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Lees A, Tolosa E, Stocchi F, Ferreira JJ, Rascol O, Antonini A, Poewe W. Optimizing levodopa therapy, when and how? Perspectives on the importance of delivery and the potential for an early combination approach. Expert Rev Neurother 2023; 23:15-24. [PMID: 36729395 DOI: 10.1080/14737175.2023.2176220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There is currently a resurgence of levodopa as the initial treatment of choice for most patients with Parkinson's disease, albeit at lower doses than previously used. The addition of adjuvant treatments (including MAO-B inhibitors, COMT inhibitors and dopamine agonists) is an established strategy to reduce motor complications that develop with sustained levodopa therapy. AREAS COVERED In this narrative review, the authors discuss the evidence underpinning current levodopa optimization strategies, during early disease and once motor complications occur. To support the discussion, the authors performed a broad PubMed search with the terms 'levodopa/L-dopa/L-Dopa, and Parkinson's disease,' restricted to clinical trials. There is now a wealth of evidence that improving levodopa delivery to the brain improves outcomes and we discuss how agents can be combined earlier in the course of disease to leverage the full potential of this strategy. EXPERT OPINION Levodopa remains the cornerstone of antiparkinsonian therapy. Several promising advances in formulation have been made and include novel extended-release oral drugs as well as non-oral delivery systems. However, evidence has long suggested that anti-parkinsonian medications may be better used in combination earlier in the disease, and consequently patients will benefit from low doses of several agents rather than ever larger levodopa doses.
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Affiliation(s)
- Andrew Lees
- University College London, Reta Lila Weston Institute, London, UK
| | - Eduardo Tolosa
- Parkinson disease and Movement Disorders Unit, Neurology Service, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED: CB06/05/0018-ISCIII) Barcelona, Barcelona, Spain
| | - Fabrizio Stocchi
- Department of Neurology, University San Raffaele and IRCCS San Raffaele Pisana, Rome, Italy
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,CNS - Campus Neurológico, Torres Vedras, Portugal
| | - Olivier Rascol
- Department of Neurosciences and Clinical Pharmacology, Clinical Investigation center CIC1436 and NS-Park/FCRIN network; University Hospital of Toulouse, INSERM and University of Toulouse 3, Toulouse, France
| | - Angelo Antonini
- Movement Disorders Unit, Study Center for Neurodegenerative Diseases (CESNE), Department of Neuroscience, University of Padova
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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2
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Xie L, Qi X, Wang X, He B, Wang Y, Zhang W, Yu Z, Deng M, Liang S, Lü M. Adverse event profiles of adjuvant treatment with opicapone in Parkinson's disease: A systematic review and meta-analysis. Front Pharmacol 2022; 13:1042992. [PMID: 36506576 PMCID: PMC9729693 DOI: 10.3389/fphar.2022.1042992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Opicapone, a novel third-generation catechol-O-methyltransferase inhibitor, has demonstrated efficacy in Parkinson's Disease (PD) patients with end-of-dose motor fluctuations. Objective: This study aimed to compare the short-term (<6 months) and long-term (≥6 months) tolerability of opicapone adjuvant treatment in PD patients. Method: Electronic databases including PubMed, Embase, Web of Science and Cochrane library were searched for randomized controlled trials (RCTs) and observational studies. The end points included any treatment-related adverse events (TEAEs), serious TEAEs (SAEs) and treatment discontinuation. A random-effects model was used to generate overall incidences of TEAE. Results: Three RCTs, three RCT extension studies and three open-label studies involving 2177 PD patients were evaluated. In the short-term studies, there were reports of TEAEs with an incidence of ≥5% in individuals treated with opicapone 50 mg, including dyskinesia (14.1%), elevated blood creatine phosphokinase levels (8.0%) and urinary tract infection (6.0%). Any TEAEs, SAEs and treatment discontinuation all occurred at rates of 62.9%, 4.8% and 9.3%, respectively. TEAEs with opicapone 50 mg that were reported by more than 5% of patients in long-term studies included dyskinesia (16.1%), dry mouth (12.1%), medication effect decreased (12.1%), PD exacerbated (7.8%), blood creatine phosphokinase level raised (7.4%), nausea (6.1%) and insomnia (5.1%). The incidence of any TEAEs, SAEs and treatment discontinuation were, correspondingly, 73.2%, 8.7% and 8.4%. Conclusion: These studies demonstrated that opicapone was generally well-tolerated and had a low risk of adverse events, suggesting that it could be a valuable therapeutic choice for people with PD.
