- History of sensitivity to any of the study medications, or components thereof or a history of drug or other allergy that, in the opinion of the investigator or GSK Medical Monitor, contraindicates their participation.
- Where participation in the study would result in donation of blood or blood products in excess of 500 mL within a 56-day time-period.
Data sourced from ClinicalTrials.gov (NCT01602549). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.