- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01539837
A Pilot Clinical Trial With the Iron Chelator Deferiprone in Parkinson's Disease (DeferipronPD)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
BACKGROUND Parkinson's disease (PD) is a progressive neurodegenerative disorder that affects approximately 2% of the population aged over 60 years. The common clinical motor control features are tremor, bradykinesia, postural abnormality and rigidity. However, in many patients non-motor features such as cognitive decline, depression, autonomic disturbances also occur as the disease progresses. The principal pathology is the degeneration of the nigrostriatal dopaminergic system which plays a major role in movement control through the release of dopamine in the striatum. Current therapeutic approach focus on dopamine replacement strategies either through the dopamine precursor L-DOPA or the use of dopamine agonists, and/or the use of monoamine oxidase inhibitors or catecholamine transferase inhibitors which prevent the breakdown of dopamine or facilitate L-DOPA entry into the brain. However, such therapeutic approaches are associated with declining efficacy and long term complications e.g. dyskinesias. Additionally, such therapeutic approaches only treat the clinical symptoms of PD and due not protect the neurons against degeneration hence the disease continues to progress with the patient experiencing increasing disability. Hence there is a chronic need for the development of neuroprotective drugs which prevent further neuronal loss and thus prevent the progression of the disease.
RATIONALE FOR CURRENT STUDY Hypothesis: Increased iron and oxidative stress play a major role in the neurodegenerative process in PD and iron chelation therapy can be effective in removing excess iron from the brain and potentially slowing the neurodegenerative process.
Research question: Can iron chelation therapy with Deferiprone remove excess iron in the substantia nigra in PD patients without toxic side effects. What effect does Deferiprone therapy have on the severity of PD and other brain function e.g. cognition, depression etc.
Increased iron levels have been heavily implicated in the neurodegenerative process in PD. Although many of our cellular processes require iron, when in excessive amounts it can trigger the formation of toxic chemicals called free radicals, of which there is extensive evidence of their increased formation in the PD brain. Hence removal of excess iron by iron chelation (drugs which bind and detoxify iron) represents a potential drug target.
Iron chelators e.g. Deferiprone in doses around 100mg/kg/day, are extensively utilised to treat peripheral iron overload disorders such as beta thalassaemia, where the patients requires regular blood transfusions but iron accumulates in the body when the red blood cells are removed from the circulation. Iron chelation therapy in such patients is associated with minimal side effects with long term use. Recently, in animal models of brain iron overload, we have demonstrated iron chelators can enter the brain removing excess iron. Additionally, we have recently shown that iron chelation therapy protects neurons against toxins in animal models of PD.
In 2007 20 or 30mg/kg/day Deferiprone was used in a pilot clinical trial in Friedreich ataxia (FA)patients, to assess whether the drug was well tolerated, removed excess brain iron and improved the clinical symptoms of FA. FA occurs due to a gene defect leading iron accumulation in the mitochondria in the cerebellum, toxicity of which leads to ataxia or inability to control muscle movements. FA is diagnosed in young individuals (14-26 years of age) and has no clinical treatment. In this 6 months FA study Deferiprone at 20 or 30mg/kg/day was well tolerated by the patients and resulted in a reduction in brain iron, as indicated by MRI brain imaging, and led to a clinical improvement in patient symptoms. Whilst this represents the first clinical use of an iron chelator to treat a neurodegenerative disorder, the FA patients in this study were young (14-23 years old) hence we do not know how aged (average age 60years) individuals commonly affected by PD will respond to iron chelator treatment. Hence the first aim of this study is to conduct the first pilot clinical trial with an iron chelator in newly diagnosed PD patients to assess tolerability along with its ability to reduce iron content in the brain area affected in PD, the substantia nigra, as assessed by MRI.
A number of clinical trials have already been conducted in PD with potential neuroprotective drugs but their ability to slow the disease process has been controversial since these drugs have a direct effects on the symptoms of PD itself. Hence it is difficult to say whether the beneficial effects of the drugs are due the prevention of further neuronal loss thus slowing the disease or whether they improve the patient's ability to move directly. PD progresses in most patients fairly slowly, hence we don't expect to see detectable neuroprotection following 6 months Deferiprone treatment but it will allow us to assess whether Deferiprone therapy has any direct effects on PD symptoms. Hence the second aim of this study will be to examine whether iron chelation therapy has a direct effect on PD symptomology.