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Affiliation(s)
- Luwen Xie
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaoyi Qi
- Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xuan Wang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Bing He
- The Public Platform of Advanced Detecting Instruments, Public Center of Experimental Technology, Southwest Medical University, Luzhou, China
| | - Yu Wang
- Department of Orthopedics, Gulin County People’s Hospital, Luzhou, China
| | - Wei Zhang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zehui Yu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China,Human Microecology and Precision Diagnosis and Treatment of Luzhou Key Laboratory, Luzhou, China
| | - Mingming Deng
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Sicheng Liang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China,The Public Platform of Advanced Detecting Instruments, Public Center of Experimental Technology, Southwest Medical University, Luzhou, China,Human Microecology and Precision Diagnosis and Treatment of Luzhou Key Laboratory, Luzhou, China,Cardiovascular and Metabolic Diseases of Sichuan Key Laboratory, Luzhou, China,*Correspondence: Sicheng Liang, ; Muhan Lü,
| | - Muhan Lü
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China,Human Microecology and Precision Diagnosis and Treatment of Luzhou Key Laboratory, Luzhou, China,Cardiovascular and Metabolic Diseases of Sichuan Key Laboratory, Luzhou, China,*Correspondence: Sicheng Liang, ; Muhan Lü,
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Loureiro AI, Fernandes-Lopes C, Bonifácio MJ, Sousa F, Kiss LE, Soares-da-Silva P. Metabolism and disposition of opicapone in the rat and metabolic enzymes phenotyping. Pharmacol Res Perspect 2021; 10:e00891. [PMID: 34939338 PMCID: PMC8929358 DOI: 10.1002/prp2.891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/11/2022] Open
Abstract
Opicapone (2,5‐dichloro‐3‐(5‐(3,4‐dihydroxy‐5‐nitrophenyl)‐1,2,4‐oxadiazol‐3‐yl)‐4,6‐dimethylpyridine 1‐oxide) is a selective catechol‐O‐methyltransferase inhibitor that has been granted marketing authorization in Europe, Japan, and United States. The present work describes the metabolism and disposition of opicapone in the rat obtained in support to its development and regulatory filling. Plasma levels and elimination of total radioactivity were determined after oral and intravenous administration of [14C]‐opicapone. The maximum plasma concentrations of opicapone‐related radioactivity were reached at early time points followed by a gradual return to baseline with a biphasic elimination. Fecal excretion was the primary route of elimination of total radioactivity. Quantitative distribution of drug‐related radioactivity demonstrated that opicapone and related metabolites did not distribute to the central nervous system. Opicapone was extensively metabolized in rats resulting in more than 20 phase I and phase II metabolites. Although O‐glucuronidation, ‐sulfation, and ‐methylation of the nitrocatechol moiety were the principal metabolic pathways, small amount of the N‐acetyl derivative was detected, as a result of reduction of the nitro group and subsequent conjugation. Other metabolic transformations included N‐oxide reduction to the pyridine derivative and reductive cleavage of 1,2,4‐oxadiazole ring followed by further conjugative reactions. Reaction phenotyping studies suggested that SULT 1A1*1 and *2 and UGT1A7, UGT1A8, UGT1A9, and UGT1A10 may be involved in opicapone sulfation and glucuronidation, respectively. However, the reductive metabolic pathways mediated by gut microflora cannot be excluded. Opicapone, in the rat, was found to be rapidly absorbed, widely distributed to peripheric tissues, metabolized mainly via conjugative pathways at the nitro catechol ring, and primarily excreted via feces.
