Cholinesterase inhibitor to prevent falls in Parkinson's disease (CHIEF-PD) trial: a phase 3 randomised, double-blind placebo-controlled trial of rivastigmine to prevent falls in Parkinson's disease

S Neumann, J Taylor, A Bamford, C Metcalfe, D M Gaunt, A Whone, D Steeds, S R Emmett, W Hollingworth, Y Ben-Shlomo, E J Henderson, S Neumann, J Taylor, A Bamford, C Metcalfe, D M Gaunt, A Whone, D Steeds, S R Emmett, W Hollingworth, Y Ben-Shlomo, E J Henderson

Abstract

Background: Falls are a common complication of Parkinson's disease. There is a need for new therapeutic options to target this debilitating aspect of the disease. Cholinergic deficit has been shown to contribute to both gait and cognitive dysfunction seen in the condition. Potential benefits of using cholinesterase inhibitors were shown during a single centre phase 2 trial. The aim of this trial is to evaluate the effectiveness of a cholinesterase inhibitor on fall rate in people with idiopathic Parkinson's disease.

Methods: This is a multi-centre, double-blind, randomised placebo-controlled trial in 600 people with idiopathic Parkinson's disease (Hoehn and Yahr stages 1 to 4) with a history of a fall in the past year. Participants will be randomised to two groups, receiving either transdermal rivastigmine or identical placebo for 12 months. The primary outcome is the fall rate over 12 months follow-up. Secondary outcome measures, collected at baseline and 12 months either face-to-face or via remote video/telephone assessments, include gait and balance measures, neuropsychiatric indices, Parkinson's motor and non-motor symptoms, quality of life and cost-effectiveness.

Discussion: This trial will establish whether cholinesterase inhibitor therapy is effective in preventing falls in Parkinson's disease. If cost-effective, it will alter current management guidelines by offering a new therapeutic option in this high-risk population.

Trial registration: REC reference: 19/SW/0043. EudraCT: 2018-003219-23.

Iscrtn: 41639809 (registered 16/04/2019). ClinicalTrials.gov Identifier: NCT04226248 PROTOCOL AT TIME OF PUBLICATION: Version 7.0, 20th January 2021.

Keywords: Accidental falls; Cholinesterase inhibitor; Parkinson disease; Randomized controlled trials; Rivastigmine.

Conflict of interest statement

EJH has received funding from the National Institute of Health Research, Parkinson’s UK, The Gatsby Foundation and The British Geriatrics Society and has received fees and / or travel support from Bial, Abbvie, Luye and Profile, Ever, and Kyowa Kirin.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Trial flow chart
Fig. 2
Fig. 2
Titration schedule for transdermal patches of rivastigmine or placebo

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