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Höllerhage M, Becktepe J, Classen J, Deuschl G, Ebersbach G, Hopfner F, Lingor P, Löhle M, Maaß S, Pötter-Nerger M, Odin P, Woitalla D, Trenkwalder C, Höglinger GU. Pharmacotherapy of motor symptoms in early and mid-stage Parkinson's disease: guideline "Parkinson's disease" of the German Society of Neurology. J Neurol 2024:10.1007/s00415-024-12632-6. [PMID: 39207521 DOI: 10.1007/s00415-024-12632-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 08/07/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND OBJECTIVE There are multiple pharmacological treatment options for motor symptoms of Parkinson's disease (PD). These comprise multiple drug classes which are approved for the condition, including levodopa, dopamine agonists, COMT inhibitors, MAO-B inhibitors, NMDA-receptor antagonists, anticholinergics, and others. Some of the drugs are approved for monotherapy and combination therapy while others are only approved as adjunctive therapy to levodopa. Furthermore, treatment for special treatment situations, e.g., rescue medication for off-phases, for tremor, treatment during pregnancy and breast feeding is discussed and recommendations are given with further details. METHODS The recommendations were based on systematic literature reviews, drafted by expert teams, consented in online polls followed by online consensus meetings of the whole German Parkinson's Guideline Group, and publicly released in November 2023. RESULTS In the new S2k (i.e., consensus-based) guidelines, the pharmacotherapy of the motor symptoms of PD is discussed in five chapters. These comprise "Parkinson medication", "Initial monotherapy", "Early combination therapy", "Fluctuations and dyskinesia", and "Parkinsonian tremor". Furthermore, there is a chapter for special treatment situations, including perioperative management, freezing of gait, and pregnancy and breastfeeding. CONCLUSION The recommendations for the pharmacotherapy of motor symptoms of PD have been updated. Newly available drugs have been added, while other drugs (e.g., ergoline dopamine agonists, anticholinergics, budipine) have been removed from the recommendations.
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Affiliation(s)
| | - Jos Becktepe
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Joseph Classen
- Department of Neurology, Leipzig University Medical Center, Leipzig, Germany
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | | | - Franziska Hopfner
- Department of Neurology with Friedrich Baur Institute, LMU University Hospital, Ludwig-Maximilians-Universität (LMU) München, Marchioninistr. 15, 81377, Munich, Germany
| | - Paul Lingor
- School of Medicine and Health, Department of Neurology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Matthias Löhle
- Department of Neurology, University of Rostock, 18051, Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Sylvia Maaß
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Per Odin
- Division of Neurology, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Dirk Woitalla
- Department of Neurology, St. Josef-Hospital, Katholische Kliniken Ruhrhalbinsel, Contilia Gruppe, Essen, Germany
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurosurgery, University Medical Center, Göttingen, Germany
| | - Günter U Höglinger
- Department of Neurology with Friedrich Baur Institute, LMU University Hospital, Ludwig-Maximilians-Universität (LMU) München, Marchioninistr. 15, 81377, Munich, Germany.
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
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Kawahata I, Fukunaga K. Pathogenic Impact of Fatty Acid-Binding Proteins in Parkinson's Disease-Potential Biomarkers and Therapeutic Targets. Int J Mol Sci 2023; 24:17037. [PMID: 38069360 PMCID: PMC10707307 DOI: 10.3390/ijms242317037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/26/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Parkinson's disease is a neurodegenerative condition characterized by motor dysfunction resulting from the degeneration of dopamine-producing neurons in the midbrain. This dopamine deficiency gives rise to a spectrum of movement-related symptoms, including tremors, rigidity, and bradykinesia. While the precise etiology of Parkinson's disease remains elusive, genetic mutations, protein aggregation, inflammatory processes, and oxidative stress are believed to contribute to its development. In this context, fatty acid-binding proteins (FABPs) in the central nervous system, FABP3, FABP5, and FABP7, impact α-synuclein aggregation, neurotoxicity, and neuroinflammation. These FABPs accumulate in mitochondria during neurodegeneration, disrupting their membrane potential and homeostasis. In particular, FABP3, abundant in nigrostriatal dopaminergic neurons, is responsible for α-synuclein propagation into neurons and intracellular accumulation, affecting the loss of mesencephalic tyrosine hydroxylase protein, a rate-limiting enzyme of dopamine biosynthesis. This review summarizes the characteristics of FABP family proteins and delves into the pathogenic significance of FABPs in the pathogenesis of Parkinson's disease. Furthermore, it examines potential novel therapeutic targets and early diagnostic biomarkers for Parkinson's disease and related neurodegenerative disorders.