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Affiliation(s)
- Ana I Loureiro
- Department of Research and Development, BIAL-Portela & Cª. S.A., S Mamede do Coronado, Portugal
| | - Carlos Fernandes-Lopes
- Department of Research and Development, BIAL-Portela & Cª. S.A., S Mamede do Coronado, Portugal
| | - Maria João Bonifácio
- Department of Research and Development, BIAL-Portela & Cª. S.A., S Mamede do Coronado, Portugal
| | - Filipa Sousa
- Department of Research and Development, BIAL-Portela & Cª. S.A., S Mamede do Coronado, Portugal
| | - László E Kiss
- Department of Research and Development, BIAL-Portela & Cª. S.A., S Mamede do Coronado, Portugal
| | - Patricio Soares-da-Silva
- Department of Research and Development, BIAL-Portela & Cª. S.A., S Mamede do Coronado, Portugal.,Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUp-Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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Opicapone for the Treatment of Parkinson's Disease "Off" Episodes: Pharmacology and Clinical Considerations. Clin Drug Investig 2021; 42:127-135. [PMID: 34935105 DOI: 10.1007/s40261-021-01109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/27/2022]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder. It is also the fastest-growing neurodegenerative disorder and has more than doubled between 1990 and 2016. Parkinson's disease causes significant morbidity and disability from motor dysfunction, sleep disturbances, and cognitive and psychiatric symptoms. This paper reviews recent evidence in the treatment of PD "off" episodes with the novel drug opicapone, including its efficacy, safety, and clinical indications. Opicapone is a novel, peripherally acting catechol-O-methyl transferase (COMT) inhibitor used as adjunctive therapy to carbidopa/levodopa for treatment and prevention of "off" episodes. It has been approved for use as an adjunct to levodopa since 2016 in Europe and has recently (April 2020) gained FDA approval for use in the USA. By inhibiting COMT, opicapone slows levodopa metabolism and increases its availability. Several clinical studies demonstrated significant improvement in treatment efficacy and reduction in the duration of "off" episodes The main side effect demonstrated was dyskinesia, mostly with the 100 mg dose, which is higher than the approved, effective dose of 50 mg.
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Jenner P, Rocha JF, Ferreira JJ, Rascol O, Soares-da-Silva P. Redefining the strategy for the use of COMT inhibitors in Parkinson's disease: the role of opicapone. Expert Rev Neurother 2021; 21:1019-1033. [PMID: 34525893 DOI: 10.1080/14737175.2021.1968298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Levodopa remains the gold-standard Parkinson's disease (PD) treatment, but the inevitable development of motor complications has led to intense activity in pursuit of its optimal delivery. AREAS COVERED Peripheral inhibition of dopa-decarboxylase has long been considered an essential component of levodopa treatment at every stage of illness. In contrast, only relatively recently have catechol-O-methyltransferase (COMT) inhibitors been utilized to block the other major pathway of degradation and optimize levodopa delivery to the brain. First and second-generation COMT inhibitors were deficient because of toxicity, sub-optimal pharmacokinetics or a short duration of effect. As such, they have only been employed once 'wearing-off' has developed. However, the third-generation COMT inhibitor, opicapone has overcome these difficulties and exhibits long-lasting enzyme inhibition without the toxicity observed with previous generations of COMT inhibitors. In clinical trials and real-world PD studies opicapone improves the levodopa plasma profile and results in a significant improvement in ON time in 'fluctuating' disease, but it has not yet been included in the algorithm for early treatment. EXPERT OPINION This review argues for a shift in the positioning of COMT inhibition with opicapone in the PD algorithm and lays out a pathway for proving its effectiveness in early disease.
