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A major clinical trial involving 410 people with early Parkinson's disease has found no clinical benefit from nicotinamide riboside (NR), a compound that increases cellular levels of nicotinamide adenine dinucleotide (NAD). The findings are published in JAMA.

The NOPARK trial was led by professor Charalampos Tzoulis at Haukeland University Hospital and the University of Bergen. Participants at 11 Norwegian centers were randomly assigned to receive either NR or placebo for one year. Neither the participants nor the study teams knew who received which treatment.

Disease severity was measured using the MDS-UPDRS scale, on which a higher score indicates more pronounced symptoms. After 52 weeks, participants who received NR had worsened by an average of 2.45 points, while the placebo group remained essentially unchanged. The adjusted difference was 2.72 points in favor of placebo.

The difference was statistically significant, but modest and below the commonly used threshold for a clinically important difference. These findings show that NR provided no clinical benefit in early Parkinson's disease, with outcomes on average slightly worse than with placebo.

Brain imaging showed no evidence that NR either slowed or accelerated changes in the brain's dopamine system. The overall occurrence of adverse events was similar in the two groups.

"We had a strong biological rationale for testing this treatment, and earlier, smaller clinical studies had produced encouraging findings. NR clearly increased NAD metabolism, but this did not translate into clinical improvement.

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