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Affiliation(s)
- Ichiro Kawahata
- Department of CNS Drug Innovation, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai 980-8578, Japan;
| | - Kohji Fukunaga
- Department of CNS Drug Innovation, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai 980-8578, Japan;
- BRI Pharma Inc., Sendai 982-0804, Japan
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3
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Sako W, Kogo Y, Koebis M, Kita Y, Yamakage H, Ishida T, Hattori N. Comparative efficacy and safety of adjunctive drugs to levodopa for fluctuating Parkinson's disease - network meta-analysis. NPJ Parkinsons Dis 2023; 9:143. [PMID: 37853009 PMCID: PMC10584871 DOI: 10.1038/s41531-023-00589-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
It remains unclear which adjunctive drug for Parkinson's disease (PD) in combination with levodopa is more effective, tolerable, and safe. We aimed to compare the efficacy, tolerability, and safety among anti-PD drugs from several classes in patients with fluctuating PD who received levodopa through network meta-analysis (NMA). Twelve anti-PD drugs belonging to 4 different drug classes (dopamine agonists, monoamine oxidase type B inhibitors, catechol-O-methyl transferase inhibitors, and an adenosine A2A receptor antagonist) were selected. We systematically searched PubMed, Embase, and the Cochrane Library for eligible randomized controlled trials (RCTs) comparing placebo with anti-PD drug or among anti-PD drugs in patients with PD who experienced motor fluctuations or wearing-off and received levodopa. We included 54 RCTs in the analysis. The NMA was performed under a frequentist framework using a random-effects model. The efficacy outcome was change in daily off-time, and the tolerability outcome was discontinuation due to all causes. Safety outcomes included discontinuation due to adverse events (AEs) and the incidence of AEs, dyskinesia, hallucination, and orthostatic hypotension. According to the surface under the cumulative ranking curve (SUCRA) in the NMA, ropinirole transdermal patch (SUCRA, 0.861) ranked the highest in efficacy, followed by pramipexole (0.762), ropinirole extended release (ER) (0.750), and safinamide (0.691). In terms of tolerability, ropinirole (0.954) ranked the highest, followed by pramipexole (0.857), safinamide (0.717), and ropinirole ER (0.708). Each anti-PD drug had different SUCRA ranking profiles for the safety outcomes. These findings suggest that ropinirole, pramipexole, and safinamide are well-balanced anti-PD drugs that satisfy both efficacy and tolerability outcomes.
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Affiliation(s)
- Wataru Sako
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Yuki Kogo
- Medical Headquarters, Eisai Co., Ltd., Tokyo, Japan
| | | | - Yoshiaki Kita
- Publication Business, Medical Professional Relations Inc., Osaka, Japan
| | - Hajime Yamakage
- Department of Medical Statistics, Satista Co., Ltd., Kyoto, Japan
| | | | - Nobutaka Hattori
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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4
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Zhang Q, Chen XT, Chen FF, Wen SY, Zhou CQ. Dopamine agonists versus levodopa monotherapy in early Parkinson's disease for the potential risks of motor complications: A network meta-analysis. Eur J Pharmacol 2023:175884. [PMID: 37385577 DOI: 10.1016/j.ejphar.2023.175884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Compared with levodopa, dopamine agonists (DAs) as initial treatment are associated with lower incidences of motor complications in early Parkinson's disease (PD). There is no strong evidence that a given DA is more potent in lower incidences of motor complications than another. OBJECTIVE We performed a network meta-analysis of levodopa versus DAs as monotherapy in early PD to access the risk of motor complications. METHODS Databases were searched up to June 2022 for eligible RCTs. Levodopa and four DAs (pramipexole, ropinirole, bromocriptine and pergolide) were investigated. The incidences of motor complications and efficacy, tolerability and safety outcomes were analyzed. RESULTS Nine RCTs (2112 patients) were included in the current study. The surface under the cumulative ranking curve (SUCRA) indicated that levodopa ranked first in the incidence of dyskinesia (0.988), followed by pergolide, pramipexole, ropinirole, and bromocriptine (0.704, 0.408, 0.240, 0.160). Pramipexole was least prone to wearing-off (0.109) and on-off fluctuation (0.041). Levodopa performed best in improvements of UPDRS-II, UPDRS-III, and UPDRS-II + III (0.925, 0.952, 0.934). Bromocriptine ranked first in total withdrawals and withdrawals due to adverse events (0.736, 0.751). Four DAs showed different adverse events profiles. CONCLUSION In the two non-ergot DAs, ropinirole is associated with a lower risk of dyskinesia while pramipexole is associated with lower risks of wearing-off and on-off fluctuations. Our research may facilitate head-to-head research, larger sample sizes, long following-up time RCTs to confirm the findings of this network meta-analysis.
