Hey Scott, firstly let me repeat that I think that this investment is about as good as it gets in development biotechs. That said it is not a certainty till we see good 201 trial results. There are things that could affect the placebo result if not well managed.
Take the Parkinson's drug, Levodopa. Autopsy studies have shown Ldopa can affect MSA patients. particularly early stage. B vitamins is another. Levodopa treatment is not an exclusion criteria in the 201 trial, but any other significant neurological disorder other than MSA is excluded. So maybe levodopa use is less
"Previous reports have suggested 30-50% of patients with MSA have good responsiveness to Levodopa in the early stages of the disease."
"MSA-P is typically considered Levodopa-ineffective because both the pre and post synaptic nerves of the dopaminergic pathway are impaired, however Levodopa can be effective if the dopaminergic postsynaptic fibers are preserved."
" Therefore the degree of putaminal atrophy is a useful predictor of levodopa efficacy in MSA-P in the early stages."
frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1293732/full
I am not sure how widespread levodopa off label use is in MSA patients, but with this trial restricted to <4 yrs and MRI structural brain abnormality an exclusion criteria, this trial appears to me optimised for levodopa effect. Wild card?
Just sayin you can't have a certainty till the results are in. Some investors don't move before peer reviewed publication of results.
All just my opinion as an investor. DYOR
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