Trial of Prasinezumab in Early-Stage Parkinson’s Disease

Authors: Gennaro Pagano, Kirsten I. Taylor, Judith Anzures‐Cabrera, Maddalena Marchesi, Tanya Simuni, Kenneth Marek, Ronald B. Postuma, Nicola Pavese, Fabrizio Stocchi, Jean‐Philippe Azulay, Brit Mollenhauer, Lydia López Manzanares, David Russell, James T. Boyd, Anthony P. Nicholas, M.R. Luquin, Robert A. Hauser, Thomas Gasser, Werner Poewe, Benedicte Ricci, Anne Boulay, Annamarie Vogt, Frank Boess, Juergen Dukart, Giulia D’Urso, Rebecca Finch, Stefano Zanigni, Annabelle Monnet, Nathalie Pross, Andrea Hahn, Hanno Svoboda, Markus Britschgi, Florian Lipsmeier, Ekaterina Volkova-Volkmar, Michael Lindemann, Sebastian Dziadek, Štefan Holiga, Daria Rukina, Thomas Kustermann, Geoffrey A. Kerchner, Paulo Fontoura, Daniel Umbricht, Rachelle S. Doody, Tania Nikolcheva, Azad Bonni - New England Journal of Medicine, NEJM 2022 cited by 395

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: I-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.).