Exenatide once a week versus placebo as a potential disease-modifying treatment for people with Parkinson's disease in the UK: a phase 3, multicentre, double-blind, parallel-group, randomised, placebo-controlled trial.
Creators: name: Vijiaratnam, Nirosen
name: Girges, Christine
name: Auld, Grace
name: McComish, Rachel
name: King, Alexa
name: Skene, Simon S
name: Hibbert, Steve
name: Wong, Alan
name: Melander, Sabina
name: Gibson, Rachel
name: Matthews, Helen
name: Dickson, John
name: Carroll, Camille
name: Patrick, Abigail
name: Inches, Jemma
name: Silverdale, Monty
name: Blackledge, Bethan
name: Whiston, Jessica
name: Hu, Michele
name: Welch, Jessica
name: Duncan, Gordon
name: Power, Katie
name: Gallen, Sarah
name: Kerr, Jacqueline
name: Chaudhuri, K Ray
name: Batzu, Lucia
name: Rota, Silvia
name: Jabbari, Edwin
name: Morris, Huw
name: Limousin, Patricia
name: Greig, Nigel
name: Li, Yazhou
name: Libri, Vincenzo
name: Gandhi, Sonia
name: Athauda, Dilan
name: Chowdhury, Kashfia
name: Foltynie, Tom
Publisher: name: The Francis Crick Institute
Year: 2025
Subjects: classificationCode: Stem Cells
subject: Stem Cells
classificationCode: Neurosciences
subject: Neurosciences
subject: FOS: Clinical medicine
classificationCode: Cell Biology
subject: Cell Biology

description: BACKGROUND: GLP-1 receptor agonists have neurotrophic properties in in-vitro and in-vivo models of Parkinson's disease and results of epidemiological studies and small randomised trials have suggested possible benefits for risk and progression of Parkinson's disease. We aimed to establish whether the GLP-1 receptor agonist, exenatide, could slow the rate of progression of Parkinson's disease. METHODS: We did a phase 3, multicentre, double-blind, parallel-group, randomised, placebo-controlled trial at six research hospitals in the UK. Participants were aged 25-80 years with a diagnosis of Parkinson's disease, were at Hoehn and Yahr stage 2·5 or less when on dopaminergic treatment, and were on dopaminergic treatment for at least 4 weeks before enrolment. Participants were randomly assigned (1:1) using a web-based system with minimisation according to Hoehn and Yahr stage and study site to receive extended-release exenatide 2 mg by subcutaneous pen injection once per week over 96 weeks, or visually identical placebo. All participants and all research team members at study sites were masked to randomisation allocation. The primary outcome was the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III score, off dopaminergic medication at 96 weeks, analysed in the intention-to-treat population using a linear mixed modelling approach. This study is registered with ISRCTN (14552789), EudraCT (2018-003028-35), and ClinicalTrials.gov (NCT04232969). FINDINGS: Between Jan 23, 2020, and April 23, 2022, 215 participants were screened for eligibility, of whom 194 were randomly assigned to exenatide (n=97) or placebo (n=97). 56 (29%) participants were female and 138 (71%) were male. 92 participants in the exenatide group and 96 in the placebo group had at least one follow-up visit and were included in analyses. At 96 weeks, MDS-UPDRS III OFF-medication scores had increased (worsened) by a mean of 5·7 points (SD 11·2) in the exenatide group, and by 4·5 points (SD 11·4) points in the placebo group (adjusted coefficient for the effect of exenatide 0·92 [95% CI -1·56 to 3·39]; p=0·47). Nine (9%) participants in the exenatide group had at least one serious adverse event compared with 11 (11%) in the placebo group. INTERPRETATION: Our findings suggest that exenatide is safe and well tolerated. We found no evidence to support exenatide as a disease-modifying treatment for people with Parkinson's disease. Studies with agents that show better target engagement or in specific subgroups of patients are needed to establish whether there is any support for the use of GLP-1 receptor agonists for Parkinson's disease. FUNDING: National Institute for Health and Care Research and Cure Parkinson's.