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Could ketamine help dyskinesia in Parkinson’s Disease patients?

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Could ketamine help dyskinesia in Parkinson’s Disease patients?

Currently, there is no cure for Parkinson’s Disease, however, certain medications can help improve symtoms. A Phase 2 clinical trial is now aiming to explore the efficacy of ketamine as a treatment for symptoms caused by certain Parkinson’s medication.

More than ten million people across the globe are living with Parkinson’s Disease, a condition that affects the brain and is caused by a loss of nerve cells. Some treatments can help improve motor deficit symptoms, such as the medication levodopa and other dopamine agonists. These medications, which have been in use for nearly 50 years, restore the dopamine deficits in the brain caused by the lost nerve cells.

Years of using dopamine agonists, however, can cause dyskinesia in some patients, a condition characterised by involuntary muscle movements. The cause of this is currently not well understood.

One company, PharmaTher, is now aiming to find out if ketamine could be an effective treatment for levodopa-induced dyskinesia with a randomised, double-blind, active placebo-controlled Phase 2 “KET-LID” trial.

PharmaTher CEO, Fabio Chianelli, commented: “Initiation of the Phase 2 clinical trial of ketamine to treat Parkinson’s disease, or the KET-LID trial, is a significant milestone for PharmaTher and we are excited about the opportunity to advance a potential new therapeutic solution for Parkinson’s disease patients.”

In 2016, the effectiveness of low-dose ketamine on levodopa-induced dyskinesia was highlighted in an analysis of Parkinson’s disease patients, who had received the drug for pain relief, when it was observed that the patients experienced an improvement in symptoms lasting several weeks beyond treatment.

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The results were corroborated in a test of low-dose ketamine in a rodent levodopa-induced dyskinesia model, and has also been examined in a controlled study. A further study in 2020 provided pre-clinical evidence to support the repurposing of sub-anesthetic ketamine treatment for Parkinson’s patients with levodopa-induced dyskinesia.

An Investigational New Drug (IND) for the trial has been approved by the FDA, and, if the Phase 2 clinical study is positive, PharmaTher will request a meeting with the FDA to discuss moving to a Phase 3 clinical study in the first half of 2022.

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Policy

FDA MDMA therapy advice may be a setback, but it is not the end of the road

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FDA MDMA therapy advice may be a setback, but it is not the end of the road

An advisory body to the U.S Food and Drug Administration (FDA) has recommended against the approval of Lykos Therapeutics’ MDMA-assisted therapy – but the development is not deterring the industry.

Four months ago the psychedelics industry was abuzz when Lykos Therapeutics (formerly MAPS Public Benefit Corporation) announced it had received FDA acceptance and priority review for a New Drug Application (NDA) concerning its MDMA-assisted therapy for PTSD.

While the final decision on the matter is not expected until 11 August 2024, the FDA’s Psychopharmacologic Drugs Advisory Committee (PDAC) has delivered a major blow to the development.

The committee voted “no” on the question of whether the data shows the treatment’s effecitveness as well as on the question of whether the benefits outweigh the risks, with concerns raised over trial design, data gaps, and the potential for abuse and unethical practice.

As highlighted by Lykos, the FDA is not bound by PDAC’s guidance but it does take its advice into consideration – meaning the outcome is not looking good for the FDA’s final decision later this year.

Lykos has expressed its disappointment on the vote outcome given “the urgent unmet need in PTSD”, however, the organisation has acknowledged that the committee “faced a challenging and atypical assignment, which was to evaluate a therapeutic approach that combines drug therapy (MDMA) and psychological intervention.”

Amy Emerson, Chief Executive Officer of Lykos Therapeutics, stated: “We remain committed to working with the FDA to address outstanding questions so that we may find a path forward to ensure the responsible and careful introduction of MDMA-assisted therapy into the healthcare system, if approved.”

Not the end of the road

While the advisory vote may not bode well, industry stakeholders believe this is not the end of the road for MDMA-assisted psychotherapy.

With the advice concerning only the Lykos trial, there may be scope for concerns raised by the committee to be addressed in further trials, as well as other MDMA analogues or therapy designs to make it to approval.

See also  Findings on psychedelics presented at Neuroscience 2022

Christian Angermayer, Founder of atai Life Sciences, believes that there is still a strong chance that, with a properly conducted Phase 3 trial, MDMA-assisted therapy will get approved.

“I (still) believe MDMA is a promising drug with tremendous therapeutic potential for patients with severe mental health issues,” wrote Angermayer.

“It isn’t MDMA itself that was rejected per se, but the specific, poor data set provided by Lykos; the committee particularly cited discrepancies in clinical trial design and conduct, inadequate collection of safety and other relevant data, bias in the evaluation of patients, and cases of patient abuse during the trials.”

