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Zhang N, Chan ML, Li J, Brohawn PZ, Sun B, Vainshtein I, Roskos LK, Faggioni R, Savic RM. Combining pharmacometric models with predictive and prognostic biomarkers for precision therapy in Crohn's disease: A case study of brazikumab. CPT Pharmacometrics Syst Pharmacol 2023; 12:1945-1959. [PMID: 37691451 PMCID: PMC10725267 DOI: 10.1002/psp4.13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/11/2023] [Accepted: 07/11/2023] [Indexed: 09/12/2023] Open
Abstract
Pharmacometric models were used to investigate the utility of biomarkers in predicting the efficacy (Crohn's Disease Activity Index [CDAI]) of brazikumab and provide a data-driven framework for precision therapy for Crohn's disease (CD). In a phase IIa trial in patients with moderate to severe CD, treatment with brazikumab, an anti-interleukin 23 monoclonal antibody, was associated with clinical improvement. Brazikumab treatment effect was determined to be dependent on the baseline IL-22 (BIL22) or baseline C-reactive protein (BCRP; predictive biomarkers), and placebo effect was found to be correlated with the baseline CDAI (a prognostic biomarker). A maximal total inhibition on CDAI input function of 50.6% and 42.4% was predicted for patients with extremely high BIL22 or BCRP, compared to a maximal total inhibition of 20.9% and 17.8% for patients with extremely low BIL22 or BCRP, respectively, which were mainly due to the placebo effect. We demonstrated that model-derived baseline biomarker levels that achieve 50% of maximum unbound systemic concentration of 22.8 pg/mL and 8.03 mg/L for BIL22 and BCRP as the cutoffs to select subpopulations can effectively identify high-response subgroup patients with improved separation of responders when compared to using the median values as the cutoff. This work exemplifies the utility of pharmacometrics to quantify biomarker-driven responses in biologic therapies and distinguish between predictive and prognostic biomarkers, complementing clinical efforts of identifying subpopulations with higher likelihood of response to brazikumab.
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Affiliation(s)
- Nan Zhang
- Department of Bioengineering and Therapeutic SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Ming Liang Chan
- Department of Bioengineering and Therapeutic SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Jing Li
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences (CPSS), R&D, AstraZenecaSouth San FranciscoCaliforniaUSA
| | - Philip Z. Brohawn
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology (R&I), BioPharmaceutical R&D, AstraZenecaGaithersburgMarylandUSA
| | - Bo Sun
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences (CPSS), R&D, AstraZenecaSouth San FranciscoCaliforniaUSA
| | - Inna Vainshtein
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences (CPSS), R&D, AstraZenecaSouth San FranciscoCaliforniaUSA
| | - Lorin K. Roskos
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences (CPSS), R&D, AstraZenecaSouth San FranciscoCaliforniaUSA
| | - Raffaella Faggioni
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences (CPSS), R&D, AstraZenecaSouth San FranciscoCaliforniaUSA
| | - Rada M. Savic
- Department of Bioengineering and Therapeutic SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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An integrative model of Parkinson's disease treatment including levodopa pharmacokinetics, dopamine kinetics, basal ganglia neurotransmission and motor action throughout disease progression. J Pharmacokinet Pharmacodyn 2020; 48:133-148. [PMID: 33084988 DOI: 10.1007/s10928-020-09723-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023]
Abstract
Levodopa is considered the gold standard treatment of Parkinson's disease. Although very effective in alleviating symptoms at their onset, its chronic use with the progressive neuronal denervation in the basal ganglia leads to a decrease in levodopa's effect duration and to the appearance of motor complications. This evolution challenges the establishment of optimal regimens to manage the symptoms as the disease progresses. Based on up-to-date pathophysiological and pharmacological knowledge, we developed an integrative model for Parkinson's disease to evaluate motor function in response to levodopa treatment as the disease progresses. We combined a pharmacokinetic model of levodopa to a model of dopamine's kinetics and a neurocomputational model of basal ganglia. The parameter values were either measured directly or estimated from human and animal data. The concentrations and behaviors predicted by our model were compared to available information and data. Using this model, we were able to predict levodopa plasma concentration, its related dopamine concentration in the brain and the response performance of a motor task for different stages of disease.
