Evaluation of Safety, Tolerability, and Pharmacokinetics of Exidavnemab in Patients with Mild to Moderate Parkinson's Disease and Multiple System Atrophy
- Trial ID
- 2024-511222-30-00
- Protocol
- BAN0805-201
- Sponsor
- BioArctic AB
Trial statistics
Diseases & Conditions
Objectives
The primary objective of this Phase 2a, randomized, double-blind, placebo-controlled trial is to assess the **safety** and **tolerability** of exidavnemab after multiple dosing compared to placebo in patients with mild to moderate **Parkinson's Disease** and **Multiple System Atrophy**. Evaluating safety and tolerability is crucial for determining the potential of exidavnemab as a therapeutic option, ensuring that adverse effects are manageable and that the treatment is acceptable for patients.
Secondary objectives include:
- To establish an appropriate dose range for a proof-of-concept trial, which is essential for optimizing therapeutic efficacy while minimizing adverse effects.
- To assess the pharmacokinetics (PK) of exidavnemab after multiple ascending dosing, providing insights into the drug's absorption, distribution, metabolism, and excretion.
- To assess and describe the systemic immunogenicity effects of exidavnemab, which is important for understanding potential immune responses that could impact treatment safety and efficacy.
Participants
The clinical trial involves participants diagnosed with **Parkinson's Disease** and **Multiple System Atrophy**, with an age range of 40 to 85 years. Both male and female subjects are included, and the study population is characterized by a stable health status, as participants are required to have cognition inconsistent with dementia, confirmed by a MoCA score of 22 or higher. The trial population was selected based on specific inclusion criteria, such as having a stable and optimized symptomatic PD medication regimen and a body weight between 50 kg and 120 kg. Participants are expected to maintain their daily medication regimen without changes during the trial. The trial includes individuals classified as Stage 1 to 2.5 on the modified Hoehn and Yahr scale for PD severity and Stage 1 to 3 for MSA severity. The sponsor has not provided information regarding the total number of participants. Lifestyle considerations include the ability to use a tablet device to measure cognitive function and compliance with scheduled visits and trial procedures. The trial also involves a vulnerable population, as indicated by the inclusion of individuals with specific medical conditions and cognitive requirements.
Plans and Procedures
The clinical trial is a **Phase 2a**, randomized, double-blind, placebo-controlled study designed to evaluate the safety, tolerability, and pharmacokinetics of multiple ascending doses of **Exidavnemab** in patients with mild to moderate **Parkinson's Disease** and **Multiple System Atrophy**. The trial will involve two cohorts: one for Parkinson's Disease and another for Multiple System Atrophy, with participants aged 40 to 85 years. The trial is expected to commence recruitment on September 16, 2024, and conclude by April 30, 2026, with a maximum treatment period of 16 weeks.
Participants will undergo a series of study visits, beginning with a screening visit to confirm eligibility based on inclusion criteria such as age, cognitive function, and stable medication regimen. The baseline visit will follow, where initial assessments and randomization to either the Exidavnemab or placebo group will occur. Subsequent visits will be scheduled to monitor safety, tolerability, and pharmacokinetics, with assessments including adverse events, vital signs, and laboratory tests. The primary endpoint is the occurrence of adverse events and serious adverse events after four treatment cycles, evaluated by frequency, severity, and causality. Secondary endpoints include determining the recommended maximal dose based on safety and pharmacokinetic data, as well as assessing immunogenicity through serum antibody detection.
The trial will conclude with an end-of-study visit, where final assessments will be conducted to ensure participant safety and collect data on the long-term effects of the treatment. Participant involvement is expected to last approximately 16 weeks, with conditions for early termination including significant adverse events or withdrawal of consent. The trial's design ensures rigorous monitoring and data collection to achieve its objectives while maintaining participant safety and adherence to ethical standards.
