Ursodeoxycholic acid as a novel disease-modifying treatment for Parkinson's disease: protocol for a two-centre, randomised, double-blind, placebo-controlled trial, The 'UP' study

. 2020 Aug 5;10(8):e038911.

doi: 10.1136/bmjopen-2020-038911.

Matilde Sassani 1, Ellen Buckley 2 3, Sarah Moll 2, Adriana Anton 2 4, Matthew Appleby 5, Seema Maru 5, Rosie Taylor 6, Alisdair McNeill 1, N Hoggard 4, Claudia Mazza 3, Iain D Wilkinson 4, Thomas Jenkins 1, Thomas Foltynie 5, O Bandmann 7 2

Affiliations

PMID: 32759251
PMCID: PMC7409998
DOI: 10.1136/bmjopen-2020-038911

Thomas Payne et al. BMJ Open. 2020.

Abstract

Introduction: There are no disease-modifying treatments for Parkinson's disease (PD). We undertook the first drug screen in PD patient tissue and idntified ursodeoxycholic acid (UDCA) as a promising mitochondrial rescue agent. The aims of this trial are to determine safety and tolerability of UDCA in PD at 30 mg/kg, confirm the target engagement of UDCA, apply a novel motion sensor-based approach to quantify disease progression objectively, and estimate the mean effect size and its variance on the change in motor severity.

Methods and analysis: This is a phase II, two-centre, double-blind, randomised, placebo-controlled trial of UDCA at a dose of 30 mg/kg in 30 participants with early PD. Treatment duration is 48 weeks, followed by an 8-week washout phase. Randomisation is 2:1, drug to placebo. Assessments are performed at baseline, week 12, 24, 36, 48 and 56. The primary outcome is safety and tolerability. Secondary outcomes will compare the change between baseline and week 48 using the following three approaches: the Movement Disorders Society Unified Parkinson's Disease Rating Scale Part 3 in the practically defined 'OFF' medication state; confirmation of target engagement, applying 31Phosphorus MR Spectroscopy to assess the levels of ATP and relevant metabolites in the brain; and objective quantification of motor impairment, using a validated, motion sensor-based approach. The primary outcome will be reported using descriptive statistics and comparisons between treatment groups. For each secondary outcome, the change from baseline will be summarised within treatment groups using summary statistics and appropriate statistical tests assessing for significant differences. All outcomes will use an intention-to-treat analysis population.

Ethics and dissemination: This trial has been approved by the East of England - Cambridgeshire and Hertfordshire Research Ethics committee. Results will be disseminated in peer-reviewed journals, presentations at scientific meetings and to patients in a lay-summary format.

Trial registration number: NCT03840005.

Keywords: adult neurology; clinical trials; magnetic resonance imaging; neurology; neuroradiology; parkinson's disease.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1

Representative 31P-MRS spectra obtained from the midbrain of a healthy volunteer following appropriate phasing and 10 Hz Lorentzian apodisation with no further editing. From left to right, phosphomonoesters (PME), inorganic phosphate (PI), phosphodiesters (PDE), phosphocreatine (PCr) and the three spectral resonances of adenosine triphosphate (γ-,α-,β-ATP). 31P-MRS, 31phosphorus MR spectroscopy.

Figure 2

The substantia nigra slice is placed to cover the midbrain with the highlighted voxels of interest for subsequent analyses highlighted in yellow in the sagittal (A) and axial planes (B). Placement of 31P-MRS slices. The basal ganglia slice is placed over the putamen aligned in both the coronal (C) axial planes (D), and voxels of interest for subsequent analyses are highlighted in yellow. One voxel covers the anterior putamen and another the posterior putamen.

Figure 3

Protocols deployed at the two sites. all participants undergo 7-day physical activity monitoring in order to estimate physical activity levels and capture temporal and gait quality measures in a real-world setting. In-clinic instrumented gait tasks are also completed at both sites to provide spatiotemporal and gait quality measures of gait capacity. At UCL only red sensor location is implemented.

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Ursodeoxycholic acid as a novel disease-modifying treatment for Parkinson's disease: protocol for a two-centre, randomised, double-blind, placebo-controlled trial, The 'UP' study - PubMed (original) (raw)