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Véronneau-Veilleux F, Ursino M, Robaey P, Lévesque D, Nekka F. Nonlinear pharmacodynamics of levodopa through Parkinson's disease progression. CHAOS (WOODBURY, N.Y.) 2020; 30:093146. [PMID: 33003902 DOI: 10.1063/5.0014800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The effect of levodopa in alleviating the symptoms of Parkinson's disease is altered in a highly nonlinear manner as the disease progresses. This can be attributed to different compensation mechanisms taking place in the basal ganglia where the dopaminergic neurons are progressively lost. This alteration in the effect of levodopa complicates the optimization of a drug regimen. The present work aims at investigating the nonlinear dynamics of Parkinson's disease and its therapy through mechanistic mathematical modeling. Using a holistic approach, a pharmacokinetic model of levodopa was combined to a dopamine dynamics and a neurocomputational model of basal ganglia. The influence of neuronal death on these different mechanisms was also integrated. Using this model, we were able to investigate the nonlinear relationships between the levodopa plasma concentration, the dopamine brain concentration, and a response to a motor task. Variations in dopamine concentrations in the brain for different levodopa doses were also studied. Finally, we investigated the narrowing of a levodopa therapeutic index with the progression of the disease as a result of these nonlinearities. In conclusion, various consequences of nonlinear dynamics in Parkinson's disease treatment were studied by developing an integrative model. This model paves the way toward individualization of a dosing regimen. Using sensor based information, the parameters of the model could be fitted to individual data to propose optimal individual regimens.
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Affiliation(s)
| | - Mauro Ursino
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi," University of Bologna, 40136 Bologna, Italy
| | - Philippe Robaey
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario K1H 8L1, Canada
| | - Daniel Lévesque
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - Fahima Nekka
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec H3C 3J7, Canada
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Lonser RR, Akhter AS, Zabek M, Elder JB, Bankiewicz KS. Direct convective delivery of adeno-associated virus gene therapy for treatment of neurological disorders. J Neurosurg 2020; 134:1751-1763. [PMID: 32915526 DOI: 10.3171/2020.4.jns20701] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/16/2020] [Indexed: 11/06/2022]
Abstract
Molecular biological insights have led to a fundamental understanding of the underlying genomic mechanisms of nervous system disease. These findings have resulted in the identification of therapeutic genes that can be packaged in viral capsids for the treatment of a variety of neurological conditions, including neurodegenerative, metabolic, and enzyme deficiency disorders. Recent data have demonstrated that gene-carrying viral vectors (most often adeno-associated viruses) can be effectively distributed by convection-enhanced delivery (CED) in a safe, reliable, targeted, and homogeneous manner across the blood-brain barrier. Critically, these vectors can be monitored using real-time MRI of a co-infused surrogate tracer to accurately predict vector distribution and transgene expression at the perfused site. The unique properties of CED of adeno-associated virus vectors allow for cell-specific transgene manipulation of the infused anatomical site and/or widespread interconnected sites via antero- and/or retrograde transport. The authors review the convective properties of viral vectors, associated technology, and clinical applications.
