Erythromycin in Parkinson’s Disease

Overview

Gastroparesis (slow stomach emptying) is a common feature of Parkinson's Disease. Levodopa (Sinemet), a common medication for Parkinson's Disease, can make gastroparesis worse. Gastroparesis effects how the levodopa is absorbed and used by the body. This study will explore the possibility of using Erythromycin, a drug commonly used (off label) for gastroparesis, along with levodopa to determine if there is improved levodopa absorption and motor function.

Full Title of Study: “Erythromycin in Parkinson’s Disease: A Pilot Study of Its Effects on Levodopa Pharmacokinetics and Pharmacodynamics”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Crossover Assignment
    • Primary Purpose: Treatment
    • Masking: Double (Participant, Investigator)
  • Study Primary Completion Date: June 2015

Detailed Description

Participants will be required to make four visits for evaluation. Visit 1 is a screening visit, participants will receive the study drug or a placebo during visits 2 and 3, and visit 4 is a follow up visit. Participants will provide blood and urine samples during the visits. Participants will also be required to complete questionnaires and a series of motor tests.

Interventions

  • Drug: Erythromycin
  • Drug: placebo

Arms, Groups and Cohorts

  • Placebo Comparator: Placebo
    • One time IV dose of placebo
  • Experimental: Erythromycin
    • One time IV dose of 100 mg Erythromycin

Clinical Trial Outcome Measures

Primary Measures

  • Gastric Emptying Time
    • Time Frame: 2 weeks, between visits 2 and 3
    • Mean gastric emptying time in minutes as measured by SmartPill
  • Area Under the Curve 0-4 Hours for Plasma Levodopa After Erythromycin Versus Placebo
    • Time Frame: 2 weeks, between visits 2 and 3
    • Mean Area under the Curve 0-4 hours for plasma levodopa after erythromycin versus placebo. Plasma samples were collected at the following times post-levodopa dose: 15, 30, 45, 60, 75, 90, 105, 120, 150, 180, 210, and 240 minutes.

Secondary Measures

  • 9-hole Peg Test Right Hand
    • Time Frame: 2 weeks, between visits 2 and 3
    • Change in motor function as assessed by 9-hole peg test for upper extremity manipulation/dexterity. This test measures the total time required to place and remove 9 holes in a pegboard. Each hand is tested separately.
  • 9-hole Peg Test Left Hand
    • Time Frame: 2 weeks, between visits 2 and 3
    • Change in motor function as assessed by 9-hole peg test for upper extremity manipulation/dexterity. This test measures the total time required to place and remove 9 holes in a pegboard. Each hand is tested separately.
  • Five Times Sit-to-stand Test
    • Time Frame: 2 weeks, between visits 2 and 3
    • Change in motor function as measured by Five times sit-to-stand test. This test measures the total time to complete 5 repetitions of sit to stand.
  • Comfortable 20 Feet Gait Speed (CGS)
    • Time Frame: 2 weeks, between visits 2 and 3
    • Change in motor function as assessed by comfortable 20 feet gait speed (CGS)
  • Timed up and go Test (TUAG) Comfortable Speed
    • Time Frame: 2 weeks, between visits 2 and 3
    • Change in motor function as assessed by timed up and go test (comfortable speed). This test measures the total time to stand from a chair, walk 10 feet, and return to sitting.
  • Timed up and go Test (TUAG) Fast Speed
    • Time Frame: 2 weeks, between visits 2 and 3
    • Change in motor function as assessed by timed up and go test (fast speed). This test measures the total time to stand from a chair, walk 10 feet, and return to sitting.
  • Change in Dyskinesia
    • Time Frame: 2 weeks, between visits 2 and 3
    • Mean total AIMS (Abnormal Involuntary Movements Scale) score after receiving erythromycin minus mean total AIMS score after receiving placebo. The AIMS test has a total of twelve items rating involuntary movements of various areas of the patient’s body. Ten of the items are rated on a five-point scale of severity from 0-4. The scale is rated from 0 (none), 1 (minimal), 2 (mild), 3 (moderate), 4 (severe). Two of the items are not scored. Total score range is from 0 to 40. Higher scores represent more severe dyskinesia (a worse outcome).
  • MDS-UPDRS Part 3 (Movement Disorders Society- Unified Parkinson’s Disease Rating Scale)
    • Time Frame: 2 weeks, between visits 2 and 3
    • Part 3 of this scale is a standardized physical assessment that quantifies the total burden of motor symptoms in Parkinson’s disease patients. Each of the 18 items on the scale is rated from 0 (none, 1 (slight), 2 (mild), 3 (moderate) and 4 (severe). Scores range from 0-72. Higher scores represent a more severe burden of motor symptoms (a worse outcome).
  • Mean Cmax of Plasma Levodopa After Erythromycin Versus Placebo
    • Time Frame: 2 weeks, between visits 2 and 3
    • Mean Cmax of plasma levodopa after erythromycin versus placebo. Plasma samples were collected at the following times post-levodopa dose: 15, 30, 45, 60, 75, 90, 105, 120, 150, 180, 210, and 240 minutes.

Participating in This Clinical Trial

Inclusion Criteria

  • Subjects must have a definitive diagnosis of Parkinson's Disease (per United Kingdom brain bank criteria), Hoehn and Yahr stage 1-3,
  • must exhibit unequivocal levodopa responsiveness
  • must be able to distinguish between the "off" versus "on" state
  • Subjects must be on a stable dose of levodopa for at least 28 days prior to enrollment and should be anticipated to maintain a stable dose throughout both study periods
  • Subjects may be on concomitant therapy with Monoamine oxidase B inhibitors, entacapone, and amantadine, though the doses of these medications must have remained stable for at least 28 days prior to enrollment and must be expected to remain stable throughout both study periods.

Exclusion Criteria

  • History of deep brain stimulation for Parkinson Disease
  • History of ablative (tissue removal) surgery for Parkinson Disease
  • Presence of dementia (MMSE<25)
  • Presence of active psychosis
  • History of any chronic gastrointestinal diseases
  • History of any prior gastrointestinal surgeries except for appendectomy, cholecystectomy, and hysterectomy
  • Any gastrointestinal surgeries in the past 3 months
  • Severe dysphagia (difficulty swallowing) to pills or food
  • History of physiological or mechanical gastrointestinal obstruction
  • History of strictures or fistulae (abnormal or narrow connections) along the gastrointestinal tract
  • History of gastric bezoars (undigested mass)
  • Allergy to wheat, soy, milk, or nuts
  • Presence of portable electromechanical devices such as pacemaker, defibrillator, or infusion pump
  • Female subjects who are pregnant or lactating
  • Symptomatic orthostatic hypotension (low blood pressure)
  • Diabetes
  • Presence of symptomatic anemia
  • Abnormal liver or kidney function
  • Cardiac arrhythmia (past or present) or abnormal QT interval on entrance EKG
  • Known hypersensitivity to any of the study drugs
  • Subjects receiving certain medications during specified time frames

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 80 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Virginia Commonwealth University
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Leslie J Cloud, M.D., Principal Investigator, Virginia Commonwealth University

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