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Background The Edmond J Safra Accelerating Clinical Trials in Parkinson’s Disease (EJS ACT-PD) multi-arm, multi-stage trial has been designed to efficiently assess the clinical and cost-effectiveness of potential disease-modifying therapies (DMTs) compared with a shared placebo on the rate of PD progression.Methods >90 key stakeholders, including people with PD, collaborated to design the trial. Robust processes were created and implemented to identify meaningful outcome measures (including digital, imaging and wet biomarkers), prioritise promising therapies and select sites (to ensure efficient recruitment and maximise trial participation opportunities, including in under-served populations).Results The trial will launch in 2025 with two treatment arms and one placebo arm. A third treatment arm will be added after 12 months. 40 confirmed UK sites will recruit 1,600 participants over 3-4 years. The primary outcome is rate of change in MDS-UPDRS parts I&II combined. Study visits will be 6-monthly for 36 months and be deliverable remotely or in-person. Early-stage analyses will identify ineffective treatments for discontinuation. Core-funded staff will support delivery at key sites to maximise inclusivity and retention.Conclusion This innovative trial provides a sustainable and efficient DMT assessment process which supports the addition of future treatment arms and offers ongoing research opportunities.camille.carroll@newcastle.ac.uk