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Affiliation(s)
- Russell R Lonser
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Asad S Akhter
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Mirosław Zabek
- 2Department of Neurological Surgery, Bródno Hospital, Warsaw, Poland
| | - J Bradley Elder
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Krystof S Bankiewicz
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
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Black KJ, Acevedo HK, Koller JM. Dopamine Buffering Capacity Imaging: A Pharmacodynamic fMRI Method for Staging Parkinson Disease. Front Neurol 2020; 11:370. [PMID: 32477245 PMCID: PMC7232584 DOI: 10.3389/fneur.2020.00370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/14/2020] [Indexed: 11/13/2022] Open
Abstract
We propose a novel pharmacological fMRI (phMRI) method for objectively quantifying disease severity in Parkinson disease (PD). It is based on the clinical observation that the benefit from a dose of levodopa wears off more quickly as PD progresses. Biologically this has been thought to represent decreased buffering capacity for dopamine as nigrostriatal cells die. Buffering capacity has been modeled based on clinical effects, but clinical measurements are influenced by confounding factors. The new method proposes to measure the effect objectively based on the timing of the known response of several brain regions to exogenous levodopa. Such responses are robust and can be quantified using perfusion MRI. Here we present simulation studies based on published clinical dose-response data and an intravenous levodopa infusion. Standard pharmacokinetic-pharmacodynamic methods were used to model the response. Then the effect site rate constant k e was estimated from simulated response data plus Gaussian noise. Predicted time - effect curves sampled at times consistent with phMRI differ substantially based on clinical severity. Estimated k e from noisy input data was recovered with good accuracy. These simulation results support the feasibility of levodopa phMRI hysteresis mapping to measure the severity of dopamine denervation objectively and simultaneously in all brain regions with a robust imaging response to exogenous levodopa.
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Affiliation(s)
- Kevin J. Black
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
- Departments of Neurology, Radiology and Neuroscience, Washington University in St. Louis, St. Louis, MO, United States
| | - Haley K. Acevedo
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
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Nutt JG, Curtze C, Hiller A, Anderson S, Larson PS, Van Laar AD, Richardson RM, Thompson ME, Sedkov A, Leinonen M, Ravina B, Bankiewicz KS, Christine CW. Aromatic L-Amino Acid Decarboxylase Gene Therapy Enhances Levodopa Response in Parkinson's Disease. Mov Disord 2020; 35:851-858. [PMID: 32149427 PMCID: PMC7318280 DOI: 10.1002/mds.27993] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/15/2020] [Accepted: 01/24/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND As Parkinson's disease progresses, levodopa treatment loses efficacy, partly through the loss of the endogenous dopamine-synthesizing enzyme L-amino acid decarboxylase (AADC). In the phase I PD-1101 study, putaminal administration of VY-AADC01, an investigational adeno-associated virus serotype-2 vector for delivery of the AADC gene in patients with advanced Parkinson's disease, was well tolerated, improved motor function, and reduced antiparkinsonian medication requirements. OBJECTIVES This substudy aimed to determine whether the timing and magnitude of motor response to intravenous levodopa changed in PD-1101 patients after VY-AADC01 administration. METHODS Participants received 2-hour threshold (0.6 mg/kg/h) and suprathreshold (1.2 mg/kg/h) levodopa infusions on each of 2 days, both before and approximately 6 months after VY-AADC01. Infusion order was randomized and double blinded. Unified Parkinson's Disease Rating Scale motor scores, finger-tapping speeds, and dyskinesia rating scores were assessed every 30 minutes for 1 hour before and ≥3 hours after start of levodopa infusion. RESULTS Of 15 PD-1101 patients, 13 participated in the substudy. Unified Parkinson's Disease Rating Scale motor score area under the curve responses to threshold and suprathreshold levodopa infusions increased by 168% and 67%, respectively, after VY-AADC01; finger-tapping speeds improved by 162% and 113%, and dyskinesia scores increased by 208% and 72%, respectively, after VY-AADC01. Adverse events (mild/moderate severity) were reported in 5 participants during levodopa infusions pre-VY-AADC01 and 2 participants post-VY-AADC01 administration. CONCLUSIONS VY-AADC01 improved motor responses to intravenous levodopa given under controlled conditions. These data and findings from the parent study support further clinical development of AADC gene therapy for people with Parkinson's disease. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- John G Nutt
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Carolin Curtze
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Amie Hiller