Rivki Stern Youdkevich, Co-founder and CEO at Shortwave Life Sciences (SWLS), which is developing psychedelic medicines for the treatment of anorexia nervosa, has said the decision is not deterring their developments.

Youdkevich commented: “We were disappointed to learn of the panel’s recommendation but we are not discouraged.

“Mental ill health is growing at an alarming rate with an increasing number of conditions affecting more people in every age group worldwide. This necessitates novel approaches to medication and treatment, as existing therapies do not suffice. So our enthusiasm for development of psychedelics-based treatments and medicine remains undiminished.

“In fact, we are doubling down on it. Shortwave Life Sciences’ goal is to become a leader in the origination, development and operation of innovative solutions in the field of mental health. Like other psychedelics drug makers, we remain unwavering in our commitment to overcome the expected challenges on the way to approval and wide acceptance of this new field as safe, effective and viable.”

Youdkevich emphasised that the FDA’s advice will not affect Shortwave’s chances of approving its drug product for anorexia nervosa.

“Specifically at Shortwave we have several strengths in our clinical and development approach which would lead us, I believe and hope, to a positive reception,” explained Youdkevich.

“Our team of experienced clinical experts led by Dr. Nadya Lisovoder designed our clinical strategy to anticipate and meet the most stringent requirements from the regulator. We are undergoing a full set of pre-clinical studies to create a robust base of evidence and research which will illuminate our clinical trials design.

See also  Is connection key? How clinicians impact patient outcomes in psychedelic therapy

“Furthermore, our by-the-book clinical trial design will be further wisened by real-time data and learnings from our partners at the Sheba Medical Center Department of Eating disorders’ Phase 1 psilocybin-assisted therapy trial for anorexia patients.

“Our anorexia programme is based on a combination of psilocybin and additional APIs. We initially designed this combination to extend the mechanism of action of the drug, giving us flexibility in dosing of the scheduled component, psilocybin. Our drug delivery method allows for efficient administration and absorption which is currently being tested, thus maximising the effect even in a potentially lower dose of psilocybin.

“Anorexia nervosa is a life-threatening disease, with the highest mortality rate of mental health conditions and with no FDA-approved medication.

“Today, treatment for anorexia nervosa is psychotherapy based, with no standardised protocol. Our novel drug product and delivery method would naturally fit into this mode of care with the aim of achieving remission in a relatively short period, and reducing the need for years of therapy and treatment. So, although psychotherapy adds complexity to the process of regulatory approval, in our case, it is the incumbent standard of care.

“We applaud and look up to the pioneers in psychedelics drug development who are the avant-garde in creating this “new field of medicine”. They are facing head on the challenges and hurdles of evaluation and acceptance into mainstream medicine.

“Our strategy at SWLS has always been to follow in the regulatory path created by the first-comers and implement their learnings vis-a-vis the regulators. Such learning may include special attention to communication at all stages and on all aspects of trial methodology design and implementation with the regulators, to the degree trial participants are novice to the drug, as well as consideration of all aspects and the possibility of conducting blind studies with psychedelic compounds.”

MDMA is gaining global traction

While it remains to be seen if MDMA-assisted therapy will gain approval in the United States in August, the compound is gaining traction as a treatment for mental health conditions including PTSD elsewhere across the world.

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Canada added MDMA-assisted therapy to its Special Access Programme in 2022 for the treatment of PTSD, and in 2023 Australia rescheduled the compound to allow authorised access to the therapy for select patients living with PTSD.

In fact, just days following the FDA’s advice, a Dutch advisory committee, which conducted a multidisciplinary analysis of the health risks of MDMA to advise the Dutch Cabinet, recommended the Government should allow access to MDMA-assisted therapy for people living with PTSD.

The independent State Commission was established by the Dutch Parliament to research the legal status of MDMA and provide advice on its medical use.

The report produced by the committee specifically advises on the pros and cons of the medicinal use of MDMA for the treatment of PTSD, advising that there appears to be sufficient scientific evidence for the effectiveness and safety of this form of therapy.

The committee has now recommended developing the medical use of MDMA for PTSD as quickly as possible, advising that regulatory frameworks are established.

In a statement, Minister Pia Dijkstra, Minister for Medical Care of the Netherlands, commented: “I am pleased that the report is now available, because it provides tools to further develop the therapeutic application of MDMA.

“Research into the therapeutic use of MDMA is promising. It is possible that MDMA as a therapy-supporting medication can help, especially for mental health patients who have been dealing with their problems for years and have not been helped by the current range of therapies.

