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This study examines the efficacy of three doses of IPX066 as compared to placebo in Parkinson's disease.
A randomized, double-blind, placebo-controlled, fixed-dose, parallel-arm study of three doses of IPX066 versus placebo.
Total of 427 subjects were screened and 381 were randomized and received one of the four treatment groups (1) placebo (N=92), (2) IPX066 145 mg LD (N=87) (3) IPX066 245 mg LD (N=104) (4) IPX066 390 mg LD (N=98) three times a day.
Study duration is approximately 30 weeks for each subject including 4 weeks of titration (up to 3 weeks of dose escalation and I week of stabilization for safe escalation to the allocated dose), and 26 weeks of maintenance.
During the titration phase:
The following dose strengths were used to titrate up to the final three strengths that were assigned to the three IPX066 treatment arms.
IPX066 95 mg LD capsule containing 95 mg LD and 23.75 mg CD. IPX066 145 mg LD capsule containing 145 mg LD and 36.25 mg CD. IPX066 195 mg LD capsule containing 195 mg LD and 48.75 mg CD. IPX066 245 mg LD capsule containing 245 mg LD and 61.25 mg CD.
During the maintenance phase:
IPX066 145 mg LD treatment arm received 145 mg LD and 36.25 mg CD. IPX066 245 mg LD treatment arm received 245 mg LD and 61.25 mg CD. IPX066 390 mg LD treatment arm received 390 mg LD and 97.50 mg CD.
Primary efficacy outcome measure was change from baseline in the sum of UPDRS Part II and Part III scores at the end of study or last value reported if subject discontinued prematurely.
Summary of Change From Baseline to End of Study in Mean Parkinson's Disease Questionnaire-39 (PDQ-39) Score.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Placebo | Placebo Comparator | One Placebo capsule was given TID for the first 21 days. Two placebo capsules were given TID on days 22 till end of study (week 30). |
|
| IPX066 145 mg LD | Experimental | One IPX066 95 mg LD was given TID on days 1-3. One IPX066 145 mg LD was given TID on days 4-21. One IPX066 145 mg LD and one placebo capsule were given TID on days 22 till end of study (week 30). |
|
| IPX066 245 mg LD | Experimental | One IPX066 95 mg LD was given TID on days 1-3. One IPX066 145 mg LD was given TID on days 4-7. One IPX066 195 mg LD was given TID on days 8-14. One IPX066 245 mg LD was given TID on days 15-21. One IPX066 245 mg LD and one placebo capsule were given TID on days 22 till end of study (week 30). |
|
| IPX066 390 mg LD | Experimental | One IPX066 95 mg LD was given TID on days 1-3. One IPX066 145 mg LD was given TID on days 4-7. One IPX066 195 mg LD was given TID on days 8-14. One IPX066 245 mg LD was given TID on days 15-21. Two IPX066 195 mg LD capsules were given TID on days 22 till end of study (week 30). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Placebo | Drug | Placebo |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Change From Baseline in the Sum of UPDRS Part II + UPDRS Part III at Week 30 | Analysis of the Change from Baseline in the sum of the Unified Parkinson's Disease Rating Scale (UPDRS) Part II (Activities of Daily Living) + UPDRS Part III (Motor Examination) at Week 30 (End of Study). Unified Parkinson's Disease Rating Scale (UPDRS) - Four Parts Higher score values represent a worse outcome. Subscales II and III were summed: Part I: Mentation, Behavior and Mood - 4 questions 1-4 Score range: 1-16 Part II: Activities of Daily Living - 13 questions 5-17 Score range: 0-52 Part III: Motor Examination - 19 questions 18-31 and 25 total assessments Score range: 0-100 Part IV: Complications of Therapy (In the past week) - 11 questions Score range: 0-25 | Week 30 |
| Measure | Description | Time Frame |
|---|---|---|
| Summary of Change From Baseline to End of Study in Mean Parkinson's Disease Questionnaire-39 (PDQ-39) Score | Change from Baseline in Parkinson's disease Questionnaire 39 (PDQ-39) at Weeks 4, 9, 16, 23 and 30 or early discontinuation was collected. The PDQ-39 is a self-reported questionnaire consisting of 39 questions regarding the subjects mobility and the responses consist of "Never" (better in outcome), (value 0), "Occasionally" (value 1), "Sometimes" (value 2), , "Often" (value 3), and "Always" (value 4), (worse in outcome). The minimum possible score is "0" and the maximum is "156". The outcome measure calculated was the change from baseline to end of study in mean PDQ-39 score. Negative values indicate a better result. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Impax Study Director | Impax Laboratories, LLC | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Alabama at Birmingham, Dept. of Neurology | Birmingham | Alabama | 35233 | United States | ||
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24055014 | Background | Pahwa R, Lyons KE, Hauser RA, Fahn S, Jankovic J, Pourcher E, Hsu A, O'Connell M, Kell S, Gupta S; APEX-PD Investigators. Randomized trial of IPX066, carbidopa/levodopa extended release, in early Parkinson's disease. Parkinsonism Relat Disord. 2014 Feb;20(2):142-8. doi: 10.1016/j.parkreldis.2013.08.017. Epub 2013 Sep 5. |
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Following enrollment, subjects were randomized into one of the four treatment groups.
