The Effect of Pramipexole on Metabolic Network Activity Compared With Levodopa in Early Parkinson’s Disease

Overview

Levodopa and non-ergot dopaminergic agonists such as pramipexole are both recommended as the first-line symptomatic treatment for early untreated Parkinson's disease (PD), previous clinical trial indicated that initial pramipexole owns advantage over levodopa regarding motor complications, on the contrary, less adverse effect like freezing and severe somnolence favors initial treatment of levodopa. Thus, it remains controversial that initiation of which medication will be better for those patients with early PD. Parkinson's disease-related spatial covariance patter (PDRP) is a new biomarker which can represent the network activity of brain and severity of PD. Based on the literatures and our previous data, the investigators hypothesize that PDRP will be served as a biomarker to help us evaluate and compare the effect of levodopa or pramipexole on the progression of PD, which might be able to provide further evidence for clinicians to address the above critical issue.

Full Title of Study: “a Pilot Follow-up Study of Investigating the Effect of Pramipexole on Metabolic Network Activity Compared With Levodopa in Chinese Patients With Early Parkinson’s Disease”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: August 2014

Detailed Description

CALM-PD study found that Pramipexole can reduce the occurrence of motor complication compared with Levodopa used as initiative treatment, but it still remains debatable that initiation of which medication will be better for those patients with De Novo PD. PDRP (Parkinson's disease-related spatial covariance pattern) is a biomarker which can represent the network activity of cortico-striato-pallido-thalamocortical pathways and highly reproducible with stable network activity in individual subjects. The study published in "J Neuroscience" in 2010 showed that the abnormal PDRP antecede the appearance of motor signs by about 2 years, indicating PDRP might be a very promising biomarker for identifying PD at its early stage. Moreover, PDRP is able to represent the progression and severity of PD as well. It was reported that Levodopa can reduce the PD-related network activity, and the degree of network suppression correlates with the clinical improvement. However, there is no study currently showing the impact of pramipexole on brain PDRP network compared with levodopa as initiative treatment.

Interventions

  • Drug: pramipexole
    • tablets, 0.375mg-4.5mg/day divided by 3 times according to the optimal improvement of motor dysfunction in PD patients. duration is 1 year.
  • Drug: Sinemet CR
    • tablet of Sinemet CR, dosage of levodopa ranging from 200mg-600mg/day divided by 2 or 3 times, Duration is 1 year

Arms, Groups and Cohorts

  • Active Comparator: pramipexole
    • 0.375mg-4.5mg/day, flexible dosage according to an optimal improvement of movement dysfunction in PD patients
  • Active Comparator: Levodopa
    • Sinemet CR CR, Controlled Release

Clinical Trial Outcome Measures

Primary Measures

  • Longitudinal Change of Brain Network Activity
    • Time Frame: twice, baseline and 1 year after baseline
    • The brain network activity is evaluated by Parkinson’s disease-related spatial covariance pattern(PDRP) value (Z score). The change of brain network activity is calculated by the PDRP value (Z score) at V5 – the PDRP value (Z score) at V1.

Secondary Measures

  • Unified Parkinson’s Disease Rating Score (UPDRS II, III)
    • Time Frame: three times: baseline, 10 weeks, 1 year
    • baseline (1st visit, V1), completion of dosage titration within 10 weeks after baseline (2nd visit, V2), 1 year after baseline (final visit, V5) UPDRS II score 0-52 (13 items); UPDRS III score 0-56 (14 items); The more scores,the more severe; the two scales were evaluated separately.
  • Parkinson’s Disease Questionnaire (PDQ39)
    • Time Frame: twice baseline and 1 year
    • The PDQ39 score was assessed at baseline (1st visit, V1) and 1 year after baseline (final visit, V5). PDQ39 score ranges from 0-156 (0-4 each item); the more score, the more severe.
  • Hoehn&Yahr (H&Y) Staging
    • Time Frame: twice baseline and 1 year
    • The Hoehn and Yahr scale is a commonly used scale for describing how the symptoms of Parkinson’s disease progress and the disease stages. Bigger numbers indicate more symptoms and disease progression. H&Y stage range from 0-5; the greater, the more severe. The H&Y stages of patients were evaluated at baseline (1st visit, V1), and 1 year after baseline (final visit, V5).
  • Patients With Clinical Improvement as Evaluated by Global Impression Scale (CGI).
    • Time Frame: twice, at 10 weeks(V2) and 1 year(V5)
    • Patients with a score <= 2 (very much or much improved in relation to baseline) are considered as clinically improved. The numbers of participants with clinical improvement are reported here. The completion of dosage titration within 10 weeks after baseline (visit 2) and 1 year after baseline (final visit)

Participating in This Clinical Trial

Inclusion Criteria

  • idiopathic Parkinson's disease meeting United Kingdom (UK) brain bank criteria – De Novo – Hoehn&Yahr staging (H&Y) I-II Exclusion Criteria:

  • Atypical Parkinsonism – Pregnant or breast-feeding women – those with abnormal Liver/kidney function – those participating other clinical trials within 30 days before being enrolled for this trial.

Gender Eligibility: All

Minimum Age: 30 Years

Maximum Age: 75 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Huashan Hospital
  • Collaborator
    • Boehringer Ingelheim
  • Provider of Information About this Clinical Study
    • Principal Investigator: Jian Wang, Professor – Huashan Hospital
  • Overall Official(s)
    • Jian Wang, MD, Principal Investigator, Huashan Hospital

References

Izumi Y, Sawada H, Yamamoto N, Kume T, Katsuki H, Shimohama S, Akaike A. Novel neuroprotective mechanisms of pramipexole, an anti-Parkinson drug, against endogenous dopamine-mediated excitotoxicity. Eur J Pharmacol. 2007 Feb 28;557(2-3):132-40. Epub 2006 Nov 14.

Parkinson Study Group. A randomized placebo-controlled trial of rasagiline in levodopa-treated patients with Parkinson disease and motor fluctuations: the PRESTO study. Arch Neurol. 2005 Feb;62(2):241-8.

Huang C, Tang C, Feigin A, Lesser M, Ma Y, Pourfar M, Dhawan V, Eidelberg D. Changes in network activity with the progression of Parkinson's disease. Brain. 2007 Jul;130(Pt 7):1834-46. Epub 2007 Apr 30.

Ma Y, Tang C, Spetsieris PG, Dhawan V, Eidelberg D. Abnormal metabolic network activity in Parkinson's disease: test-retest reproducibility. J Cereb Blood Flow Metab. 2007 Mar;27(3):597-605. Epub 2006 Jun 28.

Tang CC, Poston KL, Dhawan V, Eidelberg D. Abnormalities in metabolic network activity precede the onset of motor symptoms in Parkinson's disease. J Neurosci. 2010 Jan 20;30(3):1049-56. doi: 10.1523/JNEUROSCI.4188-09.2010.

Wang J, Ma Y, Huang Z, Sun B, Guan Y, Zuo C. Modulation of metabolic brain function by bilateral subthalamic nucleus stimulation in the treatment of Parkinson's disease. J Neurol. 2010 Jan;257(1):72-8. doi: 10.1007/s00415-009-5267-3. Epub 2009 Aug 7.

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