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This is a multicenter, parallel-group, rater-blinded, randomized clinical study in subjects with advanced PD investigating the efficacy, PK, safety and tolerability of continuous SC infusion of 2 dosing regimens of ND0612H, a solution of LD/CD delivered via a pump system as a continuous SC infusion, compared to standard oral LD/CD. After screening, subjects will undergo 1 day of standard oral LD/CD inpatient dosing followed by 2 days of inpatient treatment with 1 of 2 randomly allocated (1:1 randomization ratio) dosing regimens of ND0612H continuous SC infusion. Subjects will then continue on a maintenance dose of the assigned ND0612H dosing regimen for the next 25 days. A safety visit will be performed 4 weeks after the last SC administration of the study drug for a total of about 2.5 months of participation for each subject enrolled into the trial.
This phase IIa randomized, controlled, parallel-group study will be conducted in 36 subjects with advanced PD who are treated with oral LD/CD at a stable dose and have predictable morning "OFF" periods and at least 2.5 hrs of daily "OFF" periods. The study will investigate the efficacy, PK, safety and tolerability of continuous SC infusion of 2 dosing regimens of ND0612H. Regimen 1 will employ continuous infusion for 24 hrs using a low infusion rate at night and a higher rate at daytime with supplemental administration of oral immediate release (IR) LD/CD in the mornings. During the inpatient period of about 3 days, the site staff will manage the administration and replacement of the infusions. On Day 4 subjects will be discharged home after they and their study partners have received training on the administration of the infusion. Subjects will then continue on a maintenance dose of the assigned ND0612 dosing regimen for the next 25 days. A safety visit will be performed 4 weeks after the last SC administration of the study drug.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ND0612 (Levodopa/Carbidopa solution) Dosing Regimen 1 | Experimental | Dosing Regimen 1 of ND0612 (Levodopa/Carbidopa solution) continuous SC infusion over 24 hours. |
|
| ND0612 (Levodopa/Carbidopa solution) Dosing Regimen 2 | Experimental | Dosing Regimen 2 of ND0612 (Levodopa/Carbidopa solution) continuous SC infusion over 14 hours. Infusion started at wake-up time supplemented with an oral IR LD/CD tablet. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ND0612 (Levodopa/Carbidopa solution) | Drug | The total daily dose of levodopa/carbidopa 720/90 mg. Device: CRONO TWIN pump system. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change in Daily "OFF" Time | Based on Parkinson's disease symptom assessment, "ON" time is when there is good response to medication and few symptoms. "OFF" time is when no there is no response to medication and significant motor symptoms. An "ON/OFF" Log was completed by a blinded rater starting before the first dose of LD/DDI and following the first dose at 30 min intervals for 8 hrs. The changes in "OFF" time as hours (normalized to 16 hrs of awake time) during the 8 hrs of data collection were estimated. Negative change from baseline for "OFF" time indicates improvement. | Baseline to Day 28 |
| Measure | Description | Time Frame |
|---|---|---|
| The Percentage of Subjects With Full "ON" at Approximately 08:00 and Approximately 09:00, as Determined by the Subject | Based on Parkinson's disease symptom assessment, "ON" time is when there is good response to medication and few symptoms. "OFF" time is when no there is no response to medication and significant motor symptoms. Subjects were asked to indicate when exactly in their opinion they had turned to full "ON" (i.e. an "ON" response comparable to the "ON" response to standard oral LD/DDI treatment). Higher percentage of subjects with full "ON" on Day 28 indicates improvement. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Laurence Salin, MD | NeuroDerm Ltd. | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Northwestern University | Chicago | Illinois | 60611 | United States | ||
| QUEST Research Institute |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33164945 | Result | Olanow CW, Espay AJ, Stocchi F, Ellenbogen AL, Leinonen M, Adar L, Case RJ, Orenbach SF, Yardeni T, Oren S, Poewe W; 006 study group. Continuous Subcutaneous Levodopa Delivery for Parkinson's Disease: A Randomized Study. J Parkinsons Dis. 2021;11(1):177-186. doi: 10.3233/JPD-202285. |
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| ID | Title | Description |
|---|---|---|
