Measuring Disease Progression in Early Parkinson Disease: The National Institutes of Health Exploratory Trials in Parkinson Disease (NET-PD) Experience | Lifestyle Behaviors | JAMA Neurology | JAMA Network
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    1 Comment for this article
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    Possible reasons for the unsatisfactory results of Ubiquinone trials on patients with early Parkinson .
    Ahmed Negida | Zagazig University , Faculty of Medicine , Egypt
    Results of clinical trials on coenzyme Q10 for early Parkinson aren't satisfactory to the expected extent (1). However this doesn't mean that coenzyme Q10 has no effect on neurons protection .It's still possible that Coenzyme Q10 can slow the progress of Parkinson in earlier cases that don't require medications . Another possible reason for this negative results is that Vitamin E reduces the absorption of coenzyme Q10 (2) . Also Ubiquinone mayn't give the expected outcome due to its hydrophobicity and large molecular weight which makes the absorption of dietary CoQ10 is slow and very limited(3). A recent study showed that the water soluble form Ubisol-Q10 is effective in low doses (4).References :-1. Shults CW. Treatments of Parkinson disease: circa 2003. Arch Neurol. 2003;60:1680-1684. doi:10.1001/archneur.60.12.1680.2. Lass A, Sohal RS. Effect of coenzyme Q(10) and alpha-tocopherol content of mitochondria on the production of superoxide anion radicals. FASEB J. 2000;14(1):87-94. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10627283.3. Bhagavan HN, Chopra RK. Coenzyme Q10: absorption, tissue uptake, metabolism and pharmacokinetics. Free Radic Res. 2006;40(5):445-53. doi:10.1080/10715760600617843.4. Muthukumaran K, Leahy S, Harrison K, et al. Orally delivered water soluble Coenzyme Q10 (Ubisol-Q10) blocks on-going neurodegeneration in rats exposed to paraquat: potential for therapeutic application in Parkinson’s disease. BMC Neurosci. 2014;15(1):21. doi:10.1186/1471-2202-15-21.
    CONFLICT OF INTEREST: None Reported
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    Original Investigation
    June 2014

    Measuring Disease Progression in Early Parkinson Disease: The National Institutes of Health Exploratory Trials in Parkinson Disease (NET-PD) Experience

    Author Affiliations
    • 1Struthers Parkinson’s Center, Golden Valley, Minnesota
    • 2Division of Biostatistics, University of Texas at Houston
    • 3Department of Neurology, University of Rochester, Rochester, New York
    • 4State University of New York, Downstate Medical Center, Brooklyn
    • 5The Parkinson’s Institute and Clinical Center, Sunnyvale, California
    • 6VA Pacific Islands Health Care System, Honolulu, Hawaii
    • 7Department of Neurology, University of Maryland School of Medicine, Baltimore
    JAMA Neurol. 2014;71(6):710-716. doi:10.1001/jamaneurol.2014.391
    Abstract

    Importance  Optimizing assessments of rate of progression in Parkinson disease (PD) is important in designing clinical trials, especially of potential disease-modifying agents.

    Objective  To examine the value of measures of impairment, disability, and quality of life in assessing progression in early PD.

    Design, Setting, and Participants  Inception cohort analysis of data from 413 patients with early, untreated PD who were enrolled in 2 multicenter, randomized, double-blind clinical trials.

    Interventions  Participants were randomly assigned to 1 of 5 treatments (67 received creatine, 66 received minocycline, 71 received coenzyme Q10, 71 received GPI-1485, and 138 received placebo). We assessed the association between the rates of change in measures of impairment, disability, and quality of life and time to initiation of symptomatic treatment.

    Main Outcomes and Measures  Time between baseline assessment and need for the initiation of symptomatic pharmaceutical treatment for PD was the primary indicator of disease progression.

    Results  After adjusting for baseline confounding variables with regard to the Unified Parkinson’s Disease Rating Scale (UPDRS) Part II score, the UPDRS Part III score, the modified Rankin Scale score, level of education, and treatment group, we assessed the rate of change for the following measurements: the UPDRS Part II score; the UPDRS Part III score; the Schwab and England Independence Scale score (which measures activities of daily living); the Total Functional Capacity scale; the 39-item Parkinson’s Disease Questionnaire, summary index, and activities of daily living subscale; and version 2 of the 12-item Short Form Health Survey Physical Summary and Mental Summary. Variables reaching the statistical threshold in univariate analysis were entered into a multivariable Cox proportional hazards model using time to symptomatic treatment as the dependent variable. More rapid change (ie, worsening) in the UPDRS Part II score (hazard ratio, 1.15 [95% CI, 1.08-1.22] for 1 scale unit change per 6 months), the UPDRS Part III score (hazard ratio, 1.09 [95% CI, 1.06-1.13] for 1 scale unit change per 6 months), and the Schwab and England Independence Scale score (hazard ratio, 1.29 [95% CI, 1.12-1.48] for 5 percentage point change per 6 months) was associated with earlier need for symptomatic therapy.

    Conclusions and Relevance  In early PD, the UPDRS Part II score and Part III score and the Schwab and England Independence Scale score can be used to measure disease progression, whereas the 39-item Parkinson’s Disease Questionnaire and summary index, Total Functional Capacity scale, and the 12-item Short Form Health Survey Physical Summary and Mental Summary are not sensitive to change.

    Trial Registration  clinicaltrials.gov Identifiers: NCT00063193 and NCT00076492

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