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Preladenant

Phase 3

Parkinson Disease | Small molecule | Neurology |Merck & Company, Inc.|Last Updated: Feb 2, 2021

Success Probability
Approval Probability 71%
TA Base Rate26%
Adjusted LOA41%
ML RiskLOW_RISK
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Market & Valuation
rNPV $3.2B
Market Size $9.4B
Revenue Basis $1.6B
Competitors 6
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Trial Design
RandomizedDouble-BlindCONTROLLEDDMCBiomarker
Total Trials5
Total Enrollment1,693
FDA Designations
No designations recorded
Clinical Trials (5)
NCT IDTitlePhaseStatusEnrollmentVelocityDesignStartCompletionLast UpdatedSitesCountries
NCT01227265Placebo Controlled Study of Preladenant in Participants With Moderate to Severe Parkinson's Disease (P07037)PHASE3 COMPLETED 476Nov 19, 2010Apr 16, 2013Sep 24, 2018 -
NCT01155466A Placebo- and Active Controlled Study of Preladenant in Subjects With Moderate to Severe Parkinson's Disease (P04938)PHASE3 COMPLETED 778Jul 14, 2010Dec 20, 2012Nov 6, 2018 -
NCT00537017Follow Up Safety Study of SCH 420814 in Subjects With Parkinson's Disease (P05175)PHASE2 COMPLETED 140Nov 23, 2007Nov 19, 2009Feb 2, 2021 -
NCT00406029Dyskinesia in Parkinson's Disease (Study P04501)PHASE2 COMPLETED 253Nov 20, 2006Nov 3, 2008Nov 9, 2018 -
NCT01323855A Study to Assess Pharmacokinetics (PK) of Preladenant in Participants With Chronic Renal Impairment (CRI) (P06512)PHASE1 COMPLETED 46Mar 28, 2011Nov 29, 2011Oct 2, 2018 -
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Study Endpoints
Primary Endpoints
Change From Baseline in Average "Off" Time (Hours Per Day) at Week 12
Baseline and Week 12

The "on" state is defined as the period of time during which a patient's symptoms of PD improve or disappear following treatment with L-dopa or dopamine agonists. The "off" state is defined as the period of time characterized by the return of symptoms (i..e. tremor, slowness, and rigidity) following treatment with L-dopa or dopamine agonists. Study participants reported their symptoms at half-hour intervals as "off", "on", or "asleep" on their daily diary for 3 days before randomization (baseline) and for the 3 days immediately before their Week 12 visit. The mean change from baseline in "off" time was based on a constrained longitudinal data analysis (cLDA) with treatment, time, and treatment-by-time interaction as fixed effects and subject as random effect.

Number of Participants With Systolic Blood Pressure (SBP) ≥180 mmHg and 20 mmHg Increase
Up to Week 14

The number of participants with Systolic Blood Pressure (SBP) ≥180 mmHg and 20 mmHg increase was reported. Participants lie supine at rest for 5 minutes, then have a single BP measurement taken (ie, 1 reading). Participants then stand for 3 minutes at rest, followed by a single BP measurement (1 reading) in the standing position.

Number of Participants With Diastolic Blood Pressure (DBP) ≥105 mmHg and 15 mmHg Increase
Up to Week 14

The number of participants with Diastolic Blood Pressure (DBP) ≥105 mmHg and 15 mmHg increase was reported. Participants lie supine at rest for 5 minutes, then have a single BP measurement taken (ie, 1 reading). Participants then stand for 3 minutes at rest, followed by a single BP measurement (1 reading) in the standing position.

Percentage of Participants With Suicidality
Up to Week 12

The percentage of participants with suicidality using the Columbia - Suicide Severity Rating Scale (C-SSRS) was reported. The C-SSR was used in this study only for the purpose of safety monitoring by measuring the incidence of different types of suicidality categories during treatment. The assessment was done by the nature of the responses, not by a numbered scale. Participants who reported at least one occurrence of suicidal behavior or suicidal ideation were counted as having experienced suicidality. Suicidal behavior included suicide attempt, aborted attempt, interrupted attempt, or preparatory behavior. Suicidal ideation included a wish to die or active suicidal thought with or without method, intent or plan.

Change From Baseline in Total Epworth Sleepiness Scale (ESS) at Week 12
Baseline and Week 12

The ESS is a self-administered questionnaire providing a measure of a person's general level of daytime sleepiness, or their average sleep propensity in daily life. The scale consists of 8 situations in which the participant rates their tendency to become sleepy on a scale of 0=no chance of dozing to 3=high chance of dozing. The overall score is the sum of the scores for the 8 situations for a minimum of 0 and a maximum of 24 with a higher score indicating greater sleepiness. The mean change from baseline in total EES was based on a cLDA with treatment, time, and treatment-by-time interaction as fixed effects and subject as random effect.