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Shannon Anderson
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Paul S Larson
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Amber D Van Laar
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - R Mark Richardson
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marin E Thompson
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | | | | | - Bernard Ravina
- Voyager Therapeutics, Inc., Cambridge, Massachusetts, USA
| | - Krystof S Bankiewicz
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,Department of Neurology, University of California San Francisco, San Francisco, California, USA.,Department of Neurological Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Chadwick W Christine
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
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Christine CW, Bankiewicz KS, Van Laar AD, Richardson RM, Ravina B, Kells AP, Boot B, Martin AJ, Nutt J, Thompson ME, Larson PS. Magnetic resonance imaging-guided phase 1 trial of putaminal AADC gene therapy for Parkinson's disease. Ann Neurol 2019; 85:704-714. [PMID: 30802998 PMCID: PMC6593762 DOI: 10.1002/ana.25450] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To understand the safety, putaminal coverage, and enzyme expression of adeno-associated viral vector serotype-2 encoding the complementary DNA for the enzyme, aromatic L-amino acid decarboxylase (VY-AADC01), delivered using novel intraoperative monitoring to optimize delivery. METHODS Fifteen subjects (three cohorts of 5) with moderately advanced Parkinson's disease and medically refractory motor fluctuations received VY-AADC01 bilaterally coadministered with gadoteridol to the putamen using intraoperative magnetic resonance imaging (MRI) guidance to visualize the anatomic spread of the infusate and calculate coverage. Cohort 1 received 8.3 × 1011 vg/ml and ≤450 μl per putamen (total dose, ≤7.5 × 1011 vg); cohort 2 received the same concentration (8.3 × 1011 vg/ml) and ≤900 μl per putamen (total dose, ≤1.5 × 1012 vg); and cohort 3 received 2.6 × 1012 vg/ml and ≤900 μl per putamen (total dose, ≤4.7 × 1012 vg). (18)F-fluoro-L-dihydroxyphenylalanine positron emission tomography (PET) at baseline and 6 months postprocedure assessed enzyme activity; standard assessments measured clinical outcomes. RESULTS MRI-guided administration of ascending VY-AADC01 doses resulted in putaminal coverage of 21% (cohort 1), 34% (cohort 2), and 42% (cohort 3). Cohorts 1, 2, and 3 showed corresponding increases in enzyme activity assessed by PET of 13%, 56%, and 79%, and reductions in antiparkinsonian medication of -15%, -33%, and -42%, respectively, at 6 months. At 12 months, there were dose-related improvements in clinical outcomes, including increases in patient-reported ON-time without troublesome dyskinesia (1.6, 3.3, and 1.5 hours, respectively) and quality of life. INTERPRETATION Novel intraoperative monitoring of administration facilitated targeted delivery of VY-AADC01 in this phase 1 study, which was well tolerated. Increases in enzyme expression and clinical improvements were dose dependent. ClinicalTrials.gov Identifier: NCT01973543 Ann Neurol 2019;85:704-714.
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Affiliation(s)
| | | | | | | | | | | | | | - Alastair J Martin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - John Nutt
- Department of Neurology, Oregon Health Sciences University
| | - Marin E Thompson
- Department of Neurological Surgery, University of California, San Francisco
| | - Paul S Larson
- Department of Neurological Surgery, University of California, San Francisco
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Rajput AH, Rajput ML, Ferguson LW, Rajput A. Baseline motor findings and Parkinson disease prognostic subtypes. Neurology 2017; 89:138-143. [PMID: 28592451 PMCID: PMC5501934 DOI: 10.1212/wnl.0000000000004078] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 04/11/2017] [Indexed: 11/15/2022] Open
Abstract
Objective: To identify the significance of baseline motor features to the lifelong prognostic motor subtypes in a Parkinson disease (PD) cohort. Methods: In a previous study of 166 PD cases, we observed different prognosis in tremor-dominant, akinetic-rigid, and mixed subtypes. This study includes the same cases, but we excluded 10 cases with symptoms of ≥15 years duration at baseline. Relative severity of tremor, bradykinesia/akinesia, and rigidity at baseline were evaluated as predictors of the motor subtypes, which are known to have different prognosis. Results: The most common motor subtype was mixed, followed by akinetic-rigid and then the tremor-dominant. Seventy cases were not receiving antiparkinsonian drugs at baseline. The prognostic subtypes could be predicted at baseline in 85% of all and in 91% of the treatment-naive cases. Sensitivity, specificity, and positive predictive values were strong for the mixed and the akinetic-rigid but weak for the tremor-dominant subtype. Conclusions: Our data show that motor profile at baseline can predict prognosis in most PD cases. These findings can be incorporated into clinical practice.
