Movement disorders : official journal of the Movement Disorder Society · 2025
Feasibility of Simon Two-Stage Futility Trials in People with Early, Symptomatically Treated Parkinson's Disease.
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Koch Marcus W, Kalia Lorraine V, Sarna Justyna, Aquino Camila, Wile Daryl, Mestre Tiago A, Schlossmacher Michael G, D'Haeseleer Miguel, Mostert Jop, Strijbis Eva M M, Uitdehaag Bernard, McPherson Tarrant, Cutter Gary
Аннотация
BACKGROUND: Disease-modifying treatments are a critical unmet need in Parkinson's disease (PD). Phase 2 futility trials using the Simon two-stage design offer an efficient strategy to evaluate candidate treatments in an early PD population.
OBJECTIVE: The aim was to assess the feasibility of Simon two-stage futility trials in early, levodopa-treated PD subjects using historical patient-level clinical trial datasets.
METHODS: We analyzed patient-level data from two completed trials, that is, STEADY-PD 3 (n = 336, untreated at baseline) and NET-PD LS1 (n = 1741, treated at baseline). We defined disability progression as a ≥5-point worsening on the motor (Part III) subscore of the Unified Parkinson's Disease Rating Scale at 12 and 24 months. We tested multiple scenarios, including the reanalysis of STEADY-PD 3 participant data after starting dopaminergic treatment. We assessed predictors of progression using logistic regression analysis and calculated sample size estimates.
RESULTS: Both trials showed similar progression rates at 12 months (~26%) and 24 months (~35%). In NET-PD LS1, older age and lower baseline motor scores were associated with worsening; no predictors were significant in STEADY-PD 3. We estimate that in futility trials that use OFF-state scores to assess motor performance, 39 early PD participants are required to detect significant disability worsening over an observation period of 12 months.
CONCLUSIONS: Phase 2 futility trials using the Simon two-stage methodology are feasible in early PD, including in treated and untreated patients. OFF-state scores are preferable to ON-state scores as the primary outcome measure. Futility trials offer a smaller-scale, faster, and cost-effective approach to assessing new candidate treatments in PD. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
OBJECTIVE: The aim was to assess the feasibility of Simon two-stage futility trials in early, levodopa-treated PD subjects using historical patient-level clinical trial datasets.
METHODS: We analyzed patient-level data from two completed trials, that is, STEADY-PD 3 (n = 336, untreated at baseline) and NET-PD LS1 (n = 1741, treated at baseline). We defined disability progression as a ≥5-point worsening on the motor (Part III) subscore of the Unified Parkinson's Disease Rating Scale at 12 and 24 months. We tested multiple scenarios, including the reanalysis of STEADY-PD 3 participant data after starting dopaminergic treatment. We assessed predictors of progression using logistic regression analysis and calculated sample size estimates.
RESULTS: Both trials showed similar progression rates at 12 months (~26%) and 24 months (~35%). In NET-PD LS1, older age and lower baseline motor scores were associated with worsening; no predictors were significant in STEADY-PD 3. We estimate that in futility trials that use OFF-state scores to assess motor performance, 39 early PD participants are required to detect significant disability worsening over an observation period of 12 months.
CONCLUSIONS: Phase 2 futility trials using the Simon two-stage methodology are feasible in early PD, including in treated and untreated patients. OFF-state scores are preferable to ON-state scores as the primary outcome measure. Futility trials offer a smaller-scale, faster, and cost-effective approach to assessing new candidate treatments in PD. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.