A Randomized Controlled Trial of Nicotinamide Riboside Supplementation in Early Parkinson's Disease (NOPARK)

A Randomized Controlled Trial of Nicotinamide Riboside Supplementation in Early Parkinson's Disease: the NOPARK Study

NOPARK is a double-blinded randomized controlled phase II trial, with the aim to assess the efficacy of nicotinamide adenine dinucleotide (NAD)-replenishment therapy in the form of oral nicotinamide riboside (NR) in delaying the progression of early Parkinson's disease (PD). A total of 400 persons with early stage Parkinson's disease will be enrolled, randomized on nicotinamide riboside (NR) 500mg x 2 per day or placebo, and followed for 52 weeks.

NOPARK is a multi-center, double-blinded randomized controlled trial, with the aim to assess the efficacy of NAD-replenishment therapy in the form of oral nicotinamide riboside (NR) in delaying the progression of early Parkinson's disease (PD). Individuals with PD (n = 400) will be recruited from multiple centers across Norway. Eligible participants must have been diagnosed with PD within 2 years of study enrollment and meet the trial's inclusion criteria. All participants will be given a standard PD-treatment regimen comprising selegiline 10 mg/day and oral levodopa (Sinemet or Madopar) at a dose of 100mg x 3, 150mg x3, or 200mg x 3 per day. The PD-treatment regimen will be frozen at baseline and remain stable throughout the duration of the study. At baseline, participants will be randomized on a 1:1 ratio on either nicotinamide riboside (NR) 500mg x 2 per day or placebo. Both the participants and the investigators will be blinded. The trial duration will be 52 weeks, during which participants will be assessed at baseline, 13, 26, 39 and 52 weeks. Measures include clinical evaluation using established scales for motor and non-motor dysfunction, as well as quality of life, 123I-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) nortropane ([¹²³I]FP-CIT) single photon emission tomography (DaTscan), magnetic resonance imaging (MRI) of the brain, blood safety tests, and blood sampling for metabolomics, transcriptomics, and other exploratory analyses. The primary outcome of the study is the total score of the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS).

Randomized double-blinded study. 400 Participants randomized in 1:1 ratio to either Nicotinamide Riboside or placebo.

nicotinamide riboside, 1000mg daily for the duration of the trial (52 weeks). Dosage form is capsules.

Nicotinamide Riboside 500mg administered two times a day. Given as capsules. Duration of the trial; 52 weeks.

Disease severity assessed by the total MDS-UPDRS (Movement Disorder Society Unified Parkinson's Disease rating Scale) subsections I-III

The Movement Disorder Society Unified Parkinson's Disease rating Scale (MDS-UPDRS) measures multiple clinical disabilities, each on a scale of 1-4. The subscores are summed providing a total score for MDS-UPDRS. The total score ranges from 0 to 260. Higher score indicates worse outcome. Here, the total score of MDS-UPDRS sections 1-3 will be used.

Change in the severity of nigrostriatal degeneration assessed by [¹²³I]FP-CIT single photon emission CT (DaTscan)

Change in the clinical severity of non-motor symptoms assessed by the Non-Motor Symptoms Assessment Scale

Non-Motor Symptoms Scale (NMSS) has 30 items, score range is 0-360 with higher scores indicating a worse outcome.

Change in the clinical severity of cognitive decline assessed by the Montreal Cognitive Assessment (MoCA) scale

Montreal Cognitive Assessment (MoCA), score range is 0-30 with lower scores indicating a worse outcome.

Change in quality of life assessed by the EuroQuality of Life Five Dimensions (EQ-5D-5L) questionnaire.

Inclusion Criteria: Have a clinical diagnosis of idiopathic PD according to the MDS clinical diagnostic criteria for Parkinson's disease [¹²³I]FP-CIT single photon emission CT (DaTscan) confirming nigrostriatal degeneration Diagnosed with PD within 2 years from enrolment Hoehn and Yahr score < 3 at enrolment Optimal symptomatic therapy, not requiring adjustments, for at least 1 month. Age equal to or greater than 35 years at time of enrolment. Exclusion Criteria: Dementia or other neurodegenerative disorder at baseline visit Diagnosed with atypical parkinsonism or vascular parkinsonism Any psychiatric disorder that would interfere with compliance in the study. Any severe somatic illness that would make the individual unable to comply and participate in the study. Use of high dose vitamin B3 supplementation within 30 days of enrolment Metabolic, neoplastic, or other physically or mentally debilitating disorder at baseline visit. Genetically confirmed mitochondrial disease