| FG000 | ND0612 (Levodopa/Carbidopa Solution) Dosing Regimen 1 | Dosing Regimen 1 of ND0612 (Levodopa/Carbidopa solution) continuous SC infusion over 24 hours ND0612 (Levodopa/Carbidopa solution, 720/90 mg daily) |
| FG001 | ND0612 (Levodopa/Carbidopa Solution) Dosing Regimen 2 |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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|
| ND0612 (Levodopa/Carbidopa solution) + morning oral IR-LD/CD | Drug | The total daily dose levodopa/carbidopa from ND0612 538/67 mg. Morning dose of oral IR-LD/CD 150/15 mg. Device: CRONO TWIN pump system. |
|
|
| Baseline to Day 28 |
| Change in Daily "Good ON" Time as Assessed by a Blinded Rater | Based on Parkinson's disease symptom assessment, "ON" time is when there is good response to medication and few symptoms. "OFF" time is when no there is no response to medication and significant motor symptoms. "Good ON" time means "ON" time without troublesome dyskinesia (involuntary muscle movement), defined as the sum of "ON" time without dyskinesia and "ON" time with non-troublesome dyskinesia. An "ON/OFF" Log was completed by a blinded rater starting before the first dose of LD/DDI and following the first dose at 30 min intervals for 8 hrs. Daily total scores were normalized to 16 hours of awake time. Positive change from baseline for "ON" time without dyskinesia and for "Good ON" time, and a negative change in "ON" time with moderate or severe (troublesome) dyskinesia indicates improvement. | Baseline to Day 28 |
| Change in Morning UPDRS Part III (Motor) Scores | The Unified Parkinson's Disease Rating Scale (UPDRS) is an Investigator-used rating tool to follow the longitudinal course of Parkinson's disease. UPDRS part III (motor) score is calculated as the sum of the individual UPDRS items 18-31, each of which are measured on a 5-point scale (i.e., 0 is normal and 4 indicates a severe abnormality). UPDRS part III was done as a motor examination on Day 1 before the first dose of standard oral LD/DDI and at the same time on Day 28. The range of score values is from 0 to 132. Higher scores correlate with greater motor impairment. | Baseline to Day 28 |
| Change in UPDRS Part II (ADL) Scores | The Unified Parkinson's disease rating scale (UPDRS) is an Investigator-used rating tool to follow the longitudinal course of Parkinson's disease. The UPDRS Part II (activity of daily living) score was calculated as the sum of the individual UPDRS items 5-17. The Part II score is the sum of the answers to the 13 questions that comprise Part II, each of which are measured on a 5-point scale (i.e., 0 is normal and 4 indicates a severe abnormality). The range of score values is from 0 to 52. Higher scores correlate with greater impairments for daily activities. | Baseline to Day 28 |
| CGI-Improvement (CGI-I) Score as Assessed by Investigator | Global improvement was rated by the investigator or designee using Clinical Global Impression of Improvement (CGI-I). The CGI-I employs a 7-point scale with 1 being "very much improved" and 7 being "very much worse" for improvement rating. | Baseline to Day 28 |
| Change in PDSS-2 Total Score | The quality of night sleep was rated by the subjects using the Parkinson's Disease Sleep Scale (PDSS)-2, which includes questions addressing 15 commonly reported symptoms associated with sleep disturbance in PD. Each question is assessed from 0 (Always) to 10 (Never). The total score values range from 0 to 150. Higher scores indicate a lower quality of sleep, i.e., a reduction in the score indicates an improvement in sleep quality. | Baseline to Day 27 |
| Change in PDQ-39 Summary Index and the 8-dimension Scores | Subjects were requested to rate their quality of life using the Quality of Life in Parkinson's Disease (PDQ)-39, a 39-item, self-administered questionnaire with 8 discrete dimensions (mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort.). The PDQ-39 Summary Index is the sum of the dimension scores divided by the number of dimensions. The total score values range from 0 to 100%. Higher scores indicate a worse quality of life. | Baseline to Day 27 |
| Farmington Hills |
| Michigan |
| 48334 |
| United States |
| University of Cincinnati | Cincinnati | Ohio | 45219 | United States |
| Medical University Innsbruck | Innsbruck | A- 4060 | Austria |
| Rabin Medical Center | Petah Tikva | 4941492 | Israel |
| Chaim Sheba Medical Center | Ramat Gan | 56520 | Israel |
| Sourasky Medical Center | Tel Aviv | 64239 | Israel |
| University Foundation | Chieti | 66100 | Italy |
| AOU Pisa | Pisa | 56126 | Italy |
