Epigallocatechin gallate does not modify MSA progression

In the placebo controlled PROMESA trial, epigallocatechin gallate (EGCG) did not modify disease progression in patients with multiple system atrophy (MSA). EGCG, found in low levels in green tea, was well-tolerated. The hepatotoxic effects observed in some patients limit dosing, however [1].

These results where shared as a late-breaking abstract at the EAN 2019 and simultaneously published [2]. First author Dr Johannes Levin (Ludwig-Maximilians-University of Munich, Germany) explained that the polyphenol EGCG inhibits α-synuclein aggregation in higher doses. A dozen specialist centres in Germany participated in the trial. In total, 92 participants were randomly assigned to oral EGCG 400 mg or matching placebo once daily for 4 weeks, then twice daily for 4 weeks, followed by three times daily for 40 weeks; 63 patients completed the study per protocol.

After 52 weeks, there was no difference in change from baseline in motor examination scores on the Unified Multiple System Atrophy Rating Scale (UMSARS), which was the primary endpoint. The UMSARS score was 5.66 and 6.60 in the EGCG and placebo group, respectively (P=0.51). An MRI analysis in 19 patients treated per protocol revealed a significant reduction of over 50% in brain atrophy rate. Two patients in the EGCG group had to stop treatment because of severe hepatotoxicity. This is why, according to Dr Levin, doses of more than 1,200 mg should be avoided.

1. Höglinger G, et al. EAN 2019, PLEN 04_6.
2. Levin J, et al. Lancet Neurol. 2019;18(8):724-35.



Posted on 27 August 201918 March 2021