Opicapone as an Add-on to Levodopa in Patients with Parkinson's Disease Without Motor Fluctuations: Rationale and Design of the Phase III, Double-Blind, Randomised, Placebo-Controlled EPSILON Trial

Disease Stage and Motor Fluctuation Duration Predict Drug Tolerability: A Real-Life, Prospective Italian Multicenter Study on the Use of Opicapone in Parkinson's Disease

BACKGROUND

Opicapone is a third-generation catechol-O-methyl-transferase inhibitor currently used for the treatment of motor fluctuations in Parkinson's disease. Its benefit and safety have been established by clinical trials; however, data about its use in a real-life context, and particularly in an Italian population of patients with Parkinson's disease, are missing.

OBJECTIVES

We aimed to gather data about the real-life tolerability/safety of opicapone when used for the treatment of Parkinson's disease-related motor fluctuations.

METHODS

We enrolled 152 consecutive patients with Parkinson's disease and followed them for 2 years after opicapone introduction. We obtained baseline clinical and demographical information, including disease duration, stage, phenotype, as well as axial and non-motor symptoms. We collected the reasons for any treatment interruption and adverse events emerging after opicapone introduction.

RESULTS

Eighty-nine (58%) patients reported adverse events and 46 (30%) patients discontinued the treatment. Adverse events occurred less frequently in "earlier" patients accordingly to the disease course and L-Dopa treatment pathway; a motor fluctuation duration ≥12 months and Hoehn and Yahr scale score ≥2.5 were the main predictors of therapy withdrawal.

CONCLUSIONS

This study confirms the good tolerability/safety profile of opicapone in a real-life setting and provides country-specific data for Italian patients with Parkinson's disease.

Adoption of deep learning-based magnetic resonance image information diagnosis in brain function network analysis of Parkinson's disease patients with end-of-dose wearing-off

OBJECTIVE

this study was to analyze the brain functional network of end-of-dose wearing-off (EODWO) in patients with Parkinson's disease (PD) using a convolutional neural network (CNN)-based functional magnetic resonance imaging (fMRI) data classification model.

METHODS

one hundred PD patients were recruited and assigned to control (Ctrl) group (39 cases without EODWO) and experimental (Exp) group (61 cases with EODWO). The data classification model based on a CNN was employed to assist the analysis of the changes in brain functional network structure in the two groups. The CNN-based fMRI data classification model was primarily based on a CNN architecture, with improvements made to the initialization of convolutional kernel parameters. Firstly, a structure based on restricted Boltzmann machine (RBM) was constructed, followed by the initialization of convolutional kernel parameters. Subsequently, the model underwent training. Utilizing the data analysis module within the GRETNA toolbox, extracted feature sets were analyzed, including local measures such as betweenness centrality (BC) and degree centrality (DC), as well as global measures such as global efficiency (Eg) and local efficiency (Eloc).

RESULTS

as sparsity increased, there was a gradual upward trend observed in Eg; however, the values of Eg in both brain functional networks remained relatively stable within the range of 0.2-0.5. The Eg value of the Ctrl group's whole-brain functional network was 0.17 ± 0.02, while that of the Exp group's whole-brain functional network was 0.17 ± 0.03, with no significant difference between them (P>0.05). The functional DC value of the superior frontal gyrus in the Exp group (8.71 ± 2.56) was significantly lower than that of the Ctrl group (13.32 ± 3.22), whereas the functional DC value of the anterior cingulate gyrus in the Exp group (19.33 ± 4.78) was significantly higher than that of the Ctrl group (15.21 ± 4.02) (P<0.05). There was no significant correlation observed between the functional DC value and levodopa or dopamine agonist therapy (DDT) in the Exp group, whereas the Ctrl group exhibited a significant positive correlation.

CONCLUSION

analysis conducted via a CNN-based fMRI data classification model revealed a correlation between the occurrence of EODWO in PD patients and functional impairments in the left precuneus. Additionally, the occurrence of EODWO may potentially diminish the plasticity of the central prefrontal dopamine.

Objective assessment of the effects of opicapone in Parkinson's disease through kinematic analysis

BACKGROUND

Opicapone (OPC) is a third-generation, selective peripheral COMT inhibitor that improves peripheral L-DOPA bioavailability and reduces OFF time and end-of-dose motor fluctuations in Parkinson's disease (PD) patients.

