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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.00424

Nicotine bitartrate reduces falls and freezing of gait in Parkinson disease: A reanalysis

 Abraham Lieberman1*, Thurmon Lockhart2,  Markey Olson1, Victoria Smith1, Christopher Frames1, Arshia Sadreddin3, Margaret McCauley1 and  Elizabeth Ludington4
  • 1Barrow Neurological Institute (BNI), United States
  • 2Ira A. Fulton Schools of Engineering, Arizona State University, United States
  • 3California Pacific Neuroscience Institute, United States
  • 4Neuraltus Pharmaceuticals Inc, United States

Objective: Determine if NC001, an oral formulation of nicotine that reduces levodopa-induced dyskinesias (LIDs) in MPTP-Parkinson monkeys, could reduce falls, freezing of gait (FOG), and LIDs in Parkinson disease (PD) patients.
Methods: Previously collected data from a study analyzing the effects of NC001 on LIDs in PD patients was reanalyzed. Because indirect-acting cholinergic drugs are sometimes helpful in reducing falls, we hypothesized that NC001, a direct-acting cholinergic agonist, could reduce falls in PD. The original 12-center, double-blind, randomized trial enrolled 65 PD patients. NC001 or placebo was administered 4 times per day for 10 weeks, beginning at 4 mg/day and escalating to 24 mg/day. Assessments included the Unified Dyskinesia Rating Scale (UDysRS) and Parts II-III of the original Unified Parkinson’s Disease Rating Scale (UPDRS).
Results: Randomization (1:1) resulted in 35 patients on NC001 and 30 on placebo at baseline. Thirty and 27 patients, respectively, had data available for an intent-to-treat analysis. NC001 was safe and well tolerated. After 10 weeks, NC001 patients (14/30) had a significant reduction in falls versus placebo patients (3/27) (p=0.0041) as assessed by UPDRS Part II. NC001 patients (12/30) also had significantly reduced FOG versus placebo patients (4/27) (p=0.0043). NC001 patients, compared with placebo patients, had a significant improvement (p=0.01) in UDysRS ambulation subtest (40% vs 3%, respectively). Although NC001 patients had a greater reduction in dyskinesias on the UDysRS than placebo patients (30% vs 19%, respectively), this was not significant (p=0.09).
Conclusions: NC001 significantly improved two refractory symptoms of PD, falls and FOG. The reduction in falls and FOG is attributed to selective stimulation of nicotinic receptors.
Clinical Trial: Conducted under IND 105, 268, serial number 0000. ClinicalTrials.gov identifier NCT00957918.

Keywords: Dyskinesia, falls, freezing of gait, Nicotine, Parkinson Disease

Received: 22 Oct 2018; Accepted: 08 Apr 2019.

Edited by:

Ruey-Meei WU, National Taiwan University, Taiwan

Reviewed by:

Pedro Chana, Universidad de Santiago de Chile, Chile
Yih-Ru Wu, Chang Gung Memorial Hospital, Taiwan  

Copyright: © 2019 Lieberman, Lockhart, Olson, Smith, Frames, Sadreddin, McCauley and Ludington. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Abraham Lieberman, Barrow Neurological Institute (BNI), Phoenix, United States, neuropub.lieberman@barrowneuro.org