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Affiliation(s)
- Qian Zhang
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
| | - Xiang-Ting Chen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
| | - Fei-Fei Chen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
| | - Si-Yuan Wen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
| | - Chang-Qing Zhou
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, China.
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McGee C, Liebert A, Bicknell B, Pang V, Isaac V, McLachlan CS, Kiat H, Herkes G. A Randomized Placebo-Controlled Study of a Transcranial Photobiomodulation Helmet in Parkinson's Disease: Post-Hoc Analysis of Motor Outcomes. J Clin Med 2023; 12:jcm12082846. [PMID: 37109183 PMCID: PMC10146323 DOI: 10.3390/jcm12082846] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Emerging evidence is increasingly supporting the use of transcranial photobiomodulation (tPBM) to improve symptoms of neurodegenerative diseases, including Parkinson's disease (PD). The objective of this study was to analyse the safety and efficacy of tPBM for PD motor symptoms. The study was a triple blind, randomized placebo-controlled trial with 40 idiopathic PD patients receiving either active tPBM (635 nm plus 810 nm LEDs) or sham tPBM for 24 min per day (56.88J), six days per week, for 12 weeks. The primary outcome measures were treatment safety and a 37-item MDS-UPDRS-III (motor domain) assessed at baseline and 12 weeks. Individual MDS-UPDRS-III items were clustered into sub-score domains (facial, upper-limb, lower-limb, gait, and tremor). The treatment produced no safety concerns or adverse events, apart from occasional temporary and minor dizziness. There was no significant difference in total MDS-UPDRS-III scores between groups, presumably due to the placebo effect. Additional analyses demonstrated that facial and lower-limb sub-scores significantly improved with active treatment, while gait and lower-limb sub-scores significantly improved with sham treatment. Approximately 70% of participants responded to active treatment (≥5 decrease in MDS-UPDRS-III score) and improved in all sub-scores, while sham responders improved in lower-limb sub-scores only. tPBM appears to be a safe treatment and improved several PD motor symptoms in patients that responded to treatment. tPBM is proving to be increasingly attractive as a possible non-pharmaceutical adjunct therapy.