| IRCCS San Raffaele Pisana | Rome | 00163 | Italy |
| Fondazione Ospedale San Camillo - I.R.C.C.S. | Venice | 30126 | Italy |
Dosing Regimen 2 of ND0612 (Levodopa/Carbidopa solution) continuous SC infusion over 14 hours ND0612 (Levodopa/Carbidopa solution, 538/67 mg daily) + IR-LD/CD (oral Levodopa/Carbidopa, 150/15 mg in the morning) |
| COMPLETED |
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| NOT COMPLETED |
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|
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| ID | Title | Description |
|---|---|---|
| BG000 | ND0612 Regimen 1 - 24-hr Infusion | Randomized participants received via a pump continuous, SC, 24-hour infusion of ND0612. |
| BG001 | ND0612 Regimen 2 - 14-hr Infusion | Randomized participants received via a pump continuous, SC, 14-hour infusion of ND0612. Infusion started at wake-up time supplemented with an oral IR LD/CD tablet. |
| BG002 | 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 |
| ||||||||||||||||
| Modified Hoehn and Yahr Stage | A commonly used system for describing how the symptoms of Parkinson's disease progress. Stage 0: No signs of disease. Stage 1: Unilateral symptoms only. Stage 1.5: Unilateral and axial involvement. Stage 2: Bilateral symptoms. No impairment of balance. Stage 2.5: Mild bilateral disease with recovery on pull test. Stage 3: Balance impairment. Mild to moderate disease. Physically independent. Stage 4: Severe disability, but still able to walk or stand unassisted. Stage 5: Needing a wheelchair or bedridden unless assisted. | Count of Participants | Participants |
| |||||||||||||||
| Time since Parkinson's disease diagnosis | Mean | Standard Deviation | Years |
| |||||||||||||||
| Time since motor fluctuations | Mean | Standard Deviation | Years |
| |||||||||||||||
| Time since dyskinesia onset | Mean | Standard Deviation | years |
| |||||||||||||||
| Daily "OFF" time | "OFF" state is a phase with no response to medication and significant motor symptoms. An assessment of motor state ("OFF", "ON" without dyskinesia, "ON" with dyskinesia (mild, moderate, severe)) was performed by the blinded rater during 8 hours (normalized to 16 hours of awake time). | Mean | Standard Deviation | Hours |
| ||||||||||||||
| Daily "Good ON" time | "ON" without dyskinesia and "ON" with mild dyskinesia. An assessment of motor state ("OFF", "ON" without dyskinesia, "ON" with dyskinesia (mild, moderate, severe)) was performed by the blinded rater during 8 hours (normalized to 16 hours of awake time). | Mean | Standard Deviation | Hours |
| ||||||||||||||
| Daily time with troublesome dyskinesia | Dyskinesia defined as moderate or severe in intensity. An assessment of motor state ("OFF", "ON" without dyskinesia, "ON" with dyskinesia (mild, moderate, severe)) was performed by the blinded rater during 8 hours (normalized to 16 hours of awake time). | Mean | Standard Deviation | Hours |
| ||||||||||||||
| UPDRS Part III (motor) score | Unified Parkinson's Disease Rating Scale (UPDRS) is divided into four scales. Part III (questions 18-31) is done as a motor examination. The various items to be rated are scored using a 5-point system (i.e., 0 is normal and 4 indicates a severe abnormality, half point scores are allowed for Part III questions). The range of score values is from 0 to 132. Higher value indicate greater impairment. | Mean | Standard Deviation | Score |
| ||||||||||||||
| PD medications | Count of Participants | Participants |
| ||||||||||||||||
| Levodopa dose | Mean | Standard Deviation | mg |
|
| 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 in Daily "OFF" Time | Based on Parkinson's disease symptom assessment, "ON" time is when there is good response to medication and few symptoms. "OFF" time is when no there is no response to medication and significant motor symptoms. An "ON/OFF" Log was completed by a blinded rater starting before the first dose of LD/DDI and following the first dose at 30 min intervals for 8 hrs. The changes in "OFF" time as hours (normalized to 16 hrs of awake time) during the 8 hrs of data collection were estimated. Negative change from baseline for "OFF" time indicates improvement. | mITT Set | Posted | Least Squares Mean | 95% Confidence Interval | Hours | Baseline to Day 28 |
|
|
| ||||||||||||||||||||||||||||
