Parkinson's Disease Tulip


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Old 11-22-2006, 03:31 PM #1
paula_w paula_w is offline
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Default From the author of the GDNF result paper

Yet it isn't mentioned...trial participants ignored again....I just want to mention in passing that this DBS neurosurgeon says no conflicts of interest.


Refl ection and Reaction


http://neurology.thelancet.com
Vol 5 December 2006 991
rationale and evidence of benefi t in animal models.


14,15

Unfortunately, mounting experience from these trials suggests that our current hypotheses of the mechanism of neurodegeneration in Parkinson’s disease might still
be inadequate to predict which treatment approaches should be pursued. In light of these uncertainties and the huge costs of undertaking trials, such as the TCH346
study, futility analyses will be increasingly used in the initial evaluation of putative neuroprotective drugs.16 Although available animal models, which largely produce a non-progressive presynaptic nigrostriatal dopamine defi ciency, have been especially useful in predicting symptomatic treatment eff ects, so far they have been disappointing in predicting outcomes of trials studying neuroprotection as well as neurorestoration.

Two of the highest priorities in this area of research must be the development of animal models that more closely mimic the progressive multisystems nature of the
neurodegenerative process of PD and the establishment of biomarkers that accurately refl ect the state of neuronal dysfunction and death in the many brain regions
aff ected. Until these are available, further eff orts—eg, use of a large simple study design with multiple functional outcomes analysed by global statistical tests as proposed
by the NIH NET-PD programme15—might provide some clinical evidence to suggest disease modifi cation, but will never convincingly prove that the underlying progressive
degenerative process has been truly altered.

Perhaps it is now time “for something completely diff erent” in our approach to neuroprotection for PD. Although the scientifi c underpinnings that supported a
move to large-scale trials seemed sound, we now need to step back and critically assess our current concepts of disease patho genesis and possibly reconsider ongoing
eff orts that are continuing to build on a potentially faulty foundation. Advances in our understanding of genetic causes of PD, the infl uence of other genes and environmental factors on the penetrance and manifestations of these disorders, and the generation of
better animal models may provide new insights that can redirect our eff orts. Perhaps only when neuroprotective trials are grounded in further basic-science discovery
will we see the development of treatments that are not subsequently classifi ed as another “dead parrot”.

Anthony E Lang
University of Toronto, Toronto, Canada
lang@uhnres.utoronto.ca
I have no conflicts of interest.

1 Olanow CW, Schapira AHV, LeWitt PA, et al. TCH346 as a neuroprotective
drug in Parkinson’s disease: a double-blind, randomised, controlled trial.
Lancet Neurol


2006; 5: 1013–20.
2 Waldmeier P, Bozyczko-Coyne D, Williams M, Vaught JL. Recent clinical
failures in Parkinson’s disease with apoptosis inhibitors underline the need
for a paradigm shift in drug discovery for neurodegenerative diseases.
Biochem Pharmacol


2006; 72: 1197–206.
3 Parkinson Study Group. Eff ect of deprenyl on the progression of disability
in early Parkinson’s disease. N Engl J Med 1989; 321: 1364–71.
4 Shoulson I, Parkinson Study Group PRECEPT Investigators. CEP-1347
treatment fails to favorably modify the progression of Parkinson’s disease
(PRECEPT) study. Neurology 2006; 67: 185.
5 Rascol O, Olanow W, Brooks D, Koch G, Truffi net P, Bejuit R. A 2-year,
multicenter, placebo-controlled, double-blind, parallel-group study of the
eff ect of riluzole on Parkinson’s disease progression. Mov Disord 2002;
17


(suppl 5): S39.
6 Olanow CW, Hauser RA, Gauger L, et al. The eff ect of deprenyl and levodopa
on the progression of Parkinson’s disease. Ann Neurol 1995; 38: 771–77.
7 Palhagen S, Heinonen E, Haegglund J, et al. Selegiline slows the progression
of the symptoms of Parkinson disease. Neurology 2006; 66: 1200–06.
8 Siderowf A, Parkinson Study Group. A controlled, randomized, delayed-start
study of rasagiline in early Parkinson disease. Arch Neurol 2004; 61: 561–66.
9 Shults CW, Oakes D, Kieburtz K, et al. Eff ects of coenzyme Q10 in early
Parkinson disease: evidence of slowing of the functional decline.
Arch Neurol


2002; 59: 1541–50.
10 Holloway R, Shoulson I, Kieburtz K, et al. Pramipexole vs levodopa as initial
treatment for Parkinson disease: a randomized controlled trial. JAMA 2000;
284:


1931–38.
11 Whone AL, Watts RL, Stoessl AJ, et al. Slower progression of Parkinson’s
disease with ropinirole versus levodopa: the REAL-PET study. Ann Neurol
2003;


54: 93–101.
12 Fahn S, Shoulson I, Kieburtz K, et al. Levodopa and the progression of
Parkinson’s disease. N Engl J Med 2004; 351: 2498–508.
13 Schapira AH, Obeso J. Timing of treatment initiation in Parkinson’s disease:
a need for reappraisal? Ann Neurol 2006; 59: 559–62.
14 Ravina BM, Fagan SC, Hart RG, et al. Neuroprotective agents for clinical trials in
Parkinson’s disease: a systematic assessment. Neurology 2003; 60: 1234–40.
15 Kieburtz K. Issues in neuroprotection clinical trials in Parkinson’s disease.
Neurology


2006; 66 (10 suppl 4): S50–57.
16 NINDS NET-PD Investigators. A randomized, double-blind, futility clinical
trial of creatine and minocycline in early Parkinson disease. Neurology


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Old 11-22-2006, 08:41 PM #2
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Default Neuroprotection?

