2.5.De beschrijving van EP 296 bevat onder meer de volgende paragrafen:
[0001]The invention relates to a new compositions and methods of treating Parkinson’s disease. More specifically, the invention relates to methods for treating Parkinson’s Disease through the administration of safinamide in combination with levodopa.
BACKGROUND OF THE INVENTION
[0002]Parkinson’s Disease (PD) currently affects about 10 million people world-wide. PD is a highly specific degeneration of dopamine-containing cells of the substantia nigra of the midbrain. Degeneration of the substantia nigra in Parkinson’s disease causes a dopamine deficiency in the striatum. Effective management of a patient with PD is possible in the first 5-7 years of treatment, after which time a series of often debilitating complications, together referred to as Late Motor Fluctuations (LMF) occur (Marsden and Parkes, Lancet II: 345-349,1997). It is believed that treatment with levodopa, or L-dopa, the most effective antiparkinson drug, may facilitate or even promote the appearance of LMF. Dopamine agonists are employed as a treatment alternative, but they do not offer the same degree of symptomatic relief to patients as L-dopa does (Chase, Drugs, 55 (suppl.1): 1-9,1998).
[0003]Symptomatic therapies improve signs and symptoms without affecting the underlying disease state. Levodopa ((-)-L-alpha-anino-beta-(3,4-dihydroxybenzene) propanoic acid) increases dopamine concentration in the striatum, especially when its peripheral metabolism is inhibited by a peripheral decarboxylase inhibitor (PDI). Levodopa/PDI therapy is widely used for symptomatic therapy for Parkinson’s disease, such as combinations with levodopa, with carbidopa ((-)-L-alpha-hydrazino-alpha-methyl-beta-(3,4-dihydroxybenzene) propanoic acid monohydrate), such as SINEMET®; levodopa and controlled release carbidopa (SINEMET-CR®), levodopa and benserazide (MADOPAR®, Prolopa), levodopa plus controlled release benserazide (2-Amino-3-hydroxy-propionic acid N-(2,3,4-trihydroxybenzyl)-hydrazide), MADOPAR-HBS.
[0004]COMT (catechol-O-methyltransferase) inhibitors enhance levodopa treatment as they inhibit levodopa’s metabolism, enhancing its bioavailability and thereby making more of the drug available in the synaptic cleft for a longer period of time. Examples of COMT inhibitors include tolcapone (3,4-dihydroxy-4’-methyl-5-nitrobenzophenone) and entacapone ((E)-2-cyano-3-(3,4-dihydroxy-5-nitrophenyl)-N,N-diethyl-2-propenamide).
[0005]Dopamine agonists provide symptomatic benefit by directly stimulating post-synaptic striatal dopamine receptors. Examples include bromocriptine ((5α)-2-Bromo-12’-hydroxy-2’-(1-methylethyl)-5’-(2-methylpropyl)ergotaman-3’,6’, 18-trione), pergolide (8B-[(Methylthio)methyl]-6-propylergoline), ropinirole (4-[2-(Dipropylamino)ethyl]-1,3-dihydro-2H indol-2-one), pramipexole ((S)-4,5,6,7-Tetrahydro-N6-propyl-2,6-benzothiazolediamine), lisuride (N’-[(8α)-9,10-didehy dro-6-methylergolin-8-yl]-N,N-diethylurea), cabergoline ((8β)-N-[3-(Dimiethylamino)propyl]-N-[(ethylamino)carbonyl] 6-(2-propenyl)ergoline-8-carboxamide), apomorphine ((6aR)-5,6,6a,7-Tetrahydro-6-methyl-4H-dibenzo[de,g]quinoline 10,11-diol), sumanirole (5-(methylamino)-5,6-dihydro-4H-imidazo {4,5,1-ij} quinolin-2(1H)-one), rotigotine ((-)(S) 5,6,7,8-tetrahydro-6-[propyl[2-(2-thienyl)ethyl]amino]-1-naphthol), talipexole (5,6,7,8-Tetrahydro-6-(2-propenyl)-4H-thi azolo[4,5-d]azepin-2-amine), and dihydroergocriptine (ergotaman-3’,6’,18-trione,9,10-dihydro-12’-hydro-2’-methyl-5’ phenylmethyl) (5’α)). Dopamine agonists are effective as monotherapy early in the course of Parkinson’s disease and as an adjunct to levodopa in more advanced stages. Unlike levodopa, dopamine agonists directly stimulate post-synaptic dopamine receptors. They do not undergo oxidative metabolism and are not thought to accelerate the disease process. In fact, animals fed a diet including pergolide were found to experience less age-related loss of dopamine neurons.