If this pilot study clearly demonstrates good tolerability of Deferiprone in PD patients whilst showing good removal of excess SN iron level yet having minimal direct effect on PD symptomology this data will form the basis of large funding application for a multicentre clinical trials to investigate whether long term Deferiprone treatment can slow/halt the progression of PD.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
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-
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London, United Kingdom, W120NN
- Centre for Neuroscience, Imperial College London
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Clinical diagnosis of Parkinson's disease
- disease duration less than 5 years
- stable response to standard anti-Parkinson's medication for at least 6 weeks
Exclusion Criteria:
- Other neurological conditions
- Diabetes
- Renal or liver disease
- Blood disorders
- Pregnancy or breast feeding
- Conditions which cause immunocompromise e.g. episodes of neutropaenia or agranulocytosis, HIV etc
- Prior history of hypersensitivity to Deferiprone or its excipient
- Pacemaker
- artificial heart valves
- ever had surgery to the head
- Metalic implants in the CNS e.g. cerebral aneurysm clips
- history of metal entering the eye
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Placebo
Drug excipient
|
Feriprox placebo administered orally at the same dosing volume as the 20mg/kg/day feriprox per day
Other Names:
|
Active Comparator: Deferiprone 20mg
20mg/kg/day deferiprone
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20mg/kg/d Deferiprone divided into two equal doses (morning and evening), every day for 6 months
Other Names:
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Active Comparator: Deferiprone 30mg
30mg/kg/day Deferiprone
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30mg/kg/d Deferiprone divided into two equal doses (morning and evening), every day for 6 months
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants With Serious Adverse Events
Time Frame: 6 months
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To assess whether there were any serious adverse events in 6-month treatment with Deferiprone.
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6 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Iron Concentrations in the Dentate Nucleus
Time Frame: 6 months
|
Assess whether Deferiprone therapy directly affects the symptoms of Parkinson's disease, modify regional brain mineralization (iron concentration) as assessed with T2* MRI in PD patients in the dentate nucleus.
In previous animal studies, Deferiprone treatment reduced dentate nucleus iron content, as assessed by MRI.
An increase in the T2*MRI value represents an increase in mineralization.
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6 months
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: David T Dexter, PhD, Imperial College London
Publications and helpful links
General Publications
- Dexter DT, Wells FR, Agid F, Agid Y, Lees AJ, Jenner P, Marsden CD. Increased nigral iron content in postmortem parkinsonian brain. Lancet. 1987 Nov 21;2(8569):1219-20. doi: 10.1016/s0140-6736(87)91361-4. No abstract available.
- Oakley AE, Collingwood JF, Dobson J, Love G, Perrott HR, Edwardson JA, Elstner M, Morris CM. Individual dopaminergic neurons show raised iron levels in Parkinson disease. Neurology. 2007 May 22;68(21):1820-5. doi: 10.1212/01.wnl.0000262033.01945.9a.
- Ward RJ, Dexter D, Florence A, Aouad F, Hider R, Jenner P, Crichton RR. Brain iron in the ferrocene-loaded rat: its chelation and influence on dopamine metabolism. Biochem Pharmacol. 1995 Jun 16;49(12):1821-6. doi: 10.1016/0006-2952(94)00521-m.
- Dexter DT, Statton SA, Whitmore C, Freinbichler W, Weinberger P, Tipton KF, Della Corte L, Ward RJ, Crichton RR. Clinically available iron chelators induce neuroprotection in the 6-OHDA model of Parkinson's disease after peripheral administration. J Neural Transm (Vienna). 2011 Feb;118(2):223-31. doi: 10.1007/s00702-010-0531-3. Epub 2010 Dec 17.
- Boddaert N, Le Quan Sang KH, Rotig A, Leroy-Willig A, Gallet S, Brunelle F, Sidi D, Thalabard JC, Munnich A, Cabantchik ZI. Selective iron chelation in Friedreich ataxia: biologic and clinical implications. Blood. 2007 Jul 1;110(1):401-8. doi: 10.1182/blood-2006-12-065433. Epub 2007 Mar 22.
- Martin-Bastida A, Ward RJ, Newbould R, Piccini P, Sharp D, Kabba C, Patel MC, Spino M, Connelly J, Tricta F, Crichton RR, Dexter DT. Brain iron chelation by deferiprone in a phase 2 randomised double-blinded placebo controlled clinical trial in Parkinson's disease. Sci Rep. 2017 May 3;7(1):1398. doi: 10.1038/s41598-017-01402-2.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Parkinsonian Disorders
- Basal Ganglia Diseases
- Movement Disorders
- Synucleinopathies
- Neurodegenerative Diseases
- Parkinson Disease
- Molecular Mechanisms of Pharmacological Action
- Chelating Agents
- Sequestering Agents
- Iron Chelating Agents
- Deferiprone
Other Study ID Numbers
- ICL-11/SC/0101
- 2011-001148-31 (EudraCT Number)
- 11/SC/0101 (Other Identifier: Research Ethics Committee)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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