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Affiliation(s)
- Ali H Rajput
- From the Division of Neurology (A.H.R., A.R.), Saskatoon Health Region/University of Saskatchewan, Rosthern; and Movement Disorders Program (M.L.R.) and College of Medicine (L.W.F.), University of Saskatchewan, Saskatoon, Canada.
| | - Michele L Rajput
- From the Division of Neurology (A.H.R., A.R.), Saskatoon Health Region/University of Saskatchewan, Rosthern; and Movement Disorders Program (M.L.R.) and College of Medicine (L.W.F.), University of Saskatchewan, Saskatoon, Canada
| | - Leslie W Ferguson
- From the Division of Neurology (A.H.R., A.R.), Saskatoon Health Region/University of Saskatchewan, Rosthern; and Movement Disorders Program (M.L.R.) and College of Medicine (L.W.F.), University of Saskatchewan, Saskatoon, Canada
| | - Alex Rajput
- From the Division of Neurology (A.H.R., A.R.), Saskatoon Health Region/University of Saskatchewan, Rosthern; and Movement Disorders Program (M.L.R.) and College of Medicine (L.W.F.), University of Saskatchewan, Saskatoon, Canada
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Mao ZL, Modi NB. Dose-Response Analysis of the Effect of Carbidopa-Levodopa Extended-Release Capsules (IPX066) in Levodopa-Naive Patients With Parkinson Disease. J Clin Pharmacol 2016; 56:974-82. [PMID: 26632091 PMCID: PMC5066683 DOI: 10.1002/jcph.683] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/19/2015] [Indexed: 11/12/2022]
Abstract
Parkinson disease is an age-related disorder of the central nervous system principally due to loss of dopamine-producing cells in the midbrain. Levodopa, in combination with carbidopa, is widely regarded as an effective treatment for the symptoms of Parkinson disease. A dose-response relationship is established for carbidopa-levodopa extended-release capsules (IPX066) in levodopa-naive Parkinson disease patients using a disease progression model. Unified Parkinson Disease Rating Scale (UPDRS) part II plus part III scores from 171 North American patients treated with placebo or IPX066 for approximately 30 weeks from a double-blind, parallel-group, dose-ranging study were used to develop the pharmacodynamic model. The model comprised 3 components: a linear function describing disease progression, a component describing placebo (or nonlevodopa) effects, and a component to describe the effect of levodopa. Natural disease progression in early Parkinson disease as measured by UPDRS was 11.6 units/year and faster in patients with more severe disease (Hoehn-Yahr stage 3). Maximum placebo/nonlevodopa response was 23.0% of baseline UPDRS. Maximum levodopa effect from IPX066 was 76.7% of baseline UPDRS, and the ED50 was 450 mg levodopa. Equilibration half-life for the effect compartment was 62.8 days. Increasing age increased and being female decreased equilibration half-life. The quantitative model allowed description of the entire time course of response to clinical trial intervention.