Change From Baseline in Mean "Off" Time
Baseline and Week 12

The "on" state is defined as the period of time during which a patient's symptoms of PD improve or disappear following treatment with L-dopa or dopamine agonists. The "off" state is defined as the period of time characterized by the return of symptoms (i..e. tremor, slowness, and rigidity) following treatment with L-dopa or dopamine agonists. Study participants reported their symptoms at half-hour intervals as "off", "on", or "asleep" on their daily diary for 3 days before randomization (baseline) and for the 3 days immediately before their Week-12 visit. The mean change from baseline in "off" time was based on a constrained longitudinal data analysis with treatment, time, and treatment-by-time interaction as fixed effects and subject as random effect.

Numberof Participants With Systolic Blood Pressure >=180 mm Hg
Up to Week 14

The number of participants with Systolic Blood Pressure \>=180 mm Hg was reported.

Number of Participants With Diastolic Blood Pressure >=105 mm Hg
Up to Week 14

The number of participants with Diastolic Blood Pressure \>=105 mm Hg was reported.

Number of Participants With Alanine Aminotransferase >=3 Times the Upper Limit of Normal
Up to Week 14

The number of participants with alanine aminotransferase \>=3 times the upper limit of normal and a \>=10% increase was reported.

Number of Participants With Aspartate Aminotransferase >=3 Times the Upper Limit of Normal
Up to Week 14

The number of participants with aspartate aminotransferase \>=3 times the upper limit of normal and a \>=10% increase was reported.

Change From Baseline at Week 12 in Epworth Sleepiness Scale (ESS)
Baseline and Week 12

The ESS is a self-administered questionnaire providing a measure of a person's general level of daytime sleepiness, or their average sleep propensity in daily life. The scale consists of 8 situations in which the participant rates their tendency to become sleepy on a scale of 0=no chance of dozing to 3=high chance of dozing. The overall score is the sum of the scores for the 8 situations for a minimum of 0 and a maximum of 24.

Number of Participants Who Experienced at Least One Adverse Event
Up to 42 weeks

An adverse event is defined as any unfavorable and unintended sign including an abnormal laboratory finding, symptom or disease associated with the use of a medical treatment or procedure, regardless of whether it is considered related to the medical treatment or procedure. A serious adverse event is an adverse event that that results in death, life threatening adverse event, permanent or significant disability / unfitness for work, hospital treatment (i.e., admission to hospital) or prolongation of a patient's length of stay, or congenital deformity or birth defect.

Change From Baseline to Endpoint of 12 Weeks in the 3-day Average of Awake Time Per Day Spent in the "Off" State
Baseline (Week -1) and up to 12 weeks

"Off" time refers to periods of inadequate control of Parkinson disease symptoms (worsening or presence of symptoms). For baseline and the 12 weeks treatment period, hours spent in the "off" state during awake time were recorded in half-hour time intervals using a daily diary at least 3 full days before scheduled visits. For baseline, the 24-hour average over 3 consecutive days was derived for Week -1. For endpoint, the 24-hour average was derived for the last available 3 consecutive days with postbaseline data available during the treatment period. Change from baseline in least squares (LS) means and pooled standard deviation (SD) were obtained from an analysis of covariance (ANCOVA) model with effect for treatment and baseline covariate. A negative change from baseline signifies less time spent in the "off" state.

Area Under the Concentration-time Curve From Time 0 to Infinity (AUC0-∞) After Single Dosing With Preladenant for Participants With Severe CRI Versus Healthy Matched Controls
Pre-dose to 48 hours post-dose

Blood samples were taken at the following timepoints: pre-dose, 0.25, 0.50, 0.75, 1, 2, 4, 6, 12, 16, 24, 30, 36 and 48 hours postdose in order to determine the AUC0-∞ of preladenant

AUC0-∞ After Single Dosing With Preladenant for Participants With Moderate CRI Versus Healthy Matched Controls
Pre-dose to 48 hours post-dose

Blood samples were taken at the following timepoints: pre-dose, 0.25, 0.50, 0.75, 1, 2, 4, 6, 12, 16, 24, 30, 36 and 48 hours postdose in order to determine the AUC0-∞ of preladenant

AUC0-∞ After Single Dosing With Preladenant for Participants With Mild CRI Versus Healthy Matched Controls
Pre-dose to 48 hours post-dose

Blood samples were taken at the following timepoints: pre-dose, 0.25, 0.50, 0.75, 1, 2, 4, 6, 12, 16, 24, 30, 36 and 48 hours postdose in order to determine the AUC0-∞ of preladenant