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Affiliation(s)
- Claire McGee
- Faculty of Health Sciences, Torrens University Australia, Sydney, NSW 2000, Australia
| | - Ann Liebert
- School of Medical Sciences, University of Sydney, Camperdown, NSW 2050, Australia
- Department of Research and Governance, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia
- NICM Health Research Institute, University of Western Sydney, Westmead, NSW 2145, Australia
| | - Brian Bicknell
- NICM Health Research Institute, University of Western Sydney, Westmead, NSW 2145, Australia
| | - Vincent Pang
- NICM Health Research Institute, University of Western Sydney, Westmead, NSW 2145, Australia
| | - Vivian Isaac
- School of Allied Health, Exercise & Sports Sciences, Faculty of Science & Health, Charles Sturt University, Albury Campus, Albury, NSW 2640, Australia
| | - Craig S McLachlan
- Centre for Healthy Futures, Torrens University Australia, Sydney, NSW 2000, Australia
| | - Hosen Kiat
- NICM Health Research Institute, University of Western Sydney, Westmead, NSW 2145, Australia
- Centre for Healthy Futures, Torrens University Australia, Sydney, NSW 2000, Australia
- Faculty of Medicine, Human and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia
- College of Health and Medicine, Australian National University, Canberra, ACT 2601, Australia
- Cardiac Health Institute, Sydney, NSW 2000, Australia
| | - Geoffrey Herkes
- College of Health and Medicine, Australian National University, Canberra, ACT 2601, Australia
- Department of Neurology, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia
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6
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Chen XT, Zhang Q, Wen SY, Chen FF, Zhou CQ. Efficacy and safety of non-ergot dopamine-receptor agonists as an adjunct to levodopa in advanced Parkinson's disease: A network meta-analysis. Eur J Neurol 2023; 30:762-773. [PMID: 36380711 PMCID: PMC10099912 DOI: 10.1111/ene.15635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/21/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Non-ergot dopamine agonists (NEDAs) have been used as an adjunct therapy to levodopa in advanced Parkinson's disease (PD) for many years. However, there is no strong evidence that a given NEDA is more potent than another. To compare and rank the efficacy, tolerability, and safety of six commonly used NEDAs as an adjunct to levodopa in advanced PD, which includes long-acting and standard formulations, a network meta-analysis was performed. METHODS The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang databases were searched from January 1996 to June 2022 for eligible randomized controlled trials (RCTs). Six NEDAs, including rotigotine transdermal patch, ropinirole immediate-release (IR)/prolonged-release (PR), pramipexole IR/extended-release (ER), and piribedil, were investigated. RESULTS A total of 34 RCTs (7868 patients) were included in the current study. The surface under the cumulative ranking curve indicated that ropinirole PR was associated with the best improvement in Unified Parkinson's Disease Rating Scale (UPDRS)-II, UPDRS-III, and UPDRS-II + III (0.811, 0.742, and 0.827). For OFF time reduction, pramipexole IR ranked first (0.979), and ropinirole PR ranked first in OFF time responder rate (0.927). Pramipexole ER ranked first in overall withdrawals, and rotigotine transdermal patch ranked first in the incidence of adverse events (≥1 AEs). CONCLUSIONS This network meta-analysis suggests six commonly used NEDAs are effective as an adjunct to levodopa in advanced PD. In comprehensive consideration of better symptomatic management, ropinirole PR may be a better choice than other NEDAs in advanced PD. Six NEDAs showed different profiles of AEs.
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Affiliation(s)
- Xiang-Ting Chen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Zhang
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, China
| | - Si-Yuan Wen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, China
| | - Fei-Fei Chen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, China
| | - Chang-Qing Zhou
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, China
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7
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Rota S, Urso D, van Wamelen DJ, Leta V, Boura I, Odin P, Espay AJ, Jenner P, Chaudhuri KR. Why do 'OFF' periods still occur during continuous drug delivery in Parkinson's disease? Transl Neurodegener 2022; 11:43. [PMID: 36229860 PMCID: PMC9558383 DOI: 10.1186/s40035-022-00317-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
Continuous drug delivery (CDD) is used in moderately advanced and late-stage Parkinson’s disease (PD) to control motor and non-motor fluctuations (‘OFF’ periods). Transdermal rotigotine is indicated for early fluctuations, while subcutaneous apomorphine infusion and levodopa-carbidopa intestinal gel are utilised in advanced PD. All three strategies are considered examples of continuous dopaminergic stimulation achieved through CDD. A central premise of the CDD is to achieve stable control of the parkinsonian motor and non-motor states and avoid emergence of ‘OFF’ periods. However, data suggest that despite their efficacy in reducing the number and duration of ‘OFF’ periods, these strategies still do not prevent ‘OFF’ periods in the middle to late stages of PD, thus contradicting the widely held concepts of continuous drug delivery and continuous dopaminergic stimulation. Why these emergent ‘OFF’ periods still occur is unknown. In this review, we analyse the potential reasons for their persistence. The contribution of drug- and device-related involvement, and the problems related to site-specific drug delivery are analysed. We propose that changes in dopaminergic and non-dopaminergic mechanisms in the basal ganglia might render these persistent ‘OFF’ periods unresponsive to dopaminergic therapy delivered via CDD.