| Secondary | The Percentage of Subjects With Full "ON" at Approximately 08:00 and Approximately 09:00, as Determined by the Subject | Based on Parkinson's disease symptom assessment, "ON" time is when there is good response to medication and few symptoms. "OFF" time is when no there is no response to medication and significant motor symptoms. Subjects were asked to indicate when exactly in their opinion they had turned to full "ON" (i.e. an "ON" response comparable to the "ON" response to standard oral LD/DDI treatment). Higher percentage of subjects with full "ON" on Day 28 indicates improvement. | mITT Set in Regimen 1. Regimen 2 was not optimized for morning efficacy assessment (it required the arrival of a nurse in the morning to administer oral IR LD/CD and begin the infusion). | Posted | Count of Participants | Participants | Baseline to Day 28 |
|
| ||||||||||||||||||||||||||||||
| Secondary | Change in Daily "Good ON" Time as Assessed by a Blinded Rater | Based on Parkinson's disease symptom assessment, "ON" time is when there is good response to medication and few symptoms. "OFF" time is when no there is no response to medication and significant motor symptoms. "Good ON" time means "ON" time without troublesome dyskinesia (involuntary muscle movement), defined as the sum of "ON" time without dyskinesia and "ON" time with non-troublesome dyskinesia. An "ON/OFF" Log was completed by a blinded rater starting before the first dose of LD/DDI and following the first dose at 30 min intervals for 8 hrs. Daily total scores were normalized to 16 hours of awake time. Positive change from baseline for "ON" time without dyskinesia and for "Good ON" time, and a negative change in "ON" time with moderate or severe (troublesome) dyskinesia indicates improvement. | mITT Set | Posted | Least Squares Mean | 95% Confidence Interval | Hours | Baseline to Day 28 |
| ||||||||||||||||||||||||||||||
| Secondary | Change in Morning UPDRS Part III (Motor) Scores | The Unified Parkinson's Disease Rating Scale (UPDRS) is an Investigator-used rating tool to follow the longitudinal course of Parkinson's disease. UPDRS part III (motor) score is calculated as the sum of the individual UPDRS items 18-31, each of which are measured on a 5-point scale (i.e., 0 is normal and 4 indicates a severe abnormality). UPDRS part III was done as a motor examination on Day 1 before the first dose of standard oral LD/DDI and at the same time on Day 28. The range of score values is from 0 to 132. Higher scores correlate with greater motor impairment. | mITT Set | Posted | Least Squares Mean | 95% Confidence Interval | score on a scale | Baseline to Day 28 |
|
| |||||||||||||||||||||||||||||
| Secondary | Change in UPDRS Part II (ADL) Scores | The Unified Parkinson's disease rating scale (UPDRS) is an Investigator-used rating tool to follow the longitudinal course of Parkinson's disease. The UPDRS Part II (activity of daily living) score was calculated as the sum of the individual UPDRS items 5-17. The Part II score is the sum of the answers to the 13 questions that comprise Part II, each of which are measured on a 5-point scale (i.e., 0 is normal and 4 indicates a severe abnormality). The range of score values is from 0 to 52. Higher scores correlate with greater impairments for daily activities. | mITT Set | Posted | Least Squares Mean | 95% Confidence Interval | score on a scale | Baseline to Day 28 |
|
| |||||||||||||||||||||||||||||
| Secondary | CGI-Improvement (CGI-I) Score as Assessed by Investigator | Global improvement was rated by the investigator or designee using Clinical Global Impression of Improvement (CGI-I). The CGI-I employs a 7-point scale with 1 being "very much improved" and 7 being "very much worse" for improvement rating. | mITT | Posted | Count of Participants | Participants | Baseline to Day 28 |
|
| ||||||||||||||||||||||||||||||
| Secondary | Change in PDSS-2 Total Score | The quality of night sleep was rated by the subjects using the Parkinson's Disease Sleep Scale (PDSS)-2, which includes questions addressing 15 commonly reported symptoms associated with sleep disturbance in PD. Each question is assessed from 0 (Always) to 10 (Never). The total score values range from 0 to 150. Higher scores indicate a lower quality of sleep, i.e., a reduction in the score indicates an improvement in sleep quality. | mITT Set | Posted | Least Squares Mean | 95% Confidence Interval | score on a scale | Baseline to Day 27 |
|
| |||||||||||||||||||||||||||||
| Secondary | Change in PDQ-39 Summary Index and the 8-dimension Scores | Subjects were requested to rate their quality of life using the Quality of Life in Parkinson's Disease (PDQ)-39, a 39-item, self-administered questionnaire with 8 discrete dimensions (mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort.). The PDQ-39 Summary Index is the sum of the dimension scores divided by the number of dimensions. The total score values range from 0 to 100%. Higher scores indicate a worse quality of life. | mITT Set | Posted | Least Squares Mean | 95% Confidence Interval | score on a scale | Baseline to Day 27 |
