Study of Rifampicin in Multiple System Atrophy
Condition: Multiple System Atrophy
MeSH terms: Multiple System Atrophy; Shy-Drager Syndrome; Atrophy
Intervention: Rifampicin; placebo
Intervention description: 300 mg, 2 times daily; placebo
Intervention MeSH terms: Riboflavin; Rifampin
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Enrollment: 100.0
Sex: All
Minimum age: 30 Years
Maximum age: 80 Years
Healthy volunteers: No

Summary:

      The purpose of this study was to determine whether Rifampicin was effective in slowing or
      reversing the progression of multiple system atrophy (MSA). Research studies indicate that
      there is an abnormality in protein synthesis and structure in parts of the brain responsible
      for MSA (protein misfolding) and the drug Rifampicin could potentially prevent or reverse
      this protein alteration. The study was done on participants with early MSA. The study
      consisted of taking the drug 2 times a day for 12 months. Participants underwent an
      evaluation of symptoms and function and will underwent a neurologic examination at the
      beginning of the study, at 6 months and at 12 months. They were also be contacted at 3 and 9
      months by telephone. Studies were done at 10 participating sites.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Participants aged 30-80 years old with a diagnosis of Possible or Probable MSA of the
             parkinsonian subtype (MSA-P) or cerebellar subtype (MSA-C) according to The Gilman
             Criteria (2008).

          -  Participants who are less than 4 years from the time of documented MSA diagnosis.

          -  Participants with an anticipated survival of at least 3 years in the opinion of the
             investigator.

          -  Participants who are willing and able to give informed consent.

          -  "Normal" cognition as assessed by Mini-Mental State Examination (MMSE). We will
             require a value >24.

          -  Patients should be able to swallow capsules whole.

        Exclusion Criteria:

          -  Pregnant or lactating females.

          -  Unified Multiple System Atrophy Rating Scale (UMSARS) score >17 on modified UMSARS I
             (question 11 eliminated).

          -  Participants with a clinically significant or unstable medical or surgical condition
             that, in the opinion of the investigator, might preclude safe completion of the study
             or might affect the results of the study. These include conditions causing significant
             Central Nervous System (CNS) or autonomic dysfunction, including congestive heart
             failure, recent (<6 months) myocardial infarct, thrombocytopenia (<50 x10(9)/L),
             immunosuppressed state, severe uncontrolled hypertension, severe cardiopulmonary
             disease, severe anemia (<8g/dl), severe liver or kidney disease (creatinine >2.3
             mg/dl) uncontrolled diabetes mellitus (HbA1c >10g%), alcoholism, malignant neoplasms,
             amyloidosis, uncontrolled hypothyroidism, unstable peripheral neuropathies, concurrent
             infections, orthopedic problems that compromise mobility and activity of daily living,
             severe cerebrovascular accidents (such as hemiplegia, aphasia and non-dominant
             parietal lobe syndrome), and neurotoxins or neuroactive drug exposure, parkinsonism
             due to drugs (including neuroleptics, a-methyldopa, reserpine, metoclopramide).

          -  Participants who have taken any investigational products within 60 days prior to
             baseline.

          -  Women of child-bearing potential who do not practice an acceptable method of birth
             control. Acceptable methods of birth control in this study are: surgical
             sterilization, intrauterine devices, partner's vasectomy, a double-protection method
             (condom or diaphragm with spermicide), hormonal contraceptive drug (i.e., oral
             contraceptive, contraceptive patch, long-acting injectable contraceptive) with a
             required second mode of contraception.

          -  Participants taking Tetrabenazine, Rasagiline or Selegiline. The participant will
             qualify for the Rifampicin study after they have stopped these drugs for 3 months

          -  Participants known to have porphyria.

          -  Participants with abnormal liver function tests defined as 1.5 times the upper limit
             of normal.

          -  Concomitant therapy with anticholinergic, alpha and beta adrenergic antagonists, or
             other medications that affect autonomic function will be stopped prior to autonomic
             evaluation.

          -  The regular use of neuroleptics within the six months prior to the initial evaluation.
             Occasional use of a neuroleptic as an anti-emetic in the past is allowed, providing
             not more than three doses were taken within the previous 12 months.

          -  Since Rifampicin has significant drug-drug interactions, particular attention has been
             devoted to the use of concomitant medications. Considering the target population, we
             will exclude participants taking antifungal medication (itraconazole), antiarrhythmics
             like amiodarone, digitalis and lorcainide, female hormones and quetiapine (Seroquel).
             Use of methylphenidate, cinnarizine, reserpine, amphetamine, atypical antipsychotics
             such as risperidone, olanzapine, and quetiapine or a Monoamine oxidase A (MAO-A)
             inhibitor within one month prior to the baseline visit are also exclusionary.

          -  Diseases with features of Parkinson's Disease; e.g., progressive supranuclear palsy,
             essential tremor, inherited cerebellar degeneration, or postencephalitic parkinsonism.

          -  Dementia (DSM-IV criteria - Amer. Psych. Association, 1994). The score on the MMSE
             must be >24.