First patient enrolled: 4/13/2009 Last patient out 10/05/2010
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| ID | Title | Description |
|---|---|---|
| FG000 | Placebo | Placebo capsules were used |
| FG001 | IPX066 145 mg LD | IPX066 capsule containing 145 mg levodopa and 36.25 mg carbidopa |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| IPX066 95 mg LD |
| Drug |
IPX066 capsule containing 95 mg LD/23.75 mg CD |
|
|
| IPX066 145 mg LD | Drug | IPX066 capsule containing 145 mg LD/36.25 mg CD |
|
|
| IPX066 195 mg LD | Drug | IPX066 capsule containing 195 mg LD/48.75 mg CD |
|
|
| IPX066 245 mg LD | Drug | IPX066 capsule containing 245 mg LD/61.25 mg CD |
|
|
| Baseline and Week 30 (or End of Study) |
| HOPE Research Institute, LLC |
| Phoenix |
| Arizona |
| 85050 |
| United States |
| Collaborative NeuroScience Network, Inc. | Garden Grove | California | 92845 | United States |
| Coastal Neurological Medical Group | La Jolla | California | 92037 | United States |
| Coordinated Clinical Research | La Jolla | California | 92037 | United States |
| The Parkinson's Institute | Sunnyvale | California | 94085 | United States |
| Yale Neurology Clinics, Temple Medical Center | New Haven | Connecticut | 06510 | United States |
| Bradenton Research Center, Inc. | Bradenton | Florida | 34205 | United States |
| Sunrise Clinical Research, Inc. | Hollywood | Florida | 23021 | United States |
| Renstar Medical Research | Ocala | Florida | 34471 | United States |
| Charlotte Neurological Services | Port Charlotte | Florida | 33952 | United States |
| Suncoast Neuroscience Associates, Inc. | St. Petersburg | Florida | 33713 | United States |
| University of South Florida | Tampa | Florida | 33612 | United States |
| Idaho Elks Rehabilitation Hospital | Boise | Idaho | 83702 | United States |
| Rush University Medical Center, Dept. of Neurological Sciences | Chicago | Illinois | 60612 | United States |
| Landon Center on Aging, Dept. of Neurology, Parkinson's Disease Center | Kansas City | Kansas | 66160-7314 | United States |
| Boston University School of Medicine | Boston | Massachusetts | 02118 | United States |
| Quest Research Institute | Bingham Farms | Michigan | 48025 | United States |
| Struthers Parkinson's Center | Golden Valley | Minnesota | 55427 | United States |
| UMDNJ Robert Wood Johnson Medical Center, Department of Neurology | New Brunswick | New Jersey | 08901 | United States |
| Mount Sinai School of Medicine | New York | New York | 10029 | United States |
| Columbia University | New York | New York | 10032 | United States |
| State University of New York Upstate Medical University, Dept. of Neurology | Syracuse | New York | 13210 | United States |
| Duke University Medical Center Movement Disorders Center | Durham | North Carolina | 27705 | United States |
| University of Toledo | Toledo | Ohio | 43614 | United States |
| Baylor College of Medicine, Parkinson's Disease Center | Houston | Texas | 77030 | United States |
| Wisconsin Institute for Neurologic and Sleep Disorders | Milwaukee | Wisconsin | 53233 | United States |
| Movement Disorders Clinic, Glenrose Rehabilitation Hospital | Edmonton | Alberta | T5G 0B7 | Canada |
| Saint Boniface Clinic | Winnipeg | Manitoba | R3J2H7 | Canada |
| London Health Science Center | London | Ontario | N6A 5A5 | Canada |
| Parkinson's and Neurodegenerative Disorders Clinic | Ottawa | Ontario | K1G 4G3 | Canada |
| Ottawa Hospital Civic Site | Ottawa | Ontario | K1Y 4E9 | Canada |
| Toronto Western Hospital | Toronto | Ontario | M5T 2S8 | Canada |
| Memory and Motor Skills Clinic | Québec | Quebec | G1R 3X5 | Canada |
| University of Sherbrooke | Sherbrooke | Quebec | J1H 5N4 | Canada |
| East Tallinn Central Hospital | Tallinn | 10138 | Estonia |
| West Tallin Central Hopsital | Tallinn | 10617 | Estonia |
| P.Stradina university hospital | Riga | 1002 | Latvia |
| Gailezers hospital | Riga | Latvia |