Treatment
The clinical trial involves the administration of **Exidavnemab**, an investigational medication, which is a **solution for infusion**. Exidavnemab is a humanized IgG4 kappa monoclonal antibody targeting alpha-synuclein, developed by BioArctic AB. The pharmaceutical form of Exidavnemab is a solution for infusion, and it is administered via **intravenous infusion**. The dosing schedule involves multiple ascending doses over a maximum treatment period of 16 weeks. The specific dosage in milligrams is not provided, but the administration is designed to evaluate the safety, tolerability, and pharmacokinetics in patients with mild to moderate Parkinson's Disease and Multiple System Atrophy. Participant compliance with the dosing schedule is monitored throughout the trial.
The trial also includes a **placebo** group, which receives a blank or empty saline solution. This placebo is used as a comparator to assess the effects of Exidavnemab. The placebo is administered in the same manner as the investigational drug, via intravenous infusion, to maintain the double-blind nature of the study. The use of a placebo is critical in determining the true efficacy and safety profile of Exidavnemab by providing a baseline for comparison. Participants in the placebo group are monitored with the same rigor as those receiving the investigational medication to ensure the integrity of the trial results.
Efficacy
Efficacy in this clinical trial will be assessed through a series of primary and secondary endpoints. The primary endpoint focuses on the safety and tolerability of the investigational product, **Exidavnemab**, by evaluating the occurrence of adverse events (AEs) and serious adverse events (SAEs) after four treatment cycles. This includes assessing the frequency, severity, causality, and nature of AEs and SAEs, as well as changes in electrocardiograms (ECG), vital signs such as arterial blood pressure, heart rate, and temperature, and laboratory tests including hematology, serum chemistry, and urine analysis. The severity of AEs and SAEs will be determined using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Secondary endpoints will include determining the recommended maximal dose based on the safety and tolerability profile and pharmacokinetic (PK) data. Additionally, the trial will measure exposure levels of Exidavnemab in serum to evaluate PK parameters. Immunogenicity will also be assessed by determining the presence of anti-drug antibodies (ADAs) in serum using a tier-based approach, followed by the determination of neutralizing antibodies (NAbs) if relevant. These assessments will provide comprehensive data on the efficacy and safety profile of Exidavnemab in patients with mild to moderate Parkinson's Disease and Multiple System Atrophy.
Inclusion and Exclusion Criteria
Inclusion Criteria
- Inclusion Criteria for Cohorts 1 and 2a (Parkinson’s Disease): 1. Male and female participants 40 to 85 years of age.
- Negative urine or serum pregnancy test at the Screening Visit and Baseline for premenopausal women, and for women who have experienced menopause onset less than 12 months prior to the first planned dose of trial medication.
- Males and persons of childbearing potential (POCBP) must agree to practice an effective means of birth control during their participation in the trial and until 3 months after their last dose of the trial medication.
- Willingness and ability to comply with scheduled visits, treatment plan, laboratory tests, and trial procedures.
- Participants must understand their daily medication regimen and must agree that they will not change their daily medication doses during the trial.
- The participant is capable of providing informed consent and has signed and dated the ICF before any trial specific procedures are performed.
- Body weight more than or equal to 50 kg and less than or equal to 120 kg.
- Have idiopathic PD (i.e., not induced by drugs or other diseases) as defined by bradykinesia combined with at least 1 of resting tremor and rigidity, as per the Movement Disorder Society Criteria for PD
- Classified as Stage 1 to 2.5 on the modified Hoehn and Yahr scale for the staging of PD severity.
- Participants must have cognition inconsistent with dementia as confirmed by a score of more than or equal to 22 on the MoCA.
- Stable and optimized symptomatic PD medication, defined as the same list of medications for at least 3 months prior to the Screening Visit with no change in the dose for at least 1 month prior to the Baseline Visit, and no planned changes in dose-regimen during trial participation.
- Prior (any time; i.e., no time limit) or current DaT-SPECT or DaT-PET consistent with dopamine transporter deficit, as per the Movement Disorder Society Criteria for PD. For participants who have not undergone DaT-SPECT or DaT-PET prior to Screening, or who have previously undergone DaT-SPECT or DaT-PET scan(s) but without results consistent with dopamine transporter deficit, DaT-SPECT or DaT-PET should be performed and read locally as part of the Screening procedures.
- Positive smell test showing hyposmia, as defined by UPSIT scores of around or below the 15% percentile for their relevant sex and age group.