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Affiliation(s)
| | - Nishit B. Modi
- Impax Specialty Pharmaa division of Impax LaboratoriesIncHaywardCAUSA
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Verhagen Metman L, Stover N, Chen C, Cowles VE, Sweeney M. Gastroretentive carbidopa/levodopa, DM-1992, for the treatment of advanced Parkinson's disease. Mov Disord 2015; 30:1222-8. [DOI: 10.1002/mds.26219] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 02/18/2015] [Accepted: 03/02/2015] [Indexed: 11/12/2022] Open
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LeWitt PA, Huff FJ, Hauser RA, Chen D, Lissin D, Zomorodi K, Cundy KC. Double-blind study of the actively transported levodopa prodrug XP21279 in Parkinson's disease. Mov Disord 2013; 29:75-82. [DOI: 10.1002/mds.25742] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 09/25/2013] [Accepted: 10/01/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Peter A. LeWitt
- Department of Neurology; Henry Ford Hospital; West Bloomfield Michigan USA
- Department of Neurology; Wayne State University School of Medicine; Detroit Michigan USA
| | | | - Robert A. Hauser
- Parkinson's Disease and Movement Disorders Center; University of South Florida; Tampa Florida USA
| | - Dan Chen
- XenoPort, Inc.; Santa Clara California USA
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Disease progression and neuroscience. J Pharmacokinet Pharmacodyn 2013; 40:369-76. [DOI: 10.1007/s10928-013-9316-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
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Vu TC, Nutt JG, Holford NHG. Progression of motor and nonmotor features of Parkinson's disease and their response to treatment. Br J Clin Pharmacol 2012; 74:267-83. [PMID: 22283961 DOI: 10.1111/j.1365-2125.2012.04192.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIMS (i) To describe the progression of the cardinal features of Parkinson's disease (PD); (ii) to investigate whether baseline PD subtypes explain disease progression; and (iii) to quantify the symptomatic and disease-modifying effects of anti-parkinsonian treatments. METHODS Data were available for 795 PD subjects, initially untreated, followed for up to 8 years. Cardinal features [tremor, rigidity, bradykinesia, and postural instability and gait disorder (PIGD)] were derived from the total unified Parkinson's disease rating scale (total UPDRS), cognitive status from the mini-mental status exam score (MMSE) and depression status from the Hamilton depression scale (HAM-D). Analysis was performed using a nonlinear mixed effects approach with an asymptotic model for natural disease progression. Treatment effects (i.e. symptomatic and disease modifying) were evaluated by describing changes in the natural history model parameters. RESULTS Tremor progressed more slowly (half-time of 3.9 years) than all other motor features (half-time 2-3 years). The MMSE progression was negligible, while HAM-D progressed with a half-time of 5 years. Levodopa had marked symptomatic effects on all features, but low potency for effect on PIGD (ED₅₀ of 1237 mg day⁻¹ compared with 7-24 mg day⁻¹ for other motor and nonmotor features). Other anti-parkinsonian treatments had much smaller symptomatic effects. All treatments had disease-modifying effects on the cardinal features of PD. Baseline PD subtypes only explained small differences in disease progression. CONCLUSIONS This analysis indicates that tremor progresses more slowly than other cardinal features and that PIGD is less treatment responsive in early PD patients. There was no evidence of baseline PD subtypes as a clinically useful predictor of disease progression rate. Anti-parkinsonian treatments have symptomatic and disease-modifying effects on all major features of PD.
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Affiliation(s)
- Thuy C Vu
- Department of Pharmacokinetics and Drug Metabolism, Amgen Inc., Thousand Oaks, CA, USA
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Sujith OK, Lane C. Therapeutic options for continuous dopaminergic stimulation in Parkinson's disease. Ther Adv Neurol Disord 2011; 2:105-13. [PMID: 21180645 DOI: 10.1177/1756285608101378] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Treatment of Parkinson's disease aims to replace dopaminergic transmission at striatal synapses. In the normal state, nigral neurons fire continuously, exposing striatal dopamine receptors to relatively constant levels of dopamine. In the disease state, periodic dosing and the short half-life of antiparkinsonian drugs leads to more intermittent stimulation. Abnormal pulsatile stimulation of striatal dopamine receptors may lead to dysregulation of genes and proteins in downstream neurons and consequently, alterations in neuronal firing patterns. This may ultimately lead to motor complications. In order to prevent the development of motor complications a therapy that provides continuous dopaminergic stimulation as observed in the normal state would be ideal. Different routes of administration of levodopa and other dopaminergic drugs have been tried to achieve continuous dopaminergic stimulation (CDS). This review discusses the various methods available to achieve this goal with particular emphasis on duodenal dopa administration.
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Affiliation(s)
- O K Sujith
- Pacific Parkinson's Research Center, WesBrook Mall, UBC, Canada and Chief Neurologist and Movement Disorder specialist, Kannur Medical college.