“However, more scientific, clinical research needs to be done. With regard to the recreational use of MDMA, the report emphasises the principle of Dutch drug policy, which primarily emphasises health, prevention and reducing the harmful consequences of use, for example through monitoring and testing.

“It is therefore good that this report is now available and supports the need for substantiated policy and further scientific research.”

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Policy

Psychedelics are here, now: preparing psychiatry for a psychedelic future

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Psychedelics are here, now: preparing psychiatry for a psychedelic future

An emerging body of evidence is showing psychedelics as promising treatments for mental health conditions, and psychiatry needs to be prepared for their arrival, say researchers.

Recent years have seen an increasing amount of scientific evidence pointing to the potential of psychedelics as treatments for mental health conditions such as anxiety, depression, and PTSD. So far, this evidence has led countries such as Australia, Canada, and the US to allow special access to these medicines for select patients.

In particular, MDMA and psilocybin have produced robust results – now in Phase III trials – that show their efficacy for PTSD and treatment-resistant depression, respectively. 

The developments around these two substances may lead to their approval as licenced medicines in the near future, with Lykos Therapeutics MDMA-assisted therapy for PTSD already receiving US Food and Drug Administration (FDA) acceptance and priority review for a New Drug Application (NDA), for example.

See also  UK advisory body issues rapid response on psychedelics for PTSD

In a new article published in the British Journal of Psychiatry, researchers emphasise the need for the psychiatry profession to prepare for this possible outcome, and discuss how health systems might respond to these developments.

The authors write: “Given the rapidly emerging body of evidence of efficacy for psilocybin and MDMA, people’s great need for innovative treatments and the move towards approval in some countries before licences are awarded, it seems likely that these two drugs will become a part of psychiatric practice for many in the foreseeable future. The psychiatry profession and practising psychiatrists need to prepare for this.”

Supporting patient access

Medicines must undergo rigorous, double-blind randomised controlled trials (RTCs) to reach patients under approved licensing. 

However, the authors highlight that this model poses challenges due to the high cost of trials, commercial incentives for indication testing, and socioeconomic/demographic factors impacting decisions on where a company makes a licensing application – such as population size and income.

This can mean that cancer treatments are prioritised over physiatric treatments, for example, and can lead to low- and middle-income countries waiting decades to gain access to new medicines. 

The researchers suggest that off-license administration may provide a solution.

“Already psychiatrists in many countries are using ketamine ‘off licence’ to treat people with resistant depression. There is now comparable evidence of safety and efficacy for psilocybin and MDMA to allow, with the patients’ informed consent, competent clinicians to try them out ‘off licence’ as well as in severe illnesses when other treatments have failed,” write the authors.

“One of the main arguments from patients and their carers is the distress that they cannot access treatments of proven efficacy until a company chooses to market them; these people are totally disempowered. In Australia, the issue of drug supply outside the usual drug company medicine marketing model was solved by a charity sourcing the medicines from accredited manufacturers. This model could be used elsewhere.”

The authors also highlight that ensuring patient access to psychedelics will need a country-by-country approach, taking into consideration the unique challenges of each place.

Using the UK as an example, they highlight that the Advisory Council on the Misuse of Drugs (ACMD) “appear to be acting under the misperception that a marketing authorisation generated by a pharmaceutical company is necessary to change the Schedule 1 status of these compounds in the Misuse of Drugs Regulations.”

However, the UK’s Chief Medical Officer confirmed there was ample real-world evidence to support the legalisation of medical cannabis in 2018.

“There is now indubitably better evidence for psilocybin and MDMA in their respective Australian-approved indications than there was then for medical cannabis,” the authors write, suggesting regulatory controls for psychedelics such as a register of practitioners and supervised data collection for efficacy and adverse effects.

Training psychedelic psychiatrists 

While scientific data may be mounting up and regulation changes are slowly creeping in across the globe, the roll-out of psychedelic therapies will also depend on having trained psychedelic therapists.

Lack of education and training has resulted in hesitation from NHS practitioners to prescribe medical cannabis, the authors highlight, so systematic training and relevant education will be vital if psychedelic medicines are to reach patients.

“By utilising innovative technologies, many of the educational and administrative tasks can be undertaken remotely, and we can learn from other countries, such as Australia, as to how to coordinate the delivery of excellent treatment,” the authors write.

“It is up to the gamut of professionals and organisations – for example, Royal College of Psychiatrists, the Chief Medical Officer, ACMD and other groups, to take the initiative early.”

The authors also suggest that the UK should establish a working group to explore the implementation of psychedelic therapies.

“We need to be ready for a change in the law which would signal a turning point in the provision of better treatment for some of the most incapacitating illnesses in medicine,” the authors conclude.

