Terazosin Therapy for Parkinson's Disease

Overseen By MaryClare Kelly, MS

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: Cedars-Sinai Medical Center

Must not be taking: Beta-blockers, Phosphodiesterase inhibitors

Disqualifiers: Dementia, Severe depression, Hypertension, Diabetes, others

No Placebo Group

Prior Safety Data

Approved in 2 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial is testing terazosin, a medication that helps relax muscles and improve blood flow, on people with early signs of Parkinson's disease risks. The goal is to see if it can slow down or prevent the progression of the disease. Terazosin and similar drugs were recently found to enhance energy production and reduce Parkinson's disease progression in animal studies and human data.

Will I have to stop taking my current medications?

The trial requires that you stop taking certain medications, such as beta-adrenergic antagonists and phosphodiesterase type 5 inhibitors like Viagra, Cialis, or Levitra. If you are using any investigational drugs, you must stop them at least 30 days before screening.

What data supports the effectiveness of the drug Terazosin for Parkinson's disease?

Research suggests that Terazosin, a drug that enhances energy production in cells, may slow the progression of motor symptoms and protect against cognitive decline in Parkinson's disease patients. Studies in animals and humans indicate that it could be neuroprotective, potentially reducing the risk of developing Parkinson's disease. ^{1 2 3 4 5}

Is Terazosin safe for humans?

Terazosin, also known as Hytrin, is generally considered safe for human use as it has been used for treating conditions like high blood pressure and benign prostatic hyperplasia (enlarged prostate) for many years. While specific safety data for Parkinson's disease is limited, its long history of use in other conditions suggests a well-established safety profile. ^{6 7 8 9 10}

How does the drug Terazosin differ from other treatments for Parkinson's disease?

Terazosin is unique because it is primarily used to treat high blood pressure and benign prostatic hyperplasia (enlarged prostate), but it is being explored for Parkinson's disease due to its potential effects on cellular energy production, which may help protect nerve cells. ^{11 12 13 14 15}

Research Team

Michele Tagliati, MD, FAAN

Principal Investigator

Cedars-Sinai Medical Center

Eligibility Criteria

This trial is for people who were part of a previous Parkinson's study, can consent, and don't have conditions like secondary Parkinsonism, dementia, severe depression, recent heart issues or certain other health problems. It's not for those with low blood pressure, untreated sleep apnea, heart failure or kidney issues.

Inclusion Criteria

I understand the details of the clinical trial and can consent to participate.

Enrolled in the study 'The Effect of alpha1- adrenergic receptor antagonist Therapy on Cardiac and Striatal Transporter Uptake in Pre-Motor and Symptomatic Parkinson's Disease' (STUDY #000540)

Exclusion Criteria

I have no health issues that prevent me from taking terazosin.

Use of investigational drugs within 30 days before screening

I have had a severe heart condition causing very low blood pressure.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive terazosin therapy and undergo MIBG scan, DAT scan, and NM-MRI. Subjects return for research visits and imaging every six months.

3 years

Every 6 months

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments of motor and non-motor symptoms.

6 months

Open-label extension (optional)

Participants may opt into continuation of treatment long-term to further assess the effects of terazosin.

Long-term

Treatment Details

Interventions

• Terazosin (Alpha-1 Adrenergic Blocker)

Trial Overview The study tests the long-term effects of Terazosin on people at risk for pre-motor Parkinson's disease. Researchers will look at brain imaging changes and compare them to motor and non-motor symptoms as well as cardiac function over time.

Participant Groups

Group I: terazosin therapy extension Experimental Treatment 1 Intervention

Primary procedures in this study are MIBG scan, DAT scan, NM-MRI, and terazosin medication. Subjects will return for research visits and imaging every six months for three years. The investigators hypothesize that the rate of decline in DAT scan123I-Ioflupane uptake will be slower in subjects who have received the alpha1- adrenergic receptor antagonist terazosin, resulting in a decreased clinical conversion rate to parkinsonism.

Who Is Running the Clinical Trial?

Cedars-Sinai Medical Center

Lead Sponsor

Trials

523

Recruited

165,000+

Findings from Research

In rodent models of Parkinson's disease, terazosin was found to preserve cognitive function, suggesting it may protect against cognitive symptoms associated with the disease.

In a study of Parkinson's patients, those starting terazosin had a lower risk of being diagnosed with dementia compared to those on tamsulosin, indicating that terazosin's mechanism of enhancing glycolysis may provide additional cognitive benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Glycolysis-enhancing α1-adrenergic antagonists modify cognitive symptoms related to Parkinson's disease. Weber, MA., Sivakumar, K., Tabakovic, EE., et al.[2023]

In a 12-week pilot study involving 13 participants with Parkinson's disease, terazosin (TZ) significantly increased ATP levels in both the brain and blood, indicating its potential to enhance energy metabolism.

