Phase 3
N=298
Study of Urate Elevation in Parkinson's Disease, Phase 3
Parkinson's Disease
Bottom Line
View on ClinicalTrials.gov: NCT02642393 ↗Enrolled (actual)
298
Serious AEs
12.5%
Results posted
Jul 2020
Primary outcome: Primary: Rate of Clinical Decline — 11.116; 9.860 score per year — p=0.183
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 3
- Interventions
- Inosine (Drug); Placebo (Drug)
- Age
- Adult, Older Adult · 30+ yrs
- Sex
- All
- Sponsor
- Michael Alan Schwarzschild
- Primary completion
- Jun 2019
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Rate of Clinical Decline |
11.116; 9.860 | 0.183 |
| SECONDARY Rate of Developing Adverse Effects |
354.05; 327.73 | 0.124 |
| SECONDARY Percentage Developing Adverse Effects |
129; 137 | 0.004 sig |
| SECONDARY Percentage of Subjects Tolerant of the Treatment |
93.2; 98.7; 76.1; 91.3; 50.3; 70.8 | 0.002 sig |
| SECONDARY Percentage of Participants Developing Disability Warranting Dopaminergic Therapy Over Time |
0; 0; 30.81; 32.42; 59.01; 56.32 | 0.497 |
| SECONDARY Clinical Efficacy: Rate of Change in Parkinson's Disease Questionnaire - 39 Item Version (PDQ-39) Scale |
0.686; 0.756 | 0.856 |
| SECONDARY Clinical Efficacy: Rate of Change in Quality of Life in Neurological Disorders (Neuro-QOL) |
-0.397; -0.473; 0.014; -0.282; 0.055; -0.201 | 0.736 |
| SECONDARY Clinical Efficacy: Rate of Change in Quality of Life in Neurological Disorders (Neuro-QOL) Depression Module |
-0.023; 0.083 | 0.454 |
| SECONDARY Clinical Efficacy: Rate of Change in Schwab and England Scale |
-0.833; -0.880 | 0.910 |
| SECONDARY Clinical Efficacy: Rate of Change in Montreal Cognitive Assessment (MoCA) |
0.186; 0.226 | 0.758 |
| SECONDARY Symptomatic Effects |
-1.509; -1.301; -2.729; -0.328 | 0.796 |
Summary
A multicenter, randomized, double-blind, placebo-controlled, phase 3 trial to determine whether oral inosine dosed to moderately elevate serum urate (from ≤5.7 mg/dL to 7.1-8.0 mg/dL) over 2 years slows clinical decline in early PD.
Clinical decline will be assessed as change in the primary outcome variable of the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), a composite scale comprising patient- and clinician-reported outcomes.
Eligibility Criteria
INCLUSION CRITERIA
Study subjects meeting all of the following criteria will be allowed to enroll in the study:
- Willingness and ability to give written informed consent and to comply with trial procedures.
- Fulfillment of diagnostic criteria for idiopathic PD with at least two of the cardinal signs of PD (resting tremor, bradykinesia, rigidity) present at 2nd screening and baseline evaluations, as assessed by the Site Investigator.
- Absence of current or imminent (within 90 days of enrollment) PD disability requiring dopaminergic therapy, as assessed by the Site Investigator.
- Modified Hoehn and Yahr Scale Stage 1 to 2.5 inclusive.
- Age 30 or older at the time of PD diagnosis.
- Diagnosis of PD made within 3 years prior to 1st Screening Visit.
- Non-fasting serum urate ≤ 5.7 mg/dL at 1st Screening Visit (SC1).
- If the subject is female, then:
- Being surgically sterile (hysterectomy or tubal ligation), or
- Being postmenopausal (last menstruation was two years or more prior to 2nd Screening Visit), or
- For those of childbearing potential
- Using a reliable form of contraception for 60 days or more prior to Baseline Visit and agreeing to continue such use for 30 days post last dose of study drug. Reliable forms of contraception include: abstinence; implanted, injected or oral contraceptives (birth control pills), intrauterine device in place for at least 3 months prior to Baseline Visit, vaginal ring with spermicide, barrier with spermicide such as male or female condom, diaphragm or cervical cap, transdermal patch; male partner with vasectomy.
- And having a negative pregnancy test at the 2nd Screening Visit. [Note that a urine pregnancy test will be performed at screening on all women who are not at least two years postmenopausal or surgically sterile.]
EXCLUSION CRITERIA
Study subjects meeting any of the following criteria during screening evaluations will be excluded from entry into the study:
- Atypical parkinsonism, including that due to drugs, metabolic disorders, encephalitis, cerebrovascular disease, normal pressure hydrocephalus, or other neurodegenerative disease.
- Dopamine transporter (DAT) brain scan without evidence of dopamine deficit.
- History of gout.
- History of uric acid or urate urolithiasis, or recurrent urolithiasis all of unknown type.
- A screening test positive for uric acid crystalluria, urine pH ≤ 5.0, or an estimated glomerular filtration rate < 60 ml/min/1.73 m2.
- History of myocardial infarction or stroke.
- Symptomatic congestive heart failure with a documented ejection fraction below 45%.
- History of severe chronic obstructive pulmonary disease.
- Mini Mental State Exam score < 25; i.e., a score of 0 to 24.
- Use of any anti-parkinsonian medication (including levodopa, dopamine agonists, amantadine, entacapone and the anticholinergic agents trihexyphenidyl and benztropine) other than monoamine oxidase-B inhibitors within 60 days of Baseline, or in excess of 90 days.
- Change in the dosage of (or initiation of) a monoamine oxidase-B (MAO-B) inhibitor within 90 days prior to Baseline, i.e., entry on a MAO-B inhibitor requires a stable dosage for the 90 days prior to Baseline.
- Use of the following within 30 days prior to the Baseline Visit: inosine, allopurinol, febuxostat, probenecid, more than 50 IU of vitamin E daily, or more than 300 mg of vitamin C daily (though a daily standard multivitamin such as Bayer One-A-Day® or Centrum® is permissible), reserpine, methylphenidate, amphetamines, cinnarizine, monoamine oxidase-A inhibitors, tetrabenazine, neuroleptics or other dopamine blocking drugs.
- Use of the following within 90 days prior to the DAT neuroimaging screening evaluation: modafinil, armodafinil, metoclopramide, alpha-methyldopa, methylphenidate, reserpine, or amphetamine derivative.
- Unstable dosing of a thiazide -- such as hydrochlorothiazide (e.g., Esidrex), chlorothiazide (e.g., Diuril), chlorthalidone (e.g., Hygroton), indapamide
Data sourced from ClinicalTrials.gov (NCT02642393). 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.