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[0007]Other medications used in the treatment of Parkinson’s disease include MAO-B inhibitors. Inhibition of L-dopa metabolism through inactivation of the monoamino oxidase type B (MAO-B) is an effective means of enhancing the efficacy of both endogenous residual dopamine and that exogenously derived from its precursor, L-dopa (Youdim and Finberg, Biochem Pharmacol. 41: 155-162,1991). Selegiline (methyl-(1-methyl-2-phenyl-ethyl)-prop-2-ynyl-amine) is a MAO-B inhibitor. There is evidence that treatment with selegiline may slow down disease progression in PD by blocking the formation of free radicals derived from the oxidative metabolism of dopamine (Heikkila et al., Nature 311: 467-469,1984; Mytilineou et al., J Neurochem., 68: 33-39,1997). Another MAO-B inhibitor under development is rasagiline (N-propargyl-1-(R)aminoindan, TEVA Pharmaceutical Industries, Ltd.). Other examples of MAO B inhibitors include lazabemide (N-(2-Aminoethyl)-5-chloro-2-pyridinecarboxamide) and caroxazone (2-Oxo-2H-1,3-benzoxazine-3(4H) acetamide).
[0008]The present invention is based, in part, on the unexpected finding that the combination of safinamide and other Parkinson’s Disease agents provides a more effective treatment for Parkinson’s Disease (PD) than either component alone. The invention includes methods of using such compounds to treat Parkinson’s Disease and pharmaceutical compositions for treating PD which may be used in such methods.
[0009]In one embodiment, the invention relates to methods for treating Parkinson’s Disease through the administration of safinamide from 0.5 to 1, 2, 3, 4 or 5 mg/kg/day in combination with levodopa/PDI, COMT inhibitors, amantidine. When safinamide is used in combination with other types of drugs, an unexpected, synergistic effect is achieved. The improvement of symptoms and the delay of disease progression are more evident in patients treated with the combination of drugs than those treated with a single type of drug alone. When safinamide was administered alone, patients improved only by an average 6.9% whereas when safinamide was added to a stabilized dose of a variety of dopamine agonists, the average improvement reached 27.8%.
[0010]In one embodiment, methods of treating Parkinson’s Disease are disclosed, wherein safnamide, and a Parkinson’s Disease agent are administered to a subject having Parkinson’s Disease, such that the Parkinson’s Disease is treated or at least partially alleviated. The safinamide, and Parkinson’s Disease agent may be administered as part of a pharmaceutical composition, or as part of a combination therapy. The amount of safinamide, and a Parkinson’s Disease agent is typically effective to reduce symptoms and to enable an observation of a reduction in symptoms.
[0011]Safinamide is an anti-PD agent with multiple mechanisms of action. One mechanism of safinamide may be, as a MAO-B inhibitor.
[0012]Parkinson’s Disease agents which may be used with safinamide in the pharmaceutical compositions, methods and combination therapies of the invention include levodopa/PDIs.
[0013]Levodopa/PDIs include, but are not limited to, levodopa plus carbidopa (SINEMET®), levodopa plus controlled release carbidopa (SINEMET-CR®), levodopa plus benserazide (MADOPAR®), and levodopa plus controlled release benserazide (MADOPAR-HBS).
[0014]COMT inhibitors include, but are not limited to, tolcapone and entacapone.
[0015]Combinations of safinamide, from 0.5 to 1, 2, 3, 4 or 5 mg/kg/day and levodopa/PDI may also include additional Parkinson’s Disease agents such as COMT inhibitors, amantidine and/or dopamine agonists. One combination which can be used in the pharmaceutical compositions, methods and combination therapies of the invention includes safinamide and levodopa/PDI. Another combination which can be used in the pharmaceutical compositions, methods and combi nation therapies of the invention includes safinamide, levodopa/PDI, and a COMT inhibitor. Another combination which can be used in the pharmaceutical compositions, methods and combination therapies of the invention includes safinamide, levodopa/PDI, a COMT inhibitor, and a dopamine agonist. Yet another combination which can be used in the pharmaceutical compositions, methods and combination therapies of the invention includes safinamide, levodopa/PDI, a COMT inhibitor, a dopamine agonist, and amantidine.
