Apomorphine Pump in Early Stage of Parkinson's Disease (EARLY-PUMP)

NCT ID: NCT02864004

Last Updated: 2023-11-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

PHASE3

Total Enrollment

134 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-03-03

Study Completion Date

2025-01-30

Brief Summary

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The aim of the study is to assess the use of the apomorphine pump in earlier stages of Parkinson' Disease (PD), when motor complications have just developed and before patients are significantly affected in their social and occupational functioning. The investigators hypothesize that apomorphine pump is superior in terms of positive impact on quality of life (QoL) to oral medical therapy alone at a relatively early stage of PD, before the appearance of severe disabling motor complications thus favoring the maintain of patients' social and occupational status with a significant positive economic impact of the health system.

Detailed Description

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The recruitment period will be 36 months. The duration of the study period will be one year for each patient due to:

* adjustments of apomorphine pump parameters and oral medication (3 months interval),
* motor and psychosocial changes which need time to develop and have an impact on QoL.

At the end of the study period, two additional visits at Months 18 and 24 will be performed during an long term follow up to collect QoL and costs related data required to medico-economic analysis.

APOMORPHINE (APO) group:

The apomorphine pump will be installed and adjusted at baseline during a first hospitalization (10 days). Modifications of the hourly flow of the pump and readjustment (reduction) of anti-parkinsonian oral medication will be checked and performed at Months 1, 2, 4, 5, 6, 9 during visits and phone calls, and at month 3 during a 3 days hospitalization. Clinical evaluations will be performed at months 6 and 12.

Control group:

Patients will be treated by optimized medical treatment according to the guidelines of the European Federation of Neurological Societies. Dose adjustments will be done at Months 3, 6, 9. Clinical evaluations will be performed at months 6 and 12.

In both groups, data for medico-economic evaluation will be collected from patients at baseline, Months 6, 12, 18 and 24 for Quality Adjusted Life Year (QALYs) and costs related data from a patient's diary and French Health Insurance database.

Conditions

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Parkinson's Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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APO group

An apomorphine pump will be installed and adjusted. The target dose corresponds to the patient's individual optimized dose :maximum dose of 10 mg/hour for 16 hours

Group Type EXPERIMENTAL

Apomorphine

Intervention Type DRUG

Apomorphine (5 mg/ml) is supplied as solution for infusion in a 10 ml glass ampoule Hourly flow rate is adjusted during the whole duration of the study to doses of minimum 3 mg/hour up to a maximum of 10 mg/hour

Control group

Patients will be optimally treated with oral dopaminergic therapy to obtain the best medical treatment (BMT) defined as the most efficient single treatment options or their combination.

Group Type ACTIVE_COMPARATOR

Best Medical Treatment

Intervention Type OTHER

Most efficient single treatment of Parkinson's disease symptoms or their combinations, in concordance with the guidelines of the European Federation of Neurological Societies

Interventions

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Apomorphine

Apomorphine (5 mg/ml) is supplied as solution for infusion in a 10 ml glass ampoule Hourly flow rate is adjusted during the whole duration of the study to doses of minimum 3 mg/hour up to a maximum of 10 mg/hour

Intervention Type DRUG

Best Medical Treatment

Most efficient single treatment of Parkinson's disease symptoms or their combinations, in concordance with the guidelines of the European Federation of Neurological Societies

Intervention Type OTHER

Other Intervention Names

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Apokinon

Eligibility Criteria

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Inclusion Criteria

* Adults aged ≤ 65 years,
* Idiopathic PD (According to British Brain Bank Criteria) without any other known or suspected cause of Parkinsonism,
* Hoehn and Yahr stage ≤ 2.5 in the best ON,
* Disease duration ≥ 4 years,
* Presence of fluctuations and/or dyskinesias for no more than 3 years,
* One of the two following forms of impairment :

* Impairment in activities of daily living (MDS-UPDRS II\>6) due to PD-symptoms despite medical treatment in the worst condition or,
* Impairment of social and occupational functioning (measured with SOFAS) due to PD-symptoms despite medical treatment (51-80%),
* PDQ39 completed,
* Able to understand and remember the component of the study,
* Written informed consent,
* Patients covered with social insurance.

Exclusion Criteria

* Dementia (MoCA \< 22),
* Major uncontrolled depression at the time of assessment (BDI \> 25) or Bipolar disease,
* Active hallucinations or history of hallucinations in the past year,
* Need for nursing care,
* Previous use of apomorphine pump treatment,
* History of respiratory depression,
* History of deep brain stimulation or lesional surgery for PD or intrajejunal L-Dopa,
* Presence of severe freezing or clinically relevant postural instability leading to falls during the ON state,
* Symptomatic clinically relevant and medically uncontrolled orthostatic hypotension,
* Clinically relevant hepatic dysfunction (total bilirubin \>2.0 mg/dL, Alanine Amino Transferase (ALT) and Aspartate Amino Transferase (AST) \>2 times the upper limit of normal),
* Clinically relevant renal dysfunction (serum creatinine \>2.0 mg/dL),
* Pregnant and breastfeeding women,
* Hypersensitivity to apomorphine or any excipients of the medicinal product,
* Concomitant therapy or within 28 days prior to baseline with : alpha-methyl dopa, metoclopramide, reserpine, neuroleptics (except Clozapine), methylphenidate, or amphetamine, intrajejunal Ldopa,
* History or current drug or alcohol abuse or dependencies,
* Patients with a borderline QT interval corrected for heart rate according to Bazett's formula (QTc) of \>470 ms for male and \>480 ms for female at screening or history of long QT syndrome;
* Adults legally protected (under judicial protection, guardianship or supervision), persons deprived of their liberty.
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Rennes University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Sophie DRAPIER, Dr

Role: PRINCIPAL_INVESTIGATOR

Rennes University Hospital

Locations

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Amiens University Hospital

Amiens, , France

Site Status

Bayonne Côte Basque Hospital

Bayonne, , France

Site Status

Pellegrin University Hospital

Bordeaux, , France

Site Status

Pierre Wertheimer Hospital

Bron, , France

Site Status

Caen University Hospital

Caen, , France

Site Status

Clermont-Ferrand University Hospital

Clermont-Ferrand, , France

Site Status

Lille University Hospital

Lille, , France

Site Status

APHM, hospital of Timone

Marseille, , France

Site Status

Clinique Beau-Soleil

Montpellier, , France

Site Status

Montpellier University Hospital

Montpellier, , France

Site Status

Nancy University Hospital

Nancy, , France

Site Status

Laennec Hospital

Nantes, , France

Site Status

Pasteur 2 University Hospital

Nice, , France

Site Status

Caremeau University Hospital

Nîmes, , France

Site Status

Pitié-Salpêtriere Hospital

Paris, , France

Site Status

Poitiers University Hospital

Poitiers, , France

Site Status

Rennes University Hospital

Rennes, , France

Site Status

Saint-Etienne University Hospital

Saint-Etienne, , France

Site Status

Hautepierre University Hospital

Strasbourg, , France

Site Status

Purpan University Hospital

Toulouse, , France

Site Status

Countries

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France

Other Identifiers

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35RC15_9724_EARLY-PUMP

Identifier Type: -

Identifier Source: org_study_id