While TZ showed promise in engaging its target and improving ATP levels, some participants experienced mild dizziness and orthostatic hypotension, leading to three dropouts, highlighting the need for further safety assessments in larger studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A pilot to assess target engagement of terazosin in Parkinson's disease. Schultz, JL., Brinker, AN., Xu, J., et al.[2023]

A large cohort study involving over 52,000 men in Denmark and nearly 95,000 in the US found that those using terazosin, doxazosin, or alfuzosin had a significantly lower risk of developing Parkinson's disease (PD) compared to those using tamsulosin, with hazard ratios indicating a protective effect.

The study also revealed a dose-response relationship, where longer use of terazosin/doxazosin/alfuzosin correlated with a progressively lower risk of PD, suggesting that these medications may have a beneficial effect on delaying or preventing the disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association of Glycolysis-Enhancing α-1 Blockers With Risk of Developing Parkinson Disease. Simmering, JE., Welsh, MJ., Liu, L., et al.[2023]

In a study involving eight patients with Parkinson's Disease, terguride significantly improved neurological symptoms, achieving an average of 50.6% improvement on the Webster scale after 21 days at the highest dose of 1.2 mg.

Terguride demonstrated efficacy similar to dopamine agonists in alleviating symptoms like bradykinesia and rigidity, but importantly, it did not produce the typical side effects associated with those medications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Therapeutic efficacy of a partial dopamine agonist in drug-free parkinsonian patients. Corsini, GU., Bonuccelli, U., Rainer, E., et al.[2019]

Tandospirone citrate, a selective 5-HT1A agonist, was administered to 10 patients with Parkinson's disease and L-DOPA-induced dyskinesia, showing a 50% effectiveness in reducing dyskinesia severity after 12 weeks.

While tandospirone alleviated dyskinesia in some patients, it also caused slight worsening of parkinsonian features in half of the participants, indicating the need for careful monitoring and further research to confirm its safety and efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Tandospirone citrate, a selective 5-HT1A agonist, alleviates L-DOPA-induced dyskinesia in patients with Parkinson's disease]. Kannari, K., Kurahashi, K., Tomiyama, M., et al.[2013]

In a study of 29 patients with Tourette syndrome, aripiprazole was found to be safe and reasonably well tolerated, with a discontinuation rate of 20.7% due to adverse effects.

The most common side effects included sedation (30%) and sleep problems (17%), but most adverse effects were not severe, indicating that while some patients may experience issues, the overall tolerability of aripiprazole is favorable.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tolerability profile of aripiprazole in patients with Tourette syndrome. Cavanna, AE., Selvini, C., Termine, C., et al.[2015]

In a pilot study involving 14 patients with Parkinson's disease, rimantadine showed potential antiparkinsonian effects, with 71% of participants reporting a subjective improvement in symptoms and a significant 20% improvement in motor function as measured by the Unified Parkinson's Disease Rating Scale.

The treatment was well-tolerated, with mild side effects, primarily nausea, and a notable improvement in rigidity, suggesting that rimantadine could be a promising option for managing Parkinson's symptoms, warranting further investigation in a larger, controlled trial.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A pilot study on the motor effects of rimantadine in Parkinson's disease. Evidente, VG., Adler, CH., Caviness, JN., et al.[2019]

An 18-year-old male with Tourette's disorder experienced an acute dystonic episode after just 3 days of treatment with aripiprazole, despite the medication being effective at a low dose of 10 mg daily.

This case highlights that aripiprazole, a partial dopamine agonist, can still cause acute dystonia, which is unexpected given its generally favorable safety profile and low incidence of extrapyramidal symptoms reported in short-term trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acute dystonia with low-dosage aripiprazole in Tourette's disorder. Fountoulakis, KN., Siamouli, M., Kantartzis, S., et al.[2015]

ADS-5102, an extended-release formulation of amantadine, allows for once-daily dosing at bedtime, resulting in higher plasma concentrations of the drug during the day when Parkinson's disease symptoms are most prevalent.

In a phase II/III study, ADS-5102 demonstrated a different pharmacokinetic profile compared to immediate-release amantadine, suggesting it may effectively reduce dyskinesia with potentially fewer central nervous system side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pharmacokinetics of ADS-5102 (Amantadine) Extended Release Capsules Administered Once Daily at Bedtime for the Treatment of Dyskinesia. Hauser, RA., Pahwa, R., Wargin, WA., et al.[2022]

In a pilot study involving 7 patients with Parkinson's disease, naftazone showed potential efficacy by significantly reducing 'ON-time with troublesome dyskinesia' for 5 out of 7 patients, suggesting it may help manage dyskinesia symptoms.

While naftazone was generally well-tolerated, 4 patients experienced adverse events, mostly mild to moderate, indicating the need for careful monitoring in future studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A proof-of-concept, randomized, placebo-controlled, multiple cross-overs (n-of-1) study of naftazone in Parkinson's disease. Rascol, O., Ferreira, J., Nègre-Pages, L., et al.[2022]

In a study involving 11 Parkinson's disease patients experiencing severe symptoms, the addition of 1 mg/day of terguride to their stable levodopa treatment significantly reduced dyskinesias and motor fluctuations.

