Research in Action

Back to top

Not Just A Load Of Old Tablets

The Peninsula Parkinson’s Research Interest Group turns the Zoom camera on the other end of the stick, the people who participate in research as the target of a novel treatment. John and Sue Whipps give a presentation about their journey from his diagnosis to their involvement in clinical trials, explaining the issues they dealt with along the way. They take questions from a Panel and explore the challenge of finding and motivating people to get involved.

There are strong messages here about involvement, the pay-back from it, and the contribution a partner can make. This video is aimed at those who are recently diagnosed and those further down the track who are open to the possibility of participation. We promise a jargon-free experience.
The video is 20 minutes long and the Panel session a further 25 minutes. We hope you find “Not Just a Load of Old Tablets” useful and enjoyable!

Back to top

Bringing Research Closer To Home

Back to top

Exenatide Trials: My Story

I got involved in trials back in 2013 when a friend of mine saw a leaflet asking for volunteers at her GP practice.

Phase 1 was a not blinded proof- of-concept and I ended up in the control group that didn’t take the active drug. This allowed me to be part of the double-blinded phase 2 trial in 2014/15, where volunteers were randomised into injecting Exanatide or a placebo once a week over the course of a year. I did feel a bit nervous at first, this being my first delve into the world of research, but the research team put me at ease quickly. And with Exanatide already being tested & approved for diabetes, the risks were minimal.

The trial required me to inject myself once a week into either thigh or belly, and once you get over sticking a needle into yourself, that’s fine. Every 3 months I travel to the UCL in London for a half day assessment. This required me to stop my usual Parkinson’s medication for 24 hours to allow the research team to see me both in off and on state. They conducted a series of test checking motor functions and cognitive abilities. I also had regular blood and urine tests as well as a DAT scan and spinal fluid test at the start and finish of the trial period.

Overall a very positive experience, it was great having an extra few pairs of hands and eyes taking care of me for a couple of years.

See also this video of Dr. Dilan Athauda explaining the background and history of how Exanatide came into play for Parkinson’s. At the very end Dilan ventures further into the brave new world of drug repurposing, i.e. using medication already tested and approved for other illnesses, e.g. diabetes for use in treatment of other diseases such as Parkinson’s. International experts have compiled a list of 7 promising candidates and I’ve been lucky enough to be involved in trials for 2 of these (Exanatide & Simvastatin).

Just wanted to give an update on my personal journey as Exanatide is currently moving into a third trial phase, involving more participants over a longer period of time.

About a year after phase 2 trial ended back in 2016, the results were very promising, indicating that patients with the active drug showed significant improvement in motor symptoms over the trial period and also at the checkpoint 2 month after trial end, compared to the placebo control group. As it turned out, I had been on the active drug and my test results were in line with the overall assessment showing improvement beyond trial end.

When it came to discussing next steps in my personal journey with Parkinson’s and managing my symptoms with the right cocktail of medication, it was decided by my neurologist and GP that I would benefit from receiving Exanatide on an ongoing basis. I’m having quarterly blood tests to check for any unwanted side effects, but so far so good. When I think about this, I’m probably one of only a handful of PwP who are taking this leading-edge medication to fight their disease – and that is quite a humbling thought.

© Ulli Funken 2019, 2021

Exenatide Phase 2
Editor’s Notes: Summary of Trial Results © The Lancet

Clinical Trial identifier http://clinicaltrials.gov/show/NCT0197242

Background
Exenatide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has neuroprotective effects in preclinical models of Parkinson’s disease. We investigated whether these effects would be apparent in a clinical trial.

Methods
In this single-centre, randomised, double-blind, placebo-controlled trial, patients with moderate Parkinson’s disease were randomly assigned (1:1) to receive subcutaneous injections of exenatide 2 mg or placebo once weekly for 48 weeks in addition to their regular medication, followed by a 12-week washout period. Eligible patients were aged 25–75 years, had idiopathic Parkinson’s disease as measured by Queen Square Brain Bank criteria, were on dopaminergic treatment with wearing-off effects, and were at Hoehn and Yahr stage 2·5 or less when on treatment. Randomisation was by web-based randomisation with a two strata block design according to disease severity. Patients and investigators were masked to treatment allocation. The primary outcome was the adjusted difference in the Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) motor subscale (part 3) in the practically defined off-medication state at 60 weeks. All efficacy analyses were based on a modified intention-to-treat principle, which included all patients who completed any post-randomisation follow-up assessments. The study is registered at ClinicalTrials.gov (NCT01971242) and is completed.