| Kaunas Medical University Hospital | Kaunas | LT-50009 | Lithuania |
| Siauliai Regional Hospital | Šiauliai | LT- 76231 | Lithuania |
| Vilnius University Emergency Hospital | Vilnius | LT-04130 | Lithuania |
| Vilnius University Centre of Gerontology and Rehabilitation | Vilnius | LT-08420 | Lithuania |
| Vilnius University Hospital Santariskiu klinikos | Vilnius | LT-08661 | Lithuania |
| Psychiatry and Neurology Hospital, Neurology Department | Brasov | 500123 | Romania |
| Colentina Clinical Hospital Bucharest, II Neurology Department | Bucharest | 020125 | Romania |
| County Emergency Clinical Hospital Cluj-Napoca, I Neurology Clinic | Cluj-Napoca | 400012 | Romania |
| CFR Clinical Hospital Constanta | Constanța | 900123 | Romania |
| Clinical Rehabilitation Hospital Iasi, Neurology Department | Iași | Romania |
| County Clinical Emergency Hospital, Targu Mures, II Neurology Department, | Târgu Mureş | 540136 | Romania |
| County Clinical Emergency Hospital Timisoara | Timișoara | 300736 | Romania |
| Neurology department of Regional hospital named after Mechnikov | Dnipro | 49005 | Ukraine |
| Department of Psychiatry and Medical Psychology of Donetsk National Medical University | Donetsk | 83037 | Ukraine |
| Department of Neurological Diseases and Medical Genetic of Donetsk National Medical University | Donetsk | 83099 | Ukraine |
| 1st neurology department of Central Clinical Hospital of Ukrzaliznytsya | Kharkiv | Kharkiv | Ukraine |
| Institute of Gerontology Parkinson's Disease Center | Kiev | 04114 | Ukraine |
| Neurology department of Lviv regional clinical hospital | Lviv | 79010 | Ukraine |
| Neurology department of Medical Dental Academy based on Poltava regional hospital | Poltava | 36000 | Ukraine |
| Neurology department of Vinnitsa Medical University | Vinnitsa | 21018 | Ukraine |
| Neurology department, Zaporozhye State Medical University | Zaporizhzhya | 69035 | Ukraine |
| FG002 | IPX066 245 mg LD | IPX066 capsules containing 245 mg levodopa and 61.25 mg carbidopa |
| FG003 | IPX066 390 mg LD | IPX066 capsules that contained 390 mg levodopa and 97.5 mg carbidopa |
| Week 4 |
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| Week 9 |
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| Week 16 |
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| Week 23 |
|
| COMPLETED | Week 30 |
|
| NOT COMPLETED |
|
|
Baseline Analysis Population is all treated
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| ID | Title | Description |
|---|---|---|
| BG000 | Placebo | Placebo capsules were used |
| BG001 | IPX066 145 mg LD | IPX066 capsules containing 145 mg levodopa and 36.25 mg carbidopa |
| BG002 | IPX066 245 mg LD | IPX066 capsules containing 245 mg levodopa and 61.25 mg carbidopa |
| BG003 | IPX066 390 mg LD | IPX066 capsules containing 390 mg levodopa and 97.5 mg carbidopa |
| BG004 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | years |
| |||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
| ||||||||||||||||
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
| ||||||||||||||||
| Race/Ethnicity, Customized | Number | participants |
| ||||||||||||||||
| Region of Enrollment | Number | participants |
| ||||||||||||||||
| Age at Parkinson's disease onset | Mean | Standard Deviation | years |
| |||||||||||||||
| Duration of Parkinson's disease | Mean | Standard Deviation | years |
| |||||||||||||||
| UPDRS Parts II and III Score | Unified Parkinson's Disease Rating Scale (UPDRS) - Four Parts Higher score values represent a worse outcome. Subscales II and III were summed: Part I: Mentation, Behavior and Mood - 4 questions 1-4 Score range: 1-16 Part II: Activities of Daily Living - 13 questions 5-17 Score range: 0-52 Part III: Motor Examination - 19 questions 18-31 and 25 total assessments Score range: 0-100 Part IV: Complications of Therapy (In the past week) - 11 questions Score range: 0-25 | Mean | Standard Deviation | units on a scale |
