Stopping the progression of Parkinson’s
Despite 30 years of research, not a single therapy has been found to successfully delay or stop the progression of Parkinson’s disease. Many potential disease-modifying therapies have been identified as suitable for clinical evaluation in Parkinson’s. Each potential cure for Parkinson’s has to go through three clinical trial phases to test its safety investigating if it shows signs of improving Parkinson’s and if there are any meaningful benefit to people with Parkinson’s.
Running a clinical trial is a huge logistical, costly and time-consuming undertaking. For a single new therapy this process can take the best part of a decade. Currently, phase II and phase III clinical trials are set up in isolation from each other – a process that is lengthy, costly and inefficient.
“The current way we do trials in Parkinson’s is too slow and inefficient. We need to develop new ways of doing trials, which will speed up the process and bring us closer to finding a cure, faster. We have the opportunity to learn from the experience in these other conditions and design a new trial that will work for people with Parkinson’s.”
Dr Camille Carroll, Associate Professor and Honorary Consultant Neurologist
Evaluating several Parkinson’s therapies at once
Dr Camille Carroll and Dr Marie-Louise Zeissler report on the possibility of using a multi-arm, multi-stage (MAMS) trial platform to evaluate several potential therapies at once, using lessons learned from other diseases such as prostate, renal and oropharyngeal cancer, as well as other neurogenerative disorders, progressive multiple sclerosis (PMS) and motor neuron disease (MND).
MAMS trials test many potential therapies in parallel (multi-arm), transitioning seamlessly through various phases (multi-stage), i.e., from a phase II safety and efficacy study to a phase III trial. Early analyses allow unsuccessful therapies to be replaced. At the interim checkpoint, ineffective arms can be dropped and replaced by new treatment arms, thereby allowing for the continuous evaluation of interventions.
Speeding up the search for a cure
To maximise the potential of a MAMS platform trial over many years, it is crucial that there is a pipeline in place that will continuously identify and evaluate suitable drug candidates.
Furthermore, outcome measures have to be chosen that are sensitive enough to changes in disease progression over interim stages as well as the full duration of the trial.
In 2020 and 2021, Dr Carroll, Dr Zeissler and their team will be working with The Cure Parkinson’s Trust, the Edmond J. Safra Foundation and other organisations national and internally to achieve just this.
It is hoped this will dramatically speed up the search for a cure.
Peninsula Clinical Trials Unit (PenCTU)
Clinical, methodological and trial management expertise to design, set-up, conduct, analyse and publish clinical trials.
Zeissler, Marie-Louisea; Li, Vivienb; Parmar, Mahesh K.B.; Carroll, Camille Buchholza, 2020 ‘Is It Possible to Conduct a Multi-Arm Multi-Stage Platform Trial in Parkinson’s Disease: Lessons Learned from Other Neurodegenerative Disorders and Cancer’ Journal of Parkinson's Disease, vol. 10, no. 2, pp. 413-428, 2020.