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Completed

NCT Number: NCT02480803

INfusion VErsus STimulation in Parkinson's Disease

Both Continuous intrajejunal Levodopa Infusion (CLI) and Deep Brain Stimulation (DBS) are accepted therapies for the treatment of advanced Parkinson's disease (PD). To date, no comparative studies have been executed. The INVEST study is an open label randomised controlled trial with cost-effectiveness as primary outcome. The main clinical outcome is quality of life; secondary outcomes are motor symptoms and neurological impairments, among others.

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Key information

Conditions

Parkinson's Disease Basal Ganglia Diseases Brain Diseases Central Nervous System Diseases Movement Disorders Nervous System Diseases Neurodegenerative Diseases Parkinson Disease Parkinsonian Disorders Synucleinopathies

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 4

Primary location

Academic Medical Center

Amsterdam, North Holland, 1100ZZ, Netherlands

About this study

Rationale: Both Continuous intrajejunal Levodopa Infusion (CLI) and Deep Brain Stimulation (DBS) are accepted therapies for the treatment of advanced Parkinson's disease (PD). As directly comparative studies are lacking, it is unknown whether one of the therapies is more effective. Besides, CLI seems to be more expensive. To determine the optimal treatment in advanced PD, a comparative study of CLI and DBS is warranted.

Hypothesis: We hypothesize that CLI is a more expensive therapy in advanced PD than DBS and that the surplus in costs is not cost-effective with regard to benefits for the patient and caregivers in quality of life, PD symptoms and adverse events.

Objective: To realize a cost-effective treatment strategy in advanced PD. Study design: Prospective, randomized, open label multicentre trial, with two additional patient preference treatment arms ("patient preference randomized trial").

Study population: Patients with PD who, despite optimal pharmacological treatment, have severe response fluctuations, dyskinesias, painful dystonia, or bradykinesia. A total of 66 patients will be randomized, at least 120 patients will be included in the patient preference arms.

Intervention: Patients will be randomized to DBS or CLI. For DBS treatment, 2 electrodes will be implanted in the brain. The electrodes are connected to an implanted pulse generator, which will be placed subcutaneously in the subclavian area. For CLI treatment, a tube will be placed in the jejunum via a percutaneous endoscopic gastrostomy (PEG). This tube is connected to an external pump that delivers the levodopa-gel.

Main study parameters: There are 8 specified assessment visits: at baseline, and 1 week, 3, 6, 9, 12, 24 and 36 months after start of the study treatment. The primary health economic outcomes are the costs per changed unit on the PDQ-39 (and the costs per changed QALY for the cost-effectiveness and cost-utility analyses, respectively. The EQ-5D will be applied as the utility measure. Change in quality of life (expressed in the between group difference in change from baseline to 12 months on the PDQ-39 summary index score) is the main clinical outcome. Among the secondary outcomes are functional health, complications and adverse effects, use of care and perceptions of patients and neurologists regarding both treatments.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Idiopathic Parkinson's Disease with bradykinesia and at least two of the following signs; resting tremor, rigidity, and asymmetry;
  • Despite optimal pharmacological treatment, at least one of the following symptoms: severe response fluctuations, dyskinesias, painful dystonia or bradykinesia;
  • A life expectancy of at least two years.

Exclusion criteria

  • Age below 18 years
  • Previous PD-neurosurgery (e.g., DBS, pallidotomy, thalamotomy);
  • Previous CLI (through a PEG-tube or Nasal Jejuna| tube);
  • Hoehn and Yahr stage 5 at the best moment during the day;
  • Other severely disabling disease;
  • Dementia or signs of severe cognitive impairment
  • Psychosis;
  • Current depression;
  • Contraindications for DBS surgery, such as a physical disorder making surgery hazardous;
  • Contraindications for PEG surgery such as interposed organs, ascites and oesophagogastric varices, or for Duodopa;
  • Pregnancy, breastfeeding, and women of child bearing age not using a reliable method of contraception;
  • No informed consent;
  • Legally incompetent adults;

Treatment and study plan

Continuous intrajejunal infusion of levodopa-carbidopa

Drug

Continuous delivery of levodopa-carbidopa intestinal gel through an intrajejunal percutaneous tube (Duodopa, CLI, CILI)

Other names: Duodopa infusion, Intestinal levodopa-carbidopa infusion

Deep brain stimulation

Device

Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN)

Other names: DBS, DBS-STN

Primary outcomes

  1. Cost effectiveness in costs per changed unit on PDQ-39

    Time frame: 12 months

    The costs per changed unit on the PDQ-39.