| ||||||||||||||
| Hoehn and Yahr Stage | Hoehn and Yahr Staging of Parkinson's Disease: Stages move from 1 - 5 with the worse outcome stage being Stage 5. Stage 1 = Symptoms on one side of the body only. Stage 2 = Symptoms on both sides of the body, No impairment of balance. Stage 3 = Balance impairment. Mild to moderate disease. Physically independent. Stage 4 = Severe disability but still able to walk or stand unassisted. Stage 5 = Wheelchair bound or bedridden unless assisted. | Number | units on a scale |
| |||||||||||||||
| MMSE | The Mini-Mental State Examination (MMSE) is a 30-point questionnaire that is used extensively to measure cognitive impairment. Any score greater than or equal to 24 points (out of 30) indicates a normal cognition. Below this, scores can indicate severe (≤9 points), moderate (10-18 points) or mild (19-23 points) cognitive impairment. | Mean | Standard Deviation | units on a scale |
|
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Change From Baseline in the Sum of UPDRS Part II + UPDRS Part III at Week 30 | Analysis of the Change from Baseline in the sum of the Unified Parkinson's Disease Rating Scale (UPDRS) Part II (Activities of Daily Living) + UPDRS Part III (Motor Examination) at Week 30 (End of Study). Unified Parkinson's Disease Rating Scale (UPDRS) - Four Parts Higher score values represent a worse outcome. Subscales II and III were summed: Part I: Mentation, Behavior and Mood - 4 questions 1-4 Score range: 1-16 Part II: Activities of Daily Living - 13 questions 5-17 Score range: 0-52 Part III: Motor Examination - 19 questions 18-31 and 25 total assessments Score range: 0-100 Part IV: Complications of Therapy (In the past week) - 11 questions Score range: 0-25 | Analysis included all treated subjects with at least one efficacy measurement after dosing. Subjects who had no post-baseline efficacy assessments (N4) and those who had early termination assessments>3 days after last dose and no other post-baseline measurements (N16) were not included in the efficacy analysis set. Randomized (381)-(4+16) = 361. | Posted | Mean | Standard Deviation | units on a scale | Week 30 |
|
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| ||||||||||||||||||||||||||||||||||
| Secondary | Summary of Change From Baseline to End of Study in Mean Parkinson's Disease Questionnaire-39 (PDQ-39) Score | Change from Baseline in Parkinson's disease Questionnaire 39 (PDQ-39) at Weeks 4, 9, 16, 23 and 30 or early discontinuation was collected. The PDQ-39 is a self-reported questionnaire consisting of 39 questions regarding the subjects mobility and the responses consist of "Never" (better in outcome), (value 0), "Occasionally" (value 1), "Sometimes" (value 2), , "Often" (value 3), and "Always" (value 4), (worse in outcome). The minimum possible score is "0" and the maximum is "156". The outcome measure calculated was the change from baseline to end of study in mean PDQ-39 score. Negative values indicate a better result. | Subjects who had no postbaseline efficacy assessments (N=4) and those who had early termination assessments >3 days after last dose and no other postbaseline measurements (N=16) were not included in the efficacy analysis. 2 subjects without a baseline measurement, 1 each from 145mg and 390mg arm were also excluded. Randomized 381-4-16-2=359. | Posted | Mean | Standard Deviation | score on a scale | Baseline and Week 30 (or End of Study) |
|
1 year, 6 months
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Placebo | Placebo capsules were used | 3 | 92 | 26 | 92 | ||
| EG001 | IPX066 145 mg LD | IPX066 capsules containing 145 mg levodopa and 36.25 mg carbidopa | 4 | 87 | 27 | 87 | ||
| EG002 | IPX066 245 mg LD | IPX066 capsules containing 245 mg levodopa and 61.25 mg carbidopa | 5 | 104 | 47 | 104 | ||
