Prasinezumab May Benefit Early-Stage Parkinson Patients With Rapid Progression

Prasinezumab may ease motor worsening to a greater extent in patients with more rapidly progressing early-stage Parkinson disease (PD) than in other early-stage PD patients, according to an exploratory analysis of a phase 2 study published in Nature Medicine.

Despite failing to meet the primary endpoint—change in the sum of the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Parts I, II , and III at week 52—in the PASADENA study, prasinezumab was associated with slower progression of motor signs rated by clinicians (MDS-UPDRS Part III) than placebo in the trial overall. 

Researchers conducted the post hoc analysis to investigate whether prasinezumab showed special benefit in clinician-rated motor progression in prespecified patient subgroups, such as those using monoamine oxidase B (MAO-B) inhibitors at baseline and patients with other indicators of faster motor progression. 

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According to the study, all patient subgroups with rapidly progressing PD, such as those that were diffuse malignant or taking MAO-B inhibitors at baseline, consistently showed a numerically greater prasinezumab effect, as assessed by MDS-UPDRS Part III, compared with subgroups with slower PD progression.

The findings might suggest that prasinezumab slows motor sign progression over 1 year even more in patients with early-stage PD who have characteristics associated with more rapid disease progression, concluded corresponding author Gennaro Pagano, MD, PhD, of the Roche Innovation Center, Basel, Switzerland, and study coauthors.

“It is important to emphasize, however, that the current report is an exploratory analysis of a phase 2 study that failed to show an effect on the primary endpoint. Thus, a phase 2 randomized trial is required to support further the hypothesis that prasinezumab can slow progression in early-stage PD,” the authors advised.

Reference

Pagano G, Taylor KI, Anzures Cabrera J, et al. Prasinezumab slows motor progression in rapidly progressing early-stage Parkinson's disease. Nat Med. Published online April 15, 2024. doi: 10.1038/s41591-024-02886-y