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[0021]The invention further relates to kits for treating patients having Parkinson’s Disease. Such kits include a therapeutically effective dose of an agent for treating or at least partially alleviating the symptoms of Parkinson’s Disease (e.g., levodopa plus carbidopa (SINEMET®), levodopa plus controlled release carbidopa (SINEMET-CR®), levodopa plus benserazide (MADOPAR®), levodopa plus controlled release benserazide (MADOPAR-HBS), bromocriptine, per golide, ropinirole, pramipexole, lisuride, cabergoline, apomorphine, sumanirole, rotigotine, talipexole, dihydroergocrip tine, entacapone, tolcapone, amantidine) and safinamide from 0.5 to 1, 2, 3, 4 or 5 mg/kg/day either in the same or separate packaging, and instructions for its use.
[0022]Pharmaceutical compositions including safinamide, from 0.5 to 1, 2, 3, 4 or 5 mg/kg/day and a Parkinson’s Disease agents, in an effective amount(s) to treat Parkinson’s Disease, are also included in the invention.
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DETAILED DESCRIPTION OF THE INVENTION
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[0024]Safinamide, (+)-(S)-2=[[p-[(m-fluorobenzyl)oxy]-benzyl]amino]propionamide, (NW-1015, FCE26743 or PNU151774E), is an α-aminoamide, a chemical class of compounds with a favorable pharmacological and safety profile. Safinamide and its analogs or derivatives are thought to be multi-mechanism drugs which potentially exert biological activity via a variety of mechanisms, including sodium and a calcium channel blockade and dopamine re-uptake inhibition (Fariello et al., J. Pharmacol. Exp. Ther. 285: 397-403, 1998; Salvati et al, J. Pharmacol. Exp. Ther. 288:1151-1159,1999; US Patents 5,236,957; 5,391,577; 5,502,079; 5,502,658; 5,945,454; 6,306,903, and PCT publications WO 90/14334; WO 97/05102 WO 99/35125. Safinamide is also a potent, reversible inhibitor of MAO-B activity (Strolin Benedetti et al., J. Pharm. Pharmacol. 46:814-819, 1994). Safinamide has been shown to be an anticonvulsant and neuroprotectant and it is under clinical development by oral route as anticonvulsant and anti-Parkinson agent,
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[0028]Safinamide derivatives include those described by Formula I:
R is C1-C8 alkyl; a C3-C8 cycloalkyl, furyl, thienyl or pyridyl ring; or a phenyl ring unsubstituted or substituted by 1 to 4 substituents independently chosen from halogen, C1-C6 alkyl, C1-C6 alkoxy and trifluoromethyl; A is a -(CH2)m - or -(CH2)p-X-(CH2)q - group, wherein m is an integer of 1 to 4, one of p and q is zero and the other is zero or an integer of 1 to 4, and X is -O-, -S- or NR4 - in which R4 is hydrogen or C1-C4 alkyl; n is zero or I; each of R1 and R2, independently, is hydrogen or C1 -C4 alkyl;
R3 is hydrogen, C1 -C4 alkyl unsubstituted or substituted by hydroxy or by a phenyl ring optionally substituted by 1 to 4 substituents independently chosen from halogen, C1-C6 alkyl, C1-C6 alkoxy and trifluoromethyl; R3’ is hydrogen; or R3 and R3 taken together with the adjacent carbon atom form a C3-C6 cycloalkyl ring; each of R5 and R6, independently, is hydrogen or C1-C6 alkyl; and wherein when R is C1-C8 alkyl, then A is a -(CH2)p-X-(CH2)q - group in which p and q are both zero and X is as defined above.
[0030]The present invention includes all the possible optical isomers of the compounds of formula (I) and their mixtures, as well as the metabolizes of the compounds of formula (I). The present invention also includes within its scope pharmaceutically acceptable bioprecursors and prodrugs of the compounds of formula (I), i.e. compounds, which have a formula different to formula (I), but which nevertheless are directly or indirectly converted in vivo into a compound of formula (I) upon administration to a human being.
[0031]Pharmaceutically acceptable salts of the compounds of formula (I) include acid addition salts with inorganic acids, e.g. nitric, hydrochloric, hydrobromic, sulphuric, perchloric, and phosphoric acid, or organic acids, e.g. acetic, propionic, glycolic, lactic, oxalic, malonic, malic, tartaric, citric, benzoic, cinnamic, mandelic, methanesulfonic and salicylic acids.