  2. Cost-utility in costs per changed Quality Adjusted Life Year (QALY, years)

    Time frame: 12 months

    The costs per QALY. The EuroQol 5D-3L (EQ-5D; 5 questions, each score 1-3, providing a health state, to be translated with provided Valuation set) will be applied as the utility measure.

Secondary outcomes

  1. Quality of life (on PDQ-39)

    Time frame: 12, 24 and 36 months

    Changes from Baseline on Parkinson's Disease Questionnaire-39 (PDQ-39; score 0-100, higher score is lower quality of life)

  2. Quality of life (on EQ-5D)

    Time frame: 12, 24 and 36 months

    Change from Baseline on EuroQol 5D-3L (EQ-5D; 5 questions, each score 1-3, providing a health state, to be translated with provided Valuation set)

  3. Motor symptoms

    Time frame: 12 and 36 months

    Score changes from Baseline in off and on state on Movement Disorder Society's Unified Parkinson Disease Rating Scale (MDS-UPDRS part 3; 0-132, high score is more motor symptoms)

  4. Motor symptoms: time in off and on-state

    Time frame: 12, 24 and 36 months

    Change from Baseline in time in off-state, on-state without dyskinesias, on-state without troublesome dyskinesias and on-state with troublesome dyskinesias measured with motor symptom diary

  5. Motor experiences of daily living

    Time frame: 12, 24 and 36 months

    Changes from Baseline on MDS-UPDRS part 2 (Movement Disorder Society's Unified Parkinson Disease Rating Scale (MDS-UPDRS part 2; score 0-52, high score is more worse health)

  6. Dyskinesia

    Time frame: 12 and 36 months

    Change from Baseline on clinical Dyskinesia Rating Scale (CDRS; score 0-28, high score is more dyskinesia)

  7. PD-medication (levodopa-equivalent dose)

    Time frame: 12, 24 and 36 months

    Change from Baseline expressed in levodopa-equivalent dose

  8. Functional health status

    Time frame: 12, 24 and 36 months

    Change from Baseline on Amsterdam Linear Disability Score (ALDS, 29 items; 0-100, high score is high level of functional status)

  9. Non-motor symptoms (Non Motor Symptom Checklist)

    Time frame: 12, 24 and 36 months

    Changes from Baseline on Non Motor Symptom Checklist

  10. Non-motor symptoms (Rotterdam Symptom Checklist

    Time frame: 12, 24 and 36 months

    Change from Baseline on Rotterdam Symptom Checklist

  11. Non-motor symptoms (SCOPA-AUT)

    Time frame: 12, 24 and 36 months

    Change from Baseline on SCOPA-AUT (SCales for Outcomes in PArkinson's Autonomic symptoms; score 0-92, higher score is more symptoms)

  12. Disability

    Time frame: 12, 24 and 36 months

    Change from Baseline in Hoehn and Yahr stage (H&Y stage; 1-5: a higher score is more disease progression)

  13. Cognitive functioning

    Time frame: 12 and 36 months

    Change from Baseline on Parkinson's Disease Cognition Rating Scale (PD-CRS; 0-134, higher score is a result of better cognitive performance)

  14. Cognitive functioning Mattis

    Time frame: 12 and 36 months

    Change from Baseline in Mattis Dementia Rating score (score 0-144, higher score is better cognitive function)

  15. Neuropsychologic functioning BNT

    Time frame: 12 and 36 months

    Change from Baseline in Boston Naming Test (range 0-30, higher is better)

  16. Neuropsychologic functioning Letter Fluency

    Time frame: 12 and 36 months

    Change from Baseline in Letter Fluency (score 0-100, higher is better)

  17. Neuropsychologic functioning WAIS IV

    Time frame: 12 and 36 months

    Change from Baseline in WAIS IV (Wechsler Adult Intelligence Scale IV - subsection similarities; score 0-36, higher is better)