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Holford NHG, Nutt JG. Interpreting the results of Parkinson's disease clinical trials: Time for a change. Mov Disord 2011; 26:569-77. [DOI: 10.1002/mds.23555] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 10/12/2010] [Accepted: 11/01/2010] [Indexed: 11/11/2022] Open
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Baek IH, Kang W, Yun HY, Lee SS, Kwon KI. Modelling the atypical absorption of menatetrenone and the metabolism to its epoxide: effect ofVKORC1polymorphism. J Clin Pharm Ther 2010; 36:390-8. [PMID: 21545618 DOI: 10.1111/j.1365-2710.2010.01183.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- I H Baek
- College of Pharmacy, Chungnam National University, Daejeon, South Korea
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Stefani A, Pierantozzi M, Koch G, Galati S, Stanzione P. Therapy for dyskinesias in Parkinson’s disease patients. FUTURE NEUROLOGY 2010. [DOI: 10.2217/fnl.10.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Dyskinesia hampers the quality of life for most Parkinson’s disease patients following several years of therapy. However, the severity of L-Dopa-induced dyskinesia (LID) varies between patients, being quite tolerable in late-onset patients. Understanding the pathogenesis of LID has contributed to the development of a set of therapeutic strategies, including the choice, in early stages, of the least pulsatile regimen of dopamine-receptor activation. In cases where LIDs are already disabling, there is only a limited number of options: the optimization of ongoing DOPA-centered treatment, the utilization of glutamate antagonists and the exploration of the benefits of antipsychotic agents. More radical solutions are provided by deep brain stimulation in the subthalamic nucleus (or internal pallidus). This approach has proved efficacious in reducing LID, largely because it allows a reduction in dopaminergic daily doses. Stereotactic neurosurgery has fuelled several lines of investigation regarding the crosstalk between the basal ganglia and motor cortex. Here, we will present interesting evidence highlighting the potential for repetitive transcranial stimulation in reducing the occurrence of LID. The future may disclose important new avenues for the treatment of LIDs, given the current development of promising agents that might target different facets of dyskinesia, such as the impairment of striatal plasticity and non-Dopaminergic contributors such as adenosine, nitric oxide and the nucleotide cascade.
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Affiliation(s)
- Alessandro Stefani
- Movement Disorder Centre, Department of Neuroscience, Clinica Neurologica, Policlinico Tor Vergata, Viale Montpellier 1, 00133 Rome, Italy and IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00173 Rome, Italy
| | - Mariangela Pierantozzi
- Movement Disorder Centre, Department of Neuroscience, Clinica Neurologica, Policlinico Tor Vergata, Viale Montpellier 1, 00133 Rome, Italy and IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00173 Rome, Italy
| | - Giacomo Koch
- Movement Disorder Centre, Department of Neuroscience, Clinica Neurologica, Policlinico Tor Vergata, Viale Montpellier 1, 00133 Rome, Italy and IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00173 Rome, Italy
| | - Salvatore Galati
- Movement Disorder Centre, Department of Neuroscience, Clinica Neurologica, Policlinico Tor Vergata, Viale Montpellier 1, 00133 Rome, Italy and IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00173 Rome, Italy
| | - Paolo Stanzione
- Movement Disorder Centre, Department of Neuroscience, Clinica Neurologica, Policlinico Tor Vergata, Viale Montpellier 1, 00133 Rome, Italy and IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00173 Rome, Italy
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LeWitt PA, Jennings D, Lyons KE, Pahwa R, Rabinowicz AL, Wang J, Guarnieri M, Hubble JP, Murck H. Pharmacokinetic-pharmacodynamic crossover comparison of two levodopa extension strategies. Mov Disord 2009; 24:1319-24. [DOI: 10.1002/mds.22587] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
Levodopa serves as the gold standard of anti-parkinsonian therapy and nearly every patient with Parkinson's disease eventually receives this drug. To improve upon levodopa therapy, several forms of treatment have been devised to augment its actions, and new delivery systems are under development. This new research offers promise for improving outcomes with this highly effective therapy.
