TY - JOUR
T1 - Trial of Prasinezumab in Early-Stage Parkinson's Disease
AU - the PASADENA Investigators and Prasinezumab Study Group
AU - Pagano, Gennaro
AU - Taylor, Kirsten I.
AU - Anzures-Cabrera, Judith
AU - Marchesi, Maddalena
AU - Simuni, Tanya
AU - Marek, Kenneth
AU - Postuma, Ronald B.
AU - Pavese, Nicola
AU - Stocchi, Fabrizio
AU - Azulay, Jean Philippe
AU - Mollenhauer, Brit
AU - López-Manzanares, Lydia
AU - Russell, David S.
AU - Boyd, James T.
AU - Nicholas, Anthony P.
AU - Luquin, María R.
AU - Hauser, Robert A.
AU - Gasser, Thomas
AU - Poewe, Werner
AU - Ricci, Benedicte
AU - Boulay, Anne
AU - Vogt, Annamarie
AU - Boess, Frank G.
AU - Dukart, Juergen
AU - D'Urso, Giulia
AU - Finch, Rebecca
AU - Zanigni, Stefano
AU - Monnet, Annabelle
AU - Pross, Nathalie
AU - Hahn, Andrea
AU - Svoboda, Hanno
AU - Britschgi, Markus
AU - Lipsmeier, Florian
AU - Volkova-Volkmar, Ekaterina
AU - Lindemann, Michael
AU - Dziadek, Sebastian
AU - Holiga, Štefan
AU - Rukina, Daria
AU - Kustermann, Thomas
AU - Kerchner, Geoffrey A.
AU - Fontoura, Paulo
AU - Umbricht, Daniel
AU - Doody, Rachelle
AU - Nikolcheva, Tania
AU - Bonni, Azad
N1 - Funding Information:
Supported by F. Hoffmann–La Roche and Prothena Biosciences. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. A data sharing statement provided by the authors is available with the full text of this article at NEJM.org. We thank all the participants and their families who participated in the trial, and the staff of the clinical trial sites around the world for their ongoing partnership and assistance. We also thank Lisa Michelle Restelli (Roche) and Amanda Gallagher
Publisher Copyright:
© 2022 Massachusetts Medical Society.
PY - 2022/8/4
Y1 - 2022/8/4
N2 - 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.
AB - 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.
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U2 - 10.1056/NEJMoa2202867
DO - 10.1056/NEJMoa2202867
M3 - Article
C2 - 35921451
AN - SCOPUS:85135623173
SN - 0028-4793
VL - 387
SP - 421
EP - 432
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 5
ER -