Clinical trials in REM sleep behavioural disorder: Challenges and opportunities

Aleksandar Videnovic, Yo El S. Ju, Isabelle Arnulf, Isabelle Arnulf, Valérie Cochen-De Cock, Valérie Cochen-De Cock, Birgit Högl, Dieter Kunz, Federica Provini, Federica Provini, Pietro Luca Ratti, Mya C. Schiess, Carlos H. Schenck, Carlos H. Schenck, Claudia Trenkwalder, Claudia Trenkwalder

Research output: Contribution to journalReview article

Abstract

The rapid eye movement sleep behavioural disorder (RBD) population is an ideal study population for testing disease-modifying treatments for synucleinopathies, since RBD represents an early prodromal stage of synucleinopathy when neuropathology may be more responsive to treatment. While clonazepam and melatonin are most commonly used as symptomatic treatments for RBD, clinical trials of symptomatic treatments are also needed to identify evidence-based treatments. A comprehensive framework for both disease-modifying and symptomatic treatment trials in RBD is described, including potential treatments in the pipeline, cost-effective participant recruitment and selection, study design, outcomes and dissemination of results. For disease-modifying treatment clinical trials, the recommended primary outcome is phenoconversion to an overt synucleinopathy, and stratification features should be used to select a study population at high risk of phenoconversion, to enable more rapid clinical trials. For symptomatic treatment clinical trials, objective polysomnogram-based measurement of RBD-related movements and vocalisations should be the primary outcome measure, rather than subjective scales or diaries. Mobile technology to enable objective measurement of RBD episodes in the ambulatory setting, and advances in imaging, biofluid, tissue, and neurophysiological biomarkers of synucleinopathies, will enable more efficient clinical trials but are still in development. Increasing awareness of RBD among the general public and medical community coupled with timely diagnosis of these diseases will facilitate progress in the development of therapeutics for RBD and associated neurodegenerative disorders.

Original languageEnglish
Pages (from-to)740-749
Number of pages10
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume91
Issue number7
DOIs
StatePublished - Jul 1 2020
Externally publishedYes

Keywords

  • Lewy body dementia
  • Parkinson's disease
  • randomised trials
  • sleep disorders

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  • Cite this

    Videnovic, A., Ju, Y. E. S., Arnulf, I., Arnulf, I., Cochen-De Cock, V., Cochen-De Cock, V., Högl, B., Kunz, D., Provini, F., Provini, F., Ratti, P. L., Schiess, M. C., Schenck, C. H., Schenck, C. H., Trenkwalder, C., & Trenkwalder, C. (2020). Clinical trials in REM sleep behavioural disorder: Challenges and opportunities. Journal of Neurology, Neurosurgery and Psychiatry, 91(7), 740-749. https://doi.org/10.1136/jnnp-2020-322875