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Hauser RA, Videnovic A, Soares-da-Silva P, Liang GS, Olson K, Jen E, Rocha JF, Klepitskaya O. OFF-times before, during, and after nighttime sleep periods in Parkinson's disease patients with motor fluctuations and the effects of opicapone: A post hoc analysis of diary data from BIPARK-1 and -2. Parkinsonism Relat Disord 2024; 123:106971. [PMID: 38631081 DOI: 10.1016/j.parkreldis.2024.106971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION In BIPARK-1 and BIPARK-2, addition of once-daily opicapone to levodopa/carbidopa significantly reduced daily "OFF"-time relative to placebo in adults with Parkinson's disease (PD) and motor fluctuations. Diary data from these studies were pooled and analyzed post hoc to characterize "OFF"-times around nighttime sleep and to explore the effects of opicapone 50 mg. METHODS "OFF" before sleep (OBS), "OFF during the nighttime sleep period" (ODNSP), early morning "OFF" (EMO), and duration of nighttime sleep and awake periods were analyzed descriptively at baseline. Mean changes from baseline to Week 14/15 (end of double-blind treatment) were analyzed using two-sided t-tests in participants with data for both visits. RESULTS At baseline, 88.3 % (454/514) of participants reported having OBS (34.0 %), ODNSP (17.1 %), or EMO (79.6 %). Those with ODNSP had substantially shorter mean duration of uninterrupted sleep (4.4 h) than the overall pooled population (7.1 h). At Week 14/15, mean decrease from baseline in ODNSP duration was significantly greater with opicapone than with placebo (-0.9 vs. -0.4 h, P < 0.05). In participants with ODNSP at baseline, the decrease in total time spent awake during the night-time sleep period was significantly greater with opicapone than with placebo (-1.0 vs. -0.4 h, P < 0.05), as was the reduction in percent time spent awake during the night-time sleep period (-12.8 % vs. -4.5 %, P < 0.05). CONCLUSION "OFF"-times around nighttime sleep were common in BIPARK-1 and BIPARK-2. Opicapone may improve sleep by decreasing the amount of time spent awake during the night in patients with PD who have night-time sleep period "OFF" episodes.
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Affiliation(s)
- Robert A Hauser
- University of South Florida, Parkinson's Disease & Movement Disorders Center, 4001 E. Fletcher Ave, 6th Floor, Tampa, FL, 33613, USA.
| | - Aleksandar Videnovic
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, 165 Cambridge Street, Suite 650, Boston, MA, 02214, USA
| | - Patrício Soares-da-Silva
- BIAL-Portela & C(a), S.A., À Avenida da Siderurgia Nacional, 4745-457, Coronado, Portugal; University of Porto, Praça Gomes Teixeira, 4099-002, Porto, Portugal
| | - Grace S Liang
- Neurocrine Biosciences, Inc., 12780 El Camino Real, San Diego, CA, 92130, USA
| | - Kurt Olson
- Neurocrine Biosciences, Inc., 12780 El Camino Real, San Diego, CA, 92130, USA
| | - Eric Jen
- Neurocrine Biosciences, Inc., 12780 El Camino Real, San Diego, CA, 92130, USA
| | - José-Francisco Rocha
- BIAL-Portela & C(a), S.A., À Avenida da Siderurgia Nacional, 4745-457, Coronado, Portugal
| | - Olga Klepitskaya
- Neurocrine Biosciences, Inc., 12780 El Camino Real, San Diego, CA, 92130, USA
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Fernandez HH, Macklin EA, Hauser RA, Chou KL, Cakmak YO, Ozsoy B, Fahn S. Intrinsic auricular muscle zone stimulation for Parkinson disease: The EARSTIM-PD Phase II multi-center pilot study results. Parkinsonism Relat Disord 2024; 121:105959. [PMID: 38246833 DOI: 10.1016/j.parkreldis.2023.105959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/09/2023] [Accepted: 12/10/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Studies have suggested that intrinsic auricular muscle zones (IAMZ) stimulation alleviates motor features of Parkinson disease (PD). METHODS A randomized, blinded, active sham-controlled pilot trial was conducted to evaluate the safety and dose-response-time curve of Earstim using a 3-treatment, 3-period crossover design in PD patients experiencing OFF time on levodopa. Treatments were: short (20-min) IAMZ stimulation; long (60-min) IAMZ stimulation; and 20-min active sham stimulation of non-muscular areas. Assessment time points were: prior to treatment, and 20, 40, 60, 90, and 120 min after treatment onset. Primary safety endpoints were adverse events frequency and severity. Primary efficacy endpoint was the change in MDS-UPDRS motor score at 20 min after treatment onset in the IAMZ treatment groups versus sham. RESULTS Forty-six individuals consented; 38 were randomized (average age 64 years, 65 % male, mean 8.2 years from diagnosis). No serious adverse events or significant device-related events occurred. At 20 min after treatment onset, motor improvements did not differ between IAMZ treatments versus sham. However, at 60 min after treatment onset, motor improvement peaked on IAMZ treatments compared to sham (difference: 3.1 [-5.9 to 0.3], p = 0.03). While the difference in 120-min AUC change between IAMZ treatments versus sham was not significant, the short-stimulation IAMZ treatment showed the largest aggregate motor score improvement (AUC = -456 points, 95 % CI -691 to -221) compared to sham. CONCLUSION Earstim was well-tolerated. The greatest motor improvement occurred at 60 min after stimulation onset in the short-stimulation IAMZ treatment, and supports its further study to alleviate OFF periods.
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Affiliation(s)
- Hubert H Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, USA.
| | - Eric A Macklin
- Department of Neurology, Harvard Medical School/Massachusetts General Hospital, USA
| | - Robert A Hauser
- Department of Neurology, University of South Florida School of Medicine, USA
| | - Kelvin L Chou
- Department of Neurology, University of Michigan School of Medicine, USA
| | | | | | - Stanley Fahn
- Department of Neurology, Columbia University School of Medicine, USA
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Frank S, Anderson KE, Fernandez HH, Hauser RA, Claassen DO, Stamler D, Factor SA, Jimenez-Shahed J, Barkay H, Wilhelm A, Alexander JK, Chaijale N, Barash S, Savola JM, Gordon MF, Chen M. Safety of Deutetrabenazine for the Treatment of Tardive Dyskinesia and Chorea Associated with Huntington Disease. Neurol Ther 2024:10.1007/s40120-024-00600-1. [PMID: 38557959 DOI: 10.1007/s40120-024-00600-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Deutetrabenazine is a vesicular monoamine transporter 2 inhibitor used to treat tardive dyskinesia (TD) and chorea associated with Huntington disease (HD). To enhance detection of safety signals across individual trials, integrated safety analyses of deutetrabenazine in TD and HD chorea were conducted. METHODS For TD, safety data were integrated from two 12-week pivotal studies (ARM-TD and AIM-TD) and through week 15 of the open-label extension (OLE) study (RIM-TD). Data were analyzed by deutetrabenazine treatment group and placebo. For HD, safety data were integrated from the 12-week pivotal study (First-HD) and through week 15 of the OLE study (ARC-HD) for patients previously receiving placebo. Integrated deutetrabenazine data were compared with placebo from the pivotal study. RESULTS For TD, deutetrabenazine (n = 384) was generally well tolerated compared with placebo (n = 130). Adverse event (AE) incidence was numerically higher in the response-driven deutetrabenazine vs the fixed-dose deutetrabenazine and placebo groups, respectively (any AE, 59.5% vs 44.4-50.0% and 53.8%; treatment-related AE, 38.1% vs 18.1-25.0% and 30.8%). Serious AEs were reported for 2.8-8.3% of patients in the deutetrabenazine groups and 6.9% in the placebo group. Common AEs (≥ 4%) included headache, somnolence, nausea, anxiety, fatigue, dry mouth, and diarrhea. AE incidence was higher during the titration vs maintenance periods. For HD, AE incidence was numerically higher with deutetrabenazine (n = 84) vs placebo (n = 45; any AE, 64.3% vs 60.0%; treatment-related AE, 38.1% vs 26.7%); serious AEs were reported for similar proportions for the deutetrabenazine and placebo groups, 2.4% and 2.2%, respectively. Common AEs (≥ 4%) included irritability, fall, depression, dry mouth, and fatigue. CONCLUSIONS Data from an integrated analysis of studies in TD and an integrated analysis of studies of chorea in HD showed that deutetrabenazine has a favorable safety profile and is well tolerated across indications. TRIAL REGISTRATION ClinicalTrials.gov identifiers, NCT02291861, NCT02195700, NCT01795859, NCT02198794, NCT01897896.
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Affiliation(s)
- Samuel Frank
- Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Ave., Kirstein 228, Boston, MA, 02215, USA.
| | | | | | - Robert A Hauser
- University of South Florida Parkinson's Disease and Movement Disorders Center, Tampa, FL, USA
| | | | - David Stamler
- Teva Branded Pharmaceutical Products R&D, Inc., La Jolla, CA, USA
| | | | | | - Hadas Barkay
- Teva Pharmaceutical Industries Ltd., Netanya, Israel
| | - Amanda Wilhelm
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | | | - Nayla Chaijale
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Steve Barash
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | | | | | - Maria Chen
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
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Comella CL, Jankovic J, Hauser RA, Patel AT, Banach MD, Ehler E, Vitarella D, Rubio RG, Gross TM. Efficacy and Safety of DaxibotulinumtoxinA for Injection in Cervical Dystonia: ASPEN-1 Phase 3 Randomized Controlled Trial. Neurology 2024; 102:e208091. [PMID: 38295339 PMCID: PMC10962918 DOI: 10.1212/wnl.0000000000208091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/27/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES ASPEN-1 was a phase 3, randomized, double-blind, placebo-controlled study to evaluate the efficacy, duration of response, and safety of 2 doses of DaxibotulinumtoxinA for Injection (DAXI), a novel botulinum toxin type A formulation in participants with cervical dystonia (CD). METHODS Adults (aged 18-80 years) with moderate-to-severe CD (Toronto Western Spasmodic Torticollis Rating Scale [TWSTRS] total score ≥20) were enrolled at 60 sites across 9 countries in Europe and North America. Participants were randomized (3:3:1) to single-dose intramuscular DAXI 125U, 250U, or placebo and followed for up to 36 weeks after injection. The primary end point was change from baseline in TWSTRS total score averaged across weeks 4 and 6. Key secondary end points included duration of effect, Clinical and Patient Global Impression of Change (CGIC, PGIC), TWSTRS subscale scores, and safety. Multiplicity-adjusted intent-to-treat hypothesis tests with multiple imputation were performed using ANCOVA and Cochran-Mantel-Haenszel analyses. RESULTS Of 444 individuals screened, 301 were randomized to DAXI 125U (n = 125) or 250U (n = 130) or placebo (n = 46). DAXI 125U and 250U significantly improved the mean TWSTRS total score vs placebo (least squares mean [standard error] difference vs placebo: DAXI 125U, -8.5 [1.93], p < 0.0001; DAXI 250U, -6.6 [1.92], p = 0.0006). The median duration of effect (time from treatment until loss of ≥80% of the peak improvement in average TWSTRS total score achieved at weeks 4 and 6) was 24.0 (95% confidence interval 20.3-29.1) weeks with DAXI 125U and 20.3 (16.7-24.0) weeks with DAXI 250U. Significant improvements were also observed with DAXI in CGIC and PGIC responder rates and TWSTRS subscales. Treatment-related treatment-emergent adverse events (TEAEs) were reported by 29.6% of participants with DAXI 125U, 23.8% with DAXI 250U, and 17.4% with placebo, with injection site pain being the most common overall. The most frequently reported treatment-related TEAEs of interest in DAXI 125U, DAXI 250U, and placebo, respectively, were muscular weakness (4.8%, 2.3%, 0%), musculoskeletal pain (2.4%, 3.1%, 0%), and dysphagia (1.6%, 3.8%, 0%). DISCUSSION This study demonstrated that DAXI, at doses of 125U and 250U, is an effective, safe, long-acting, and well-tolerated treatment for CD. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov identifier (NCT03608397, submitted July 11, 2018) and EU Clinical Trials Register (ClinicalTrialsRegister.eu EudraCT identifier 2018-000446-19, submitted September 13, 2018). First participant enrolled on June 11, 2018. Trial registration was performed in accordance with the Food and Drug Administration Amendments Act (FDAAA 801), which stipulates that the responsible party register an applicable clinical trial not later than 21 calendar days after enrolling the first human participant (42 CFR 11.24). CLASSIFICATION OF EVIDENCE This study provides Class I evidence that in adults with moderate-to-severe idiopathic cervical dystonia, DAXI reduces dystonia more effectively than placebo.
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Affiliation(s)
- Cynthia L Comella
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Joseph Jankovic
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Robert A Hauser
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Atul T Patel
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Marta D Banach
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Edvard Ehler
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Domenico Vitarella
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Roman G Rubio
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
| | - Todd M Gross
- From the Department of Neurosurgery and Neurological Sciences (C.L.C.), Rush University Medical Center, Chicago, IL; Parkinson's Disease Center and Movement Disorders Clinic (J.J.), Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Neurology (R.A.H.), University of South Florida, Tampa, FL; Kansas City Bone & Joint Clinic (A.T.P.), Overland Park, KS; Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland; Department of Neurology (E.E.), Regional Hospital Pardubice, Czech Republic; Revance Therapeutics, Inc (D.V., R.G.R., T.M.G.), Nashville, TN; and Blue Obsidian Consulting, LLC (R.G.R.), Redwood, CA
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Fung VSC, Aldred J, Arroyo MP, Bergquist F, Boon AJW, Bouchard M, Bray S, Dhanani S, Facheris MF, Fisseha N, Freire-Alvarez E, Hauser RA, Jeong A, Jia J, Kukreja P, Soileau MJ, Spiegel AM, Talapala S, Tarakad A, Urrea-Mendoza E, Zamudio J, Pahwa R. Continuous subcutaneous foslevodopa/foscarbidopa infusion for the treatment of motor fluctuations in Parkinson's disease: Considerations for initiation and maintenance. Clin Park Relat Disord 2024; 10:100239. [PMID: 38419617 PMCID: PMC10900117 DOI: 10.1016/j.prdoa.2024.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Background As Parkinson's disease (PD) advances, management is challenged by an increasingly variable and inconsistent response to oral dopaminergic therapy, requiring special considerations by the provider. Continuous 24 h/day subcutaneous infusion of foslevodopa/foscarbidopa (LDp/CDp) provides steady dopaminergic stimulation that can reduce symptom fluctuation. Objective Our aim is to review the initiation, optimization, and maintenance of LDp/CDp therapy, identify possible challenges, and share potential mitigations. Methods Review available LDp/CDp clinical trial data for practical considerations regarding the management of patients during LDp/CDp therapy initiation, optimization, and maintenance based on investigator clinical trial experience. Results LDp/CDp initiation, optimization, and maintenance can be done without hospitalization in the clinic setting. Continuous 24 h/day LDp/CDp infusion can offer more precise symptom control than oral medications, showing improvements in motor fluctuations during both daytime and nighttime hours. Challenges include infusion-site adverse events for which early detection and prompt management may be required, as well as systemic adverse events (eg, hallucinations) that may require adjustment of the infusion rate or other interventions. A learning curve should be anticipated with initiation of therapy, and expectation setting with patients and care partners is key to successful initiation and maintenance of therapy. Conclusion Continuous subcutaneous infusion of LDp/CDp represents a promising therapeutic option for individuals with PD. Individualized dose optimization during both daytime and nighttime hours, coupled with patient education, and early recognition of certain adverse events (plus their appropriate management) are required for the success of this minimally invasive and highly efficacious therapy.
