Oral ENT-01 Targets Enteric Neurons to Treat Constipation in Parkinson Disease : A Randomized Controlled Trial

Parkinson disease (PD) is associated with α-synuclein (αS) aggregation within enteric neurons. ENT-01 inhibits the formation of αS aggregates and improved constipation in an open-label study in patients with PD. To evaluate the safety and efficacy of oral ENT-01 for constipation and neurologic sympt...

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Bibliographic Details
Published in:	Annals of internal medicine Vol. 175; no. 12; pp. 1666 - 1674
Main Authors:	Camilleri, Michael, Subramanian, Thyagarajan, Pagan, Fernando, Isaacson, Stuart, Gil, Ramon, Hauser, Robert A, Feldman, Mary, Goldstein, Mark, Kumar, Rajeev, Truong, Daniel, Chhabria, Nisha, Walter, Benjamin L, Eskenazi, Jonathan, Riesenberg, Robert, Burdick, Daniel, Tse, Winona, Molho, Eric, Robottom, Bradley, Bhatia, Perminder, Kadimi, Srinath, Klos, Kevin, Shprecher, David, Marquez-Mendoza, Otto, Hidalgo, Gonzalo, Grill, Stephen, Li, George, Mandell, Howard, Hughes, Mary, Stephenson, Sharisse, Vandersluis, Joel, Pfeffer, Michael, Duker, Andrew, Shivkumar, Vikram, Kinney, William, MacDougall, James, Zasloff, Michael, Barbut, Denise
Format:	Journal Article
Language:	English
Published:	United States American College of Physicians 01-12-2022
Subjects:	Clinical trials Constipation Defecation Dementia Double-Blind Method Humans Medical treatment Neurons Parkinson Disease Parkinson's disease Placebo effect Treatment Outcome
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Summary:	Parkinson disease (PD) is associated with α-synuclein (αS) aggregation within enteric neurons. ENT-01 inhibits the formation of αS aggregates and improved constipation in an open-label study in patients with PD. To evaluate the safety and efficacy of oral ENT-01 for constipation and neurologic symptoms in patients with PD and constipation. Randomized, placebo-controlled phase 2b study. (ClinicalTrials.gov: NCT03781791). Outpatient. 150 patients with PD and constipation. ENT-01 or placebo daily for up to 25 days. After baseline assessment of constipation severity, daily dosing was escalated to the prokinetic dose, the maximum dose (250 mg), or the tolerability limit, followed by a washout period. The primary efficacy end point was the number of complete spontaneous bowel movements (CSBMs) per week. Neurologic end points included dementia (assessed using the Mini-Mental State Examination [MMSE]) and psychosis (assessed using the Scale for the Assessment of Positive Symptoms adapted for PD [SAPS-PD]). The weekly CSBM rate increased from 0.7 to 3.2 in the ENT-01 group versus 0.7 to 1.2 in the placebo group ( < 0.001). Improvement in secondary end points included SBMs ( = 0.002), stool consistency ( < 0.001), ease of passage ( = 0.006), and laxative use ( = 0.041). In patients with dementia, MMSE scores improved by 3.4 points 6 weeks after treatment in the ENT-01 group ( = 14) versus 2.0 points in the placebo group ( = 14). Among patients with psychosis, SAPS-PD scores improved from 6.5 to 1.7 six weeks after treatment in the ENT-01 group ( = 5) and from 6.3 to 4.4 in the placebo group ( = 6). ENT-01 was well tolerated, with no deaths or drug-related serious adverse events. Adverse events were predominantly gastrointestinal, including nausea (34.4% [ENT-01] vs. 5.3% [placebo]; < 0.001) and diarrhea (19.4% [ENT-01] vs. 5.3% [placebo]; = 0.016). Longer treatment periods need to be investigated in future studies. ENT-01 was safe and significantly improved constipation. Enterin, Inc.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	0003-4819 1539-3704
DOI:	10.7326/M22-1438