Ambroxol in Disease Modification in Parkinson Disease

NCT02941822 | Completed Phase 2

• 1 other identifier: UCL 15/0118
• Study Type: interventional
• Target: 23
• Locations: 1 country
• Sites: 1

Brief Summary

This study will evaluate the safety, tolerability and pharmacodynamics of ambroxol in participants with Parkinson Disease. Participants will administer ambroxol at five dose levels and will undergo clinical assessments, lumbar punctures, venepuncture, biomarker blood analysis and cognitive assessment throughout the course of the study.

Conditions

Parkinson Disease

Outcome Measures

Primary Outcomes (1)

• Glucocerebrosidase and ambroxol levels in blood and cerebrospinal fluid

  Assess ambroxol's central nervous system and cerebrospinal fluid penetration, and its binding to GCase by examining GCase activity \& ambroxol levels at 5 intra-participant dose escalations from day 1 to day 186.

  Day 1-186

Secondary Outcomes (3)

• Prevalence of treatment-related adverse events and abnormal investigation findings at each dose escalation level

  Day 1-186

• Pharmacodynamic effects of ambroxol on glucocerebrosidase activity in blood and CSF

  Day 1-186

• Effect of ambroxol on blood and CSF biomarkers

  Day 1-186

Other Outcomes (2)

• Improvement in Montreal Cognitive Assessment (MoCA) and Unified Parkinson's Disease Rating Scale (UPDRS) scores

  Day 1-186

• Improvement in non-motor symptom assessment scale (NMSS) and non-motor symptom questionnaire (NMSQuest) scores.

  Day 1-186

Study Arms (1)

Arm 1

EXPERIMENTAL

Each patient will self-administer the study drug, ambroxol (60 mg per tablet) at 5 intra-dose escalations (DE) over the duration of 6 months that will be taken three times a day, see below: 1. Day 1-7, 60 mg 2. Day 8-14, 120 mg 3. Day 15-21, 180 mg 4. Day 22-28, 300 mg 5. Day 29-186, 420 mg

Drug: Ambroxol

Interventions

Ambroxol DRUG

Details outlines in the intervention description.

Also known as: Brand name: Ambrosan

Arm 1

Eligibility Criteria

• Age: 40 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Male or female;
• Age ≥ 40 and ≤ 80 years of age;
• Confirmed diagnosis of Parkinson disease at any time; and Hoehn and Yahr criteria, confirmed staged between I - III, inclusive;
• Able and willing to provide informed consent prior to any study related assessments and procedures at screening visit 1;
• Capable of complying with all study procedures, including fasting lumbar puncture;
• Willing to provide a blood sample for screening genomic for Parkinson Disease related DNA analysis and/or consent to Investigators obtaining and using participants previous DNA results if applicable;
• Willing and able to self-administer oral ambroxol medication, from day 1 to 186 (at 60 mg TID (day 1-7), 120 mg TID (day 8-14), 180 mg TID (day 15-21), 300 mg TID (day 22-28) and 420 mg TID (day 29-186));
• Able to travel to the participating study site;
• A female participant 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 consecutive months of spontaneous amenorrhea, at least 6 weeks post-surgical bilateral oophorectomy (with or without hysterectomy) or post tubal ligation. In questionable cases, menopausal status will be confirmed by demonstrating levels of follicle stimulating hormone (FSH) 25.8 - 134.8 IU/L and oestradiol \< 201 pmol/l at entry.
• Women of child-bearing potential must use accepted contraceptive methods (listed below), and must have a negative serum at screening visit 1 and urine pregnancy tests at subsequent visits if applicable. An additional pregnancy test will be performed, and results obtained, prior to administration of the first dose of ambroxol.
• Accepted contraception methods:
• True abstinence: When this is in line with the preferred and usual lifestyle of the participant. \[Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception).
• Contraceptive Methods with a Failure Rate of \< 1%:
• Oral contraceptive, either combined or progestogen alone;

You may not qualify if:

• Participants are excluded from participating in this study if 1 or more of the following criteria are met:
• Current treatment with anticoagulants (e.g. warfarin) that might preclude safe completion of the lumbar puncture and in the opinion of the Investigator;
• Current use of investigational medicinal product or participation in another interventional clinical trial or who have done so within 30 days prior to the first dose in the current study;
• Exposure to more than three investigational medicinal products within 12 months prior to the first dose in the current study;
• Confirmed dysphagia that would preclude self-administration of ambroxol up to 7 tablets TID for the duration of day 1 to day 186);
• Significant known lower spinal malformations or other spinal abnormalities that would preclude lumbar puncture;
• History of known sensitivity to the study medication,ambroxol or its excipients (lactose monohydrate, granulated microcrystalline cellulose, copovidone and magnesium stearate) in the opinion of the investigator that contraindicates their participation;
• History of known rare hereditary disorders of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption;
• Evidence or history of hypersensitivity to lidocaine or its derivatives;
• History of drug abuse or alcoholism in the opinion of the Investigator that would preclude participation in the study;
• Donation of blood (one unit or 350 ml) within three months prior to receiving the first dose of the study drug;
• Pregnant or breastfeeding;
• All participants of child bearing potential in the opinion of the Investigator that would preclude participation in the study and who do not agree to use double-barrier birth control or abstinence while participating in the study and for two weeks following the last dose of study drug;
• Any clinically significant or unstable medical or surgical condition that in the opinion of the PI or PI-delegated clinician may put the participant at risk when participating in the study or may influence the results of the study or affect the participant's ability to take part in the study, as determined by medical history, physical examinations, electrocardiogram (ECG), or laboratory tests. Such conditions may include:
• Impaired renal function

Sponsors & Collaborators

• University College, London: lead
• Cure Parkinson's: collaborator

Study Sites (1)

Leonard Wolfson Experimental Neurology Centre Clinical Research Facility LWENC CRF

London, United Kingdom

Location

Related Publications (1)

• Mullin S, Smith L, Lee K, D'Souza G, Woodgate P, Elflein J, Hallqvist J, Toffoli M, Streeter A, Hosking J, Heywood WE, Khengar R, Campbell P, Hehir J, Cable S, Mills K, Zetterberg H, Limousin P, Libri V, Foltynie T, Schapira AHV. Ambroxol for the Treatment of Patients With Parkinson Disease With and Without Glucocerebrosidase Gene Mutations: A Nonrandomized, Noncontrolled Trial. JAMA Neurol. 2020 Apr 1;77(4):427-434. doi: 10.1001/jamaneurol.2019.4611.

  PMID: 31930374 DERIVED

Related Links

• AiM-PD Reference 4
• AiM-PD Reference 8
• AiM-PD Reference 11
• AiM-PD Reference 13
• AiM-PD Reference 14

MeSH Terms

Conditions

Parkinson Disease

Interventions

Ambroxol

Condition Hierarchy (Ancestors)

Parkinsonian Disorders; Basal Ganglia Diseases; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Movement Disorders; Synucleinopathies; Neurodegenerative Diseases

Intervention Hierarchy (Ancestors)

Bromhexine; Aniline Compounds; Amines; Organic Chemicals; Cyclohexylamines

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: NA
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 5, 2016
• First Posted: October 21, 2016
• Study Start: December 1, 2016
• Primary Completion: April 1, 2018
• Study Completion: May 1, 2018
• Last Updated: April 15, 2020

Record last verified: 2020-04

Locations

GB (1)