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Affiliation(s)
- Victor S C Fung
- Movement Disorders Unit, Westmead Hospital, Westmead, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Jason Aldred
- Inland Northwest Research, Spokane, WA, USA
- Selkirk Neurology, Spokane, WA, USA
| | | | - Filip Bergquist
- Department of Pharmacology, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Agnita J W Boon
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Manon Bouchard
- Clinique Neuro-Lévis, Université Laval, Lévis, QC, Canada
- Centre de Recherche St-Louis, Lévis, QC, Canada
| | - Sarah Bray
- Movement Disorders Unit, Westmead Hospital, Westmead, NSW, Australia
| | - Sara Dhanani
- Banner Sun Health Research Institute, Sun City, AZ, USA
| | | | | | | | - Robert A Hauser
- Parkinson's Disease and Movement Disorders Center, University of South Florida, Tampa, FL, USA
| | | | - Jia Jia
- AbbVie Inc., North Chicago, IL, USA
| | | | | | | | | | - Arjun Tarakad
- Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX, USA
| | - Enrique Urrea-Mendoza
- Prisma Health Neurology, Greenville, SC, USA
- School of Medicine, University of South Carolina, Greenville, SC, USA
| | | | - Rajesh Pahwa
- Parkinson's Disease and Movement Disorder Center, University of Kansas Medical Center, Kansas City, KS, USA
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Olanow CW, Hauser RA, Burdick DJ, Dhall R, de Marcaida JA, Gil RA, Kreitzman DL, Elmer LW, McGarry A, Kieburtz K. A Randomized Phase 3 Study Comparing P2B001 to its Components (Low-Dose Extended-Release Rasagiline and Pramipexole) and to Optimized Doses of Marketed Extended-Release Pramipexole in Early Parkinson's Disease. Mov Disord 2024; 39:350-359. [PMID: 37886872 DOI: 10.1002/mds.29642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND There remains uncertainty as to the optimal way to initiate therapy for Parkinson's disease (PD) to maximize benefit and minimize adversity. OBJECTIVES The objective was to determine if P2B001 (a fixed, low-dose, extended-release [ER] combination of pramipexole 0.6 mg and rasagiline 0.75 mg) is superior to each of its components and compare its safety and efficacy to optimized treatment with marketed doses of pramipexole-ER. METHODS This was a 12-week, double-blind study (NCT03329508). Total of 544 untreated patients with PD were randomized (2:2:2:1) to treatment with P2B001, its individual components (pramipexole-ER 0.6 mg or rasagiline-ER 0.75 mg), or commercial doses of pramipexole-ER titrated to optimal dose (1.5-4.5 mg). The primary endpoint was change from baseline to week 12 in Unified Parkinson's Disease Rating Scale (UPDRS) parts II and III. The key secondary endpoint was the change from baseline in the Epworth Sleepiness Scale (ESS) for P2B001 versus the titrated dose of pramipexole-ER. RESULTS P2B001 provided superior efficacy compared to each of its components; mean (95% CI) treatment differences in UPDRS II + III scores were -2.66 (95% CI, -4.33 to -1.00) versus pramipexole-ER 0.6 mg (P = 0.0018) and - 3.30 (95% CI, -4.96 to -1.63) versus rasagiline-ER 0.75 mg (P < 0.0001). P2B001 had comparable efficacy with the titrated dose of pramipexole-ER (mean, 3.2 mg), but significantly less worsening in daytime-sleepiness (ESS treatment difference: -2.66 [95% CI, -3.50 to -1.81]; P < 0.0001). P2B001 was well-tolerated with fewer sleep-related and dopaminergic adverse events than titrated doses of pramipexole-ER including somnolence, orthostatic hypotension, and neuropsychiatric side effects. CONCLUSIONS P2B001 had superior efficacy to its individual components and was comparable with commercially used doses of pramipexole-ER with less worsening of sleepiness and fewer dopaminergic adverse events. These findings support considering once-daily P2B001 as initial therapy for patients with early PD. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- C Warren Olanow
- Departments of Neurology and Department of Neuroscience, Mount Sinai School of Medicine, New York, New York, USA
- Clintrex Research Corporation, Sarasota, Florida, USA
| | - Robert A Hauser
- Department of Neurology, Parkinson Foundation Center of Excellence, University of South Florida, Tampa, Florida, USA
| | - Daniel J Burdick
- Booth Gardner Parkinson's Care Center, Eastside Neuroscience Institute, Evergreen Health Medical Center, Kirkland, WA, USA
| | - Rohit Dhall
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Ramon A Gil
- Hartford HealthCare Chase Family Movement Disorders Center, Vernon, Connecticut, USA
- Parkinson's Disease Treatment Center of SW Florida, Naples, Florida, USA
| | | | - Lawrence W Elmer
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Andrew McGarry
- Clintrex Research Corporation, Sarasota, Florida, USA
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Karl Kieburtz
- Clintrex Research Corporation, Sarasota, Florida, USA
- Center for Health and Technology, University of Rochester, Rochester, New York, USA
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Espay AJ, Hauser RA, Dhall R, Thakkar S, Cloud L, Zeitlin L, Banisadr G, Fisher S, Visser H. Safety and Efficacy of IPX203 in Parkinson's Disease: The RISE-PD Open-Label Extension Study. Mov Disord 2024; 39:428-432. [PMID: 38111267 PMCID: PMC10922967 DOI: 10.1002/mds.29685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/31/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND IPX203 is a novel oral extended-release formulation of carbidopa/levodopa (CD/LD) developed to address the short half-life of immediate-release CD/LD. In the phase 3 RISE-PD trial, IPX203 significantly improved "Good On" time in patients with Parkinson's disease compared with immediate-release CD/LD. OBJECTIVES To evaluate the safety and efficacy of IPX203 in an open-label extension of the pivotal phase 3 study. METHODS This 9-month extension enrolled patients who completed the randomized, double-blind trial. Key efficacy endpoints included Movement Disorder Society-Unified Parkinson's Disease Rating Scale and Patient and Clinical Global Impression scores. Adverse events (AEs) were recorded. RESULTS Improvements in efficacy were maintained and dosing frequency and total daily dose remained stable through the trial. A total of 52.7% of patients experienced ≥1 treatment-emergent AE, mostly mild or moderate and occurred within the first 90 days of treatment. CONCLUSIONS In this phase 3 open-label extension, IPX203 exhibited a favorable safety and tolerability profile and sustained efficacy of comparable magnitude to the end of the double-blind study. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | | | - Rohit Dhall
- University of Arkansas for Medical Sciences, Little Rock, AK, USA
| | | | - Leslie Cloud
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Trosch RM, Comella CL, Caroff SN, Ondo WG, Shillington AC, LaChappelle BJ, Hauser RA, Correll CU, Friedman JH. The Clinician's Tardive Inventory (CTI): A New Clinical Tool for Documenting and Rating Tardive Dyskinesia. J Clin Psychiatry 2024; 85:23m14886. [PMID: 38270545 DOI: 10.4088/jcp.23m14886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Objective: Current clinician-rated tardive dyskinesia (TD) symptom scales have not addressed the expanding clinical signs and functional impact of TD. The study objective was to develop and test the reliability of a new integrated instrument. Methods: A movement disorder neurologist devised the outline of the rating scale. A Steering Committee (5 neurologists and 2 psychiatrists) provided revisions until consensus was reached. The Clinician's Tardive Inventory (CTI) assesses abnormal movements of the eye/eyelid/face, tongue/mouth, jaw, and limb/trunk; complex movements defined as complicated movements different from simple patterned movements or postures; and vocalizations. The CTI rates frequency of symptoms from 0 to 3 (ranging from absent to constant). Functional impairments, including activities of daily living (ADL), social impairment, symptom distress, and physical harm, are rated 0-3 (ranging from unawareness to severe impact). The CTI underwent interrater and test-retest reliability testing between February and June 2022 based on videos and accompanying vignettes, which were reviewed by 2 movement disorder specialists to determine adequacy. Four clinicians rated each video/vignette. Interrater agreement was analyzed via 2-way random-effects intraclass correlation (ICC), and test-retest agreement was assessed utilizing the Kendall tau-b. Results: Forty-five video/vignettes were assessed for interrater reliability and 16 for test-retest reliability. The most prevalent movements were those of the tongue and mouth (77.8%) and jaw (55.6%). ICCs for movement frequency for anatomic symptoms were as follows: anatomic symptom summary score 0.92, abnormal eye movement 0.89, abnormal tongue/mouth movement 0.91, abnormal jaw movement 0.89, abnormal limb movement 0.76, complex movement 0.87, and abnormal vocalization 0.77; ICCs for functional impairments were as follows: total impairment score 0.92, physical harm 0.82, social embarrassment 0.88, ADLs 0.83, and symptom bother 0.92; Retests were conducted a mean (SD) of 15 (3) days later with correlation coefficients ranging from 0.66 to 0.87. Conclusions: The CTI is a new integrated instrument with proven reliability in assessing TD signs and functional impacts. Future validation study is warranted.
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Affiliation(s)
- Richard M Trosch
- Oakland University, William Beaumont Medical School, Rochester, Michigan
| | | | - Stanley N Caroff
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - William G Ondo
- Houston Methodist Neurological Institute, Houston, Texas
- Weill Cornell Medical School, New York, New York
| | | | | | | | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York
- Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
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Hauser RA, Espay AJ, Ellenbogen AL, Fernandez HH, Isaacson SH, LeWitt PA, Ondo WG, Pahwa R, Schwarz J, Stocchi F, Zeitlin L, Banisadr G, Fisher S, Visser H, D’Souza R. IPX203 vs Immediate-Release Carbidopa-Levodopa for the Treatment of Motor Fluctuations in Parkinson Disease: The RISE-PD Randomized Clinical Trial. JAMA Neurol 2023; 80:1062-1069. [PMID: 37578800 PMCID: PMC10425876 DOI: 10.1001/jamaneurol.2023.2679] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/07/2023] [Indexed: 08/15/2023]
Abstract
Importance Levodopa has a short half-life and a limited window of opportunity for absorption in the proximal small intestine. IPX203 is an oral, extended-release formulation of carbidopa-levodopa developed to address these limitations. Objective To assess the efficacy and safety of IPX203 vs immediate-release carbidopa-levodopa in patients with Parkinson disease who are experiencing motor fluctuations. Design, Setting, and Participants RISE-PD was a 20-week, randomized, double-blind, double-dummy, active-controlled, phase 3 clinical trial. The study was conducted between November 6, 2018, and June 15, 2021, at 105 academic and clinical centers in the US and Europe. Patients with Parkinson disease taking a total daily dose of 400 mg or more of levodopa and experiencing an average of 2.5 hours or more daily off-time were included in the study. A total of 770 patients were screened, 140 were excluded (those taking controlled-release carbidopa-levodopa apart from a single daily bedtime dose, Rytary (Amneal Pharmaceuticals), additional carbidopa or benserazide, or catechol O-methyl transferase inhibitors or who had a history of psychosis within the past 10 years), and 630 were enrolled in the trial. Interventions Following open-label immediate-release carbidopa-levodopa dose adjustment (3 weeks) and conversion to IPX203 (4 weeks), patients were randomized in a 1:1 ratio to double-blind, double-dummy treatment with immediate-release carbidopa-levodopa or IPX203 for 13 weeks. Main Outcome and Measures The primary end point was mean change in daily good on-time (ie, on-time without troublesome dyskinesia) from baseline to the end of the double-blind treatment period. Results A total of 630 patients (mean [SD] age, 66.5 [8.95] years; 396 [62.9%] men) were enrolled, and 506 patients were randomly assigned to receive IPX203 (n = 256) or immediate-release carbidopa-levodopa (n = 250). The study met its primary end point, demonstrating statistically significant improvement in daily good on-time for IPX203 compared to immediate-release carbidopa-levodopa (least squares mean, 0.53 hours; 95% CI, 0.09-0.97; P = .02), with IPX203 dosed a mean 3 times per day vs 5 times per day for immediate-release carbidopa-levodopa. Good on-time per dose increased by 1.55 hours with IPX203 compared to immediate-release carbidopa-levodopa (95% CI, 1.37-1.73; P < .001). IPX203 was well tolerated. The most common adverse events in the double-blind phase (IPX203 vs immediate-release carbidopa-levodopa) were nausea (4.3% vs 0.8%) and anxiety (2.7% vs 0.0%). Conclusions and Relevance In this study, IPX203 provided more hours of good on-time per day than immediate-release carbidopa-levodopa, even as IPX203 was dosed less frequently. Trial Registration ClinicalTrials.gov Identifier: NCT03670953.
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Affiliation(s)
- Robert A. Hauser
- University of South Florida Parkinson’s Disease and Movement Disorders Center/Parkinson Foundation Center of Excellence, Tampa
| | - Alberto J. Espay
- James J. and Joan A. Gardner Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
| | - Aaron L. Ellenbogen
- Quest Research Institute/Michigan Institute for Neurological Disorders, Farmington Hills
| | - Hubert H. Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stuart H. Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, Boca Raton, Florida
| | - Peter A. LeWitt
- Wayne State University School of Medicine and Henry Ford Hospital, Detroit, Michigan
| | - William G. Ondo
- Methodist Hospital and Weill Cornell Medical School, Houston, Texas
| | - Rajesh Pahwa
- University of Kansas Medical Center, Kansas City
| | - Johannes Schwarz
- Geriatric Hospital Haag and Technical University of Munich, Munich, Germany
| | - Fabrizio Stocchi
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Department of Neurology, Roma, Italy
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Isaacson SH, Hauser RA, Pahwa R, Gray D, Duvvuri S. Dopamine agonists in Parkinson's disease: Impact of D1-like or D2-like dopamine receptor subtype selectivity and avenues for future treatment. Clin Park Relat Disord 2023; 9:100212. [PMID: 37497384 PMCID: PMC10366643 DOI: 10.1016/j.prdoa.2023.100212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/16/2023] [Accepted: 07/06/2023] [Indexed: 07/28/2023] Open
Abstract
Dopamine agonists (DAs) have demonstrated efficacy for the treatment of Parkinson's disease (PD) but are limited by adverse effects (AEs). DAs can vary considerably in their receptor subtype selectivity and affinity, chemical composition, receptor occupancy, and intrinsic activity on the receptor. Most currently approved DAs for PD treatment primarily target D2/D3 (D2-like) dopamine receptors. However, selective activation of D1/D5 (D1-like) dopamine receptors may enable robust activation of motor function while avoiding AEs related to D2/D3 receptor agonism. Full D1/D5 receptor-selective agonists have been explored in small, early-phase clinical studies, and although their efficacy for motor symptoms was robust, challenges with pharmacokinetics, bioavailability, cardiovascular AEs, and dyskinesia rates similar to levodopa prevented clinical advancement. Generally, repeated dopaminergic stimulation with full DAs is associated with frontostriatal dysfunction and sensitization that may induce plastic changes in the motor system, and neuroadaptations that produce long-term motor and nonmotor complications, respectively. Recent preclinical and clinical studies suggest that a D1/D5 receptor-selective partial agonist may hold promise for providing sustained, predictable, and robust motor control, while reducing risk for motor complications (e.g., levodopa-induced dyskinesia) and nonmotor AEs (e.g., impulse control disorders and excessive daytime sleepiness). Clinical trials are ongoing to evaluate this hypothesis. The potential emerging availability of novel dopamine receptor agonists with selective dopamine receptor pharmacology suggests that the older terminology "dopamine agonist" may need revision to distinguish older-generation D2/D3-selective agonists from D1/D5-selective agonists with distinct efficacy and tolerability characteristics.
