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Tan AH, Lim S, Mahadeva S, Loke MF, Tan JY, Ang BH, Chin KP, Mohammad Adnan AF, Ong SMC, Ibrahim AI, Zulkifli N, Lee JK, Lim WT, Teo YT, Kok YL, Ng TY, Tan AGS, Zulkifle IM, Ng CK, Ee SS, Arafin S, Mohamad Shukori K, Vadivelu JS, Marras C, Fox SH, Lang AE. Helicobacter pylori
Eradication in Parkinson's Disease: A Randomized Placebo‐Controlled Trial. Mov Disord 2020; 35:2250-2260. [DOI: 10.1002/mds.28248] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/22/2020] [Accepted: 07/27/2020] [Indexed: 01/03/2023] Open
Affiliation(s)
- Ai Huey Tan
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Shen‐Yang Lim
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Sanjiv Mahadeva
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Mun Fai Loke
- Department of Medical Microbiology University of Malaya Kuala Lumpur Malaysia
| | - Jiun Yan Tan
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Ban Hong Ang
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Kok Ping Chin
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Amni Fatihah Mohammad Adnan
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Shawna Mei Chien Ong
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Aimi Izzah Ibrahim
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Nusyaibah Zulkifli
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Jing Kun Lee
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Wan Ting Lim
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Yong Teck Teo
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Yong Leng Kok
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Tze Ying Ng
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Aaron Guan Siang Tan
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Intan Maisara Zulkifle
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Chin Khoon Ng
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Soon Sean Ee
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Shuhaina Arafin
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Khairunnisa Mohamad Shukori
- Division of Neurology, Department of Medicine, and the Mah Pooi Soo and Tan Chin Nam Centre for Parkinson's and Related Disorders, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | | | - Connie Marras
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital University of Toronto Toronto Ontario Canada
| | - Susan H. Fox
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital University of Toronto Toronto Ontario Canada
| | - Anthony E. Lang
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital University of Toronto Toronto Ontario Canada
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Oxford AE, Stewart ES, Rohn TT. Clinical Trials in Alzheimer's Disease: A Hurdle in the Path of Remedy. Int J Alzheimers Dis 2020; 2020:5380346. [PMID: 32308993 PMCID: PMC7152954 DOI: 10.1155/2020/5380346] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/18/2020] [Indexed: 11/17/2022] Open
Abstract
Human clinical trials seek to ameliorate the disease states and symptomatic progression of illnesses that, as of yet, are largely untreatable according to clinical standards. Ideally, clinical trials test "disease-modifying drugs," i.e., therapeutic agents that specifically modify pathological features or molecular bases of the disease and would presumably have a large impact on disease progression. In the case of Alzheimer's disease (AD), however, this approach appears to have stalled progress in the successful development of clinically useful therapies. For the last 25 years, clinical trials involving AD have centered on beta-amyloid (Aβ) and the Aβ hypothesis of AD progression and pathology. According to this hypothesis, the progression of AD begins following an accumulation of Aβ peptide, leading to eventual synapse loss and neuronal cell death: the true overriding pathological feature of AD. Clinical trials arising from the Aβ hypothesis target causal steps in the pathway in order to reduce the formation of Aβ or enhance clearance, and though agents have been successful in this aim, they remain unsuccessful in rescuing cognitive function or slowing cognitive decline. As such, further use of resources in the development of treatment options for AD that target Aβ, its precursors, or its products should be reevaluated. The purpose of this review was to give an overview of how human clinical trials are conducted in the USA and to assess the results of recent failed trials involving AD, the majority of which were based on the Aβ hypothesis. Based on these current findings, it is suggested that lowering Aβ is an unproven strategy, and it may be time to refocus on other targets for the treatment of this disease including pathological forms of tau.