  18. Neuropsychologic functioning Reading

    Time frame: 12 and 36 months

    Change from Baseline in Dutch Reading Test (0-100, higher is better)

  19. Neuropsychologic functioning Word Test

    Time frame: 12 and 36 months

    Change from Baseline in 15 word test (0-75, higher is better)

  20. Neuropsychologic functioning Memory

    Time frame: 12 and 36 months

    Change from Baseline in Rivermead Behavioral memory test (subsection stores; score 0-42, higher is better)

  21. Neuropsychologic functioning Trail making

    Time frame: 12 and 36 months

    Change from Baseline in Trail making test (score 10-500, higher score is longer time, i.e. worse score)

  22. Neuropsychologic functioning Color Word

    Time frame: 12 and 36 months

    Change from Baseline in Stroop Color Word Test (score 10-1000, higher is better)

  23. Neuropsychologic functioning Line Orientation

    Time frame: 12 and 36 months

    Change from Baseline in Judgement of line orientation (score 0-30, higher is better)

  24. Neuropsychologic functioning Clock

    Time frame: 12 and 36 months

    Change from Baseline in Clock construction (score 0-14, higher is better)

  25. Psychiatric disease

    Time frame: 12 and 36 months

    Change from Baseline in Mini International Neuropsychiatric Interview

  26. Apathy

    Time frame: 12, 24 and 36 months

    Change from Baseline in Starkstein's Apathy Scale (SAS; score 0-42, high score is more signs of apathy)

  27. Compulsive Disorders

    Time frame: 12, 24 and 36 months

    Change in presence of Compulsive Disorder from Baseline assessed with Parkinson's Disease Impulsive-Compulsive Disorders Questionnaire (QUIP, utilizing established thresholds)

  28. Anxiety

    Time frame: 12 and 36 months

    Changes from Baseline on Hamilton Anxiety Scale (HAM-A; 0-56, high score is worse outcome)

  29. Depression

    Time frame: 12 and 36 months

    Change from Baseline on Hamilton Depression Rating Scale (HDRS; 0-68, higher score is worse outcome)

  30. Suicidality

    Time frame: 12 and 36 months

    Changes from Baseline on Columbia Suicide Severity Rating Scale (range 0-25, higher score is worse outcome)

  31. Adverse effects

    Time frame: 12, 24 and 36 months

    Number of participants with adverse effects and description of these

  32. Complications and description of complications

    Time frame: 12, 24 and 36 months

    Number of participants with complications and description of these

  33. Stopping allocated treatment

    Time frame: 12, 24 and 36 months

    Number of participants who stopped treatment

  34. Treatment failure

    Time frame: 12, 24 and 36 months

    Number of participants with treatment failure

  35. Treatment cross-over

    Time frame: 12, 24 and 36 months

    Number of participants with treatment cross-over

  36. Patient satisfaction

    Time frame: 12, 24 and 36 months

    Descriptive questionnaire, no scale applied, descriptive statistics

  37. Patients attitude to treatment

    Time frame: 12, 24 and 36 months

    Change from Baseline on Patient Reported Outcome Scale (range 0-128, high score is worse outcome)

  38. Medical costs

    Time frame: 12, 24 and 36 months

    Calculation of the total costs in euro by means of iMCQ (iMTA Medical Consumption Questionnaire)

  39. Non-medical care costs

    Time frame: 12, 24 and 36 months

    Calculation of the total costs in euro by means of iPCQ (iMTA Productivity Cost Questionnaire)

  40. Caregiver burden

    Time frame: 12, 24 and 36 months

    Descriptive questionnaire, no scale applied, descriptive statistics

Sponsors and collaborators

Lead sponsor

Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

Other

Collaborators

  • ZonMw: The Netherlands Organisation for Health Research and Development

Registry information

Official study title

Treatment in Advanced Parkinson's Disease: Continuous Intrajejunal Levodopa INfusion VErsus Deep Brain STimulation

Acronym: INVEST

Important dates

Study start
2014
Primary completion
2021
Study completion
2024
First posted
Jun 25, 2015
Registry last updated
Feb 13, 2024

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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