- Ability to use tablet device to measure cognitive function, as per Investigator judgment.
- Inclusion Criteria for Cohort 2b (Multiple System Atrophy): Male and female participants 40 to 85 years of age.
- Body weight more than or equal to 50 kg and less than or equal to 120 kg.
- Have clinically established or clinically probable MSA (either MSA-P or MSA-C), as per the Movement Disorder Society criteria for the diagnosis of MSA
- Classified as Stage 1 to 3 on the modified Hoehn and Yahr scale for the staging of MSA severity.
- Participants must have cognition inconsistent with dementia as confirmed by a score of more than or equal to 22 on the MoCA.
- Negative urine or serum pregnancy test at the Screening Visit and Baseline for premenopausal women, and for women who have experienced menopause onset less than 12 months prior to the first planned dose of trial medication.
- Males and POCBP must agree to practice an effective means of birth control during their participation in the trial and until 3 months after their last dose of the trial medication.
- Willingness and ability to comply with scheduled visits, treatment plan, laboratory tests, and trial procedures.
- The participant is capable of providing informed consent and has signed and dated the ICF before any trial-specific procedures are performed.
- In the opinion of the Investigator, the participant has an expected survival of at least 6 months beyond the end of their participation in the trial.
Exclusion Criteria
- Exclusion Criteria for Cohorts 1 and 2a (Parkinson’s Disease): 1. Known hypersensitivity to trial medication, the infusion solution, or excipients.
- Abnormal ECG that is or may be clinically significant in the Investigator’s opinion and after consultation with the Medical Monitor, including left bundle branch block, atrial fibrillation, QTcF interval (Fredericia’s correction factor) more than 450 milliseconds (msec) for males and more than 470 milliseconds (msec) for females at the Screening Visit or Baseline.
- Systolic blood pressure (SBP) of more than 160 mmHg or diastolic blood pressure (DBP) of more than 95 mmHg on 3 separate determinations 5 minutes apart, taken at same arm, after the participant feels comfortable and relaxed at the research facility to minimize or avoid “white coat hypertension.”
- A history of clinically significant orthostatic hypotension or syncope, or orthostatic hypotension at the Screening Visit or Baseline, defined as a SBP decrease more than or equal to 20 mmHg or DBP decrease more than or equal to 10 mmHg when standing up from sitting or lying down, and/or use of medications to treat orthostatic hypotension (e.g., droxidopa, fludrocortisone) and/or presence of severe dysautonomia.
- History of transient ischemic attacks, stroke, or seizures within 12 months of Screening.
- Abnormal liver function tests: gamma-glutamyl transferase (GGT), total bilirubin (TBil), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) higher than the upper limits of normal (ULN) and regarded as potentially clinically significant by the Investigator. Note: Gilbert’s syndrome is not exclusionary.
- Poorly controlled diabetes as defined by hemoglobin A1C more than 8%.
- Contraindication, condition, or concomitant medication incompatible with lumbar puncture (e.g., lumbar scoliosis, coagulopathy, and infected skin at needle puncture site), 1.5T or 3T MRI (e.g., aneurysm clip, metal fragments [e.g., in-skull and cardiac devices other than those approved as safe for use in MRI scanners], and internal electrical devices such as a cochlear implant, spinal cord stimulator, or cardiac pacemaker/defibrillator), or DaT-SPECT.
- Taking prohibited medications, use of immunomodulatory or immunosuppressive therapy (immunoglobulins, systemic mAbs [or derivatives of mAbs], systemic immunosuppressant drugs [including azathioprine, methotrexate, mycophenolate mofetil], or plasmapheresis); use of dopaminergic antagonist therapy. Note: Use of low-dose cortisones derivative for orthostatic hypotension is permitted, as are topical corticosteroids is permitted. Use of anticoagulants (including coumarins, heparin, and derivatives) and antiplatelet drugs is permitted but must be temporarily suspended prior to and after execution of lumbar puncture according to the prescribing information.
- Severe visual or hearing impairment that, in the Investigator’s opinion, would prevent the participant from accurately completing cognitive testing assessments.