|
| |||||||||||||||||||||||||||||
| Post-Hoc | Percentage of Subjects Who Achieved at Least Certain Percent Reduction in Average Daily Normalized "OFF" Time | Determination of percentage of subjects who had a complete and 50% reduction in daily "OFF" time from baseline to Day 28 during 8 hrs observations. | mITT Set subjects in Regimen 1 who had valid data for the analysis at baseline and Day 28. LOCF Imputation. | Posted | Count of Participants | Participants | Baseline to Day 28 |
|
|
From Baseline to the end of treatment plus 28 days
Treatment emergent adverse events are defined as all AEs that start on or after the start of first study drug administration
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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 | ND0612 Regimen 1 - 24-hr Infusion | Randomized participants received via a pump continuous, SC, 24-hour infusion of ND0612. | 0 | 19 | 2 | 19 | 15 | 19 |
| EG001 | ND0612 Regimen 2 - 14-hr Infusion | Randomized participants received via a pump continuous, SC, 14-hour infusion of ND0612. Infusion started at wake-up time supplemented with an oral IR LD/CD tablet. | 0 | 19 | 2 | 19 | 14 | 19 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Facial bones fracture | Injury, poisoning and procedural complications | MedDRA 18.1 | Systematic Assessment |
| |
| Fall | Injury, poisoning and procedural complications | MedDRA 18.1 | Systematic Assessment |
| |
| Orthostatic hypotension | Vascular disorders | MedDRA 18.1 | Systematic Assessment |
| |
| Panniculitis | Skin and subcutaneous tissue disorders | MedDRA 18.1 | Systematic Assessment |
| |
| Parkinson's disease | Nervous system disorders | MedDRA 18.1 | Systematic Assessment | Worsening |
|
| Subcutaneous abscess | Infections and infestations | MedDRA 18.1 | Systematic Assessment |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Infusion site nodule | General disorders | MedDRA 18.1 | Systematic Assessment |
| |
| Infusion site bruising | General disorders | MedDRA 18.1 | Systematic Assessment |
| |
| Infusion site erythema | General disorders | MedDRA 18.1 | Systematic Assessment |
| |
| Infusion site haemorrhage | General disorders | MedDRA 18.1 | Systematic Assessment |
| |
| Infusion site haematoma | General disorders | MedDRA 18.1 | Systematic Assessment |
| |
| Infusion site pain | General disorders | MedDRA 18.1 | Systematic Assessment |
| |
| Infusion site edema | General disorders | MedDRA 18.1 | Systematic Assessment |
| |
| Infusion site pruritus | General disorders | MedDRA 18.1 | Systematic Assessment |
| |
| Parkinson's disease | Nervous system disorders | MedDRA 18.1 | Systematic Assessment | Worsening |
|
| Headache | Nervous system disorders | MedDRA 18.1 | Systematic Assessment |
| |
| Depression | Psychiatric disorders | MedDRA 18.1 | Systematic Assessment |
| |
| Orthostatic hypotension | Vascular disorders | MedDRA 18.1 | Systematic Assessment |
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The sponsor must review and approve any results of the study or abstracts for professional meetings prepared by the investigator(s). Published data must not compromise the objectives of the study. Data from individual study centers in multicenter studies must not be published separately.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Laurence Salin, MD, Senior Medical Director | NeuroDerm Ltd. | laurence@neuroderm.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 |
Not provided
Not provided
| ID | Term |
|---|---|
| D007980 | Levodopa |
| ID | Term |
|---|---|
| D004295 | Dihydroxyphenylalanine |
| D002395 | Catecholamines |
| D000588 | Amines |
| D009930 | Organic Chemicals |
| D002396 | Catechols |
| D010636 | Phenols |
| D001555 | Benzene Derivatives |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D010649 | Phenylalanine |
| D024322 | Amino Acids, Aromatic |
| D000598 | Amino Acids, Cyclic |
| D000596 | Amino Acids |
| D000602 | Amino Acids, Peptides, and Proteins |
| D014443 | Tyrosine |
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| Male |
|
| 1.5 |
|
| 2 |
|
| 2.5 |
|
| 3 |
|
| Dopamine agonists |
|
| Monoamine oxidase inhibitors |
|
| Amantadine |
|
| Entacapone |
|
| Trihexyphenidyl |
|
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| Units | Counts |
|---|---|
| Participants |
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