| EG003 | IPX066 390 mg LD | IPX066 capsules containing 390 mg levodopa and 97.5 mg carbidopa | 2 | 98 | 48 | 98 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Acute myocardial infarction | Cardiac disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Atrioventricular block complete | Cardiac disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Coronary artery disease | Cardiac disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Myocardial infarction | Cardiac disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Abdominal strangulated hernia | Gastrointestinal disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Escherichia urinary tract infection | Infections and infestations | MedDRA (12.0) | Non-systematic Assessment |
| |
| Urinary tract infection | Infections and infestations | MedDRA (12.0) | Non-systematic Assessment |
| |
| Urosepsis | Infections and infestations | MedDRA (12.0) | Non-systematic Assessment |
| |
| Osteoarthritis | Musculoskeletal and connective tissue disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Non-Hodgkin's Lymphoma | Neoplasms benign, malignant and unspecified (incl cysts and polyps) | MedDRA (12.0) | Non-systematic Assessment |
| |
| Cerebrovascular accident | Nervous system disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Chronic obstructive pulmonary disease | Respiratory, thoracic and mediastinal disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Emphysema | Respiratory, thoracic and mediastinal disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Coronary Artery Bypass | Surgical and medical procedures | MedDRA (12.0) | Non-systematic Assessment |
| |
| Prostatectomy | Surgical and medical procedures | MedDRA (12.0) | Non-systematic Assessment |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Nausea | Gastrointestinal disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Headache | Nervous system disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Dizziness | Nervous system disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Insomnia | Psychiatric disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Abnormal dreams | Psychiatric disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Dry Mouth | Gastrointestinal disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Vomiting | Gastrointestinal disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Constipation | Gastrointestinal disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Dyskinesia | Nervous system disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Anxiety | Psychiatric disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Depression | Psychiatric disorders | MedDRA (12.0) | Non-systematic Assessment |
| |
| Orthostatic Hypotension | Vascular disorders | MedDRA (12.0) | Non-systematic Assessment |
|
Publication of the results of the Study conducted at the Site shall not be made before the first multi-site publication by Sponsor.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Kaihong Jiang, Senior Director, Head of Biometrics | Impax Laboratories, LLC | 908-307-2234 | kaihong.jiang@amneal.com |
| ID | Term |
|---|---|
| D010300 | Parkinson Disease |
| ID | Term |
|---|---|
| D020734 | Parkinsonian Disorders |
| D001480 | Basal Ganglia Diseases |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D009069 | Movement Disorders |
| D000080874 | Synucleinopathies |
| D019636 | Neurodegenerative Diseases |
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| ID | Term |
|---|---|
| C009265 | carbidopa, levodopa drug combination |
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| Male |
|
| Not Hispanic or Latino |
|
| Unknown or Not Reported |
|
| Black or African American |
|
| White |
|
| Other |
|
| Latvia |
|
| Romania |
|
| United States |
|
| Ukraine |
|
| Lithuania |
|
| Estonia |
|
| Stage II |
|
| Remaining |
|
| OG002 |
| IPX066 390 mg LD |
IPX066 capsules containing 390 mg levodopa and 97.5 mg carbidopa |
| OG003 | Placebo | Placebo capsules were used |
|
|