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Affiliation(s)
- Peter A LeWitt
- Department of Neurology, Henry Ford Hospital, and the Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan 48034, USA.
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21
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Holford N, Nutt JG. Disease progression, drug action and Parkinson's disease: why time cannot be ignored. Eur J Clin Pharmacol 2007; 64:207-16. [PMID: 18092155 DOI: 10.1007/s00228-007-0427-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 11/22/2007] [Indexed: 12/21/2022]
Affiliation(s)
- Nick Holford
- Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand.
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Abstract
Control of movement depends on the continuous release of dopamine by neurons in the basal ganglia of the brain. The degeneration of these neurons in Parkinson's disease (PD) interferes with the flow of dopamine, leading to classic motor symptoms. In early PD, enough dopaminergic neurons remain to store dopamine provided by periodic dosing with oral levodopa and relatively normal, tonic levels of dopamine release are maintained. PD progression leads to degeneration of remaining dopaminergic terminals and loss of buffering capacity for exogenous levodopa. As a result, there are supraphysiological levels of dopamine after dosing and troughs when the available dopamine has been depleted. These divergent levels are associated with dyskinesia and 'off' states, respectively. Treatment strategies that provide a continuous flow of dopamine and can thus mimic normal physiological dopamine stimulation have potential to improve motor control for patients with advanced PD.
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Affiliation(s)
- Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University Hospital, SE-75185 Uppsala, Sweden.
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Chan PLS, Nutt JG, Holford NHG. Levodopa Slows Progression of Parkinson’s Disease. External Validation by Clinical Trial Simulation. Pharm Res 2007; 24:791-802. [PMID: 17308968 DOI: 10.1007/s11095-006-9202-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Accepted: 12/04/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE To externally validate the model predictions of a DATATOP cohort analysis through application of clinical trial simulation with the study design of the ELLDOPA trial. METHODS The stochastic pharmacokinetic-pharmacodynamic and disease progress model was developed from the large DATATOP cohort of patients followed for 8 years. ELLDOPA was designed to detect a difference between placebo and levodopa treated arms in the total Unified Parkinson's Disease Rating Scale (UPDRS) taken at baseline and following 2 weeks levodopa washout after 40 weeks of treatment. The total UPDRS response was simulated with different assumptions on levodopa effect (symptomatic with/without disease modifying capability) and washout speed of symptomatic effect. RESULTS The observed results of ELLDOPA were similar to the model predictions assuming levodopa slows disease progression and has a slow washout of symptomatic effect. CONCLUSIONS This simulation work confirmed the conclusion of the DATATOP analysis finding that levodopa slows disease progression. The simulation results also showed that a dose-related increased rate of progression in Parkinson's disease, obscured by symptomatic benefit, is very unlikely. Finally, the simulation results also shown that 2 weeks washout period was not adequate to completely eliminate the symptomatic benefits of levodopa.
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Affiliation(s)
- Phylinda L S Chan
- Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand
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Holford NHG, Chan PLS, Nutt JG, Kieburtz K, Shoulson I. Disease Progression and Pharmacodynamics in Parkinson Disease – Evidence for Functional Protection with Levodopa and Other Treatments. J Pharmacokinet Pharmacodyn 2006; 33:281-311. [PMID: 16625427 DOI: 10.1007/s10928-006-9012-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2005] [Accepted: 02/27/2006] [Indexed: 11/28/2022]
Abstract
We have modelled the Unified Parkinson's Disease Rating Scale (UPDRS) scores collected in 800 subjects followed for 8 years. Newly diagnosed and previously untreated subjects were initially randomized to treatment with placebo, deprenyl, tocopherol or both and, when clinical disability required, received one or more dopaminergic agents (levodopa (carbidopa/levodopa), bromocriptine, or pergolide). Using models for disease progression and pharmacodynamic models for drug effects we have characterized the changes in UPDRS over time to determine the influence of the various drug treatments. We have confirmed and quantitated the relative symptomatic benefits of the dopaminergic agents and provide model-based evidence for slowing of disease progression.
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Affiliation(s)
- Nicholas H G Holford
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, Auckland, New Zealand.
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