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Affiliation(s)
- Stuart H. Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA
| | - Robert A. Hauser
- Parkinson's Disease and Movement Disorders Center, Parkinson Foundation Center of Excellence, University of South Florida, Tampa, FL, USA
| | - Rajesh Pahwa
- Parkinson's Disease and Movement Disorder Center, University of Kansas Medical Center, Kansas City, KS, USA
| | - David Gray
- Vigil Neuroscience, Inc, Watertown, MA, USA
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Martino D, Karnik V, Bhidayasiri R, Hall DA, Hauser RA, Macerollo A, Pringsheim TM, Truong D, Factor SA, Skorvanek M, Schrag A. Scales for Antipsychotic-Associated Movement Disorders: Systematic Review, Critique, and Recommendations. Mov Disord 2023; 38:1008-1026. [PMID: 37081740 DOI: 10.1002/mds.29392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/13/2023] [Accepted: 03/13/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Antipsychotic-associated movement disorders remain common and disabling. Their screening and assessment are challenging due to clinical heterogeneity and different use of nomenclature between psychiatrists and neurologists. OBJECTIVE An International Parkinson and Movement Disorder Society subcommittee aimed to rate psychometric quality of severity and screening instruments for antipsychotic-associated movement disorders. METHODS Following the methodology adopted by previous International Parkinson and Movement Disorders Society subcommittee papers, instruments for antipsychotic-associated movement disorders were reviewed, applying a classification as "recommended," "recommended with caveats," "suggested," or "listed." RESULTS Our review identified 23 instruments. The highest grade of recommendation reached is "recommended with caveats," assigned to seven severity rating instruments (Extrapyramidal Symptoms Rating Scale, Barnes Akathisia Rating Scale, Abnormal Involuntary Movements Scale, Drug-Induced Extra-Pyramidal Symptoms Scale, Maryland Psychiatric Research Centre involuntary movements scale, Simpson Angus Scale, and Matson Evaluation of Drug Side effects). Only three of these seven (Drug-Induced Extra-Pyramidal Symptoms Scale, Maryland Psychiatric Research Centre, Matson Evaluation of Drug Side effects) were also screening instruments. Their main caveats are insufficient demonstration of psychometric properties (internal consistency, skewing, responsiveness to change) and long duration of administration. Eight "suggested" instruments did not meet requirements for the "recommended" grade also because of insufficient psychometric validation. Other limitations shared by several instruments are lack of comprehensiveness in assessing the spectrum of antipsychotic-associated movement disorders and ambiguous nomenclature. CONCLUSIONS The high number of instruments "recommended with caveats" does not support the need for developing new instruments for antipsychotic-associated movement disorders. However, addressing the caveats with new psychometric studies and revising existing instruments to improve the clarity of their nomenclature are recommended next steps. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Vikram Karnik
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Deborah A Hall
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Robert A Hauser
- Parkinson's Disease and Movement Disorders Center, Parkinson Foundation Center of Excellence, Department of Neurology, University of South Florida, Tampa, Florida, USA
| | - Antonella Macerollo
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, United Kingdom
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
| | - Daniel Truong
- The Parkinson's and Movement Disorder Institute, Orange Coast Memorial Medical Center, Fountain Valley, California, USA
| | - Stewart A Factor
- Jean and Paul Amos Parkinson's Disease and Movement Disorder Program, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matej Skorvanek
- Department of Neurology, P.J. Safarik University, Kosice, Slovak Republic
- Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovak Republic
| | - Anette Schrag
- Department of Clinical Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
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Hauser RA, Ondo WG, Zhang Y, Bowling A, Navia B, Pappert E, Isaacson SH. Dose Optimization of Apomorphine Sublingual Film for OFF Episodes in Parkinson's Disease: Is the Prophylactic Use of an Antiemetic Necessary? J Parkinsons Dis 2023; 13:403-414. [PMID: 36970914 DOI: 10.3233/jpd-223537] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Nausea is common upon initiating dopamine agonists in patients with Parkinson's disease (PD); however, pretreatment with an antiemetic is recommended only when initiating apomorphine formulations. OBJECTIVE Evaluate the need for prophylactic antiemetic use during dose optimization of apomorphine sublingual film (SL-APO). METHODS A post hoc analysis of a Phase III study evaluated nausea and vomiting treatment-emergent adverse events in patients with PD who underwent SL-APO dose optimization (10-35 mg; 5-mg increments) to achieve a tolerable FULL ON. Frequencies of nausea and vomiting were described for patients who did versus did not use an antiemetic during dose optimization and by patient subgroups based on extrinsic and intrinsic factors. RESULTS Overall, 43.7% (196/449) of patients did not use an antiemetic during dose optimization; most of these patients (86.2% [169/196]) achieved an effective and tolerable SL-APO dose. In patients who did not use an antiemetic, nausea (12.2% [24/196]) and vomiting (0.5% [1/196]) were uncommon. An antiemetic was used in 56.3% (253/449) of patients, with 17.0% (43/253) and 2.4% (6/253) experiencing nausea and vomiting, respectively. All events of nausea (14.9% [67/449]) and vomiting (1.6% [7/449]) were of mild-to-moderate severity except for 1 event each. Irrespective of antiemetic use, among patients without baseline dopamine agonist use, nausea and vomiting rates were 25.2% (40/159) and 3.8% (6/159); in those already using dopamine agonists, rates were 9.3% (27/290) and 0.3% (1/290). CONCLUSION Prophylactic treatment with an antiemetic is not necessary for most patients who initiate SL-APO for the treatment of OFF episodes in PD.
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Affiliation(s)
| | | | - Yi Zhang
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | | | | | - Eric Pappert
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
- Neurology Associates, San Antonio, TX, USA
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13
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Camilleri M, Subramanian T, Pagan F, Isaacson S, Gil R, Hauser RA, Feldman M, Goldstein M, Kumar R, Truong D, Chhabria N, Walter BL, Eskenazi J, Riesenberg R, Burdick D, Tse W, Molho E, Robottom B, Bhatia P, Kadimi S, Klos K, Shprecher D, Marquez-Mendoza O, Hidalgo G, Grill S, Li G, Mandell H, Hughes M, Stephenson S, Vandersluis J, Pfeffer M, Duker A, Shivkumar V, Kinney W, MacDougall J, Zasloff M, Barbut D. Oral ENT-01 Targets Enteric Neurons to Treat Constipation in Parkinson Disease : A Randomized Controlled Trial. Ann Intern Med 2022; 175:1666-1674. [PMID: 36343348 DOI: 10.7326/m22-1438] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Parkinson disease (PD) is associated with α-synuclein (αS) aggregation within enteric neurons. ENT-01 inhibits the formation of αS aggregates and improved constipation in an open-label study in patients with PD. OBJECTIVE To evaluate the safety and efficacy of oral ENT-01 for constipation and neurologic symptoms in patients with PD and constipation. DESIGN Randomized, placebo-controlled phase 2b study. (ClinicalTrials.gov: NCT03781791). SETTING Outpatient. PATIENTS 150 patients with PD and constipation. INTERVENTION ENT-01 or placebo daily for up to 25 days. After baseline assessment of constipation severity, daily dosing was escalated to the prokinetic dose, the maximum dose (250 mg), or the tolerability limit, followed by a washout period. MEASUREMENTS The primary efficacy end point was the number of complete spontaneous bowel movements (CSBMs) per week. Neurologic end points included dementia (assessed using the Mini-Mental State Examination [MMSE]) and psychosis (assessed using the Scale for the Assessment of Positive Symptoms adapted for PD [SAPS-PD]). RESULTS The weekly CSBM rate increased from 0.7 to 3.2 in the ENT-01 group versus 0.7 to 1.2 in the placebo group (P < 0.001). Improvement in secondary end points included SBMs (P = 0.002), stool consistency (P < 0.001), ease of passage (P = 0.006), and laxative use (P = 0.041). In patients with dementia, MMSE scores improved by 3.4 points 6 weeks after treatment in the ENT-01 group (n = 14) versus 2.0 points in the placebo group (n = 14). Among patients with psychosis, SAPS-PD scores improved from 6.5 to 1.7 six weeks after treatment in the ENT-01 group (n = 5) and from 6.3 to 4.4 in the placebo group (n = 6). ENT-01 was well tolerated, with no deaths or drug-related serious adverse events. Adverse events were predominantly gastrointestinal, including nausea (34.4% [ENT-01] vs. 5.3% [placebo]; P < 0.001) and diarrhea (19.4% [ENT-01] vs. 5.3% [placebo]; P = 0.016). LIMITATION Longer treatment periods need to be investigated in future studies. CONCLUSION ENT-01 was safe and significantly improved constipation. PRIMARY FUNDING SOURCE Enterin, Inc.
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Affiliation(s)
| | | | - Fernando Pagan
- Department of Neurology, Georgetown University Hospital, Washington, DC (F.P.)
| | - Stuart Isaacson
- Parkinson's Disease and Movement Disorder Center of Boca Raton, Boca Raton, Florida (S.I.)
| | - Ramon Gil
- Parkinson's Disease Treatment Center of SW Florida, Port Charlotte, Florida (R.G.)
| | - Robert A Hauser
- USF Parkinson's Disease and Movement Disorder Center, Tampa, Florida (R.A.H.)
| | - Mary Feldman
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (M.F.)
| | - Mark Goldstein
- JEM Headlands Research Institute, Atlantis, Florida (M.G.)
| | - Rajeev Kumar
- Rocky Mountain Movement Disorder Center, Englewood, Colorado (R.K.)
| | - Daniel Truong
- The Parkinson's and Movement Disorder Institute, Fountain Valley, California (D.T.)
| | - Nisha Chhabria
- Palm Beach Neurology and Premiere Research Institute, West Palm Beach, Florida (N.C.)
| | - Benjamin L Walter
- Parkinson's and Movement Disorders Center, Cleveland Clinic, Cleveland, Ohio (B.L.W.)
| | | | | | - Daniel Burdick
- Booth Gardner Parkinson's Care Center, EvergreenHealth, Kirkland, Washington (D.B.)
| | - Winona Tse
- Parkinson's and Movement Disorders Center, Icahn School of Medicine at Mount Sinai, New York, New York (W.T.)
| | - Eric Molho
- Parkinson's Disease and Movement Center, Albany Medical College, Albany, New York (E.M.)
| | | | | | - Srinath Kadimi
- Associated Neurologists of Southern Connecticut, Fairfield, Connecticut (S.K.)
| | - Kevin Klos
- The Movement Disorder Clinic of Oklahoma, Tulsa, Oklahoma (K.K.)
| | - David Shprecher
- Banner Sun Health Research Institute, Sun City, Arizona (D.S.)
| | | | - Gonzalo Hidalgo
- The Neuromedical Clinic of Central Louisiana, Alexandria, Louisiana (G.H.)
| | - Stephen Grill
- Parkinson's and Movement Disorders Center of Maryland, Elkridge, Maryland (S.G.)
| | - George Li
- MEDSOL Clinical Research, Port Charlotte, Florida (G.L.)
| | - Howard Mandell
- Metrolina Neurological Associates, Indian Land, South Carolina (H.M.)
| | - Mary Hughes
- Premier Neurology, Greer, South Carolina (M.H.)
| | | | - Joel Vandersluis
- Elias Research, Neurology Diagnostics, Inc., Dayton, Ohio (J.V.)
| | - Michael Pfeffer
- Allied Biomedical Neurologic Research Institute, Miami, Florida (M.P.)
| | - Andrew Duker
- University of Cincinnati, Cincinnati, Ohio (A.D.)
| | - Vikram Shivkumar
- University Physicians and Surgeons, Inc., Marshall Health, Huntington, West Virginia (V.S.)
| | | | - James MacDougall
- MacDougall Statistical Institute, Haverhill, Massachusetts (J.M.)
| | - Michael Zasloff
- Medstar-Georgetown Transplant Institute, Washington, DC, and Enterin Research Institute and Enterin, Inc., Philadelphia, Pennsylvania (M.Z.)
| | - Denise Barbut
- Enterin Research Institute and Enterin, Inc., Philadelphia, Pennsylvania (D.B.)
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Soileau MJ, Aldred J, Budur K, Fisseha N, Fung VS, Jeong A, Kimber TE, Klos K, Litvan I, O'Neill D, Robieson WZ, Spindler MA, Standaert DG, Talapala S, Vaou EO, Zheng H, Facheris MF, Hauser RA. Safety and efficacy of continuous subcutaneous foslevodopa-foscarbidopa in patients with advanced Parkinson's disease: a randomised, double-blind, active-controlled, phase 3 trial. Lancet Neurol 2022; 21:1099-1109. [PMID: 36402160 DOI: 10.1016/s1474-4422(22)00400-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/31/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Levodopa is the most effective symptomatic therapy for Parkinson's disease, but patients with advanced Parkinson's disease develop motor fluctuations with chronic oral levodopa therapy. Foslevodopa-foscarbidopa is a soluble formulation of levodopa and carbidopa prodrugs that is delivered as a 24-h/day continuous subcutaneous infusion, and we aimed to assess the safety and efficacy of this formulation in patients with advanced Parkinson's disease. METHODS A 12-week randomised, double-blind, double-dummy, active-controlled study was done at 65 academic and community study centres in the USA and Australia. Patients with levodopa-responsive advanced Parkinson's disease inadequately controlled on current therapy, including at least 2·5 h of average daily off time, were randomly assigned (1:1) to continuous subcutaneous infusion of foslevodopa-foscarbidopa plus oral placebo or to oral immediate-release levodopa-carbidopa plus continuous subcutaneous infusion of placebo solution. Randomisation was stratified by site by means of a permutated-block schedule with a block size of two. The participants, treating investigators, study site personnel, and sponsor were masked to treatment group allocation. The primary and first key secondary endpoint in the hierarchical testing strategy were change from baseline to week 12 in on time without troublesome dyskinesia and off time, respectively; both endpoints were evaluated by an intention-to-treat analysis applying a mixed model for repeated measures analysis. Safety and tolerability were assessed throughout the study. The study is completed and is listed on ClinicalTrials.gov, NCT04380142. FINDINGS Between Oct 19, 2020, and Sept 29, 2021, of 270 participants screened and 174 enrolled, 141 were randomly assigned and received continuous subcutaneous infusion of foslevodopa-foscarbidopa plus oral placebo capsules (n=74) or oral encapsulated immediate-release levodopa-carbidopa plus continuous subcutaneous infusion of placebo solution (n=67). Compared with levodopa-carbidopa, foslevodopa-foscarbidopa showed a significantly greater increase in on time without troublesome dyskinesia (model-based mean [SE] 2·72 [0·52] vs 0·97 [0·50] h; difference 1·75 h, 95% CI 0·46 to 3·05; p=0·0083) and a significantly greater reduction in off time (-2·75 [0·50] vs -0·96 [0·49] h; difference -1·79 h, -3·03 to -0·54; p=0·0054). Hierarchical testing ended after the first secondary endpoint. Adverse events were reported in 63 (85%) of 74 patients in the foslevodopa-foscarbidopa group versus 42 (63%) of 67 in the levodopa-carbidopa group, and incidences of serious adverse events were similar between the groups (six [8%] of 74 vs four [6%] of 67, respectively). The most frequent adverse events in the foslevodopa-foscarbidopa group were infusion site adverse events (erythema 20 [27%]), pain 19 [26%]), cellulitis (14 [19%]), and oedema (nine [12%]), most of which were non-serious and mild-moderate in severity. The only system organ class that had more than one serious adverse event in the foslevodopa-foscarbidopa group was infections and infestations (catheter site cellulitis [one [1%]] and infusion site cellulitis [one [1%]). Adverse events led to premature discontinuation of study drug in 16 (22%) of 74 participants in the foslevodopa-foscarbidopa group versus one (1%) of 67 participants in the oral levodopa-carbidopa group. INTERPRETATION Foslevodopa-foscarbidopa improved motor fluctuations, with benefits in both on time without troublesome dyskinesia and off time. Foslevodopa-foscarbidopa has a favourable benefit-risk profile and represents a potential non-surgical alternative for patients with advanced Parkinson's disease. FUNDING AbbVie.