Terguride, which acts as a partial dopamine agonist, also led to a slight but significant improvement in overall Parkinsonian symptoms, suggesting its potential as a beneficial adjunct therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Terguride in the treatment of Parkinson disease: preliminary experience. Giovannini, P., Piccolo, I., Genitrini, S., et al.[2019]

In a study involving 31 patients with torsion dystonia, trihexyphenidyl demonstrated a clinically significant response in 71% of participants, indicating its efficacy in managing this condition.

After an average follow-up of 2.4 years, 68% of patients continued using trihexyphenidyl, with 42% reporting considerable or dramatic benefits, and the 30-mg dose was generally well tolerated.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Torsion dystonia: a double-blind, prospective trial of high-dosage trihexyphenidyl. Burke, RE., Fahn, S., Marsden, CD.[2019]

The combination of eltoprazine and preladenant with low-dose l-dopa effectively reduced dyskinetic-like behavior in animal models of Parkinson's disease without impairing the motor benefits of l-dopa, suggesting a potential new treatment strategy.

In both rat and monkey models, this combination therapy not only prevented worsening of motor performance but also maintained the therapeutic effects of l-dopa, indicating its efficacy in managing both dyskinesia and motor symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Antidyskinetic effect of A2A and 5HT1A/1B receptor ligands in two animal models of Parkinson's disease. Pinna, A., Ko, WK., Costa, G., et al.[2017]

The novel 5-HT1A receptor biased agonist F13714 effectively abolished L-DOPA-induced dyskinesia (LID) in hemiparkinsonian rats at very low doses, suggesting a strong potential for reducing dyskinesia in Parkinson's disease treatment.

F13714's effects were linked to its ability to inhibit serotonin release while slightly increasing dopamine release, indicating that targeting 5-HT1A autoreceptors may offer a promising strategy for improving L-DOPA therapy in Parkinson's patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Activity of serotonin 5-HT(1A) receptor 'biased agonists' in rat models of Parkinson's disease and L-DOPA-induced dyskinesia. Iderberg, H., McCreary, AC., Varney, MA., et al.[2015]

References

1. United States pubmed.ncbi.nlm.nih.gov

Glycolysis-enhancing α1-adrenergic antagonists modify cognitive symptoms related to Parkinson's disease. [2023]

2. England pubmed.ncbi.nlm.nih.gov

A pilot to assess target engagement of terazosin in Parkinson's disease. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Association of Glycolysis-Enhancing α-1 Blockers With Risk of Developing Parkinson Disease. [2023]

4. Austria pubmed.ncbi.nlm.nih.gov

Therapeutic efficacy of a partial dopamine agonist in drug-free parkinsonian patients. [2019]

5. Japan pubmed.ncbi.nlm.nih.gov

[Tandospirone citrate, a selective 5-HT1A agonist, alleviates L-DOPA-induced dyskinesia in patients with Parkinson's disease]. [2013]

6. United States pubmed.ncbi.nlm.nih.gov

Tolerability profile of aripiprazole in patients with Tourette syndrome. [2015]

7. United States pubmed.ncbi.nlm.nih.gov

A pilot study on the motor effects of rimantadine in Parkinson's disease. [2019]

8. United States pubmed.ncbi.nlm.nih.gov

Acute dystonia with low-dosage aripiprazole in Tourette's disorder. [2015]

9. Switzerland pubmed.ncbi.nlm.nih.gov

Pharmacokinetics of ADS-5102 (Amantadine) Extended Release Capsules Administered Once Daily at Bedtime for the Treatment of Dyskinesia. [2022]

10. England pubmed.ncbi.nlm.nih.gov

A proof-of-concept, randomized, placebo-controlled, multiple cross-overs (n-of-1) study of naftazone in Parkinson's disease. [2022]

11. Italy pubmed.ncbi.nlm.nih.gov

Terguride in the treatment of Parkinson disease: preliminary experience. [2019]

12. United States pubmed.ncbi.nlm.nih.gov

Torsion dystonia: a double-blind, prospective trial of high-dosage trihexyphenidyl. [2019]

13. England pubmed.ncbi.nlm.nih.gov

The effect of chronic administration of sarizotan, 5-HT1A agonist/D3/D4 ligand, on haloperidol-induced repetitive jaw movements in rat model of tardive dyskinesia. [2013]

14. United States pubmed.ncbi.nlm.nih.gov

Antidyskinetic effect of A2A and 5HT1A/1B receptor ligands in two animal models of Parkinson's disease. [2017]

15. England pubmed.ncbi.nlm.nih.gov

Activity of serotonin 5-HT(1A) receptor 'biased agonists' in rat models of Parkinson's disease and L-DOPA-induced dyskinesia. [2015]