Talking About Disease-modifying Therapies for Parkinson’s (Webinar Audio

For decades, Parkinson’s treatments have focused on easing symptoms like tremor, stiffness, and slowness. These medicines and therapies can make daily life easier, but they do not touch the underlying disease. That could be about to change. At the Michael J. Fox Foundation’s latest Third Thursday Webinar, experts and patient advocates explored the exciting progress toward disease-modifying therapies—treatments designed not just to mask symptoms but to slow or even halt the progression of Parkinson’s itself. What is a disease-modifying therapy? As Dr Ruth Schneider, a movement disorder specialist at the University of Rochester, explained, these therapies aim to preserve function for longer by targeting the biology of Parkinson’s. In practical terms, this could mean delaying the need for a walking aid, preventing falls, or keeping people independent for years longer than they would otherwise be. That contrasts with today’s symptomatic therapies—like levodopa—which ease stiffness or tremor but do not change the course of the disease. For people living with Parkinson’s, this difference is life-changing. As patient advocate Sarah Zenner-Dolan put it, “Prolonging independence and delaying complications is what matters most.” Learning from multiple sclerosis To understand what might lie ahead, the panel turned to another neurological condition: multiple sclerosis (MS). Dr Jiwon Oh, a neurologist and MS researcher from Toronto, described how the arrival of disease-modifying therapies in the 1990s completely reshaped the outlook for MS. Twenty-five years ago, newly diagnosed patients were often told they would likely need a wheelchair within 10 to 15 years. Today, with nearly 25 different disease-modifying therapies available, that grim prediction has disappeared. The lesson? Progress may start slowly, but once momentum builds, treatments can dramatically improve lives. Parkinson’s may now be standing at the same threshold MS faced a generation ago. What might the first therapies look like? Dr Schneider noted that the first generation of disease-modifying treatments will almost certainly be used alongside existing symptomatic medications and lifestyle changes like exercise. Trials are currently focused on people in the earliest stages of Parkinson’s—often within two years of diagnosis—because early intervention offers the best chance of slowing progression. While these therapies may not be cures, even modest slowing of the disease could give people precious extra time. For some, that might mean attending a child’s wedding, continuing to work, or simply buttoning a shirt for longer. Targets in the pipeline Nearly half of the treatments now in development for Parkinson’s are aimed at slowing progression. Researchers are pursuing several different angles: • Alpha-synuclein: This protein clumps in the brains of people with Parkinson’s. Drugs like prasinezumab are being tested to prevent or clear these clumps. • Genetics: Mutations such as LRRK2 and GBA1 point to specific biological pathways that can be targeted. Some therapies may benefit both genetic and non-genetic cases. • Neuroinflammation: Calming inflammation in the brain and gut may help protect neurons, borrowing ideas from MS research. • Repurposed drugs: Existing medicines for other conditions may have benefits for Parkinson’s, offering a faster path to approval. • Cell-based therapies: Stem cell research is exploring whether new dopamine-producing cells can be transplanted into the brain. This broad approach reflects a key reality: Parkinson’s is not the same for everyone, so different people may need different treatments. The long road of research Even with encouraging phase two trial results, bringing a new drug to market takes time. On average, the process—from early safety studies to large phase three trials and regulatory approval—spans about ten years. But several Parkinson’s therapies are now entering or preparing for phase three, a major milestone. Repurposed drugs could arrive sooner, as their safety profiles are already well known. The role of patients and families Drug development does not happen without volunteers. Clinical trials, observational studies like the Parkinson’s Progression Markers Initiative (PPMI), and tools such as Fox Trial Finder all rely on people stepping forward. For participants like Sarah Zenner-Dolan, the reward is not only access to excellent care but also the knowledge of helping to move science forward. “We’re putting our diagnoses to good work,” she said. Don’t forget exercise While we wait for the first disease-modifying therapies, one intervention is already available: exercise. Dr Schneider pointed out that 150 minutes a week of moderate to vigorous aerobic activity can improve function and may even influence disease progression. For many, exercise is as vital as medication. Looking ahead A cure remains the ultimate goal, but as the MS story shows, real progress often comes step by step. Each small gain builds toward more powerful treatments. For Parkinson’s, the fact that phase three trials are now underway marks a historic moment. As Michael J. Fox himself reminded listeners, the Foundation’s mission is to speed a cure. Disease-modifying therapies could be the breakthrough that finally changes the trajectory of Parkinson’s, offering not just better days, but more of them.