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Affiliation(s)
| | - Jason Aldred
- Selkirk Neurology & Inland Northwest Research, Spokane, WA, USA
| | | | | | - Victor Sc Fung
- Movement Disorders Unit, Westmead Hospital, Westmead, Australia; Sydney Medical School, University of Sydney, Sydney NSW, Australia
| | | | - Thomas E Kimber
- Royal Adelaide Hospital, Adelaide, SA, Australia; Department of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Kevin Klos
- Movement Disorder Clinic of Oklahoma, Tulsa, OK, USA
| | - Irene Litvan
- Parkinson and Other Movement Disorders Center, University of California San Diego, La Jolla, CA, USA
| | - Daniel O'Neill
- South Western Sydney Local Health District, Liverpool, NSW, Australia
| | | | - Meredith A Spindler
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David G Standaert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | - Robert A Hauser
- University of South Florida Parkinson's Disease and Movement Disorders Center of Excellence, Tampa, FL, USA
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Pahwa R, Fox S, Hauser RA, Isaacson S, Lytle J, Johnson R, Llorens L, Formella AE, Tanner CM. Clinically important change on the Unified Dyskinesia Rating Scale among patients with Parkinson's disease experiencing dyskinesia. Front Neurol 2022; 13:846126. [DOI: 10.3389/fneur.2022.846126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe Unified Dyskinesia Rating Scale (UDysRS) evaluates dyskinesia in patients with Parkinson's disease (PD). A minimal clinically important change (MCIC)—the smallest change in a treatment outcome that a patient considers important—remains undefined for the UDysRS.ObjectiveTo utilize pivotal amantadine delayed-release/extended-release (DR/ER) trial data to derive MCICs for the UDysRS total score in patients with PD experiencing dyskinesia.MethodsPivotal trials included PD patients with ≥1 h daily ON time with troublesome dyskinesia and baseline scores ≥2 on the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part IV, item 4.2. Patients randomized to amantadine DR/ER or placebo completed two consecutive 24-h diaries before each clinic visit and were evaluated during ON time with dyskinesia using the UDysRS, MDS-UPDRS, and Clinician Global Impression of Change (CGI-C). The UDysRS changes from baseline to week 12 were anchored to corresponding changes in MDS-UPDRS item 4.2 scores. A minimal clinically important improvement in the CGI-C and diary-reported ON time with troublesome dyskinesia (≥0.5 h) were supportive anchors. Receiver operating characteristic curves determined the UDysRS change values optimizing sensitivity and specificity to at least minimal improvement on each anchor.ResultsThe analyses included 196 patients. Week 12 UDysRS total score reduction of ≥8 points corresponded to at least minimal MDS-UPDRS item 4.2 improvement. UDysRS reduction of ≥9 points corresponded to decreased ON time with troublesome dyskinesia of ≥0.5 h per patient diaries, and UDysRS reduction of ≥10 points corresponded to at least minimal improvement on the CGI-C.ConclusionAnchored to the MDS-UPDRS Part IV, item 4.2, an 8-point reduction in the UDysRS total score can be considered an MCIC for PD patients with dyskinesia.
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16
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Pagano G, Taylor KI, Anzures-Cabrera J, Marchesi M, Simuni T, Marek K, Postuma RB, Pavese N, Stocchi F, Azulay JP, Mollenhauer B, López-Manzanares L, Russell DS, Boyd JT, Nicholas AP, Luquin MR, Hauser RA, Gasser T, Poewe W, Ricci B, Boulay A, Vogt A, Boess FG, Dukart J, D'Urso G, Finch R, Zanigni S, Monnet A, Pross N, Hahn A, Svoboda H, Britschgi M, Lipsmeier F, Volkova-Volkmar E, Lindemann M, Dziadek S, Holiga Š, Rukina D, Kustermann T, Kerchner GA, Fontoura P, Umbricht D, Doody R, Nikolcheva T, Bonni A. Trial of Prasinezumab in Early-Stage Parkinson's Disease. N Engl J Med 2022; 387:421-432. [PMID: 35921451 DOI: 10.1056/nejmoa2202867] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Aggregated α-synuclein plays an important role in the pathogenesis of Parkinson's disease. The monoclonal antibody prasinezumab, directed at aggregated α-synuclein, is being studied for its effect on Parkinson's disease. METHODS In this phase 2 trial, we randomly assigned participants with early-stage Parkinson's disease in a 1:1:1 ratio to receive intravenous placebo or prasinezumab at a dose of 1500 mg or 4500 mg every 4 weeks for 52 weeks. The primary end point was the change from baseline to week 52 in the sum of scores on parts I, II, and III of the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS; range, 0 to 236, with higher scores indicating greater impairment). Secondary end points included the dopamine transporter levels in the putamen of the hemisphere ipsilateral to the clinically more affected side of the body, as measured by 123I-ioflupane single-photon-emission computed tomography (SPECT). RESULTS A total of 316 participants were enrolled; 105 were assigned to receive placebo, 105 to receive 1500 mg of prasinezumab, and 106 to receive 4500 mg of prasinezumab. The baseline mean MDS-UPDRS scores were 32.0 in the placebo group, 31.5 in the 1500-mg group, and 30.8 in the 4500-mg group, and mean (±SE) changes from baseline to 52 weeks were 9.4±1.2 in the placebo group, 7.4±1.2 in the 1500-mg group (difference vs. placebo, -2.0; 80% confidence interval [CI], -4.2 to 0.2; P = 0.24), and 8.8±1.2 in the 4500-mg group (difference vs. placebo, -0.6; 80% CI, -2.8 to 1.6; P = 0.72). There was no substantial difference between the active-treatment groups and the placebo group in dopamine transporter levels on SPECT. The results for most clinical secondary end points were similar in the active-treatment groups and the placebo group. Serious adverse events occurred in 6.7% of the participants in the 1500-mg group and in 7.5% of those in the 4500-mg group; infusion reactions occurred in 19.0% and 34.0%, respectively. CONCLUSIONS Prasinezumab therapy had no meaningful effect on global or imaging measures of Parkinson's disease progression as compared with placebo and was associated with infusion reactions. (Funded by F. Hoffmann-La Roche and Prothena Biosciences; PASADENA ClinicalTrials.gov number, NCT03100149.).
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Affiliation(s)
- Gennaro Pagano
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Kirsten I Taylor
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Judith Anzures-Cabrera
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Maddalena Marchesi
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Tanya Simuni
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Kenneth Marek
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Ronald B Postuma
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Nicola Pavese
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Fabrizio Stocchi
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Jean-Philippe Azulay
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Brit Mollenhauer
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Lydia López-Manzanares
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - David S Russell
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - James T Boyd
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Anthony P Nicholas
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - María R Luquin
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Robert A Hauser
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Thomas Gasser
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Werner Poewe
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Benedicte Ricci
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Anne Boulay
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Annamarie Vogt
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Frank G Boess
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Juergen Dukart
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Giulia D'Urso
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Rebecca Finch
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Stefano Zanigni
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Annabelle Monnet
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Nathalie Pross
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Andrea Hahn
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Hanno Svoboda
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Markus Britschgi
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Florian Lipsmeier
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Ekaterina Volkova-Volkmar
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Michael Lindemann
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Sebastian Dziadek
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Štefan Holiga
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Daria Rukina
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Thomas Kustermann
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Geoffrey A Kerchner
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Paulo Fontoura
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Daniel Umbricht
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Rachelle Doody
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Tania Nikolcheva
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
| | - Azad Bonni
- From the Neuroscience and Rare Diseases, Discovery and Translational Area (G.P., K.I.T., A. Boulay, A.V., F.G.B., J.D., G.D., H.S., M.B., S.D., Š.H., T.K., G.A.K., D.U., A. Bonni), and Pharmaceutical Sciences (B.R.), Roche Pharma Research and Early Development (pRED), and Roche pRED Informatics (F.L., E.V.-V., M.L.), Roche Innovation Center Basel, and Product Development Neuroscience (S.Z., A.M., N. Pross, P.F., R.D., T.N.) and Product Development Safety (M.M., D.R.), F. Hoffmann-La Roche - all in Basel, Switzerland; University of Exeter Medical School, London (G.P.), Roche Products, Welwyn Garden City (J.A.-C., R.F.), and the Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne (N. Pavese) - all in the United Kingdom; the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago (T.S.); Institute for Neurodegenerative Disorders, New Haven, CT (K.M., D.S.R.); the Department of Neurology, McGill University, and Montreal Neurological Institute, Montreal (R.B.P.); University San Raffaele Roma and the Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome (F.S.); Centre Hospitalier de la Timone, Marseille, France (J.-P.A.); Paracelsus-Elena-Klinik, Kassel (B.M.), the Department of Neurology, University Medical Center Göttingen, Göttingen (B.M.), Hertie Institute for Clinical Brain Research, University of Tübingen, and the German Center for Neurodegenerative Diseases, Tübingen (T.G.), the Institute of Neurosciences and Medicine, Brain and Behavior, Research Center Jülich, Jülich (J.D.), the Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (J.D.), and Excelya Germany, Freiburg (A.H.) - all in Germany; the Department of Neurology, University Hospital de La Princesa, Madrid (L.L.-M.), and University Clinic of Navarra, Pamplona (M.R.L.) - both in Spain; University of South Florida, Tampa (R.A.H.); University of Vermont Larner College of Medicine, Burlington (J.T.B.); University of Alabama Medical Center, Birmingham (A.P.N.); and the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (W.P.)
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Jankovic J, Comella C, Hauser RA, Patel AT, Gross TM, Rubio RG, Vitarella D. A Phase 3 Trial Evaluating the Efficacy, Duration of Effect, and Safety of DaxibotulinumtoxinA for Injection in the Treatment of Cervical Dystonia. Toxicon 2022. [DOI: 10.1016/j.toxicon.2021.11.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Hauser RA, Barkay H, Wilhelm A, Wieman M, Savola JM, Gordon MF. Minimal clinically important change in Abnormal Involuntary Movement Scale score in tardive dyskinesia as assessed in pivotal trials of deutetrabenazine. Parkinsonism Relat Disord 2022; 97:47-51. [PMID: 35299070 DOI: 10.1016/j.parkreldis.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Deutetrabenazine is approved by the US Food and Drug Administration to treat tardive dyskinesia (TD) based on 2 pivotal, 12-week, placebo-controlled studies (ARM-TD and AIM-TD) evaluating safety and efficacy in patients with baseline total motor Abnormal Involuntary Movement Scale (AIMS) score ≥6. This analysis estimated the minimal clinically important change (MCIC) in total motor AIMS score in TD patients treated with deutetrabenazine. METHODS The pooled analysis population included all patients in ARM-TD and AIM-TD who received study drug and had ≥1 postbaseline AIMS assessment. MCIC analyses were performed using Patient Global Impression of Change (PGIC) and Clinical Global Impression of Change (CGIC) as anchors. MCIC was defined as the mean change from baseline in total motor AIMS score in patients treated with deutetrabenazine who were rated minimally improved on PGIC or CGIC at Week 12. RESULTS This analysis included 295 patients (deutetrabenazine, n = 197; placebo, n = 98). At Week 12, the MCIC in deutetrabenazine-treated patients was -2.4 based on the PGIC and -2.1 based on the CGIC. Mean change from baseline in total motor AIMS score for placebo-treated patients rated minimally improved was -1.4 based on the PGIC and -1.5 based on the CGIC. The proportion of deutetrabenazine-treated patients who achieved improvement in total motor AIMS score by ≥2 and ≥3 points was 66% and 55%, respectively. CONCLUSION Using anchor-based methodology, the MCIC on the AIMS for deutetrabenazine in patients with TD was approximately -2, suggesting that a reduction in total motor AIMS score of ∼2 is associated with clinically meaningful improvement in TD symptoms.
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Affiliation(s)
- Robert A Hauser
- University of South Florida Parkinson's Disease and Movement Disorders Center, Tampa, FL, USA.
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Hauser RA, Lytle J, Formella AE, Tanner CM. Amantadine delayed release/extended release capsules significantly reduce OFF time in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:29. [PMID: 35304480 PMCID: PMC8933492 DOI: 10.1038/s41531-022-00291-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
Maintaining consistent levodopa benefits while simultaneously controlling dyskinesia can be difficult. Recently, an amantadine delayed release/extended release (DR/ER) formulation (Gocovri®) indicated for dyskinesia received additional FDA approval as an adjunct to levodopa for the treatment of OFF episodes. We evaluated OFF time reductions with amantadine-DR/ER in a pooled analysis of two phase III amantadine-DR/ER trials (NCT02136914, NCT02274766) followed by a 2-year open-label extension trial (NCT02202551). OFF outcomes were analyzed for the mITT population, as well as stratified by baseline OFF time of ≥2.5 h/day or <2.5 h/day. At Week 12, mean placebo-subtracted treatment difference in OFF time was −1.00 [−1.57, −0.44] h in the mITT population (n = 196), −1.2 [−2.08, −0.32] h in the ≥2.5 h subgroup (n = 102) and −0.77 [−1.49, −0.06] in the <2.5 h subgroup (n = 94). Amantadine-DR/ER-treated participants showed reduced MDS-UPDRS Part IV motor fluctuation subscores by week 2 that were maintained below baseline to Week 100.
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Affiliation(s)
| | - Judy Lytle
- Adamas Pharmaceuticals, Inc, Emeryville, CA, USA
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Hauser RA, Barkay H, Fernandez HH, Factor SA, Jimenez-Shahed J, Gross N, Marinelli L, Wilhelm A, Alexander J, Gordon MF, Savola JM, Anderson KE. Long-Term Deutetrabenazine Treatment for Tardive Dyskinesia Is Associated With Sustained Benefits and Safety: A 3-Year, Open-Label Extension Study. Front Neurol 2022; 13:773999. [PMID: 35280262 PMCID: PMC8906841 DOI: 10.3389/fneur.2022.773999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Deutetrabenazine is a vesicular monoamine transporter 2 inhibitor approved for the treatment of tardive dyskinesia (TD) in adults. In two 12-week pivotal studies, deutetrabenazine demonstrated statistically significant improvements in Abnormal Involuntary Movement Scale (AIMS) scores, with favorable safety/tolerability in TD patients. This study reports long-term efficacy and safety of deutetrabenazine in a 3-year, single-arm, open-label extension (OLE) study. Methods Patients who completed the pivotal studies could enroll in this single-arm OLE study, titrating up to 48 mg/day based on dyskinesia control and tolerability. Efficacy was assessed based on change from baseline in total motor AIMS score, Clinical Global Impression of Change (CGIC) and Patient Global Impression of Change (PGIC), and quality of life (QOL) assessments. Safety evaluation included adverse event (AE) incidence, reported using exposure-adjusted incidence rates, and safety scales. Results 343 patients enrolled in the study (6 patients were excluded). At Week 145 (mean dose: 39.4 ± 0.83 mg/day), mean ± SE change from baseline in total motor AIMS score was −6.6 ± 0.37 and 67% of patients achieved ≥50% improvement in total motor AIMS score. Based on CGIC and PGIC, 73% and 63% of patients achieved treatment success, respectively. QOL improvements were also observed. Deutetrabenazine was generally well tolerated, with low rates of mild-to-moderate AEs and no new safety signals; most safety scales remained unchanged over time. Conclusions Long-term deutetrabenazine treatment was associated with sustained improvement in AIMS scores, indicative of clinically meaningful long-term benefit, and was generally well tolerated. Results suggest deutetrabenazine may provide increasing benefit over time without increases in dose.
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Affiliation(s)
- Robert A Hauser
- University of South Florida Parkinson's Disease and Movement Disorders Center, Tampa, FL, United States
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Hauser RA, Favit A, Hewitt LA, Lindsten A, Gorny S, Kymes S, Isaacson SH. Durability of the Clinical Benefit of Droxidopa for Neurogenic Orthostatic Hypotension During 12 Weeks of Open-Label Treatment. Neurol Ther 2022; 11:459-469. [PMID: 35107750 PMCID: PMC8857381 DOI: 10.1007/s40120-021-00317-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/21/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction Droxidopa is approved to treat neurogenic orthostatic hypotension (nOH) symptoms in patients with autonomic failure based on short-term clinical trial data. Additional data on the long-term efficacy of droxidopa are needed. We have evaluated the 12-week efficacy and tolerability of droxidopa in patients with nOH in an open-label period of an ongoing phase 4 study . Methods Patients received 12 weeks of open-label treatment with an individually optimized droxidopa dose (100–600 mg, 3 times daily) as identified during a preceding titration period. Patient-reported outcomes included the Orthostatic Hypotension Symptom Assessment (OHSA), Orthostatic Hypotension Daily Activity Scale (OHDAS), and clinician- and patient-rated Clinical Global Impression–Severity (CGI-S) scales. Supine blood pressure (BP) and adverse events (AEs) were recorded. Results Data from 114 patients enrolled into the 12-week open-label period were available for analyses. After 12 weeks of droxidopa treatment, patients reported significant (P < 0.0001) improvements from baseline in OHSA and OHDAS composite and individual item scores and on clinician and patient CGI-S scores. Mean ± SD supine systolic and diastolic BP at week 12 increased by 15.5 ± 22.9 and 7.8 ± 11.7 mmHg from baseline, respectively (P < 0.0001 for both). The most frequently reported AEs were falls (17%), headache (13%), and dizziness (9%); one (0.9%) patient reported an AE of supine hypertension. Conclusion During 12 weeks of open-label treatment, droxidopa was associated with significant improvement from baseline in nOH symptoms and activities of daily living. No clinically important changes in supine hypertension or AEs of concern were observed. These results support the efficacy of droxidopa beyond 2 weeks of treatment. Trial Registration NCT02586623. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-021-00317-5.