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[0044]Safinamide can also be considered a potent and selective (reversible) MAO-B inhibitor, but one which possesses additional mechanisms of action such as dopamine re-uptake inhibition and sodium and calcium channel blockade.
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[0046]"Combination therapy" (or "co-tberapy") includes the administration of safinamide and at least a Parkinson’s Disease agent as part of a specific treatment regimen intended to provide the beneficial effect from the co-action of these therapeutic agents. The beneficial effect of the combination includes, but is not limited to, pharmacokinetic or pharmacodynamic co-action resulting from the combination of therapeutic agents. Administration of these therapeutic agents in combination typically is carried out over a defined time period (usually minutes, hours, days or weeks depending upon the combination selected). An example of combination therapy for treating Parkinson’s Disease with nicotinamide adenine dinucleotide and another PD agent is disclosed in U.S. Patent 4,970,200.
[0047]"Combination therapy" may, but generally is not, intended to encompass the administration of two or more of these therapeutic agents as part of separate monotherapy regimens that incidentally and arbitrarily result in the combi nations of the present invention. "Combination therapy" is intended to embrace administration of these therapeutic agents in a sequential manner, that is, wherein each therapeutic agent is administered at a different time, as well as administration of these therapeutic agents, or at least two of the therapeutic agents, in a substantially simultaneous manner. Substantially simultaneous administration can be accomplished, for example, by administering to the subject a single capsule having a fixed ratio of each therapeutic agent or in multiple, single capsules for each of the therapeutic agents. Sequential or substantially simultaneous administration of each therapeutic agent can be effected by any appropriate route including, but not limited to, oral routes, intravenous routes, intramuscular routes, and direct absorption through mucous membrane tissues. The therapeutic agents can be administered by the same route or by different routes. For example, a first therapeutic agent of the combination selected may be administered by intravenous injection while the other therapeutic agents of the combination may be administered orally.
[0048]Alternatively, for example, all therapeutic agents may be administered orally or all therapeutic agents may be administered by intravenous injection. The sequence in which the therapeutic agents are administered is not narrowly critical. "Combination therapy" also embraces the administration of the therapeutic agents as described above in further combination with other biologically active ingredients and non-drug therapies (e.g., surgery). Where the combination therapy further comprises a non-drug treatment, the non-drug treatment may be conducted at any suitable time so long as a beneficial effect from the co-action of the combination of the therapeutic agents and non-drug treatment is achieved. For example, in appropriate cases, the beneficial effect is still achieved when the non-drug treatment is temporally removed from the administration of the therapeutic agents, perhaps by days or even weeks. A combination therapy for PD may include levodopa/PDI (with or without amantidine, COMT inhibitors and/or dopamine agonists) and safinamide from 0.5 to 1, 2, 3, 4 or 5 mg/kg/day. Alternatively, or in addition, combination therapy for PD may include levodopa/PDI (with or without amantidine, COMT inhibitors and/or dopamine agonists) and a MAO-B inhibitor.
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[0053]Some symptoms of PD include bradykinesia, or slowness in voluntary movement, which produces difficulty initiating movement as well as difficulty completing movement once it is in progress. The delayed transmission of signals from the brain to the skeletal muscles, due to diminished dopamine, produces bradykinesia. Other symptoms include tremors in the hands, fingers, forearm, or foot, which tend to occur when the limb is at rest but not when performing tasks. Tremor may occur in the mouth and chin as well. Other symptoms of PD include rigidity, or stiff muscles, which may produce muscle pain and an expressionless, mask-like face. Rigidity tends to increase during movement. Other indications of PD include poor balance, due to the impairment or loss of the reflexes that adjust posture in order to maintain balance. Falls are common in people with Parkinson’s.
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[0057]There are a number of standard rating scales for the quantitation of extra-pyramidal neurological deficits. The most complete and validated scale is the Unified Parkinson’s Disease Rating Scale (UPDRS). It is subdivided into 6 sections. Part III corresponds to the outcome of a physical examination of motor function and is based on the old "Columbia Scale".