OBJECTIVES

In this study, we objectively assessed the effects of adding OPC to L-DOPA on bradykinesia in PD through kinematic analysis of finger movements.

METHODS

We enrolled 20 treated patients with PD and motor fluctuations. Patients underwent two experimental sessions (L-DOPA, L-DOPA + OPC), separated by at least 1 week. In each session, patients were clinically evaluated and underwent kinematic movement analysis of repetitive finger movements at four time points: (i) before their usual morning dose of L-DOPA (T0), (ii) 30 min (T1), (iii) 1 h and 30 min (T2), and (iv) 3 h and 30 min after the L-DOPA intake (T3).

RESULTS

Movement velocity and amplitude of finger movements were higher in PD patients during the session with OPC compared to the session without OPC at all the time points tested. Importantly, the variability of finger movement velocity and amplitude across T0-T3 was significantly lower in the L-DOPA + OPC than L-DOPA session.

CONCLUSIONS

This study is the first objective assessment of the effects of adding OPC to L-DOPA on bradykinesia in patients with PD and motor fluctuations. OPC, in addition to the standard dopaminergic therapy, leads to significant improvements in bradykinesia during clinically relevant periods associated with peripheral L-DOPA dynamics, i.e., the OFF state in the morning, delayed-ON, and wearing-OFF periods.

Clinical benefit of MAO-B and COMT inhibition in Parkinson's disease: practical considerations

Inhibitors of monoamine oxidase B (MAO-B) and catechol-O-methyltransferase (COMT) are major strategies to reduce levodopa degradation and thus to increase and prolong its effect in striatal dopaminergic neurotransmission in Parkinson's disease patients. While selegiline/rasagiline and tolcapone/entacapone have been available on the market for more than one decade, safinamide and opicapone have been approved in 2015 and 2016, respectively. Meanwhile, comprehensive data from several post-authorization studies have described the use and specific characteristics of the individual substances in clinical practice under real-life conditions. Here, we summarize current knowledge on both medication classes, with a focus on the added clinical value in Parkinson's disease. Furthermore, we outline practical considerations in the treatment of motor fluctuations and provide an outlook on ongoing studies with MAO-B and COMT inhibitors.

The safety/tolerability of opicapone when used early in Parkinson's disease patients with levodopa-induced motor fluctuations: A post-hoc analysis of BIPARK-I and II

Introduction

Post-hoc analyses of the BIPARK-I and II trials previously demonstrated that opicapone (OPC) 50 mg was efficacious over the whole trajectory of motor fluctuation evolution in patients with Parkinson's disease (PD) and end-of-dose motor fluctuations, with enhanced efficacy in patients who were earlier vs. later in their disease course and levodopa treatment pathway. Complementary post-hoc analyses were performed to evaluate the safety/tolerability of OPC following the same pre-defined segmentation of the wide spectrum of duration of both PD and levodopa therapy, as well as of motor fluctuation history, in this patient population.

Materials and methods

Data from matching treatment arms in BIPARK-I and II were combined for the placebo (PLC) and OPC 50 mg groups and exploratory post-hoc analyses were performed to investigate the safety/tolerability of OPC 50 mg and PLC in 22 subgroups of patients who were in “earlier” vs. “later” stages of both their disease course (e.g., duration of PD <6 years vs. ≥6 years) and levodopa treatment pathway (e.g., levodopa treatment duration <4 vs. ≥4 years). Safety/tolerability assessments included evaluation of treatment-emergent adverse events (TEAEs).

Results

The Safety Set included 522 patients (PLC, n = 257; OPC 50 mg, n = 265). For OPC 50 mg, incidences of TEAEs, related TEAEs, related serious TEAEs, and related TEAEs leading to discontinuation were lower for patients in earlier vs. later stages of their disease course and levodopa treatment pathway in 86.4, 86.4, 63.6, and 68.2% of the 22 pairwise comparisons conducted, respectively (compared with 63.6, 77.3, 18.2, and 45.5%, respectively, in the 22 corresponding PLC comparisons).

Conclusion

OPC 50 mg was generally well-tolerated when used to treat patients with PD with end-of-dose fluctuations, with an even more favorable tolerability profile in patients who were earlier, as opposed to later, in their disease course and levodopa treatment pathway, further supporting its use as an early adjunct to levodopa in PD.