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Affiliation(s)
- Robert A Hauser
- Parkinson Foundation Center of Excellence, University of South Florida Parkinson's Disease and Movement Disorders Center, 4001 E Fletcher Avenue, Tampa, FL, 33613, USA.
| | | | | | | | | | | | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, 33486, USA
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Hauser RA, Goud S, Formella AE. Potential utility of amantadine DR/ER in persons with Parkinson’s disease meeting 5-2-1 criteria for device aided therapy. Clin Park Relat Disord 2022; 6:100123. [PMID: 35059622 PMCID: PMC8760552 DOI: 10.1016/j.prdoa.2021.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022] Open
Abstract
5-2-1 criteria help identify PD patients who may benefit from device aided therapy. Amantadine-DR/ER increased ‘good’ ON time in patients meeting 5-2-1 criteria. Increased good ON time resulted from reductions in troublesome dyskinesia and OFF. Amantadine-DR/ER efficacy was maintained over 100 weeks in this advanced population.
Background The 5-2-1 criteria (≥5 levodopa doses/day, ≥2 h OFF/day, and ≥ 1-hour dyskinesia/day) propose to identify people with Parkinson’s disease (PD) who are poorly controlled on oral therapies and who may therefore benefit from device-aided therapies. Amantadine-DR/ER is the only medication FDA-approved for both dyskinesia and OFF episodes in levodopa-treated patients. In this post-hoc analysis of phase 3 clinical trials, we evaluated the efficacy and safety of amantadine-DR/ER in patients meeting 5-2-1 criteria. Methods Week-12 treatment differences (Amantadine-DR/ER − placebo) in the Unified Dyskinesia Rating Scale (UDysRS) and PD motor states (patient diaries) were evaluated in pooled, phase-3, double-blind trial participants meeting 5-2-1 criteria at baseline. This 5-2-1 cohort was followed into a 2-year open-label trial, where Movement Disorder Society - Unified Parkinson’s Disease Rate Scale (MDS-UPDRS) Part IV scores were assessed relative to double-blind baseline. Results Of 198 enrolled participants in the phase 3 trials, 65 (33%; n = 29 placebo; n = 36 amantadine-DR/ER) comprised the 5-2-1 cohort. At Week-12 endpoint, amantadine-DR/ER significantly improved UDysRS scores (treatment difference of 9.57 ± 3.15 points, p = 0.004) and ON time without troublesome dyskinesia (‘good ON’, treatment difference of 2.9 ± 0.90 h/day, p = 0.002). Improvements in good ON time resulted from significant reductions in both troublesome dyskinesia and OFF time. Treatment benefit on MDS-UPDRS-Part IV was sustained through open-label, follow-up. The most common adverse events in patients who met 5-2-1 criteria and were treated with amantadine-DR/ER included falls and peripheral edema. Conclusions Findings suggest Amantadine-DR/ER should be considered as an option for people with PD who meet 5-2-1 criteria.
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Comella C, Hauser RA, Isaacson SH, Truong D, Oguh O, Hui J, Molho ES, Brodsky M, Furr-Stimming E, Comes G, Hast MA, Charles D. Efficacy and safety of two incobotulinumtoxinA injection intervals in cervical dystonia patients with inadequate benefit from standard injection intervals of botulinum toxin: Phase 4, open-label, randomized, noninferiority study. Clin Park Relat Disord 2022; 6:100142. [PMID: 35330880 PMCID: PMC8938329 DOI: 10.1016/j.prdoa.2022.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/11/2022] [Indexed: 12/01/2022] Open
Abstract
Botulinum toxin treatment benefit for CD can wane before typical reinjection cycle. Shorter injection cycles of incobotulinumtoxinA are effective for treating CD. Shorter injection intervals have no unexpected AEs or loss of treatment effect.
Introduction Some patients with cervical dystonia (CD) receiving long-term botulinum neurotoxin (BoNT) therapy report early waning of treatment benefit before the typical 12-week reinjection interval. Methods This phase 4, open-label, randomized, noninferiority study (CD Flex; NCT01486264) compared 2 incobotulinumtoxinA injection schedules (Short Flex: 8 ± 2 weeks; Long Flex: 14 ± 2 weeks) in CD patients. Previous BoNT-responsive subjects who reported acceptable clinical benefit lasting < 10 weeks were recruited. Efficacy and safety were evaluated after 8 injection cycles. The primary endpoint was change in Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity subscale 4 weeks after the eighth injection. Secondary endpoints included TWSTRS total and subscale scores. Immunogenicity was assessed in a subset of patients. Results Two hundred eighty-two CD patients were randomized and treated (Short Flex, N = 142; Long Flex, N = 140), and 207 completed the study. Significant improvements in TWSTRS severity from study baseline to 4 weeks after cycle 8 were observed in both the Short Flex (4.1 points; P < 0.0001) and Long Flex (2.4 points; P = 0.002) groups; Short Flex was noninferior to Long Flex (LS mean difference = 1.4 points; 95% CI = [−2.9, 0.1] < Δ = 2.0). Key secondary endpoints favored Short Flex intervals. Adverse events (AEs) were comparable between groups. There was no secondary loss of treatment effect. Conclusion Injection cycles < 10 weeks for incobotulinumtoxinA are effective (and noninferior to longer intervals) for treating CD patients with early waning of clinical benefit. Shorter injection intervals did not increase AEs or lead to loss of treatment effect.
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Lew MF, Hauser RA, Isaacson SH, Truong D, Patel AT, Brashear A, Ondo W, Maisonobe P, Dashtipour K, Bahroo L, Wietek S. AbobotulinumtoxinA provides flexibility for the treatment of cervical dystonia with 500 U/1 mL and 500 U/2 mL dilutions. Clin Park Relat Disord 2021; 5:100115. [PMID: 34888518 PMCID: PMC8636802 DOI: 10.1016/j.prdoa.2021.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cervical dystonia (CD) is a neurologic movement disorder with potentially disabling effects and significant impact on quality of life of those affected. AbobotulinumtoxinA (aboBoNT-A) was initially approved for a dilution of 500 U/1 mL and subsequently for a dilution of 500 U/2 mL, providing flexibility for clinicians to treat CD. Here, we explore the safety and efficacy of the 500 U/2 mL dilution versus 500 U/1 mL dilution of aboBoNT-A in a retrospective analysis based on published clinical trial data. METHODS The safety and efficacy of aboBoNT-A in patients with CD was evaluated in three multicenter, double-blind, randomized, placebo-controlled trials and open-label extensions. Trials 1 (NCT00257660) and 2 (NCT00288509) evaluated the 500 U/1 mL dilution in 80 and 116 patients, respectively; Trial 3 (NCT01753310) evaluated the 500 U/2 mL dilution in 125 patients. RESULTS Comparison of the adjusted mean difference in TWSTRS total scores at Week 4 from baseline for aboBoNT-A in Trial 1 (-6.0; 95% CI, -10.8, -1.3), Trial 2 (-8.8; 95% CI, -12.9, -4.7), and Trial 3 (-8.7; 95% CI, -13.2, -4.2) showed similar, significant improvements. Dysphagia and muscle weakness patterns were comparable across the three trials, indicating that an increased dilution of aboBoNT-A does not result in an increased risk of diffusion-related adverse events. CONCLUSION The results of these trials show that aboBoNT-A is similarly efficacious using either dilution, with similar safety and tolerability across trials. Having the 500 U/1 mL and 500 U/2 mL dilution volumes available provides further flexibility in administration, benefiting patient care.
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Affiliation(s)
- Mark F. Lew
- Department of Neurology, Keck/University of Southern California School of Medicine, Los Angeles, CA 90033, USA
| | - Robert A. Hauser
- University of South Florida, Parkinson’s Disease and Movement Disorders Center of Excellence, Tampa, FL 33613, USA
| | - Stuart H. Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL 33486, USA
| | - Daniel Truong
- The Parkinson and Movement Disorder Institute, Fountain Valley, CA 92708, USA
| | - Atul T. Patel
- Kansas City Bone and Joint Clinic, Overland Park, KS 66211, USA
| | - Allison Brashear
- Department of Neurology, University of California, Davis, Sacramento, CA 95816, USA
| | - William Ondo
- Methodist Neurological Institute, Houston, TX 77030, USA
| | | | - Khashayar Dashtipour
- Department of Neurology/Movement Disorders, Loma Linda University, Loma Linda, CA 92354, USA
| | - Laxman Bahroo
- Georgetown University Hospital, Pasquerilla Healthcare Center, Washington, DC 20007, USA
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Pringsheim T, Day GS, Smith DB, Rae-Grant A, Licking N, Armstrong MJ, de Bie RMA, Roze E, Miyasaki JM, Hauser RA, Espay AJ, Martello JP, Gurwell JA, Billinghurst L, Sullivan K, Fitts MS, Cothros N, Hall DA, Rafferty M, Hagerbrant L, Hastings T, O'Brien MD, Silsbee H, Gronseth G, Lang AE. Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary: A Report of the AAN Guideline Subcommittee. Neurology 2021; 97:942-957. [PMID: 34782410 PMCID: PMC8672433 DOI: 10.1212/wnl.0000000000012868] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/11/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To review the current evidence on the options available for initiating dopaminergic treatment of motor symptoms in early-stage Parkinson disease and provide recommendations to clinicians. METHODS A multidisciplinary panel developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence. RESULTS Initial treatment with levodopa provides superior motor benefit compared to treatment with dopamine agonists, whereas levodopa is more likely than dopamine agonists to cause dyskinesia. The comparison of different formulations of dopamine agonists yielded little evidence that any one formulation or method of administration is superior. Long-acting forms of levodopa and levodopa with entacapone do not appear to differ in efficacy from immediate-release levodopa for motor symptoms in early disease. There is a higher risk of impulse control disorders associated with the use of dopamine agonists than levodopa. Recommendations on initial therapy for motor symptoms are provided to assist the clinician and patient in choosing between treatment options and to guide counseling, prescribing, and monitoring of efficacy and safety.
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Affiliation(s)
- Tamara Pringsheim
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Gregory S Day
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Don B Smith
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Alex Rae-Grant
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Nicole Licking
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Melissa J Armstrong
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Rob M A de Bie
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Emmanuel Roze
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Janis M Miyasaki
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Robert A Hauser
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Alberto J Espay
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Justin P Martello
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Julie A Gurwell
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Lori Billinghurst
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Kelly Sullivan
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Michael S Fitts
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Nicholas Cothros
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Deborah A Hall
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Miriam Rafferty
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Lynn Hagerbrant
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Tara Hastings
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Mary Dolan O'Brien
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Heather Silsbee
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Gary Gronseth
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
| | - Anthony E Lang
- From the Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), University of Calgary (N.C.), Alberta, Canada; Department of Neurology (G.S.D.), Mayo Clinic, Jacksonville, FL; Department of Neurology (D.B.S.), University of Colorado School of Medicine, Aurora; Cleveland Clinic Lerner College of Medicine (A.R.-G.), Case Western Reserve University, OH; New West Physicians (N.L.), Golden, CO; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology, Amsterdam University Medical Centers (R.M.A.d.B.), University of Amsterdam, the Netherlands; Department of Neurology (E.R.), Pitié-Salpêtrière Hospital, Sorbonne University and the Assistance Publique-Hôpitaux de Paris, France; Department of Medicine (J.M.M.), University of Alberta, Edmonton, Canada; Department of Neurology (R.A.H.), University of South Florida, Tampa; James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders and Department of Neurology (A.J.E.), University of Cincinnati, OH; Christiana Care Neurology Specialists (J.P.M.), Newark, DE; Department of Neurology (J.A.G.), University of Kentucky, Lexington; Department of Pediatrics, McMaster University (L.B.), Hamilton, Ontario, Canada; Department of Biostatistics, Epidemiology, and Environmental Health Sciences (K.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; University of Alabama at Birmingham (M.S.F.); Department of Neurological Sciences (D.A.H.), Rush University Medical Center, Chicago, IL; Shirley Ryan Ability Lab and Department of Physical Medicine and Rehabilitation (M.R.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Michael J. Fox Foundation for Parkinson's Research (L.H., T.H.), New York, NY; American Academy of Neurology (M.D.O., H.S.), Minneapolis, MN; Department of Neurology (G.G.), University of Kansas, Kansas City; The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic (A.E.L.), Toronto Western Hospital and the University of Toronto, Canada
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Schwarzschild MA, Ascherio A, Casaceli C, Curhan GC, Fitzgerald R, Kamp C, Lungu C, Macklin EA, Marek K, Mozaffarian D, Oakes D, Rudolph A, Shoulson I, Videnovic A, Scott B, Gauger L, Aldred J, Bixby M, Ciccarello J, Gunzler SA, Henchcliffe C, Brodsky M, Keith K, Hauser RA, Goetz C, LeDoux MS, Hinson V, Kumar R, Espay AJ, Jimenez-Shahed J, Hunter C, Christine C, Daley A, Leehey M, de Marcaida JA, Friedman JH, Hung A, Bwala G, Litvan I, Simon DK, Simuni T, Poon C, Schiess MC, Chou K, Park A, Bhatti D, Peterson C, Criswell SR, Rosenthal L, Durphy J, Shill HA, Mehta SH, Ahmed A, Deik AF, Fang JY, Stover N, Zhang L, Dewey RB, Gerald A, Boyd JT, Houston E, Suski V, Mosovsky S, Cloud L, Shah BB, Saint-Hilaire M, James R, Zauber SE, Reich S, Shprecher D, Pahwa R, Langhammer A, LaFaver K, LeWitt PA, Kaminski P, Goudreau J, Russell D, Houghton DJ, Laroche A, Thomas K, McGraw M, Mari Z, Serrano C, Blindauer K, Rabin M, Kurlan R, Morgan JC, Soileau M, Ainslie M, Bodis-Wollner I, Schneider RB, Waters C, Ratel AS, Beck CA, Bolger P, Callahan KF, Crotty GF, Klements D, Kostrzebski M, McMahon GM, Pothier L, Waikar SS, Lang A, Mestre T. Effect of Urate-Elevating Inosine on Early Parkinson Disease Progression: The SURE-PD3 Randomized Clinical Trial. JAMA 2021; 326:926-939. [PMID: 34519802 PMCID: PMC8441591 DOI: 10.1001/jama.2021.10207] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/05/2021] [Indexed: 01/13/2023]
Abstract
Importance Urate elevation, despite associations with crystallopathic, cardiovascular, and metabolic disorders, has been pursued as a potential disease-modifying strategy for Parkinson disease (PD) based on convergent biological, epidemiological, and clinical data. Objective To determine whether sustained urate-elevating treatment with the urate precursor inosine slows early PD progression. Design, Participants, and Setting Randomized, double-blind, placebo-controlled, phase 3 trial of oral inosine treatment in early PD. A total of 587 individuals consented, and 298 with PD not yet requiring dopaminergic medication, striatal dopamine transporter deficiency, and serum urate below the population median concentration (<5.8 mg/dL) were randomized between August 2016 and December 2017 at 58 US sites, and were followed up through June 2019. Interventions Inosine, dosed by blinded titration to increase serum urate concentrations to 7.1-8.0 mg/dL (n = 149) or matching placebo (n = 149) for up to 2 years. Main Outcomes and Measures The primary outcome was rate of change in the Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS; parts I-III) total score (range, 0-236; higher scores indicate greater disability; minimum clinically important difference of 6.3 points) prior to dopaminergic drug therapy initiation. Secondary outcomes included serum urate to measure target engagement, adverse events to measure safety, and 29 efficacy measures of disability, quality of life, cognition, mood, autonomic function, and striatal dopamine transporter binding as a biomarker of neuronal integrity. Results Based on a prespecified interim futility analysis, the study closed early, with 273 (92%) of the randomized participants (49% women; mean age, 63 years) completing the study. Clinical progression rates were not significantly different between participants randomized to inosine (MDS-UPDRS score, 11.1 [95% CI, 9.7-12.6] points per year) and placebo (MDS-UPDRS score, 9.9 [95% CI, 8.4-11.3] points per year; difference, 1.26 [95% CI, -0.59 to 3.11] points per year; P = .18). Sustained elevation of serum urate by 2.03 mg/dL (from a baseline level of 4.6 mg/dL; 44% increase) occurred in the inosine group vs a 0.01-mg/dL change in serum urate in the placebo group (difference, 2.02 mg/dL [95% CI, 1.85-2.19 mg/dL]; P<.001). There were no significant differences for secondary efficacy outcomes including dopamine transporter binding loss. Participants randomized to inosine, compared with placebo, experienced fewer serious adverse events (7.4 vs 13.1 per 100 patient-years) but more kidney stones (7.0 vs 1.4 stones per 100 patient-years). Conclusions and Relevance Among patients recently diagnosed as having PD, treatment with inosine, compared with placebo, did not result in a significant difference in the rate of clinical disease progression. The findings do not support the use of inosine as a treatment for early PD. Trial Registration ClinicalTrials.gov Identifier: NCT02642393.
