A new drug called Exenetadine

The interpretation of the results by WeAreParky

This important finding was first reported on the Lancet.com (official link) website where on August 3, 2017 the outcome of a controlled clinical trial, conducted between June 2014 and March 2015 on 62 patients who had an average progression of Parkinson’s disease, was publicly disclosed .
The study (Phase II) took place over a period of time that lasted altogether 60 weeks.
Thirty-two (32) randomly selected patients were asked to self-administer a 2-mg dose of Exenatide by subcutaneous injections in addition to their regular medication regimen which remained unchanged.
Whereas the remaining thirty (30) patients, self-administered a 2-mg dose of a placebo.
Laboratory tests on blood and on spinal fluid were taken to ascertain the presence of Exenatide.
Furthermore, readings resulting from carried out clinical scales (UPDRS II) and scanned (DatScan) dopaminergic activity levels (reference : “the Michael J Fox Fundation” which funded the study) were used as a platform for Phase III final study, which as of yet did not start.
The released outcome, of the aforementioned controlled clinical trial, showed a noticeable improvement in the symptoms but the announcement or representation that there were no serious side effects, which could be directly related to the clinical study, proved to be equally important
The authors of the study in their conclusive statement relate that : “IT IS NOT CLEAR whether Exenatide has any influence on the pathophysiology (symptoms) or has any long-term bearing on the pathology itself (i.e., if it can stop neurodegeneration).”
In fact, the clinical studies whose aim was to figure out where to “place” or better yet if Exenatide has any influence or bearing in the treatment of PD, initiated in 2009 when the first animal laboratory experiments (Phase I) were carried out by Astrazeneca and Bristol Meyers Squibb on Byetta® and Bydureon®. At the time it was demonstrated that the stimulation of the GLP-1 receptor could potentially produce a neuroprotective effect in therapeutic treatment of Parkinson’s and Ischemia.
We also found a clinical study carried out in 2014 (Aviles-Olmos) which showed that the positive effects on symptoms indeed lasted one year past the date when the administered treatment was ended
Actually, this unique result represents a singular positive hope for potentially long-lasting effects…
Is Exenatide the cure for Parkinson’s that we have all along been waiting for ?
The best answer to this question was given by dr. Weiner of the MJFF who was responsible for “putting the money in to fund the study”.

And we quote :
“The trial results are intriguing, but the data is not sufficiently robust to point to a clear benefit for exenatide in PD. Definitively evaluating exenatide’s safety and efficacy in Parkinson’s would require a larger, well-designed multicenter trial. The mechanism of exenatide and similar drugs (i.e., GLP-1 agonists, such as liraglutide and lixisenatide), as well as previous supportive evidence, make them interesting therapeutic targets in Parkinson’s. Until more is known about their potential role in PD, though, patients are cautioned not to add them to their Parkinson’s regimens”

The full article.
At the following link you can download (pdf) the full article of the clinical study

Should the exenatide-based treatment work, how much would it cost in Italy ?
Currently, a kit that contains 4 – 2mg pen and one of Bydureon® would costs about € 500.00, on the basis of the regimen implemented for the clinical study it would require a kit per month.
To date, the “generic” of these drugs it is not available because it does not exist. There are rumors, though, that there is a generic Byetta® but it does not have the slow-release feature that, on the contrary, Bydureon® has, and so for this reason Byetta® requires two injections per day.

When will Phase III start ? you should ask Trump this !
The drug has already been approved by the FDA and it has been widely used in the treatment of diabetes.
Hence, it has already followed the approval process up to Stage III. According to the “21st Century Cures Act” so much sought by the Obama’s administration but currently strongly opposed by the new US President, Donald Trump, phase III in these times of “repositioning” or maybe better yet of restructuring phase III strictly may not have to be undertaken given that it could be possible to compress Phase II and Phase III in a single process which could involve a group of “only” 1-300 patients. This, in turn, would greatly reduce both the costs and the timing associated with the approval by the FDA of the drug as a viable treatment of PD.
Then, it would only remain to evaluate the real beneficial effects on the pathology seen in the short-to-medium-long term range. Source: The Science of Parkinson’s disease

The view of WeAreParky : Cure or Therapy (remedy) ?
In recent years, the aim of most clinical studies or researches undertaken for Parkinson’s disease are finally focused on seeking a cure.
Care and therapy have two very different meanings:
• The cure eliminates the pathology, that is, it “HEALS”
• Therapy helps to MANAGE the symptoms of the disease by acting in a beneficial way on the same symptoms.
Being a neurological disorder, and as it is commonly known that once the nerve cells are damaged unfortunately they can’t be repaired, this tends to complicate things even more
This means that even if we stop the neuro-degeneration the damage already done remains, obviously we can always try to work on rehabilitation.
PD implies that the affected population may be at one of the various progressives stages of the disease – which range from those who are yet not aware of their condition (pre-diagnosis ) to those in more advanced stages of the disease.
Hence any discussion whose topic is a “cure for Parkinson’s disease” should take in due consideration the progressive nature of the disease which is also time related.
Simply stated : let’s us hypothesize for a moment that all goes well and that the outcome of phase III confirms that Exenatide works well by treating the symptoms and stopping or slowing down neurodegeneration without causing any major side effects.
This would imply two very different meanings:
For the newly-diagnosed this would entail a cure
For all the others this would mean that we have a drug therapy that stops neurodegeneration and thus the worsening of the symptoms

We have sought the opinion of Italian neurologists. A number of known neurologists were asked to kindly provide their view on the above reported topic.
All the received answers will be published soon.

 

Translated by WeAreParky volunteer Pino Porpiglia (Thanks Pino 😉 )

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