New Pharmacologic Direction for Parkinson’s Disease
SOURCE: Athauda D, Maclagan K, Skene SS, et al. Lancet 2017 Aug 3. pii: S0140-6736(17)31585-4. doi: 10.1016/S0140-6736(17)31585-4. [Epub ahead of print].
Most clinicians are used to thinking about dopamine modulation when considering treatments for Parkinson’s disease. Unfortunately, none of the current treatments can be designated as disease-modifying, even though such treatment provides transient symptomatic relief.
Current use of a glucagon-like peptide-1 receptor agonist (GLP-1RA) is limited to the management of type 2 diabetes. From where did the idea emerge that GLP-1RA might benefit Parkinson’s patients?
The authors of studies about Parkinson’s based on animal models have noted that a GLP-1RA not only crosses the blood-brain barrier, but produces sufficient neuroprotective and neurorestorative effects to improve motor function and memory. Investigators who conducted a subsequent open-label, one-year pilot trial of exenatide in humans with Parkinson’s disease found favorable effects that endured for an additional 12 months post-treatment.
Based on these early successes, Athauda et al performed a randomized, double-blind, placebo-controlled trial of exenatide administered in weekly, subcutaneous, 2 mg doses (n = 62) for 48 weeks added to whatever current regimen study participants were receiving. The primary outcome was the motor performance subscale of a Parkinson’s disease rating scale, measured 12 weeks after discontinuing exenatide treatment.
Motor function improvements were demonstrated in exenatide-treated patients, whereas investigators noted deterioration in placebo patients. Larger, longer-term studies will be needed before GLP-1RA treatment could be confirmed as an appropriate consideration for Parkinson’s patients.
Most clinicians are used to thinking about dopamine modulation when considering treatments for Parkinson’s disease. Unfortunately, none of the current treatments can be designated as disease-modifying, even though such treatment provides transient symptomatic relief.
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