- Participation in any other clinical trial, being treated with an investigational product less than or equal to 4 weeks prior to the Screening Visit, and less than or equal to 8 weeks if treated with mAbs prior to the Screening Visit.
- More than 5 years of symptomatic treatment for PD.
- Any concurrent illness or condition, including but not limited to mental illness, substance abuse, metabolic dysfunction, immunological disease, physical or neurological examination finding or clinical laboratory finding which, in the opinion of the Investigator, would make the participant unable to cooperate or participate in the trial or would represent a potential safety concern. Note: An active or recent (within 3 days) respiratory infection will not disqualify a participant from enrolling in the trial; however, all symptoms should be resolved for at least 5 days prior to the Screening Visit. The Screening Period may be extended for up to 2 weeks to accommodate this recovery.
- Current significant compulsive behaviors or impaired impulse control in response to a dopaminergic Parkinson’s Disease medication. Any major psychiatric diagnosis, including schizophrenia, bipolar disorder, and current major depressive disorder as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V).
- Renal impairment as defined by a calculated creatinine clearance (CLcr) of less than or equal to 60 mL/min.
- Positive serology test (hepatitis B virus surface antigen, hepatitis C virus antibody, human immunodeficiency virus 1 and 2 antibodies).
- Participant has cancer with the exception of the following: basal cell carcinoma or successfully treated squamous cell carcinoma of the skin; cervical carcinoma in situ; prostatic carcinoma in situ; or other malignancies curatively treated and with no evidence of disease recurrence for at least 3 years.
- Drug or alcohol abuse in the past 1 year (criteria for alcohol abuse as per the DSM-V).
- Positive urine screen for drugs of abuse that include opiates, cannabis, cocaine, amphetamines, or barbiturates.
- Suicide attempt within 1 year prior to the Screening Visit, or severe suicidal ideation within 6 months prior to the Screening Visit (i.e., the participant answers “Yes” to Questions 4 or 5 in the Baseline-Screening Columbia-Suicide Severity Rating Scale [C-SSRS]), or participant is at significant risk of suicidal behavior in the opinion of the Investigator.
- Any condition that, in the Investigator’s opinion, would make the participant unable to comply with trial procedures or make them unsuitable for participation in the trial.
- Participation in any prior exidavnemab study, regardless of treatment group assignment.
- History of neurosurgical intervention for PD including implantation of brain stimulation.
- Blood or plasma donation within 3 months prior to Screening.
- Diagnosis of PD dementia or another dementia.
- Any psychiatric diagnosis or symptoms (e.g., hallucinations, major depression, or delusions) that could interfere with trial procedures.
- Freezing episodes occurring on a weekly basis or more frequently.
- Motor fluctuations occurring on a weekly basis or more frequently.
- Levodopa-induced troublesome dyskinesia of a severity that would significantly interfere with the participant’s ability to participate or perform trial procedures as determined by the Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Subscale IV.
- History of significant cardiovascular disease or arrhythmia within 6 months of Screening.
- Females who intend to breastfeed during the trial and for up to 3 months after the last dose of trial medication.
- Exclusion Criteria for Cohort 2b (Multiple System Atrophy): 1. Known hypersensitivity to the trial medication, the infusion solution, or excipients.
- Any psychiatric diagnosis or symptoms (e.g., hallucinations, major depression, or delusions) that could interfere with trial procedures.
- History of significant cardiovascular disease or arrhythmia within 6 months of Screening.
- Abnormal ECG that is or may be clinically significant in the Investigator’s opinion and after consultation with the Medical Monitor, including left bundle branch block, atrial fibrillation, QTcF more than 450 msec for males and more than 470 msec for females at the Screening Visit or Baseline.
- History of transient ischemic attacks, stroke, or seizures within 12 months of Screening.
- Abnormal liver function tests: GGT, TBil, ALP, ALT, and AST higher than the ULN and regarded as potentially clinically significant by the Investigator. Note: Gilbert’s syndrome is not exclusionary.
- Poorly controlled diabetes as defined by hemoglobin A1C of more than 8%.
