Safety, Tolerability, Pharmacokinetics and Efficacy Study of Radotinib in Parkinson's Disease

This study is will be conducting to determine if Radotinib is safe and can be tolerated by patients with Parkinson's disease (PD) and to learn if Radotinib can be potential therapeutic agents for the treatment of PD.

Radotinib has been approved by Ministry of Food & Drug Safety of Korea to treat Chronic Myeloid Leukemia (CML) but it has not been approved for PD.

In nonclinical efficacy study, therapeutic effect of Radotinib HCl, c-Abl inhibitor, which exhibits improved pharmacokinetic properties and BBB penetration compared to nilotinib and other c-Abl inhibitors, was tested in a preclinical α-synuclein preformed fibrils (PFF) model of sporadic PD. As a result, the treatment of Radotinib HCl protects the α-synuclein PFFs-induced neuronal toxicity, reduces the PFFs-induced LB/LN-like pathology, and inhibits the PFFs-induced c-Abl activation in neurons. In vivo studies demonstrate that administration of Radotinib HCl prevents dopamine neuron loss and behavioral deficits following α-synuclein PFFs-induced toxicity. Taken together, these findings indicate that Radotinib HCl has beneficial neuroprotective effects in PD and provides strong evidence that selective and brain permeable c-Abl inhibitors can be potential therapeutic agents for the treatment of PD.

These data are very compelling to evaluate the effects of Radotinib in a phase II, randomized, double-blind, placebo-controlled trial in patients with PD.

Inclusion criteria

• Male and Female from 40 to 80 years old;
• Diagnosed with "Clinically Probable Parkinson's Disease" according to the MDS clinical diagnostic criteria, with documented onset of symptoms per treating physician's records within three years of the screening visit;
• Positive DAT-scan (e.g. a striatal dopamine transporter deficit on dopamine transporter imaging by DaT-SPECT, characterized by crescent-shaped areas of asymmetrical aspect, or of symmetrical aspect but of uneven intensity, between the right and the left brain hemisphere) confirmed by local reading;
• Hoehn & Yahr stage ≤ 2.5;
• Without previous symptomatic treatment for PD disease and with current clinical state not requiring started dopaminergic therapy within 6 months from Baseline;
• Absence of a parkinsonian syndrome and other neurovascular comorbidities, confirmed by MRI
• Female subjects must be not of childbearing potential, e.g., documented evidence that they are surgically sterile (e.g., hysterectomy, partial hysterectomy, bilateral oophorectomy, bilateral tubal ligation), or postmenopausal (at least 12 months since last menses) or using highly effective method of birth control defined as those which result in a low failure rate (i.e. less than 1% per year) when used consistently and correctly, such as combined hormonal contraception associated with inhibition of ovulation (oral, intravaginal, transdermal), progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable, implantable), intra uterine devices (IUDs), intrauterine hormone-releasing system (IUS), bilateral tubal occlusion, condom, until at least one month after the last drug intake associated to a negative pregnancy test at screening;
• Covered by Health Insurance System;
• Able to understand and to sign the informed consent prior to screening;
• Blood Pressure (BP) and Heart Rate (HR) considered NCS by Investigator;
• Electrocardiogram (ECG) recording on a 12-lead ECG considered NCS by Investigator;
• Laboratory parameters within the normal range of the laboratory. Individual values out of the normal range can be accepted if judged clinically non relevant by the Investigator.

Exclusion criteria

• Atypical Parkinsonism or drug-induced Parkinsonism;
• Current, or within 60 days of screening, use of any prescription, investigational, or over the counter medication for the symptomatic treatment of PD or to slow the progression of PD.
• Prior use of dopaminergic therapy (e.g., levodopa, dopamine agonist, amantadine, rasagiline) for 30 or more days any time in the past;
• Cognitive impairment (MMSE ≤ 24);
• Active psychiatric disorder (mood disorders, hallucinations or delirium with strong functional impact and not controlled by medication or which happened during the last 3 months before inclusion);
• Severe or uncontrolled chronic disease;
• Significant medical history of congenital or acquired bleeding disorders;
• Treatment by Deep Brain Stimulation or continuous infusion of apomorphin/dopa gel;
• Any below impaired cardiac function:

• LVEF <45% or < lower bound of normal limit of study site (whichever higher), confirmed by echocardiogram (if the subject has already carried out this examination during the last month before inclusion, he/she will be exempted from retaking this examination, but he/she will have to present the echocardiogram as well as the cardiologist's report. If not, this exam should be performed during the screening period)
• Subjects who cannot have QT intervals measured according to ECG
• Complete left bundle branch block
• Subjects with cardiac pacemakers
• Subjects with congenital long QT syndrome or the family history of known long QT syndrome
• History of, or presence of symptomatic ventricular or atrial tachyarrhythmias
• Clinically significant resting bradycardia (< 50 bpm).
• Mean QTcF >450msec following three consecutive ECG tests at baseline: Screening test will be performed again for QTcF after the adjustment of electrolyte if QTcF >450msec and the electrolyte is not within the normal range
• Medical history of clinically confirmed myocardial infarction
• Medical history of unstable angina (within last 12 months)
• Other clinically significant cardiac disease (e.g. congestive heart failure, or uncontrolled hypertension)
• Participation in other investigational drug trials within 30 days prior to Screening;
• Any concomitant medication or medication excluded that could put subject at risk, or interfere with study evaluations;
• Subjects currently receiving treatment with a strong CYP3A4 inhibitors (e.g. erythromycin, ketoconazole, itraconazole, voriconazole, clarithromycin, telithromycin, ritonavir, mibefradil) or strong CYP3A4 inducers (e.g. dexamethasone, phenytoin, carbamazepine, rifampin, rifabutin, rifapentine, phenobarbitol, St. John's Wort) or therapeutic Cumarin derivatives (e.g. warfarin, acenocoumarol, phenprocoumon) and that can neither stop the administration of these drugs before the start of the IP administration nor switch to other drugs
• Subjects who are currently receiving treatment with a medication that has the potential to extend QT intervals and can neither stop the administration of the drugs before the start of the IP administration nor switch to other drugs (list of medications that have the potential to prolong QT interval is provided in the Appendix II) If subjects need to start such drug treatments during the study, this will be discussed with the sponsor, IL-YANG PHARM. Co., Ltd.
• Subjects who are currently receiving treatment with P-gp inducers (e.g. (Ritonavir, Saquinavir, Nelfinavir, Indinavir, Amprenavir, Tipranavir…), Apalutamide, Estrone, Estriol, Trazodone, Vincristine, Tamoxifen, Doxorubicin, Carbamazepine, Oxcarbazepine, Fosphenytoin, Lorlatinib, Phenobarbital, Phenytoin, Propofol, beclomethasone, Dexamethasone, Prednisone, Hydrocortisone, Diclofenac, Rifampicin, Reserpine, Nifedipine, Digoxine, Amiodarone, Spironolactone, Levothyroxine, Tacrolimus, Sirolimus, St. John's Wort (herbal ingredient)) and that can neither stop the administration of these drugs before the start of the IP administration nor switch to other drugs;
• Gastrointestinal disorder or gastrointestinal disease that may result in a significant change in the absorption of the investigational product;
• Medical history of acute or chronic pancreatitis within the past one year;
• Acute or chronic liver, pancreas, or severe kidney disease that are not associated with the disease;
• Subjects known seropositive to human immunodeficiency virus (HIV), current acute or chronic hepatitis B (hepatitis B surface-antigen positive), hepatitis C, or cirrhosis. Inactive hepatitis B surface antigen (HBsAg) carriers, treated and stable hepatitis B (HBV DNA < 500 IU/mL or site specific local lab normal range lower limit assessed by investigator), and cured hepatitis C subjects can be enrolled;
• Men subjects who are unwilling to use and appropriate method of contraception during the study;
• Subjects who have hypersensitivity to active ingredient or any of the excipients of this investigational product;
• Any medical condition that might interfere with the protocol except those defined in Section 5.3 of the study protocol;
• Subject unable to attend scheduled visits or to comply to the protocol;
• Subject under legal guardianship or judicial protection;
• Subject in the exclusion period of another protocol;
• No possibility of contact in case of emergency.