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Markets & Industry

Major deals continue positive trajectory for psychedelics in 2024

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“Enhanced Consciousness Index” tracked by new psychedelics ETF

Psychedelics started 2024 with a bang, and the innovative medicines are continuing to gain traction as the year progresses. This week saw one of the globe’s top five biggest pharmaceutical companies – AbbVie – enter the market, while Enveric and MindBio signed a $66.5 million deal.

2024 set off to a strong start for psychedelic medicines with several watershed moments that are setting the stage for the sector’s acceleration.

These include developments such as the FDA’s acceptance of Lykos Therapeutics’ NDA for MDMA-assisted therapy for PTSD, Beckley Psytech’s securement of $50M investment from atai Life Sciences to expedite its assets through Phase 2 trials, a European Medicines Agency meeting on regulating psychedelics, and the confirmation from the UK’s independent policy body POST that it will publish a major briefing on psychedelic drugs to treat mental health conditions later this year, among others.

The positive developments for the industry are continuing, with this week seeing pharmaceutical company AbbVie – which has a clinical pipeline covering neuroscience, immunology, oncology, and eyecare – entering the industry through a new $65 million partnership with psychedelic drug developer Gilgamesh Pharmaceuticals.

Next generation neuroplastogens

The companies have stated they will be working together to discover and deliver next-generation psychedelics for mental health conditions such as anxiety, depression, and PTSD, as well as addiction.

AbbVie has highlighted the challenges posed by first-gen psychedelics including necessitating in-office administration and concomitant supportive care due to their hallucinogenic component – elements that could hinder the adoption and scale-up of these medicines.

See also  MDMA for PTSD receives priority review for New Drug Application

Gilgamesh Pharmaceuticals is working on the development of next-gen compounds that aim to improve the safety and efficacy of first-generation psychedelics and remove the hallucinogenic component, including a short-acting 5-HT2A agonist and an Ibogaine analogue.

In a press statement, Jonathon Sedgwick, Ph.D., senior vice president and global head of discovery research at AbbVie, commented: “Significant unmet need remains for people living with psychiatric disorders and we know that to innovate in this field, we need to pursue novel technologies and approaches.

See also  UK advisory body issues rapid response on psychedelics for PTSD

“We look forward to working with Gilgamesh’s world-class team to advance the development of novel neuroplastogens and pave the way for additional treatment approaches in psychiatry.”

Jonathan Sporn, M.D., chief executive officer at Gilgamesh Pharmaceuticals, added: “We are thrilled to partner with AbbVie, a global pharmaceutical company focused on innovation in psychiatric care, to address the pressing challenges in mental health treatment.

“Our collaboration will pioneer research of a new generation of therapies that hold great potential for improving patient outcomes.”

AbbVie is now the latest major pharmaceutical company to enter this market, following the likes of Janssen and Janssen and Otsuka Pharmaceutical, indicating that mainstream pharma is taking the promise of psychedelic medicines seriously.

However, this was not the only major deal to take place in the psychedelics market this week.

Enveric Biosciences also signed a $66.5 million non-binding term sheet with MindBio Therapeutics to out-license its novel psilocin prodrug candidate for mental health disorders.

Similar to Gilgamesh Pharmaceuticals, Enveric and MindBio focus on the development of next-generation neuroplastogens for that have reduced the hallucinogenic component.

Under the non-binding term sheet, Enveric will out-license a class of Novel Psilocin Prodrugs (NPP) to MindBio – a group of molecules that the company says are designed to be metabolised specifically to release therapeutic levels of systemic psilocin at varying rates.

In a press statement, Joseph Tucker, Ph.D., Director and CEO of Enveric, commented: “We look forward to working with MindBio’s team, which is pioneering an important part of the exciting psychedelic space, focused on controlling dose to reduce or eliminate hallucinations associated with these powerful compounds.

“This non-binding term sheet highlights the potential synergies between the Enveric and MindBio approaches to leveraging psychedelic-based compounds to target specific signaling pathways in the brain for the treatment of neuropsychiatric conditions.”

“We are pleased to explore an opportunity to draw on the molecular discovery engine at Enveric and believe this novel and patented asset significantly strengthens our intellectual property pipeline and aligns with our strategy to develop innovative, protected compounds with fine-tuned formulation and dosing strategies,” added CEO of MindBio, Justin Hanka.

“We look forward to the prospect of progressing this asset into clinical trials as we seek to bring important and beneficial therapies to patients in need.”

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Psychedelic Health is a journalist-led news site. Any views expressed by interviewees or commentators do not reflect our own. We do not provide medical advice or promote the personal use of psychedelic compounds. Please seek professional medical advice if you are concerned about any of the issues raised.

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