Secondary Endpoints
Percentage of Participants With >30% Change (Reduction) From Baseline at Week 12 in Mean "Off" Time
Baseline and Week 12
Change From Baseline in Average "On" Time (Hours Per Day) Without Troublesome Dyskinesia at Week 12
Baseline and Week 12
Change From Baseline at Week 12 in Mean "On" Time Without Troublesome Dyskinesia
Baseline and Week 12
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Study Design & Arms
AllocationRANDOMIZED
MaskingDOUBLE
ModelPARALLEL
PurposeTREATMENT
Treatment Arms
ArmTypeDescription
Preladenant 2 mgEXPERIMENTALParticipants received 2 mg as a single oral dose twice daily for 12 weeks. Participants could then enroll in an extension trial or return for a follow-up visit two (2) weeks later.
Preladenant 5 mgEXPERIMENTALParticipants received 5 mg as a single oral dose twice daily for 12 weeks. Participants could then enroll in an extension trial or return for a follow-up visit two (2) weeks later.
PlaceboPLACEBO_COMPARATORParticipants received preladenant-matching placebo as a single oral dose twice daily for 12 weeks. Participants could then enroll in an extention trial or return for a follow-up visit two (2) weeks later.
Preladenant 10 mgEXPERIMENTALPreladenant 10 mg tablet + placebo to rasagiline capsule in AM and preladenant 10 mg tablet in PM for 12 weeks
Rasagiline 1 mgACTIVE_COMPARATORRasagiline 1 mg capsule + placebo to preladenant tablet in AM and placebo to preladenant tablet in PM for 12 weeks
Preladenant 5 mg BIDEXPERIMENTALPreladenant 5 mg twice daily (BID) given open-label for 36 weeks to participants with moderate to severe Parkinson's Disease who are on a long-term and stable L-dopa treatment regimen.
Preladenant 1 mg BIDEXPERIMENTALParticipants received preladenant 1 mg twice daily (BID) during the 12-week treatment period.
Preladenant 2 mg BIDEXPERIMENTALParticipants received preladenant 2 mg BID during the 12-week treatment period.
Preladenant 10 mg BIDEXPERIMENTALParticipants received preladenant 10 mg BID during the 12-week treatment period.
Placebo BIDPLACEBO_COMPARATORParticipants received preladenant matching placebo BID during the 12-week treatment period.
Part 1: Severe Renal ImpairmentEXPERIMENTALParticipants with severe CRI, defined as creatinine clearance of \<30 mL/min/1.73 m\^2, were treated with a single tablet of 5 mg preladenant, administered orally
Part 2: Moderate Renal ImpairmentEXPERIMENTALParticipants with moderate CRI defined as creatinine clearance of ≥30 and \<50 mL/min/1.73 m\^2, were treated with a single tablet of 5 mg preladenant, administered orally
Part 2: Mild Renal ImpairmentEXPERIMENTALParticipants with mild CRI, defined as creatinine clearance of ≥50 and ≤80 mL/min/1.73m\^2, were treated with a single tablet of 5 mg preladenant, administered orally
Part 1: Normal Renal FunctionEXPERIMENTALParticipants with normal renal function, defined as creatinine clearance of \>80 mL/min/1.73 m\^2, were treated with a single tablet of 5 mg preladenant, administered orally
Part 2: Normal Renal FunctionEXPERIMENTALParticipants with normal renal function, defined as creatinine clearance of \>80 mL/min/1.73 m\^2, were treated with a single tablet of 5 mg preladenant, administered orally
Interventions
NameTypeDescription
PreladenantDRUGPreladenant 2 mg or 5 mg oral tablet taken twice daily
PlaceboDRUGPreladenant-matching placebo oral tablet taken twice daily
Preladenant 2 mg tabletDRUGone 2 mg tablet orally twice daily
Preladenant 5 mg tabletDRUGone 5 mg tablet orally twice daily
Preladenant 10 mg tabletDRUGone 10 mg tablet orally twice daily
Placebo to Preladenant TabletDRUGone tablet orally twice daily
Rasagiline 1 mg capsuleDRUGone 1 mg capsule orally in AM
Placebo to Rasagiline capsuleDRUGone capsule orally in AM
L-dopaDRUGParticipants must receive L-dopa as part of their usual ongoing treatment for Parkinson's Disease. L-dopa is often administered concomitantly with a dopa decarboxylase inhibitor (e.g., carbidopa).
Other Parkinson's Disease treatmentsDRUGParticipants may also receive other drugs as part of their usual ongoing treatment for Parkinson's Disease, such as dopamine agonists (e.g., pramipexole) and/or the catechol-O methyl transferase (COMT) inhibitor entacapone.
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Eligibility Criteria
Age Range30 Years — 85 Years
SexALL
Healthy VolunteersNo

Inclusion Criteria: * Each participant must have a diagnosis of idiopathic Parkinson's disease. * Each participant must have received prior therapy with L-dopa for approximately 1 or more years immediately before Screening and must continue to have a beneficial clinical response to L-dopa. * Each p...

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