Pardon my language, but screw neuroprotecton. I want neurogenesis!
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Born in 1953, 1st symptoms and misdiagnosed as essential tremor in 1992. Dx with PD in 2000.
Currently (2011) taking 200/50 Sinemet CR 8 times a day + 10/100 Sinemet 3 times a day. Functional 90% of waking day but fragile. Failure at exercise but still trying. Constantly experimenting. Beta blocker and ACE inhibitor at present. Currently (01/2013) taking ldopa/carbadopa 200/50 CR six times a day + 10/100 form 3 times daily. Functional 90% of day. Update 04/2013: L/C 200/50 8x; Beta Blocker; ACE Inhib; Ginger; Turmeric; Creatine; Magnesium; Potassium. Doing well.
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Old 11-22-2006, 08:54 PM #3
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Like I always say, I'm an instant fan of whatever works......but the thing is, there are people whose lives were ruined over this halt, and we are their hope. Hey, this stuff does grow new cells, if that is what you mean....as demonstrated by autopsy. And so I continue on.....

Happy Thanksgiving.
Paula
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Old 11-23-2006, 05:45 AM #4
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Default dear Paula, et al...

It seems the "big pharma" is at the point where they will only give us a hope
of a cure at intervals of 5 years at a time,
big pharma, has no integrity...it is looking for gold,
and
if we are made well
-their well goes dry.
I am praying about this present apathy.
but I am Thankful we do have a cure, although we need to see the evidence
of that cure ASAP.
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.


.
by
.
, on Flickr
pd documentary - part 2 and 3

.


.


Resolve to be tender with the young, compassionate with the aged, sympathetic with the striving, and tolerant with the weak and the wrong. Sometime in your life you will have been all of these.
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Old 11-24-2006, 12:13 AM #5
boann boann is offline
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Default gdnf

hi all,

i have been too wrapped up in my research on levodopa... and also seem to have been circulating in a world where people either really don't believe big pharma is capable of being naughty in a large scale, intentional sort of way (i.e., putting the bottom line before all else, including ethics, decency, and all that is right) or people who just pretend to believe same because it is in their best interest (obviously, they don't have pd) to cozy up to industry....

anyway, my point is that i have completely missed the pd perspective, i mean the down and dirty, gritty, in the trenches, have-asked-all-the-questions-it-has been-possible-to-ask-of-all-the-players-that-would-talk-to-you perspective on what really happened with gdnf.

i get the impression that it might come to rest on the idea that the kibosh (sp?) could have been put on gdnf because it actually worked - is that right? i am sure that this whole ordeal is as complex as the day is long, but if someone could give me a summary of what has gone on since the trial stopped - i am particularly interested in any conversations with amgen, researchers and any other organizations or entities that may have been involved - that would be great - or just refer me somewhere if any of it is posted anywhere, maybe?

thanks,
Boann
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Old 11-24-2006, 09:19 AM #6
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Smile plenty of info online

http://www.pdpipeline.org/yy_gdnf/gdnf_overview.htm

I am out for the day but that and links from it should get you going quite aways. I'll be in touch.

Paula
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Old 11-26-2006, 04:04 PM #7
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Hello boann:
I've just stumbled across this website and have found your post. I can personally tell you much of what has been going on since the halt of the gdnf trial. My husband is one of the 34 patients who were in Phase II.

It's very interesting that the doctors are divided between their theory of whether or not GDNF works. The reality is, from a patient viewpoint, the drug DOES work. My husband has been off the drug for two years and nearly 3 months. His regression has been minor. Prior to GDNF I had to button his clothes and cut his food. He could not walk 1 block without falling along the way, the list could go on. After GDNF he has done many things, most of which has been in the newspapers already such as replacing my kitchen cabinets and building a deck on the back of my house, yes, holding a nail and hitting it with a hammer without hitting his fingers! We've done many things since however this summer he has build stairs for me and climbed a ladder and trimmed all 30 of our 15 foot tall bushes. He is not only stable but a fully functioning human being.

The patients, as well as caregivers, advocates and some of the doctors have been fighting and trying everything possible to convince Amgen they have a good drug. My husbands PET scans prove it. I truely believe, that the halt has more to do with the delivery system than the drug itself due to the high cost of the surgery and the management of the pumps. Dr. Perlmutter has made the statement in his speech at a California college that hospitals would rather see more knee surgeries than these sort of surgeries because they can move people in and out faster.

My husband had no difficulty whatsoever with the drug or the pumps. Some patients had catheters that migrated so they were not even getting the GDNF. So essentially, we go from 34 patients in the study to, in reality, 29 or 30. If 1/2 of these patients were on placebo, then essentially only 15 people were getting GDNF for the entire time. Is 15 people over a 9 month period of time a good enough sample to judge either the safety or efficacy for a population of 1.5 million in this country alone? Not a lot of common sense in that to me. Not only that but the primates were getting 10 to 15 times the dosage of humans. You take 10 to 15 times the dosages of Tylenol and I'm sure you'll have some nasty effects. Amgen didn't even take the time to consider the "Early Withdrawal" phenomenon which, I am told, is a high probability of why the monkeys developed lesions. So who is Amgen protecting? Certainly not the patients. If they would have ever taken the time to pay attention to the patients, they may have looked at the decisions made about GDNF in a different light.
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