The Michael J. Fox Foundation for Parkinson's Research (MJFF) today announced U.S. Food and Drug Administration (FDA) approval of a multicentre, double-blind, randomised, placebo-controlled Phase IIa clinical trial to test safety and tolerability of nilotinib (Tasigna) in Parkinson's disease (PD). The trial is designed to investigate the potential of repurposing nilotinib, an FDA-approved treatment for chronic myelogenous leukemia, for use in PD.

MJFF has collaborated with the Van Andel Research Institute (VARI) of Grand Rapids, Michigan, and The Cure Parkinson's Trust (CPT) on the clinical development of nilotinib toward the launch of this clinical trial. The trial will be carried out at 25 clinical sites across the United States through the Parkinson Study Group, the largest not-for-profit scientific network of Parkinson's disease centres in North America.

Nilotinib inhibits the activity of c-Abl, a protein that has been linked to cellular pathways associated with Parkinson's.

Read an early published paper here : 'Phosphorylation by the c-Abl protein tyrosine kinase inhibits parkin's ubiquitination and protective function' - Dawson et al. 

Preliminary data from a small open-label Phase I clinical trial evaluating the safety and tolerability of nilotinib in people with advanced Parkinson's showed potential benefit in PD. The Phase IIa trial aims to expand on these preliminary safety findings, and assess potential dosing range, to better understand the implications of nilotinib's long-term use in Parkinson's. The study also will further explore nilotinib's potential to treat symptoms or to slow or stop disease progression.

Professor of neurology and head of the division of movement disorders at Northwestern University Feinberg School of Medicine, Tanya Simuni added: "As we further explore the potential safety and tolerability of nilotinib, we look forward to reporting our data and findings to researchers and patients. In the meantime, we continue to urge patients and neurologists not to add nilotinib to their Parkinson's treatment regimens until more is understood about the safety and possible efficacy of the drug in PD."

In the trial, 75 people with moderate to advanced Parkinson's disease will be randomly assigned to receive daily doses of 150 mg of nilotinib, 300 mg of nilotinib or placebo for six months. Participants will be closely monitored throughout the dosing period and for 8 weeks after all treatments are stopped to gain insights into nilotinib's safety and tolerability, and to determine the maximum dose tolerated. If outcomes provide conclusive safety data, a second funded trial will test nilotinib in a group of 60 people with early PD for 12 months at the highest tolerated daily dose of niltotinib versus placebo.

Trial participants will complete motor, cognitive and biological (i.e., blood and spinal fluid) tests, providing data for investigators to evaluate the potential impact of nilotinib on the target pathway, as well as on c-Abl biology and Parkinson's symptoms and/or disease progression.

Recruitment is anticipated to begin in September 2017. 

Further reading: Repurposed therapies to accelerate Parkinson's drug development

Repurposed drugs can usually skip Phase I clinical testing because they are already proven safe in human volunteers. However, Phase II and Phase III trials are required to rigorously evaluate the safety, tolerability and efficacy of these treatments in people with Parkinson's.

Repurposing c-Abl compounds, such as nilotinib, within the context of Parkinson's disease is an area of increasing research focus. This nilotinib trial joins others currently in the recruiting and planning stages. Multiple concurrent trials such as these can provide more data to speed conclusions about a drug's therapeutic potential. It is important for researchers to conclusively demonstrate repurposed therapies are effective in Parkinson's, and more critically, that they are safe for people with PD to take long term. Patients and clinicians are urged to wait for additional data before adding nilotinib or any other repurposed treatments to their regimen.

The source for this article: Michael J. Fox Foundation Announces Award to Drive Phase IIa Clinical Trial Investigating Potential Safety and Benefit of Nilotinib in Parkinson's Disease