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Affiliation(s)
- Michael A Schwarzschild
- Mass General Institute for Neurodegenerative Disease, Boston, Massachusetts
- Massachusetts General Hospital, Boston
| | | | | | | | - Rebecca Fitzgerald
- Parkinson's Foundation Research Advocates, Parkinson's Foundation, New York, New York
| | | | - Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Eric A Macklin
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut
| | - Dariush Mozaffarian
- Tufts School of Medicine and Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
- Friedman School of Nutrition Science and Policy, Boston, Massachusetts
| | - David Oakes
- University of Rochester, Rochester, New York
| | | | - Ira Shoulson
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | | | | | | | - Jason Aldred
- Inland Northwest Research, Spokane, Washington
- Selkirk Neurology, Spokane, Washington
| | | | | | | | - Claire Henchcliffe
- University of California, Irvine
- Weill Cornell Medical College, New York, New York
| | | | | | | | | | | | | | - Rajeev Kumar
- Rocky Mountain Movement Disorders Center, Englewood, Colorado
| | | | | | | | | | | | | | | | | | | | | | | | - David K Simon
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cynthia Poon
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mya C Schiess
- The University of Texas Health Science Center, Houston McGovern Medical School, Houston
| | | | - Ariane Park
- The Ohio State University Wexner Medical Center, Columbus
| | | | | | - Susan R Criswell
- Washington University School of Medicine in St Louis, St Louis, Missouri
| | | | | | - Holly A Shill
- Banner Sun Health Research Institute, Sun City, Arizona
- University of Arizona School of Medicine-Phoenix
| | | | | | | | - John Y Fang
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Ashley Gerald
- University of Texas Southwestern Medical Center, Dallas
| | | | | | | | | | - Leslie Cloud
- VCU Parkinson's & Movement Disorders Center, Richmond, Virginia
| | | | | | | | | | - Stephen Reich
- University of Maryland School of Medicine, Baltimore
| | - David Shprecher
- Banner Sun Health Research Institute, Sun City, Arizona
- University of Arizona School of Medicine-Phoenix
| | - Rajesh Pahwa
- University of Kansas Medical Center, Kansas City
| | | | - Kathrin LaFaver
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Peter A LeWitt
- Henry Ford Hospital-West Bloomfield, West Bloomfield Township, Michigan
| | - Patricia Kaminski
- Henry Ford Hospital-West Bloomfield, West Bloomfield Township, Michigan
| | | | | | | | | | - Karen Thomas
- Sentara Neurology Specialists, Norfolk, Virginia
| | - Martha McGraw
- Center for Movement Disorders and Neurodegenerative Disease, Northwestern Medicine/Central DuPage Hospital, Winfield, Illinois
| | - Zoltan Mari
- Cleveland Clinic-Las Vegas, Las Vegas, Nevada
| | | | | | - Marcie Rabin
- Atlantic Neuroscience Institute, Summit, New Jersey
| | - Roger Kurlan
- Atlantic Neuroscience Institute, Summit, New Jersey
| | | | - Michael Soileau
- Texas Movement Disorder Specialists, Georgetown
- Scott & White Healthcare/Texas A&M University, Temple
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sushrut S Waikar
- Boston University School of Medicine, Boston, Massachusetts
- Boston Medical Center, Boston, Massachusetts
| | - Anthony Lang
- University of Toronto, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Ontario, Canada
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Hauser RA, Hattori N, Fernandez H, Isaacson SH, Mochizuki H, Rascol O, Stocchi F, Li J, Mori A, Nakajima Y, Ristuccia R, LeWitt P. Efficacy of Istradefylline, an Adenosine A2A Receptor Antagonist, as Adjunctive Therapy to Levodopa in Parkinson's Disease: A Pooled Analysis of 8 Phase 2b/3 Trials. J Parkinsons Dis 2021; 11:1663-1675. [PMID: 34486986 PMCID: PMC8609697 DOI: 10.3233/jpd-212672] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Istradefylline is a selective adenosine A2A receptor antagonist for the treatment of patients with Parkinson's disease (PD) experiencing OFF episodes while on levodopa/decarboxylase inhibitor. OBJECTIVE This pooled analysis of eight randomized, placebo-controlled, double-blind phase 2b/3 studies evaluated the efficacy and safety of istradefylline. METHODS Istradefylline was evaluated in PD patients receiving levodopa with carbidopa/benserazide and experiencing motor fluctuations. Eight 12- or 16-week trials were conducted (n = 3,245); four of these studies were the basis for istradefylline's FDA approval. Change in OFF time as assessed in patient-completed 24-h PD diaries at Week 12 was the primary endpoint. All studies were designed with common methodology, thereby permitting pooling of data. Pooled analysis results from once-daily oral istradefylline (20 and 40 mg/day) and placebo were evaluated using a mixed-model repeated-measures approach including study as a factor. RESULTS Among 2,719 patients (placebo, n = 992; 20 mg/day, n = 848; 40 mg/day, n = 879), OFF hours/day were reduced at Week 12 at istradefylline dosages of 20 mg/day (least-squares mean difference [LSMD] from placebo in reduction from baseline [95%CI], -0.38 h [-0.61, -0.15]) and 40 mg/day (-0.45 h [-0.68, -0.22], p < 0.0001); ON time without troublesome dyskinesia (ON-WoTD) significantly increased. Similar results were found in the four-study pool (OFF hours/day, 20 mg/day, -0.75 h [-1.10, -0.40]; 40 mg/day, -0.82 h [-1.17, -0.47]). Istradefylline was generally well-tolerated; the average study completion rate among istradefylline-treated patients across all studies was 89.2%. Dyskinesia was the most frequent adverse event (placebo, 9.6%; 20 mg/day, 16.1%; 40 mg/day, 17.7%). CONCLUSION In this pooled analysis, istradefylline significantly improved OFF time and ON-WoTD relative to placebo and was well-tolerated.
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Affiliation(s)
- Robert A Hauser
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, University of South Florida, Tampa, FL, USA
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hubert Fernandez
- Center for Neuro-Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Olivier Rascol
- Clinical Investigation Center CIC1436, Departments of Neurosciences and Clinical Pharmacology, Parkinson Expert Center, NS-Park/FCRIN Network and NeuroToul COEN Center, CHU de Toulouse, INSERM and University of Toulouse 3, Toulouse, France
| | | | - June Li
- Kyowa Kirin, Inc., Princeton, NJ, USA
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Tanner CM, Pahwa R, Hauser RA, Oertel WH, Isaacson SH, Jankovic J, Johnson R, Chernick D, Hubble J. EASE LID 2: A 2-Year Open-Label Trial of Gocovri (Amantadine) Extended Release for Dyskinesia in Parkinson's Disease. J Parkinsons Dis 2021; 10:543-558. [PMID: 31929122 PMCID: PMC7242830 DOI: 10.3233/jpd-191841] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Gocovri® (amantadine) extended release capsules are approved for the treatment of dyskinesia in patients with Parkinson's disease (PD) receiving levodopa-based therapy. OBJECTIVE To evaluate the long-term safety, tolerability, and efficacy of Gocovri in patients with PD experiencing levodopa-induced dyskinesia. METHODS In this 2-year open-label trial, patients completing double-blind Gocovri clinical trials or excluded from prior trials because of deep-brain stimulation (DBS) received Gocovri 274 mg once daily at bedtime. The primary objective was to evaluate long-term safety and tolerability. In addition, dyskinesia and OFF time were assessed using Part IV (Motor Complications) scores on the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). RESULTS Among 223 enrolled patients (mean PD duration, 11.7 years; mean levodopa use, 9.3 years), 75.8% completed 1 year of treatment and 57.8% completed the trial, with a median treatment duration of 1.9 years. Common adverse events were fall (32.7%), hallucination (24.2%), peripheral edema (16.1%), constipation (13.5%), and urinary tract infection (10.3%); 31 patients (13.9%) discontinued because of adverse events considered related to study drug. At baseline, MDS-UPDRS Part IV scores were lower for patients continuing Gocovri (mean, 6.5 points) than for previous placebo (9.4) or DBS groups (10.5) but were similar for all groups by week 8 (6.3, 6.2, 6.4, respectively), and remained low for the duration of the trial (at week 100: 6.9, 7.3, 7.0, respectively). CONCLUSIONS In patients with PD, Gocovri showed long-term safety and tolerability consistent with double-blind trial findings, and durable reduction in motor complications (dyskinesia and OFF time).
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Affiliation(s)
| | - Rajesh Pahwa
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston TX, USA
| | - Reed Johnson
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
| | | | - Jean Hubble
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
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Abstract
Levodopa is the most effective symptomatic treatment for Parkinson's disease (PD), but a major treatment challenge is that over time, many patients experience periods of return of PD symptoms intermittently through the day, known as OFF periods. OFF periods typically manifest as a return of motor symptoms but can also involve non-motor symptoms and these periods can disrupt good control despite optimization of the oral levodopa regimen. OFF periods emerge in large measure due to a shortening of the duration of clinical benefit from oral levodopa, thought to be related to a progressive loss of dopamine neurons and their ability to store and release levodopa-derived dopamine over many hours. The problem is further compounded by impaired absorption of oral levodopa due to gastroparesis and other factors limiting its uptake in the small intestine, including competition for uptake by meals and their protein content. On-demand therapies are now available for the treatment of OFF episodes in PD and are administered intermittently, on an as-needed basis, on top of the patient's maintenance medication regimen. To be useful, an on-demand medication should take effect more rapidly and reliably than oral levodopa. Options for on-demand therapy for OFF periods have recently increased with the approval of levodopa inhalation powder and sublingual apomorphine as alternatives to the older option of subcutaneous apomorphine injection, each of which avoids the gastrointestinal tract and its potential for absorption delay. On-demand therapy is now available for patients experiencing episodic or intermittent need for rapid and reliable onset of benefit. On-demand therapy may also provide an alternative to more invasive treatment such as infusion of levodopa/carbidopa intestinal gel and for patients whose OFF episodes are not controlled despite deep brain stimulation.
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Affiliation(s)
- Robert A Hauser
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, University of South Florida, Tampa, Florida, USA
| | - Peter A LeWitt
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA.,Parkinson's Disease and Movement Disorders Center Henry Ford Hospital, West Bloomfield, Michigan, USA
| | - Cynthia L Comella
- Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, Rush University Medical Center, Chicago,Illinois, USA
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Videnovic A, Amara AW, Comella C, Schweitzer PK, Emsellem H, Liu K, Sterkel AL, Gottwald MD, Steinerman JR, Jochelson P, Zomorodi K, Hauser RA. Solriamfetol for Excessive Daytime Sleepiness in Parkinson's Disease: Phase 2 Proof-of-Concept Trial. Mov Disord 2021; 36:2408-2412. [PMID: 34191352 PMCID: PMC8596433 DOI: 10.1002/mds.28702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background Solriamfetol is approved (US and EU) for excessive daytime sleepiness (EDS) in narcolepsy and obstructive sleep apnea. Objectives Evaluate solriamfetol safety/efficacy for EDS in Parkinson's disease (PD). Methods Phase 2, double‐blind, 4‐week, crossover trial: adults with PD and EDS were randomized to sequence A (placebo, solriamfetol 75, 150, 300 mg/d), B (solriamfetol 75, 150, 300 mg/d, placebo), or C (placebo). Outcomes (safety/tolerability [primary]; Epworth Sleepiness Scale [ESS]; Maintenance of Wakefulness Test [MWT]) were assessed weekly. P values are nominal. Results Common adverse events (n = 66): nausea (10.7%), dizziness (7.1%), dry mouth (7.1%), headache (7.1%), anxiety (5.4%), constipation (5.4%), dyspepsia (5.4%). ESS decreased both placebo (−4.78) and solriamfetol (−4.82 to −5.72; P > 0.05). MWT improved dose‐dependently with solriamfetol, increasing by 5.05 minutes with 300 mg relative to placebo (P = 0.0098). Conclusions Safety/tolerability was consistent with solriamfetol's known profile. There were no significant improvements on ESS; MWT results suggest possible benefit with solriamfetol in PD. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Aleksandar Videnovic
- Movement Disorders Unit and Division of Sleep Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy W Amara
- Division of Movement Disorders, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cynthia Comella
- Parkinson's Disease and Movement Disorders Program, Rush University, Chicago, Illinois, USA
| | - Paula K Schweitzer
- Sleep Medicine and Research Center, St. Luke's Hospital, Chesterfield, Missouri, USA
| | - Helene Emsellem
- The Center for Sleep & Wake Disorders, Chevy Chase, Maryland, USA
| | - Kris Liu
- Jazz Pharmaceuticals, Palo Alto, California, USA
| | | | | | | | | | | | - Robert A Hauser
- Parkinson's Disease and Movement Disorders Center, University of South Florida, Tampa, Florida, USA
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Hauser RA, Mehta SH, Kremens D, Chernick D, Formella AE. Effects of Gocovri (Amantadine) Extended-Release Capsules on Motor Aspects of Experiences of Daily Living in People with Parkinson's Disease and Dyskinesia. Neurol Ther 2021; 10:739-751. [PMID: 34024025 PMCID: PMC8571461 DOI: 10.1007/s40120-021-00256-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/05/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction Gocovri, a bedtime-administered delayed-release/extended-release capsule formulation of amantadine, is the only drug approved by the US Food and Drug Administration as levodopa-adjunctive therapy for the treatment of OFF episodes and/or dyskinesia in Parkinson’s disease (PD). Part II of the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) assesses patient-perceived disability on experiences of daily living affected by PD motor symptoms. We analyzed Gocovri-related changes in MDS-UPDRS Part II ratings in two placebo-controlled clinical trials. Methods Baseline to week 12 changes in MDS-UPDRS Part II total and item scores were compared for Gocovri and placebo using pooled data from phase 3 trials (EASE LID and EASE LID 3). Results Baseline mean MDS-UPDRS Part II total score was 15.1 for Gocovri (n = 100) and 15.3 for placebo (n = 96) groups. At week 12, the least squares mean change from baseline was −3.4 for the Gocovri group and −1.4 for placebo (treatment difference, −2.0; 95% CI −3.3 to −0.7; P = 0.004). For Gocovri, change from baseline exceeded a published minimal clinically important difference threshold of 3.05. Gocovri-related treatment differences over placebo were driven primarily by improvement in the scale items of freezing (−0.4; P < 0.0001), tremor (−0.4; P = 0.002), getting out of bed/car/deep chair (−0.3; P = 0.002), and eating tasks (−0.2; P = 0.016). Conclusion In addition to improvement in dyskinesia, Gocovri-treated participants experienced improvement in motor aspects of experiences of daily living. Analyses suggest that Gocovri may specifically improve freezing, tremor, getting out of bed/car/deep chair, and eating tasks. Trial Registration ClinicalTrials.gov identifiers: NCT02136914, NCT02274766.