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Affiliation(s)
- Silvia Rota
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK. .,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Daniele Urso
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro, "Pia Fondazione Cardinale G. Panico", 73039, Tricase, Italy
| | - Daniel J van Wamelen
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Valentina Leta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Iro Boura
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,School of Medicine, University of Crete, Crete, Greece.,Department of Neurology, University Hospital of Heraklion, Crete, Greece
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Alberto J Espay
- University of Cincinnati Gardner Neuroscience Institute, Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Peter Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Science and Medicine, King's College London, London, UK.
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
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8
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Hu Y, Gu S, Yuan X, Li H, Yuan C, Ye Q. Traditional Chinese medicine syndrome differentiation and treatment by stages of Parkinson's disease: study protocol for a multicentre, randomized, double-blind, placebo-controlled clinical trial. Chin Med 2022; 17:68. [PMID: 35698234 PMCID: PMC9190110 DOI: 10.1186/s13020-022-00625-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background Parkinson’s disease (PD) is a progressive neurodegenerative disease common in aged populations. Classified by Hoehn & Yahr stages, patients are often divided into mild/early stage, moderate/middle stage, and advanced/late stage. With disease progression, PD shows high heterogeneity in each stage. Based on traditional Chinese medicine (TCM) syndrome differentiation theory and our previous works, we found that during the early stage, the main syndrome is Yin deficiency of the liver and kidney; during the moderate stage, the main syndromes are phlegm heat and wind stirring and blood stasis and wind stirring; and during the late stage, the dominant syndromes are deficiency of Yin and Yang and deficiency of Qi and blood. Hence, we proposed a new model of TCM treatment by the stage of PD. Based on Shudi Pingchan formula, an experimental formula of our team, we developed Ziyin Pingchan formula, Jiedu Pingchan formula, and Fuzheng Pingchan formula to treat each stage. This study is designed to evaluate the therapeutic effect of treating Parkinson’s disease by stages using traditional Chinese medicine and to provide an evidence base for forming a standardized scheme of diagnosis and treatment. Methods This study is designed as a multicentre, randomized, double-blind, placebo-controlled clinical trial. Patients will be stratified into 3 subgroups according to Hoehn & Yahr stage; 172, 168, and 72 participants will be required to be in the mild PD, moderate PD, and advanced PD subgroups, respectively, and will be randomized into the treatment or control group at a 1:1 ratio. The mild PD subgroup will receive a 48-week intervention, and the other 2 groups will receive a 24-week intervention. All groups will have a follow-up visit 12 weeks after starting the intervention. The intervention group will receive the Ziyin Pingchan formula, Jiedu Pingchan formula, or Fuzheng Pingchan formula, and the control group will receive the corresponding placebo. The primary outcomes will be the first addition of levodopa for the mild PD subgroup, the duration of the “OFF” period for the moderate PD subgroup, and the Parkinson's Disease Questionnaire (PDQ-39) for the advanced PD subgroup. The secondary outcomes will also be verified by subgroups, including the Unified Parkinson’s Disease Rating Scale (UPDRS), Parkinson’s Disease Sleep Scale-2 (PDSS-2), scales for Outcomes in Parkinson’s Disease—Autonomic (SCOPA-AUT), and the nonmotor symptom scale (NMSS). Expected outcomes To our knowledge, this is the first trial to combine TCM syndrome differentiation with PD clinical stages and put it into clinical practice. The results of this trial will provide clinical evidence for the therapeutic effect of TCM formulas on PD patients of all stages and help build a new TCM treatment by stage model of PD. Trial registration: This trial is registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/). Registration number: ChiCTR2200056373, Date: 2022–02-04, version 1.
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Affiliation(s)
- Yuqing Hu
- Encephalopathy Department, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 725, South Wanping Road, Shanghai, China
| | - Sichun Gu
- Encephalopathy Department, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 725, South Wanping Road, Shanghai, China
| | - Xiaolei Yuan
- Encephalopathy Department, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 725, South Wanping Road, Shanghai, China
| | - Hui Li
- Encephalopathy Department, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 725, South Wanping Road, Shanghai, China
| | - Canxing Yuan
- Encephalopathy Department, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 725, South Wanping Road, Shanghai, China
| | - Qing Ye
- Encephalopathy Department, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 725, South Wanping Road, Shanghai, China.
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