- Contraindication, condition, or concomitant medication incompatible with lumbar puncture (e.g., lumbar scoliosis, coagulopathy, and infected skin at needle puncture site), 1.5T or 3T MRI (e.g., aneurysm clip, metal fragments [e.g., in-skull and cardiac devices other than those approved as safe for use in MRI scanners], and internal electrical devices such as a cochlear implant, spinal cord stimulator, or cardiac pacemaker/defibrillator).
- Taking prohibited medications; use of immunomodulatory or immunosuppressive therapy (immunoglobulins, systemic mAbs [or derivatives of mAbs], systemic immunosuppressant drugs [including azathioprine, methotrexate, mycophenolate mofetil], or plasmapheresis); use of dopaminergic antagonist therapy. Note: Use of low-dose cortisone derivatives for orthostatic hypotension is permitted, as are topical corticosteroids. Use of anticoagulants (including coumarins, heparin, and derivatives) and antiplatelet drugs is permitted but must be temporarily suspended prior to and after execution of lumbar puncture, according to the prescribing information.
- Participation in any other clinical trial, being treated with an investigational product less than or equal to 4 weeks prior to the Screening Visit, and less than or equal to 8 weeks if treated with mAbs prior to the Screening Visit.
- Any concurrent illness or condition, including but not limited to mental illness, substance abuse, metabolic dysfunction, immunological disease, physical or neurological examination finding, or clinical laboratory finding which, in the opinion of the Investigator, would make the participant unable to cooperate or participate in the trial or would represent a potential safety concern. Note: An active or recent (within 3 days) respiratory infection will not disqualify a participant from enrolling in the trial; however, all symptoms should be resolved at least 5 days prior to the Screening Visit. The Screening Period may be extended for up to 2 weeks to accommodate this recovery.
- Any major psychiatric diagnosis, including schizophrenia, bipolar disorder, and current major depressive disorder as per DSM-V.
- Renal impairment as defined by a calculated CLcr of less than or equal to 60 mL/min.
- Positive serology test (hepatitis B virus surface antigen, hepatitis C virus antibody, human immunodeficiency virus 1 and 2 antibodies).
- Participant has cancer with the exception of the following: basal cell carcinoma or successfully treated squamous cell carcinoma of the skin; cervical carcinoma in situ; prostatic carcinoma in situ; or other malignancies curatively treated and with no evidence of disease recurrence for at least 3 years.
- Drug or alcohol abuse in the past 1 year (criteria for alcohol abuse as per the DSM-V).
- Positive urine screen for drugs of abuse that include opiates, cannabis, cocaine, amphetamines, or barbiturates.
- Suicide attempt within 1 year prior to the Screening Visit, or severe suicidal ideation within 6 months prior to the Screening Visit (i.e., the participant answers “Yes” to Questions 4 or 5 in the Baseline-Screening C-SSRS), or the participant is at significant risk of suicidal behavior in the opinion of the Investigator.
- Any condition that, in the Investigator’s opinion, would make the participant unable to comply with trial procedures or make them unsuitable for participation in the trial.
- Participation in any prior exidavnemab study, regardless of treatment group assignment.
- Blood or plasma donation within 3 months prior to Screening.
- Females who intend to breastfeed during the trial and for up to 3 months after the last dose of trial medication.
- Unable to ambulate without the assistance of another person, defined as the ability to take at least 10 steps. The use of assistive devices (e.g., a walker or cane) is permitted.
- Primary (e.g., spinocerebellar ataxia) or secondary (e.g., autoimmune neuropathy) cause of ataxia.
Trial Status by Country
| Country | Status | Start of Recruitment | Planned Patients |
|---|---|---|---|
 Poland | Not Recruiting | 16 Sept 2024 | 18 |
 Spain | Not Recruiting | 16 Sept 2024 | 18 |
Sites & Investigators
Investigational Products
Details about the medicinal products being studied in this clinical trial.
| Product Name | Role in Trial | Formulation | Administration | Max Daily Dose | Treatment Duration | EU MP Number |
|---|---|---|---|---|---|---|
Exidavnemab | Test | SOLUTION FOR INFUSION | INTRAVENOUS INFUSION | 00 | 16 | PRD11313699 |
nothingblank / empty saline solution | Placebo | N/A | — | — | — | N/A |