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Affiliation(s)
- Alexandra E. Oxford
- Department of Biological Sciences, Boise State University, Science Building, Room 228, Boise, Idaho 83725, USA
| | - Erica S. Stewart
- Department of Biological Sciences, Boise State University, Science Building, Room 228, Boise, Idaho 83725, USA
| | - Troy T. Rohn
- Department of Biological Sciences, Boise State University, Science Building, Room 228, Boise, Idaho 83725, USA
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Bechman K, Yates M, Norton S, Cope AP, Galloway JB. Placebo Response in Rheumatoid Arthritis Clinical Trials. J Rheumatol 2019; 47:28-34. [PMID: 31043548 DOI: 10.3899/jrheum.190008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Understanding the placebo response is critical to interpreting treatment efficacy, particularly for agents with a ceiling to their therapeutic effect, where an increasing placebo response makes it harder to detect potential benefit. The objective of this study is to assess the change in placebo responses over time in rheumatoid arthritis (RA) randomized placebo-controlled trials (RCT) for drug licensing authorization. METHODS The Cochrane Controlled Trials Register database was searched to identify RCT of biological or targeted synthetic disease-modifying antirheumatic drugs (DMARD) in RA. Studies were excluded if patients were conventional synthetic DMARD (csDMARD)-naive, not receiving background csDMARD therapy, or were biologic experienced. Metaregression model was used to evaluate changes in American College of Rheumatology (ACR) 20, ACR50, and ACR70 treatment response over time. RESULTS There were 32 trials in total: anti-tumor necrosis factor therapy (n = 15), tocilizumab (n = 4), abatacept (n = 2), rituximab (n = 2), and Janus kinase inhibitors (n = 9). From 1999 to 2018, there was no significant trend in the age or sex of patients in the placebo arm. Disease duration, swollen joint count, and 28-joint count Disease Activity Score using erythrocyte sedimentation rate at baseline all significantly declined over time. There was a statistically significant increase in placebo ACR50 and ACR70 responses (ACR50 β = 0.41, 95% CI 0.09-0.74, p = 0.01; ACR70 β = 0.18, 95% CI 0.04-0.31, p = 0.01) that remained significant after controlling for potential confounders. CONCLUSION There has been a rise in the placebo response in RA clinical trials over the last 2 decades. Shifting RA phenotype, changes in trial design, and expectation bias are possible explanations for this phenomenon. This observation has important implications when evaluating newer novel agents against established therapies.
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Affiliation(s)
- Katie Bechman
- From the Department of Inflammation Biology, Academic Rheumatology, and Psychology Department, Institute of Psychiatry, King's College London, London, UK. .,K. Bechman, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; M. Yates, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; S. Norton, PhD, Psychology Department, Institute of Psychiatry, King's College London; A. Cope, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London; J.B. Galloway, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London.
| | - Mark Yates
- From the Department of Inflammation Biology, Academic Rheumatology, and Psychology Department, Institute of Psychiatry, King's College London, London, UK.,K. Bechman, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; M. Yates, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; S. Norton, PhD, Psychology Department, Institute of Psychiatry, King's College London; A. Cope, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London; J.B. Galloway, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London
| | - Sam Norton
- From the Department of Inflammation Biology, Academic Rheumatology, and Psychology Department, Institute of Psychiatry, King's College London, London, UK.,K. Bechman, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; M. Yates, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; S. Norton, PhD, Psychology Department, Institute of Psychiatry, King's College London; A. Cope, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London; J.B. Galloway, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London
| | - Andrew P Cope
- From the Department of Inflammation Biology, Academic Rheumatology, and Psychology Department, Institute of Psychiatry, King's College London, London, UK.,K. Bechman, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; M. Yates, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; S. Norton, PhD, Psychology Department, Institute of Psychiatry, King's College London; A. Cope, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London; J.B. Galloway, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London
| | - James B Galloway
- From the Department of Inflammation Biology, Academic Rheumatology, and Psychology Department, Institute of Psychiatry, King's College London, London, UK.,K. Bechman, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; M. Yates, MBCHB, BSC, Department of Inflammation Biology, Academic Rheumatology, King's College London; S. Norton, PhD, Psychology Department, Institute of Psychiatry, King's College London; A. Cope, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London; J.B. Galloway, PhD, Department of Inflammation Biology, Academic Rheumatology, King's College London
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