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[0059]In an embodiment, the invention relates to methods for treating Parkinson’s Disease through the administration of safinamide, from 0.5 to 1, 2, 3, 4 or 5 mg/kg/day in combination with other Parkinson’s Disease agents or treatments. The inventors have discovered that when safinamide is used in combination with other types of drugs, an unexpected, synergistic effect is achieved. The improvement of symptoms and possibly the delay of disease progression is more evident in patients treated with the combination of drugs than those treated with a single type of drug alone. The unexpected synergistic effect of treatment with safinamide in combination with other PD agents provides a scientific rationale for the use of these co-therapies as novel PD therapy.
[0060]In one embodiment, methods of treating Parkinson’s Disease are disclosed, wherein safmamide from 0.5 to 1, 2, 3, 4 or 5 mg/kg/day and a Parkinson’s Disease agent(s) are administered to a subject having Parkinson’s Disease, such that the symptoms of Parkinson’s Disease are treated or at least partially alleviated. Safinamide and Parkinson’s Disease agent may be administered as part of a pharmaceutical composition, or as part of a combination therapy. In another embodiment, a patient is diagnosed, e.g., to determine if treatment is necessary, whereupon a combination therapy in accordance with the invention is administered to treat the patient. The amount of safinamide according to the invention and Parkinson’s Disease agent(s) is typically effective to reduce symptoms and to enable an observation of a reduction in symptoms.
[0061]The methods of treating Parkinson’s Disease disclosed, herein include administration of safinamide from 0.5 to 1, 2, 3, 4 or 5 mg/kg/day and levodopa/PDI such that the symptoms of Parkinson’s Disease are treated or at least partially alleviated. One combination which can be used in the methods of the invention includes safinamide and levodopa/PDI. Another combination which can be used in the methods of the invention includes safinamide according to the invention levodopa/PDI, and a COMT inhibitor. Another combination which can be used in the methods of the invention includes safinamide according to the invention levodopa/PDI, and a dopamine agonist. Another combination which can be used in the methods of the invention includes safinamide according to the invention levodopa/PDI, a COMT inhibitor, and a dopamine agonist. Yet another combination which can be used in the methods of the invention includes safinamide according to invention levodopa/PDI, a COMT inhibitor, a dopamine agonist and amantidine.
[0062]Administration the treatment according to the methods of the invention is made to a subject having Parkinson’s Disease, such that the symptoms of Parkinson’s Disease are treated or at least partially alleviated. The safinamide and PD agent may be administered as part of a pharmaceutical composition, or as part of a combination therapy. In another embodiment, a patient is diagnosed, e.g., to determine if treatment is necessary, whereupon a combination therapy in accordance with the invention is administered to treat the patient. The amount of safinamide from 0.5 to 1, 2, 3, 4 or 5 mg/kg/day and PD agent(s) is typically effective to reduce symptoms and to enable an observation of a reduction in symptoms.
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[0096]The pharmaceutical compositions of the present invention can be formulated for, oral administration, inhalation devices, depot, intra-adipose, intravenously, sublingually, perilingually, subcutaneously, rectally, or transdermally, or by any other medically-acceptable means, but preferably orally by mixing each of the above compounds with a pharmacologically acceptable carrier or excipient. The amount of active ingredient(s) that may be combined with desired carrier materials) to produce single or multiple dosage forms will vary depending upon the host in need thereof and the respective mode of administration. For example, a formulation intended for oral administration of humans may contain from 0.01mg to 500mg of active agent(s) compounded with an appropriate convenient amount of carrier material which may vary in composition from about 1 to 99 percent of total composition. Before orally administered drugs enter the general circulation of the human body, they are absorbed into the capillaries of the upper gastrointestinal tract and are transported by the portal vein to the liver. The enzymatic-activities the pH found in gastrointestinal fluids or tissues, concurrent intake of food and consequent agitation may inactivate the drug or cause the drug to dissolve poorly and consequently decrease compliance, increase the risk of side effects and substantially reduce the efficacy of the drug. Varying dosage unit forms of the present invention comprise safinamide from 0.5 to 1, 2, 3, 4 or 5 mg/kg/day in combination with a Parkinson’s Disease agent as active ingredients and have surprisingly shown an increase in the efficacy and for inhibiting the progression of PD.
