Margherita Fabbri, MD, PhD, University of Toulouse, Toulouse, France, gives an update on ongoing clinical trials for Parkinson’s disease. With many therapies currently under investigation, this is an exciting and rewarding time for research into Parkinson’s disease. The development of disease-modifying treatments continues to be the main priority, with agents targeting α-synuclein and LRRK2 at the forefront of trials. However, there is a significant need for target engagement measures for α-synuclein, and there hasn’t been a real clinical impact regarding disease modification. Regarding symptomatic treatment, there have been some interesting trials, such as the combination of dopamine agonists with low-dose MAO inhibitors and the use of amantadine in early Parkinson’s disease. For the management of motor complications in patients with more advanced disease, research is looking at drug repurposing strategies. This interview took place at the 2022 International Congress of Parkinson’s Disease and Movement Disorders in Madrid, Spain.
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Transcript (edited for clarity)
We can say there are many things ongoing on the disease modifying treatment, many different things ongoing. And it seems that we are spent much effort in the disease modifying, more much than we are spending in the early symptomatic treatment. And so far, we can’t say that we have a clinical, real impact in term of disease modification. So, far I mean that we can induce an immunological response by immuno active immunization...
We can say there are many things ongoing on the disease modifying treatment, many different things ongoing. And it seems that we are spent much effort in the disease modifying, more much than we are spending in the early symptomatic treatment. And so far, we can’t say that we have a clinical, real impact in term of disease modification. So, far I mean that we can induce an immunological response by immuno active immunization. We can penetrate the CSF by means of different routes of administration, but we do not have a clinical impact.
But we have a lot of things ongoing on alpha-synuclein means folding or lack to inhibition on insulin targeting agents and so on. So, we are waiting for, we need a target engagement measure for alpha-synuclein treatment still this is a real matter in terms of clinical trials’ outcome. And that regarding symptomatic treatment we had a few interesting trials above all combination of the dopamine agonist and low dose of iMAO above on the real role of amantadine in the early PD patient. Regarding patient more advanced in the motor complication management.
We are still drug reproposing phenomenon, so we are using drugs that have been already approved and known new drugs even if we are waiting for several new targets for dyskinesia. So, this all I can say, and there are several emerging methodologies also for exercise that are quite interesting.
I would like to mention that we are quite… well, the number of trials are always so high in the last years. So, we are trying to implement to continue our research, and this is important. We have finally understood the real importance of non-pharmacological approaches. And for this I’m very happy and I think that regarding disease modifying approaches, we need still to define a little bit the hypothesis and settle down all together to redefine a little bit hypothesis and the outcomes of those trials.