Parkinson’s progression not slowed by urate-elevating strategy

Urate-elevating inosine has struck out as a potential treatment for early Parkinson’s disease (PD), according to US researchers.

Despite its gout crystallopathic effects, urate’s antioxidant properties have made it a pursued therapeutic target for PD, particularly after observational studies showed an inverse association between urate levels and PD progression.

However a Phase 3 trial has put paid to those hopes. The study assessed 7.1–8.0 mg/dL oral inosine’s ability to slow disease progression in 273 early PD patients who did not yet require dopaminergic medication and had striatal dopamine transporter deficiency and serum urate below the population median concentration (<5.8 mg/dL).

It found clinical progression rates were not significantly different between inosine and placebo groups at 2 years’ follow-up (Movement Disorder Society Unified Parkinson’s Disease Rating Scale [MDS-UPDRS] score: 11.1, 95% CI: 9.7–12.6 points per year versus MDS-UPDRS score: 9.9, 95% CI: 8.4–11.3 points per year, difference: 1.26, 95% CI: -0.59–3.11 points per year, P = 0.18), despite the inosine group achieving sustained serum urate elevation (difference: 2.02 mg/dL, 95% CI: 1.85–2.19 mg/dL, P < 0.001).

There were no significant differences in dopamine transporter binding loss either, the authors reported in JAMA.

While inosine patients experienced less adverse events (7.4 versus 13.1 per 100 patient years, they did have more kidney stones (7.0 versus 1.4 stones per 100 patient-years), the authors wrote.

“Oxidative damage is thought to play a role in the underlying dopaminergic neuron degeneration of PD, and urate protects dopaminergic neurons in cellular and animal models of PD,” the authors wrote.

Additionally, elevated serum urate has been shown to reduce PD risk in healthy individuals, they noted.

Nevertheless, the authors’ prespecified interim futility analysis, which showed no significant clinical difference in PD progression rates between inosine and placebo, led them to finish their study early and conclude that their findings “do not support the use of inosine as a treatment for early PD”.

Doctor registration fees hiked

Registration fees for doctors are to increase by 3% this year, while many other regulated healthcare professions have seen their fees frozen or reduced.

The Medical Board of Australia has set registration fees for 2021–2022 at $835, which is says represents an increase limited to indexation at 3%.
However, national boards for other health professions have frozen annual registration fees, with the Nursing and Midwifery Board of Australia has frozen its registration fees for 2021–2022 at $180.

Registration fees have also been frozen by boards regulating Aboriginal and Torres Strait Island health practitioners, Chinese Medicine practitioners, chiropractors, medical radiation practitioners and podiatrists. Some boards such as those regulating psychologists and paramedics have reduced registration fees by up to 10%.

Boards regulating pharmacy and physiotherapy, occupational therapists and optometrists have increased fees by 3%
AHPRA Chief Executive Officer Martin Fletcher said the regulator recognised the impact that the COVID-19 pandemic lockdowns may have had on some practitioners’ practice.

“We have put in place a registration and renewal fee payment plan for any practitioners who are experiencing financial hardship,’ he said.

Opioid stewardship draft standards released

A draft standard for opioid analgesic stewardship in acute pain clinical care is currently open for consultation.

Clinicians are encouraged to comment on the Australian Commission on Safety and Quality in Health Care’s proposed standard, which features nine quality statements and a set of indicators to support its implementation.

Under the standard, clinicians would need to share pharmacological and non-pharmacological treatment decision making with patients and carers and prescribe analgesics based on an individual patient’s function, pain intensity and opioid-related harm risk.

“An opioid analgesic can be used if the potential benefit outweighs the potential harm,” the standard read.

Patients on opioid analgesics should be managed according to a locally approved treatment pathway to mitigate potential opioid-related harm if they are at increased risk, and assessed regularly to ensure the treatment is effective, safe and appropriate for the patient’s stage of care, it said.