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Affiliation(s)
- Robert A Hauser
- USF Parkinson's Disease and Movement Disorders Center, Parkinson Foundation Center of Excellence, University of South Florida, 4001 E. Fletcher Ave, 6th Floor, Tampa, FL, 33613, USA.
| | - Shyamal H Mehta
- Department of Neurology, Mayo Clinic-Scottsdale, Scottsdale, AZ, USA
| | - Daniel Kremens
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
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Patel AT, Lew MF, Dashtipour K, Isaacson S, Hauser RA, Ondo W, Maisonobe P, Wietek S, Rubin B, Brashear A. Correction: Sustained functional benefits after a single set of injections with abobotulinumtoxinA using a 2-mL injection volume in adults with cervical dystonia: 12-week results from a randomized, double-blind, placebo-controlled phase 3b study. PLoS One 2021; 16:e0250475. [PMID: 33852647 PMCID: PMC8046252 DOI: 10.1371/journal.pone.0250475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Hauser RA, Walsh RR, Pahwa R, Chernick D, Formella AE. Amantadine ER (Gocovri ®) Significantly Increases ON Time Without Any Dyskinesia: Pooled Analyses From Pivotal Trials in Parkinson's Disease. Front Neurol 2021; 12:645706. [PMID: 33841311 PMCID: PMC8032973 DOI: 10.3389/fneur.2021.645706] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/22/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Clinical trials for antiparkinsonian drugs aimed at managing motor complications typically use patient diaries to divide levodopa-induced dyskinesias (LID) into "troublesome" and "non-troublesome" categories. Yet, given the choice, most patients would prefer to live without experiencing any dyskinesia. However, the concept of evaluating time spent ON without any dyskinesia as an outcome has never been tested. We conducted analyses of pooled Gocovri pivotal trial data in order to evaluate the extent to which Gocovri increased the time PD patients spent ON without dyskinesia (troublesome or non-troublesome), beyond its already identified improvement in reducing troublesome dyskinesia. Methods: Patients enrolled in phase 3 trials (EASE LID [NCT02136914] or EASE LID 3 [NCT02274766]) recorded time spent in the following PD diary states at baseline and Week 12 (endpoint): asleep, OFF, ON with troublesome dyskinesia, ON with non-troublesome dyskinesia, and ON without dyskinesia. Mixed model repeated measures analyses with estimated Cohen D effect sizes were performed on the modified intent to treat population to evaluate changes in time spent in these states. Results: Patients randomized to receive Gocovri showed an increase in ON time without dyskinesia and corresponding decreases in ON time with dyskinesia and OFF time vs. placebo. Treatment effects were statistically significant for Gocovri vs. placebo starting at Week 2 and were sustained until Week 12. On MMRM analysis at Week 12, patients in the Gocovri group showed an adjusted mean ± SE increase over placebo of 2.9 ± 0.6 h in ON time without dyskinesia (Cohen D effect size 0.79) and an adjusted mean ± SE decrease of -1.9 ± 0.6 h in ON time with dyskinesia (troublesome + non-troublesome) (Cohen D effect size 0.49), that included a -1.5 ± 0.4 h placebo-adjusted reduction in ON time with troublesome dyskinesia and a -0.6 ± 0.4 h reduction in ON time with non-troublesome dyskinesia. OFF time was reduced by -1.0 ± 0.3 h compared to placebo. Conclusions: Gocovri treatment more than doubled the daily time patients spent ON without dyskinesia. These results suggest that the Gocovri treatment effect was driven by a reduction in overall motor complications including ON time with both troublesome and non-troublesome dyskinesia as well as time spent OFF.
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Affiliation(s)
- Robert A Hauser
- Department of Neurology, University of South Florida, Tampa, FL, United States
| | - Ryan R Walsh
- Muhammad Ali Parkinson Center at Barrow Neurological Institute, Phoenix, AZ, United States
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
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Jenner P, Mori A, Aradi SD, Hauser RA. Istradefylline - a first generation adenosine A 2A antagonist for the treatment of Parkinson's disease. Expert Rev Neurother 2021; 21:317-333. [PMID: 33507105 DOI: 10.1080/14737175.2021.1880896] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction It is now accepted that Parkinson's disease (PD) is not simply due to dopaminergic dysfunction, and there is interest in developing non-dopaminergic approaches to disease management. Adenosine A2A receptor antagonists represent a new way forward in the symptomatic treatment of PD.Areas covered In this narrative review, we summarize the literature supporting the utility of adenosine A2A antagonists in PD with a specific focus on istradefylline, the most studied and only adenosine A2A antagonist currently in clinical use.Expert opinion: At this time, the use of istradefylline in the treatment of PD is limited to the management of motor fluctuations as supported by the results of randomized clinical trials and evaluation by Japanese and USA regulatory authorities. The relatively complicated clinical development of istradefylline was based on classically designed studies conducted in PD patients with motor fluctuations on an optimized regimen of levodopa plus adjunctive dopaminergic medications. In animal models, there is consensus that a more robust effect of istradefylline in improving motor function is produced when combined with low or threshold doses of levodopa rather than with high doses that produce maximal dopaminergic improvement. Exploration of istradefylline as a 'levodopa sparing' strategy in earlier PD would seem warranted.
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Affiliation(s)
- Peter Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Akihisa Mori
- Medical Affairs Department, Kyowa Kirin Co Ltd, Otemachi, Chiyoda-ku, Tokyo, Japan
| | - Stephen D Aradi
- Department of Neurology, University of South Florida, Tampa, Florida, USA
| | - Robert A Hauser
- Department of Neurology, University of South Florida, Tampa, Florida, USA
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Patel AT, Lew MF, Dashtipour K, Isaacson S, Hauser RA, Ondo W, Maisonobe P, Wietek S, Rubin B, Brashear A. Sustained functional benefits after a single set of injections with abobotulinumtoxinA using a 2-mL injection volume in adults with cervical dystonia: 12-week results from a randomized, double-blind, placebo-controlled phase 3b study. PLoS One 2021; 16:e0245827. [PMID: 33524060 PMCID: PMC7850472 DOI: 10.1371/journal.pone.0245827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022] Open
Abstract
Cervical dystonia (CD) is primarily treated with botulinum toxin, at intervals of ≥ 12 weeks. We present efficacy, patient-reported outcomes (PROs), and safety in adults with CD at the last available visit after a single set of abobotulinumtoxinA (aboBoNT-A) injections versus placebo using 500 U in a 2-mL injection volume. In this 12-week, randomized, double-blind trial, patients were ≥ 18 years of age with primary idiopathic CD, had a Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total score ≥ 20, and TWSTRS-Severity subscale score > 10 at baseline. Patients (N = 134) were randomized (2:1) to aboBoNT-A (n = 89) or placebo (n = 45), with aboBoNT-A patients treated with 500 units (U) if toxin-naïve, and 250 to 500 U based on previous onabotulinumtoxinA dose if non-naïve. Endpoints included total TWSTRS, Pain Numeric Rating Scale (NRS-Pain; 24-hour), Treatment Satisfaction Questionnaire for Medication, and other PROs for pain, depression, and global health. Results are for the intent-to-treat population, with "Week 12" (Wk12) comprising the last available post-baseline assessment (end-of-study or early withdrawal). Mean TWSTRS total scores improved from 42.5 at baseline to 35.4 at Wk12 with aboBoNT-A and 42.4 to 40.4 with placebo (treatment difference: -4.8; 95% confidence interval [CI]: -8.5, -1.1; p = 0.011). At Wk12, mean (95% CI) change from baseline in NRS-Pain was -1.0 (-1.59, -0.45) for aboBoNT-A and -0.2 (-0.96, 0.65) for placebo. AboBoNT-A demonstrated numeric improvements in other PROs. More aboBoNT-A-treated patients than patients receiving placebo reported being at least "somewhat satisfied" with treatment (60.4% vs 42.2%, respectively), symptom relief (57.0% vs 40.0%), and time for treatment to work (55.8% vs 33.3%). No new adverse events were reported. Results indicate that in patients with CD, treatment with aboBoNT-A using a 2-mL injection provided sustained improvement in the TWSTRS total score and patient-perceived benefits up to 12 weeks. Trial registration: Clinicaltrials.gov Identified: NCT01753310.
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Affiliation(s)
- Atul T. Patel
- Kansas City Bone and Joint Clinic, Overland Park, KS, United States of America
| | - Mark F. Lew
- Department of Neurology, Keck/University of Southern California School of Medicine, Los Angeles, CA, United States of America
| | - Khashayar Dashtipour
- Department of Neurology/Movement Disorders, Loma Linda University, Loma Linda, CA, United States of America
| | - Stuart Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, United States of America
| | - Robert A. Hauser
- University of South Florida Health Byrd Institute, Parkinson’s Disease and Movement Disorders Center of Excellence, Tampa, FL, United States of America
| | - William Ondo
- Methodist Neurological Institute, Houston, TX, United States of America
| | | | - Stefan Wietek
- Formerly of Ipsen, Cambridge, MA, United States of America
- * E-mail:
| | - Bruce Rubin
- Formerly of Ipsen, Cambridge, MA, United States of America
| | - Allison Brashear
- University of California Davis School of Medicine, Sacramento, CA, United States of America
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Jankovic J, Comella C, Hauser RA, Patel AT, Gross TM, Rubio RG, Vitarella D. A phase 3 trial evaluating the efficacy, duration of effect, and safety of daxibotulinumtoxinA for injection in the treatment of cervical dystonia. Toxicon 2021. [DOI: 10.1016/j.toxicon.2020.11.410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Esquenazi A, Delgado MR, Hauser RA, Lysandropoulos A, Gracies JM. AbobotulinumtoxinA: Evidence for long duration of response from 5 patient populations. Toxicon 2021. [DOI: 10.1016/j.toxicon.2020.11.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hauser RA, Zeitlin L, Fisher S, D'Souza R. Duration of benefit per Dose: Carbidopa-Levodopa immediate release vs. extended release capsules (Rytary®). Parkinsonism Relat Disord 2020; 82:133-137. [PMID: 33360173 DOI: 10.1016/j.parkreldis.2020.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/09/2020] [Accepted: 12/03/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND For patients with Parkinson's disease, clinicians commonly assess duration of benefit for individual doses of levodopa in order to consider medication changes. OBJECTIVE To determine the mean duration of ON time per dose and mean duration of ON time without troublesome dyskinesia (WoTD) per dose of CD-LD IR vs. CD-LD ER in the ADVANCE-PD trial. METHODS We performed a post hoc analysis of the ADVANCE-PD trial. Mean ON time per dose and ON time WoTD was calculated at baseline and end-of-study (EOS). Changes were compared between CD-LD IR and CD-LD ER (Rytary®) treatment groups using an ANCOVA model. RESULTS Mean (SD) baseline ON time per dose of CD-LD IR (n = 393) was 2.20 h. Patients randomized to double-blind treatment with CD-LD IR (n = 192) experienced an increase in mean ON time per dose from baseline to EOS from 2.24 h to 2.38 h. In comparison, patients randomized to double-blind treatment with CD-LD ER (n = 201) experienced an increase in mean ON time per dose from baseline (on CD-LD IR) to EOS (on CD-LD ER) from 2.17 h to 3.55 h. Conversion and optimization with CD-LD ER increased ON time per dose by 1.21 h more than optimization of CD-LD IR (p < 0.0001). Similarly, CD-LD ER increased ON time WoTD per dose by 1.16 h more than CD-LD IR (p < 0.0001). CONCLUSION In the ADVANCE-PD trial, CD-LD ER significantly increased ON time per dose compared to CD-LD IR (+1.21 h, p < 0.0001) and provided significantly more ON time per dose (3.55 h vs 2.38 h, p < 0.0001).
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LeWitt PA, Aradi SD, Hauser RA, Rascol O. The challenge of developing adenosine A 2A antagonists for Parkinson disease: Istradefylline, preladenant, and tozadenant. Parkinsonism Relat Disord 2020; 80 Suppl 1:S54-S63. [PMID: 33349581 DOI: 10.1016/j.parkreldis.2020.10.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 11/28/2022]
Abstract
Laboratory and clinical experience have pointed to the value of targeting motor pathways emerging from the striatum to treat problems arising in advanced Parkinson's disease (PD). These pathways are selectively populated with a subtype of adenosine binding sites (A2A receptors) that offer a target for improving PD symptomatology. Several compounds were developed that possess high selectivity and potency for blocking this receptor. Three of these compounds - istradefylline, preladenant, and tozadenant - were chosen for clinical development programs that culminated in Phase 3 multicenter randomized clinical trials. Each of these drugs exert virtually no off-target neurochemical effects. Clinical trials with these drugs focused upon reducing OFF time when administered adjunctly to levodopa and other antiparkinsonian medications. Despite promising Phase 2 data, preladenant did not show efficacy when tested in a randomized placebo-controlled Phase 3 clinical trial. Reports of hematological toxicity necessitated ceasing an ongoing Phase 3 investigation of tozadenant. Following a challenging approval process, based on the results of randomized clinical trials carried out in the U.S. and Japan, istradefylline received approval in these countries for treatment of OFF episodes.
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Affiliation(s)
- Peter A LeWitt
- Department of Neurology, Wayne State University School of Medicine, USA; Department of Neurology, Henry Ford Hospital, Detroit, MI, USA.
| | - Stephen D Aradi
- Department of Neurology, University of South Florida, Tampa, FL, USA
| | - Robert A Hauser
- Department of Neurology, University of South Florida, Tampa, FL, USA
| | - Olivier Rascol
- Clinical Investigation Center CIC1436, Department of Pharmacology and Neurosciences, Toulouse Parkinson Expert Center, NS-Park/FCRIN Network and NeuroToul COEN Center, University Hospital of Toulouse, INSERM and University of Toulouse 3, Toulouse, France
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Farbman ES, Waters CH, LeWitt PA, Rudzińska M, Klingler M, Lee A, Qian J, Oh C, Hauser RA. A 12-month, dose-level blinded safety and efficacy study of levodopa inhalation powder (CVT-301, Inbrija) in patients with Parkinson's disease. Parkinsonism Relat Disord 2020; 81:144-150. [DOI: 10.1016/j.parkreldis.2020.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 01/05/2023]
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Abstract
Levodopa is the most effective medication for the treatment of the motor symptoms of Parkinson's disease. However, over time, the clinical response to levodopa becomes complicated by a reduction in the duration and reliability of motor improvement (motor fluctuations) and the emergence of involuntary movements (levodopa-induced dyskinesia). Strategies that have been attempted in an effort to delay the development of these motor complications include levodopa sparing and continuous dopaminergic therapy. Once motor complications occur, a wide array of medical treatments is available to maximize motor function through the day while limiting dyskinesia. Here, we review the clinical features, epidemiology, and risk factors for the development of motor complications, as well as strategies for their prevention and medical management.
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Affiliation(s)
- Stephen D Aradi
- Department of Neurology, Parkinson's Foundation Center of Excellence, University of South Florida, Tampa, FL, USA.
| | - Robert A Hauser
- Department of Neurology, Parkinson's Foundation Center of Excellence, University of South Florida, Tampa, FL, USA
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Esquenazi A, Delgado MR, Hauser RA, Picaut P, Foster K, Lysandropoulos A, Gracies JM. Duration of Symptom Relief Between Injections for AbobotulinumtoxinA (Dysport®) in Spastic Paresis and Cervical Dystonia: Comparison of Evidence From Clinical Studies. Front Neurol 2020; 11:576117. [PMID: 33101184 PMCID: PMC7546809 DOI: 10.3389/fneur.2020.576117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Botulinum toxin-A is a well-established treatment for adult and pediatric spastic paresis and cervical dystonia. While guidelines and approved labels indicate that treatment should not occur more frequently than every 12 weeks, studies and real-world evidence show that the timing of symptom recurrence between treatments may vary. Methods: We report retreatment criteria and response duration (retreatment intervals) from four pivotal, double-blind, placebo-controlled studies with open-label extensions involving patients treated with abobotulinumtoxinA (aboBoNTA) for upper limb (NCT01313299) or lower limb (NCT01249404) spastic paresis in adults, lower limb spastic paresis in children (NCT01249417), and cervical dystonia in adults (NCT00257660). We review results in light of recently available preclinical data. Results: In spastic paresis, 24.0-36.9% of upper limb patients treated with aboBoNTA and 20.1-32.0% of lower limb patients did not require retreatment before 16 weeks. Moreover, 72.8-93.8% of aboBoNTA-treated pediatric patients with lower limb spastic paresis did not require retreatment before 16 weeks (17.7-54.0% did not require retreatment before 28 weeks). In aboBoNTA-treated patients with cervical dystonia, 72.6-81.5% did not require retreatment before 16 weeks. Conclusion: AboBoNTA, when dosed as recommended, offers symptom relief beyond 12 weeks to many patients with spastic paresis and cervical dystonia. From recently available preclinical research, the amount of active neurotoxin administered with aboBoNTA might be a factor in explaining this long duration of response.
