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A new weapon against Parkinson’s-related psychosis

Published on 16/12/19 at 03:13pm

Dr Arthur Roach, Director of Research at the charity Parkinson's UK, discusses new trials on cannabidiol in the treatment of Parkinson’s-related psychosis and explains how they could potentially offer hope in improving patient’s lives in what is a seriously unmet need.

Can you tell us about the project and how it got started?

Up to 60% of people with Parkinson’s are affected by psychosis at some point while living with the condition but there are currently no medications licensed in the UK to address this distressing symptom.

Coupled to this, people with the condition told us in a recent survey that they would use cannabis-derived products if robust evidence became available that they are safe and effective in treating Parkinson's symptoms.

This makes this trial a perfect fit for our Parkinson’s Virtual Biotech which is accelerating the development of urgently needed treatments driven by patient priorities and involvement.

How will the study be conducted? Why exactly is it designed in this way?

The study has been carefully designed with input from people affected to rigorously assess the safety and potential efficacy of cannabidiol (CBD) for Parkinson’s-related psychosis.

We will be assessing how safe CBD is for people with Parkinson’s, what the correct dosage is and how it is tolerated alongside the different medications someone with the condition may already be on. The study will also look at the effect of CBD on other Parkinson’s symptoms which will pave the way for scientists to investigate the potential of the compound in treating these in future studies.

We hope that this will progress to large-scale clinical trials – the final step towards becoming a new treatment that will improve the lives of people with Parkinson’s.

Is this the first trial of its kind? What makes this project different in the way it approaches the research compared to previous efforts in the space?

This clinical trial will be one of the largest and most robust studies of CBD carried out in Parkinson's anywhere in the world. It will determine, for the first time, whether CBD can correct the abnormal functioning of the brain that causes symptoms such as hallucinations and delusions.

To date there have been few robust clinical trials looking at the potential of cannabis-derived medicines for Parkinson’s. We are committed to delivering research to the highest scientific standards through the Parkinson’s Virtual Biotech and this double-blind, placebo controlled trial will provide urgently needed evidence on the safety and potential of CBD.

What does the project hope to achieve?

We hope this unique trial will demonstrate the potential of CBD to alleviate psychotic symptoms and bring us one step closer to delivering a treatment that will improve the quality of life for those affected.

What previous research has been done into the benefits of CBD in the treatment of Parkinson’s? Does this study build on this research at all?

CBD has shown promise in lab studies and clinical trials in other conditions by dampening abnormal patterns of brain activity that cause psychosis. So far it has not been tested in people with Parkinson's who experience psychosis in a rigorously conducted clinical trial.

In the view of Parkinson’s UK, what do you think this project means for Parkinson’s research?

I believe this project represents a significant shift. The development of new medicines must be driven by patients, and this trial is really a perfect example of that. We’re aiming to address a significant unmet need using a treatment that people with the condition tell us they are interested in using.

The project is part of the Parkinson’s Virtual Biotech, for which “patient priorities and involvement are the primary drivers”. Can you tell us about the Virtual Biotech, what sets it apart from similar bodies, and how it relates to this latest project?

The Parkinson’s Virtual Biotech is investing £4 million every year into the development of new treatments. Because we’re driven by people with Parkinson’s and powered by donations we can take on projects that a traditional company wouldn’t – either because they’re too risky or because there is no clear financial return. Our only interest is delivering the treatments that people with Parkinson’s need as quickly as possible.

Unlike a traditional biotech, none of this is tied up in bricks or people: we have no large teams of scientists or expensive labs to run. This means we can take an agile approach, partnering with institutions and pharmaceutical companies worldwide that already have the expertise, tools and infrastructure and fast-tracking the projects with the greatest potential to transform the lives of people with Parkinson’s.

We monitor and manage each project. If one stalls, we redirect the funding into one that’s more promising. With none of the usual limitations, we can fund multiple biotech projects at once.

How is the current treatment/management of Parkinson’s-related psychosis, particularly in the UK? Could this therapy bridge an area of unmet need for patients?

Psychosis is one of the most frequent and distressing symptoms that people with Parkinson’s experience. It can be especially devastating for families as people may develop upsetting persistent delusions about their loved ones – for instance, that their partner is having an affair. The impact can be profound.

Current management is extremely limited. It often initially involves reducing Parkinson’s medications which can worsen other symptoms, and if that doesn’t work, taking anti-psychotic medications which typically work by blocking dopamine receptors. These can exacerbate the problems people with Parkinson’s experience with movement and can also increase the risk of cardiac problems so it needs to be very carefully monitored.

Better treatments that have fewer risks and side-effects are desperately needed by people living with Parkinson’s and their loved ones.

Do you think medicinal cannabis presents a fresh avenue through which we may see new treatment developments in Parkinson’s and similar diseases?

Yes, absolutely. We need to capitalise on opportunities for new treatments for Parkinson’s wherever they come from, whether that’s academia, companies, the Parkinson’s community or repurposing. In the Parkinson’s Virtual Biotech we progress the most promising ideas and work with the right partners to deliver the research.

Have we been prevented from delving into the potential benefit of cannabis-based medicines in the treatment of Parkinson’s because of its status as a controlled substance? Do you think this is about to change, and is there reason to be cautiously optimistic?

It has certainly been a factor. In 2018, we warmly welcomed the UK Government's decision to re-classify cannabis-based medicines to allow them to be used in a similar way to other controlled drugs like morphine. We hope this decision will accelerate research to help us fully understand the potential benefits and harms of cannabis-derived medicinal products – which ultimately may deliver vital new treatments for people living with the condition.

How does this project fit alongside Parkinson’s UK’s other efforts to fight the disease?

Our research programmes are focused on accelerating the development of better treatments and a cure for Parkinson’s. Because we’re guided by people with the condition, that means we’re investing in advancing better symptomatic therapies like this new CBD trial and also in developing new disease-modifying treatments with potential to slow, stop or even reverse Parkinson’s.

Right now, we have projects at the discovery, preclinical and early clinical development stages in the Parkinson’s Virtual Biotech. We also have a dynamic research grants programme that is funding 45 projects at universities across the UK.

Is there anything else you would like to say about the current state of Parkinson’s research/treatment?

It’s an incredibly exciting time for Parkinson’s research. There are huge opportunities for developing game-changing new treatments and pharmaceutical companies are ready to fund large-scale trials and get new drugs to market at the other end. But there’s a disconnect in the middle and a critical funding shortage in early stage drug discovery and development. That’s why we’re stepping in with the Parkinson’s Virtual Biotech to plug this gap and accelerate progress. We’re confident that this approach will deliver new and better treatments in years rather than decades.

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