Findings
Between June 18, 2014, and March 13, 2015, 62 patients were enrolled and randomly assigned, 32 to exenatide and 30 to placebo. Our primary analysis included 31 patients in the exenatide group and 29 patients in the placebo group. At 60 weeks, off-medication scores on part 3 of the MDS-UPDRS had improved by 1·0 points (95% CI −2·6 to 0·7) in the exenatide group and worsened by 2·1 points (−0·6 to 4·8) in the placebo group, an adjusted mean difference of −3·5 points (−6·7 to −0·3; p=0·0318). Injection site reactions and gastrointestinal symptoms were common adverse events in both groups. Six serious adverse events occurred in the exenatide group and two in the placebo group, although none in either group were judged to be related to the study interventions.

Interpretation
Exenatide had positive effects on practically defined off-medication motor scores in Parkinson’s disease, which were sustained beyond the period of exposure. Whether exenatide affects the underlying disease pathophysiology or simply induces long-lasting symptomatic effects is uncertain. Exenatide represents a major new avenue for investigation in Parkinson’s disease, and effects on everyday symptoms should be examined in longer-term trials.

Funding
Michael J Fox Foundation for Parkinson’s Research.

Back to top

Researcher Bio – Dr Marie-Louise Zeissler

Marie-Louise introduces herself and her passion for researching Parkinson’s.  After her lab work, including investigation of  cannabinoids she took the opportunity to investigate the scope for Multi-arm Trials in Parkinson’s, borrowing from the world of cancer medicine. This study with  Dr Camille Carroll has brought her into the Edmund J Safra ACT-PD Initiative.

This is a 3-year study, bringing together national and international experts under the joint leadership of Professor Tom Foltynie  and Dr. Carroll to develop a protocol and sustainable strategy to accelerate clinical trials in Parkinson’s using MAMS.

Back to top

Researcher Bio – Megan Courtman

Megan Courtman explains her work in this 25m video to apply Artificial Intelligence techniques to search for patterns that may indicate Parkinson’s in an NHS database of anonymised CT and MRI scans of brains.

The possibility of drugs that can arrest progression underlines the need to diagnose Parkinson’s earlier than is possible by today’s observational methods of movement disorder. (DAT scans are often taken for confirmation of diagnosis, but are not a practical screening method).

Her aim is contribute to the search for biomarkers that may be evident in the “prodromal”  stage before movement disorders become evident and by which time significant damage has already been done.

Of topical note is that these CT and MRI scans are sourced from Acute Hospital Trusts in the southwest. MRI and CT scans are used routinely in A&E admissions involving head trauma. Several thousand scans have been made available of anonymised patients who were subsequently diagnosed with Parkinson’s, and for a control group known not to be affected.

Back to top

A Treatment For Anxiety in Parkinson’s: Project In Progress

The management of anxiety is a significant unmet need for many People with Parkinson’s (PwPs) and thereby also affects care partners. Medical therapies are available but may have counterproductive side effects, and are a blunt tool for rapid fluctuations in anxiety levels.

In Part 1 of a 2-part video Chris Lovegrove explains the development of this clinical non-drug treatment for Anxiety in Parkinson’s in close collaboration with PwPs at all stages of the project.

The first consultation stage of the project, previously featured in  our Get Involved pages, is now complete and the next stage is imminent.

In the Part 2 video, Chris reflects on the influences on the project, including the changing priorities of research, how the treatment must be integrated into the National Health Service current practices, and the consequences of the insatiable demand for health services.

Back to top

The Future Of Digital Support For Home Care in Parkinson’s

… not the briefest of titles, but behind it lurks a revolution in the way Parkinson’s care will be provided in the future. Indeed several aspects of this future are already reality, as amply demonstrated by the Home Based Care Pathway.

Dr Camille Carroll offers her thoughts on the future of digitally-supported home care methods for supporting those with Parkinson’s and their care partners.