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Affiliation(s)
- Alberto Esquenazi
- Department of Physical Medicine and Rehabilitation, MossRehab Gait and Motion Analysis Laboratory, Elkins Park, PA, United States
| | - Mauricio R Delgado
- Neurology and Neurotherapeutics Department, University of Texas Southwestern Medical Center and Scottish Rite Hospital for Children, Dallas, TX, United States
| | - Robert A Hauser
- University of South Florida Parkinson's Disease and Movement Disorders Center of Excellence, Tampa, FL, United States
| | | | | | | | - Jean-Michel Gracies
- UR 7377, Université Paris-Est Créteil, Service de Rééducation Neurolocomotrice, Albert Chenevier-Henri Mondor Hospital, Créteil, France
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Hauser RA, Zeitlin L, Fisher S, D'Souza R. Carbidopa and Levodopa Extended Release Capsules in Patients with and without Troublesome and Non-Troublesome Dyskinesia. J Parkinsons Dis 2020; 10:915-925. [PMID: 32568108 PMCID: PMC7458518 DOI: 10.3233/jpd-202010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Carbidopa (CD) and levodopa (LD) extended release (CD-LD ER) capsules are designed to combine both immediate and extended release pharmacokinetics. In the phase 3, randomized, double-blind, ADVANCE-PD trial, patients randomized to CD-LD ER experienced a 1.17-hour greater reduction in OFF time compared to patients randomized to CD-LD IR (p < 0.0001). OBJECTIVE To compare CD-LD IR optimization to CD-LD ER conversion based on patient dyskinesia status at baseline using data from the ADVANCE-PD trial. METHODS This was a retrospective analysis of the ADVANCE-PD study. Patients were categorized by dyskinesia status at baseline into 1) those who had No Dyskinesia (ND), 2) those who had Non-Troublesome Dyskinesia Only (NTDO), and 3) those who had Troublesome Dyskinesia (TD). RESULTS Comparative reductions in OFF time favoring CD-LD ER over CD-LD IR were similar for the ND (-1.08 h, p = 0.0071, n = 183) and NTDO (-1.12 h, p = 0.0104, n = 131) groups, and smaller for the TD group (-0.82 h, p = 0.2382, n = 79). Reductions in OFF time for both CD-LD ER conversion and CD-LD IR adjustment were largest within the ND group and smallest within the TD group (CD-LD ER: ND -2.86 h, NTDO -2.11 h, TD -1.36 h; CD-LD IR: ND -1.78 h, NTDO -0.99 h, TD -0.55 h). CONCLUSION Responses to both CD-LD IR adjustment and CD-LD ER conversion depended on baseline dyskinesia status. Significant reductions in OFF time with CD-LD ER compared to CD-LD IR were observed in the ND and NTDO groups. In the TD group, comparing CD-LD ER conversion to CD-LD IR optimization, benefits were still observed, but there was less reduction in OFF time, less reduction in troublesome dyskinesia, and fewer patients self-rated themselves much or very much improved than in the ND and NTDO groups. These data suggest that in clinical practice, the best chances for success with conversion from CD-LD IR to CD-LD ER are in patients without TD.
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Hauser RA, Kremens DE, Elmer LW, Kreitzman DL, Walsh RR, Johnson R, Howard R, Nguyen JT, Patni R. Prevalence of Dyskinesia and OFF by 30-Minute Intervals Through the Day and Assessment of Daily Episodes of Dyskinesia and OFF: Novel Analyses of Diary Data from Gocovri Pivotal Trials. J Parkinsons Dis 2020; 9:591-600. [PMID: 31081793 PMCID: PMC6700613 DOI: 10.3233/jpd-181565] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Parkinson’s disease (PD) patients using levodopa commonly develop dyskinesia and OFF episodes that reduce quality of life. Objective: Evaluate prevalence of troublesome dyskinesia and OFF through the day, assessed by 30-minute intervals, as well as the mean number and duration of troublesome dyskinesia and OFF episodes, transitions between PD states, and effects of Gocovri® (amantadine) extended release capsules on these episodes. Methods: Evaluate diary data from pooled Gocovri phase 3, placebo-controlled trials—analyzed for 17 hours following wake-up—at baseline and week 12. Results: Diaries were evaluable for 162 patients. At baseline, 67% of patients woke up OFF, with prevalence decreasing to 13% at 2 hours and then remaining relatively steady at ∼12% (range, 6–17%) across half-hour intervals thereafter. Troublesome dyskinesia prevalence rose steadily from 5% to 24% over the first 2 hours, then fluctuated between 20% and 44% through the rest of the waking day. At baseline, patients experienced a mean of 3.0 daily episodes of troublesome dyskinesia (average duration 2.0 hours each), and 2.2 daily episodes of OFF (average duration 1.1 hour each). At week 12, Gocovri-treated patients showed greater reductions than placebo in troublesome dyskinesia and OFF episodes per day (treatment difference: –1.0 episodes and –0.4 episodes, respectively) and average episode duration (treatment difference: –0.6 hours and –0.3 hours, respectively). Mean duration of individual episodes of ON without troublesome dyskinesia (Good ON) increased by 5.0 hours for Gocovri, compared with 2.0 hours for placebo. Patients taking Gocovri experienced 2.2 fewer transitions between states than patients taking placebo. Conclusions: Troublesome dyskinesia and OFF occurred in the morning and throughout the waking day. Gocovri-treated patients experienced fewer, shorter episodes of both troublesome dyskinesia and OFF, thereby increasing the duration of continuous Good ON episodes and reducing the frequency of transitions between motor states.
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Affiliation(s)
| | | | | | - David L Kreitzman
- Parkinson's Disease and Movement Disorders Center of Long Island, Commack, NY, USA
| | - Ryan R Walsh
- Muhammad Ali Parkinson Center at Barrow Neurological Institute, Phoenix, AZ, USA
| | - Reed Johnson
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
| | | | | | - Rajiv Patni
- Adamas Pharmaceuticals, Inc., Emeryville, CA, USA
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Hauser RA, Eidelberg D, Pahwa R, Riggare S, Cenci MA. Reply to: Letter to Editor by Chaudhuri, Jenner, Antonini. Mov Disord 2020; 35:901. [PMID: 32415716 DOI: 10.1002/mds.28043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Robert A Hauser
- Department of Neurology, University of South Florida, Tampa, Florida, USA
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Rajesh Pahwa
- Movement Disorders Division, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sara Riggare
- Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - M Angela Cenci
- Basal Ganglia Pathophysiology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
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LeWitt PA, Kymes S, Hauser RA. Parkinson Disease and Orthostatic Hypotension in the Elderly: Recognition and Management of Risk Factors for Falls. Aging Dis 2020; 11:679-691. [PMID: 32489712 PMCID: PMC7220277 DOI: 10.14336/ad.2019.0805] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/05/2019] [Indexed: 12/11/2022] Open
Abstract
Parkinson disease (PD) is often associated with postural instability and gait dysfunction that can increase the risk for falls and associated consequences, including injuries, increased burden on healthcare resources, and reduced quality of life. Patients with PD have nearly twice the risk for falls and associated bone fractures compared with their general population counterparts of similar age. Although the cause of falls in patients with PD may be multifactorial, an often under-recognized factor is neurogenic orthostatic hypotension (nOH). nOH is a sustained decrease in blood pressure upon standing whose symptomology can include dizziness/lightheadedness, weakness, fatigue, and syncope. nOH is due to dysfunction of the autonomic nervous system compensatory response to standing and is a consequence of the neurodegenerative processes of PD. The symptoms associated with orthostatic hypotension (OH)/nOH can increase the risk of falls, and healthcare professionals may not be aware of the real-world clinical effect of nOH, the need for routine screening, or the value of early diagnosis of nOH when treating elderly patients with PD. nOH is easily missed and, importantly, healthcare providers may not realize that there are effective treatments for nOH symptoms that could help lessen the fall risk resulting from the condition. This review discusses the burden of, and key risk factors for, falls among patients with PD, with a focus on practical approaches for the recognition, assessment, and successful management of OH/nOH. In addition, insights are provided as to how fall patterns can suggest fall etiology, thereby influencing the choice of intervention.
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Affiliation(s)
- Peter A LeWitt
- 1Henry Ford Hospital and Wayne State University School of Medicine, West Bloomfield, MI 48322, USA
| | | | - Robert A Hauser
- 3University of South Florida Parkinson's Disease and Movement Disorders Center, Parkinson Foundation Center of Excellence, Tampa, FL 33613, USA
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Espay AJ, Hauser RA, Armstrong MJ. The Narrowing Path for Nilotinib and Other Potential Disease-Modifying Therapies for Parkinson Disease. JAMA Neurol 2020; 77:295-297. [DOI: 10.1001/jamaneurol.2019.3983] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Alberto J. Espay
- James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio
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Hauser RA, Pahwa R, Wargin WA, Souza-Prien CJ, McClure N, Johnson R, Nguyen JT, Patni R, Went GT. Pharmacokinetics of ADS-5102 (Amantadine) Extended Release Capsules Administered Once Daily at Bedtime for the Treatment of Dyskinesia. Clin Pharmacokinet 2020; 58:77-88. [PMID: 29777529 PMCID: PMC6325984 DOI: 10.1007/s40262-018-0663-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preclinical and clinical studies suggest amantadine immediate-release (IR) may reduce dyskinesia in Parkinson's disease (PD), although higher doses are associated with increased CNS adverse events (AEs). ADS-5102 is an extended release amantadine capsule formulation, designed for once-daily dosing at bedtime (qhs) to provide high concentrations upon waking and throughout the day, with lower concentrations in the evening. The pharmacokinetics (PK) of ADS-5102 were assessed in two phase I studies in healthy subjects, and a blinded, randomized phase II/III dose-finding study in PD patients. METHODS The first phase I study assessed single ADS-5102 doses (68.5, 137, and 274 mg) in a crossover design, whereas the second phase I study evaluated ADS-5102 137 mg for 7 days followed by amantadine IR 81 mg twice daily (or reverse order). In the phase II/III double-blind study, PD patients with dyskinesia were randomized to ADS-5102 (210, 274, or 338 mg) or placebo for 8 weeks. RESULTS Single ADS-5102 doses resulted in a slow initial rise in amantadine plasma concentration, with delayed time to maximum concentration (12-16 h). Amantadine plasma concentrations were higher in PD patients versus healthy volunteers. The steady-state profile of once-daily ADS-5102 was significantly different from that of twice-daily amantadine IR, such that the two formulations are not bioequivalent. PK modeling suggested the recommended daily ADS-5102 dosage (274 mg qhs) resulted in 1.4- to 2.0-fold higher amantadine plasma concentrations during the day versus amantadine IR. CONCLUSIONS ADS-5102 can be administered once-daily qhs to achieve high amantadine plasma concentrations in the morning and throughout the day, when symptoms of dyskinesia occur.
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Affiliation(s)
- Robert A Hauser
- USF Parkinson's Disease and Movement Disorders Center, Parkinson Foundation Center of Excellence, USF Health Byrd Institute, 4001 E. Fletcher Ave, 6th Floor, Tampa, FL, 33613, USA.
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, 3599 Rainbow Boulevard, Mailstop 3042, Kansas City, KS, 66160, USA
| | - William A Wargin
- Nuventra Pharma Sciences, 2525 Meridian Parkway, Suite 280, Durham, NC, 27713, USA
| | - Cindy J Souza-Prien
- Adamas Pharmaceuticals, Inc, 1900 Powell Street, Suite 750, Emeryville, CA, 94608, USA
| | - Natalie McClure
- Adamas Pharmaceuticals, Inc, 1900 Powell Street, Suite 750, Emeryville, CA, 94608, USA
| | - Reed Johnson
- Adamas Pharmaceuticals, Inc, 1900 Powell Street, Suite 750, Emeryville, CA, 94608, USA
| | - Jack T Nguyen
- Adamas Pharmaceuticals, Inc, 1900 Powell Street, Suite 750, Emeryville, CA, 94608, USA
| | - Rajiv Patni
- Adamas Pharmaceuticals, Inc, 1900 Powell Street, Suite 750, Emeryville, CA, 94608, USA.
| | - Gregory T Went
- Adamas Pharmaceuticals, Inc, 1900 Powell Street, Suite 750, Emeryville, CA, 94608, USA
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Wallace DM, Wohlgemuth WK, Trotti LM, Amara AW, Malaty IA, Factor SA, Nallu S, Wittine L, Hauser RA. Practical Evaluation and Management of Insomnia in Parkinson's Disease: A Review. Mov Disord Clin Pract 2020; 7:250-266. [PMID: 32258222 PMCID: PMC7111581 DOI: 10.1002/mdc3.12899] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 12/10/2019] [Accepted: 01/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background Insomnia is one of the most common nonmotor features of Parkinson's disease (PD). However, there are few practical guidelines for providers on how to best evaluate and treat this problem. Methods and Findings This review was developed to provide clinicians with a pragmatic approach to assessing and managing insomnia in PD. Recommendations were based on literature review and expert opinion. We addressed the following topics in this review: prevalence of insomnia in PD, sleep-wake mechanisms, theoretical models of insomnia, risk factors, assessment, pharmacologic and nonpharmacologic treatments. Insomnia treatment choices may be guided by PD severity, comorbidities, and patient preference. However, there is limited evidence supporting pharmacotherapy and nonpharmacologic treatments of insomnia in PD. Conclusions We provide a pragmatic algorithm for evaluating and treating insomnia in PD based on the literature and our clinical experience. We propose personalized insomnia treatment approaches based on age and other issues. Gaps in the existing literature and future directions in the treatment of insomnia in PD are also highlighted.
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Affiliation(s)
- Douglas M Wallace
- Department of Neurology, Sleep Medicine Division University of Miami Miller School of Medicine Miami FL USA.,Neurology Service Bruce W. Carter Department of Veterans Affairs Medical Center Miami FL USA
| | - William K Wohlgemuth
- Neurology Service Bruce W. Carter Department of Veterans Affairs Medical Center Miami FL USA.,Psychology Service Bruce W. Carter Department of Veterans Affairs Medical Center Miami FL USA
| | - Lynn Marie Trotti
- Department of Neurology and Emory Sleep Center Emory University School of Medicine Atlanta GA USA
| | - Amy W Amara
- Department of Neurology University of Alabama at Birmingham School of Medicine Birmingham AL USA
| | - Irene A Malaty
- Department of Neurology, Fixel Institute University of Florida Gainesville FL USA
| | - Stewart A Factor
- Jean and Paul Amos Parkinson's Disease and Movement Disorders Center Emory University School of Medicine Atlanta GA USA
| | - Sagarika Nallu
- Department of Pediatrics, Morsani College of Medicine University of South Florida Tampa FL USA
| | - Lara Wittine
- Department of Medicine, Morsani College of Medicine University of South Florida Tampa FL USA
| | - Robert A Hauser
- Department of Neurology, Morsani College of Medicine University of South Florida Tampa FL USA
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Olanow CW, Factor SA, Espay AJ, Hauser RA, Shill HA, Isaacson S, Pahwa R, Leinonen M, Bhargava P, Sciarappa K, Navia B, Blum D, xx X. Apomorphine sublingual film for off episodes in Parkinson's disease: a randomised, double-blind, placebo-controlled phase 3 study. Lancet Neurol 2020; 19:135-144. [DOI: 10.1016/s1474-4422(19)30396-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 01/05/2023]
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