This study evaluates the effect of iron chelation as a therapeutic strategy to slow the progression of Parkinson's disease. Half of participants will receive the deferiprone to 15 mg / kg twice daily morning and evening (30mg / kg per day), while the other half will receive a placebo. The treatment lasts nine months.
This is the new concept of "conservative iron chelation". We recently demonstrated (for the first time) the feasibility, efficacy and acceptability of the conservative iron chelation approach in pilot translational studies in Parkinson's disease with a prototype drug: deferiprone (1,2-dimethyl-3-hydroxypyridin-4-one) (in the FAIR-PARK-I project led by the applicant and funded by French Ministry of Health). The only available blood-brain-barrier-permeable iron chelator deferiprone is approved for treating systemic iron overload in transfused patients with thalassemia. Deferiprone has been on the European Union market since 1999, with a favourable risk/benefit balance at dose of 75 to 100 mg/kg/day. The investigators shall adopt a repositioning strategy by using deferiprone at a lower dose of 30 mg/kg/day in this new indication for local iron overload in Parkinson's disease. Deferiprone will be the first-in-class drug for this novel therapeutic strategy. On the basis of the preclinical and clinical data from (FAIR-PARK-I), the present (FAIR-PARK-II) project should constitute a model for future cytoprotection strategies in neurodegenerative diseases; if deferiprone treatment is associated with significant slower disease progression, it would be the first non-dopaminergic drug to have a proven disease-modifying effect in Parkinson's disease.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
372
15 mg / kg twice daily morning and evening (30mg / kg per day).The treatment lasts nine months.
the placebo twice daily morning and evening. The treatment lasts nine months
Medizinische Universitat Innsbruck
Innsbruck, Austria
Global effect (symptomatic and disease modifying effects) on motor and non motor handicap
the change in the total Movement Disorders Society-Unified Parkinson Disease Rating Scale score between baseline and 36 weeks (i.e. the end of the placebo-controlled phase for analysis of both disease-modifying and symptomatic effects)
Time frame: at 36 weeks
Disease-modifying effect on motor and non motor handicap
It will be measured as the changes in the overall Movement Disorders Society-Unified Parkinson Disease Rating Scale score between baseline and week 40 (i.e. the end of the one-month post-treatment monitoring period), to analyse the disease-modifying effect without bias from the symptomatic effect of ongoing deferiprone treatment) on the study population
Time frame: baseline, at 40 weeks
Effect of the motor symptoms
The effect of the motor symptoms will be analysed as the change in the subscale part III of the Movement Disorders Society-Unified Parkinson Disease Rating Scale score
Time frame: baseline, at 12, 36 and 40 weeks
Quality of life and autonomy by PDQ-39 score
It will be analyzed as the change in the Parkinson's Disease Quality of Life (PDQ-39, via a 39-item self-questionnaire)
Time frame: baseline, at 36 and 40 weeks
Quality of life and autonomy by Clinical Global Impression score
the Clinical Global Impression scored by the examiner and the patient
Time frame: baseline, at 36 and 40 weeks
Health economics assessment
will be performed via a specific questionnaire provides a simple descriptive profile and a single index value for health status
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Charles University
Prague, Czechia
Univerzita Karlova V Praze
Prague, Czechia
CHU Pellegrin
Bordeaux, France
Hôpital Wertheimer
Bron, France
Hôpital Montpied
Clermont-Ferrand, France
Hôpital Salengro, CHRU
Lille, France
CHU la TIMONE
Marseille, France
AP-HP, Hôpital Pitié-Salpêtrière
Paris, France
CHU de Strasbourg, Hôpital de Hautepierre
Strasbourg, France
...and 15 more locations
Time frame: baseline, at 36 and 40 weeks
EQ-5D questionnaire
the questionnaire provides a simple descriptive profile and a single index value for health status.
Time frame: baseline, at 36 and 40 weeks
Safety criteria
All the safety concerns will be listed in a table with the number of patients, the type the severity and the time of occurrence for * adverse events * neutropenia (weekly complete blood count) * agranulocytosis (weekly complete blood count) * anemia (weekly complete blood count) * iron metabolism abnormalities (haemoglobin, serum iron, ferritinemia, transferrin, total binding capacity, transferrin saturation coefficient, 24-hour urine iron). * Standard biological abnormalities (fasting glucose, urea, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and (for all sexually active, fertile females) urine pregnancy tests. * Abnormal physical examination (including vital signs, bodyweight, electrocardiogram and blood pressure)
Time frame: 40 weeks
Effect on overall cognitive status
Measured by the score in the Montreal Cognitive Assessment
Time frame: baseline, at 12, 36 and 40 weeks
Effect on gait disorders
Measured by the Stand Walk Sit test
Time frame: baseline, at 12, 36 and 40 weeks
Effect on daily living
The effect on daily living will be analysed as the change in the subscale part II (activities of daily living) of the Movement Disorders Society-Unified Parkinson Disease Rating Scale score
Time frame: baseline, at 12, 36 and 40 weeks
Effect on non-motor symptoms
The effect on non motor symptoms will be analysed as the change in the subscale part I (cognition and behavior) of the Movement Disorders Society-Unified Parkinson Disease Rating Scale score
Time frame: baseline, at 12, 36 and 40 weeks
Lack of occurrence of motor fluctuations
The lack of occurrence of motor fluctuations will be analysed on the subscale part IV of the Movement Disorders Society-Unified Parkinson Disease Rating Scale score
Time frame: baseline, at 12, 36 and 40 weeks