[0097]The pharmaceutical compositions of the present invention for inhibiting the progression of PD and/or for treating the disease, comprise safinamide from 0.5 to 1, 2, 3, 4 or 5 mg/kg/day in combination with a Parkinson’s Disease agent as active ingredients in dosage unit form(s). In cases where the biological half-life of safinamide is different than that of a Parkinson’s Disease agent, it may be advantageous to administer the drugs in separate or admixed compositions and a controlled release composition may be used for the active compound(s) with the shortest biological half-life. Alternatively, a tablet composition may be used that allows for fast release of the compound(s) with the longest duration and delayed release of the compound(s) with the shortest duration of activity. See, e.g., U.S. Patent 6,500,867.
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[0102]Pre-clinical studies of safinamide, including general and specific pharmacology studies on the mechanism of action, toxicology, pharmacokinetics and metabolism, proved that safinamide has a broad spectrum of anticonvulsant activity, with a potency comparable or superior to most classical antiepileptic drugs, without evidence of proconvulsant effect and with a very large safety index (Chazot, Current Opinion in Invest. Drugs, 2(6): 809-813, 2001.
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[0104]Phase I clinical studies in 71 healthy volunteers revealed that single doses of 10 mg/kg or 7 days of repeated doses of 5 mg/kg/day did not produce any clinically relevant side effect. Overall, the drug was very well tolerated, without objective signs of toxicity and only minor subjective complaints. A tyramine pressure test was performed in 8 healthy volunteers. To raise BP by 30 mm Hg, an equal or greater amount of i.v. tyramine was required after safinamide 2.0 mg/kg compared to placebo, demonstrating lack of "cheese effect," a dangerous hypertensive reaction caused by neural uptake of tyramine from tyramine-containing foods like aged cheeses, certain wines, yeast, beans, chicken liver and herring (Chazot PL, Current Opinion in Invest. Drugs, 2(6): 809-813, 2001).
[0105]A phase II dose finding, double-blind, placebo controlled study to investigate the efficacy and safety of safinamide, a MAO-B inhibitor, in patients affected by idiopathic early Parkinson’s disease was performed. The objective of the study was to evaluate the efficacy and safety of orally 613administered safinamide at two different doses (0.5 mg/kg and 1.0 mg/kg) in parkinsonian patients de-novo or treated with one single dopamine agonist at stable dose. This was a dose finding, double-blind, placebo-controlled, randomized, multicenter, multinational, 12-week trial, comparing two doses of safinamide (0.50 and 1.00 mg/kg) versus placebo as monotherapy or as adjunct therapy to one single dopamine agonist.
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[0108]Mode of administration was oral, once daily; and duration of treatment was 12 weeks. The primary efficacy variable in this study was the proportion of patients considered to have achieved a response defined as an improvement of at least 30% in the unified Parkinson’s disease ratings scale (UPDRS) section III score between baseline (Visit 2) and the end of the study (Visit 9 or early study termination).
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[0121]The percentage of patients with an improvement of at least 30% in the UPDRS section III score between baseline (Visit 2) and the end of the study (Visit 9 or early study termination) and results from the statistical analysis of the primary efficacy variable are displayed in Table 1.
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[0125]A further two-subgroup analysis by the patient’s treatment history (de-novo versus single dopamine agonist) generally yielded similar results to those of the first subgroup analysis. However, in the second subgroup analysis, the logistic regression model including all treatment groups showed a statistically significant difference between safinamide 1.0 mg/kg and placebo for the responder rates an the final visit in the subgroup of single dopamine agonist patients (p = 0.024). There were no relevant differences in the responder rates between safinamide 0.5 mg/kg and placebo in the single dopamine agonist subgroup or between the three treatment groups in the de-novo subgroup. In essence, while in the de novo patients (i.e. patients who were taking either placebo or Safinamide alone) there was no difference in the rate of responders in the 3 study arms; patients under stable dopamine agonist treatment had a rate of responders of 20.6% in the placebo group; of 36.4% in the Safinamide 0.5 mg/kg group and more than double the placebo (47.1%) in the safinamide 1.0 mg/kg.
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[0128]In this study, superiority of safinamide 1.0 mg/kg to placebo was demonstrated for the percentage of patients with an improvement of at least 30% in the UPDRS section III score between baseline (Visit 2) and the final visit (Visit 9 or early study termination), the primary efficacy parameter. The improvement in responder rates seen in the overall population appeared to be due to an add-on effect of safinamide in the subgroup of patients treated with a single dopamine agonist. The rate of patients with adverse events was lower in the safinamide groups than in the placebo group. There were no safety concerns associated with the results of laboratory parameters, vital signs and ECG recordings measured during the study.