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Affiliation(s)
- Peter Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade De Medicina, Universidade De Lisboa, Lisboa, Portugal.,CNS - Campus Neurológico, Torres Vedras, Portugal
| | - Olivier Rascol
- Clinical Investigation Center CIC1436, Departments of Clinical Pharmacology and Neurosciences, NS-Park/FCRIN Network and Toulouse NeuroToul Coen Center; Inserm, University Hospital of Toulouse, and University of Toulouse 3, Toulouse, France
| | - Patrício Soares-da-Silva
- Department of Research & Development, BIAL - Portela & Ca SA, Portugal.,Department of Pharmacology and Therapeutics, Faculty of Medicine, University Porto, Porto, Portugal
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Azevedo Kauppila L, Pimenta Silva D, Ferreira JJ. Clinical Utility of Opicapone in the Management of Parkinson's Disease: A Short Review on Emerging Data and Place in Therapy. Degener Neurol Neuromuscul Dis 2021; 11:29-40. [PMID: 34007239 PMCID: PMC8123942 DOI: 10.2147/dnnd.s256722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
Parkinson’s disease (PD) is a prevalent neurodegenerative disorder, and levodopa (L-dopa) remains the most efficacious drug treatment for PD and a gold-standard for symptom control. Nonetheless, a significant majority of PD patients develop motor fluctuations over their disease course, with a significant impact on quality-of-life, meaning control of such complications translates into a fundamental clinical need. Catechol-O-methyl transferase (COMT) inhibitors (COMT-i) are used as first-line adjuvant therapy to L-dopa for end-of-dose (EoD) motor fluctuations, since they increase L-dopa availability in the brain by inhibiting its peripheral metabolism. Opicapone (OPC), a once-daily, long-acting COMT-i, is the most recent and potent of its class, having been licensed in Europe in 2016 as an add-on to preparations of L-dopa/DOPA decarboxylase inhibitors in PD patients with EoD motor fluctuations. More recently, it has also received approval in the USA and Japan in 2020. Two high-quality positive efficacy studies (double-blind Phase III clinical trials) established OPC efficacy with significant reduction in OFF time (average 60 minutes vs placebo), without concomitant increase of distressing dyskinesias during ON time. These beneficial effects were sustained in open-label extension studies, without unexpected safety issues or adverse events, with dyskinesia having been the most frequent complaint. OPC also avoids liver toxicity and gastrointestinal issues compared with previous COMT-i. In this review, we aimed to cover OPC’s lifecycle (synthesis to commercialization), its clinical pharmacological data, safety, tolerability and pharmacovigilance evidence, and discuss its role in the management of motor fluctuations in PD as well as its emerging place in international recommendations.
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Affiliation(s)
- Linda Azevedo Kauppila
- Department of Neurosciences and Mental Health, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Daniela Pimenta Silva
- Department of Neurosciences and Mental Health, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Joaquim J Ferreira
- CNS - Campus Neurológico, Torres Vedras, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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7
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Abstract
Oral opicapone (Ongentys®), a potent third-generation, peripheral catechol-O-methyltransferase (COMT) inhibitor, is approved as adjunctive therapy to preparations of levodopa/dopa-decarboxylase inhibitor (L-dopa/DDCI) in adults with Parkinson's disease (PD) and end-of dose (EoD) motor fluctuations. In pivotal global trials (BIPARK 1 and BIPARK 2; 14-15 weeks' duration), open-label extensions (OLEs) of BIPARK, and in the real-world setting (OPTIPARK; 3-6 months), opicapone 50 mg once daily was an effective and generally well tolerated adjunctive therapy to L-dopa/DDCI plus other PD therapy in adults with PD and EoD motor fluctuations. Adjunctive opicapone provided better efficacy than placebo for improvements in ON- and OFF-state time and fulfilled noninferiority to adjunctive entacapone for improvements in OFF time in BIPARK 1. These beneficial effects of adjunctive opicapone on motor fluctuations were maintained during 1 year of treatment in OLE studies. Given its efficacy and safety profile, adjunctive opicapone remains an important option in the management of adults with PD and EoD motor fluctuations who cannot be stabilized on preparations of L-dopa/DDCI.
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Bonifácio MJ, Sousa F, Soares-da-Silva P. Opicapone enhances the reversal of MPTP-induced Parkinson-like syndrome by levodopa in cynomolgus monkeys. Eur J Pharmacol 2020; 892:173742. [PMID: 33220276 DOI: 10.1016/j.ejphar.2020.173742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 10/23/2022]
Abstract
Opicapone is a third generation nitrocatechol catechol-O-methyltransferase inhibitor that has received regional market approval for use as adjunctive therapy to levodopa in Parkinson's disease patients with motor fluctuations. This study evaluated the effects of opicapone as adjunct to levodopa in reversing a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) induced Parkinson's-like syndrome in cynomolgus monkeys in during opicapone preclinical development program. A Parkinson's-like syndrome was induced in cynomolgus monkeys by daily administrations of MPTP. Evaluation of the animals included scoring with the Primate Parkinsonism Motor Rating Scale (PPMRS) and assessment of locomotor activity. MPTP produced a stable Parkinson's-like behavioural syndrome as evidenced by tremor, postural changes, rigidity, impaired movements and balance, (PPMRS scores of 10-15) and decreased locomotor activity (13% of pre-MPTP values). Opicapone treatment alone, for 14 days, did not change Parkinson's-like symptoms nor decreased subject's locomotor behaviour. Ascending combinations of levodopa/benserazide dose-dependently decreased PPMRS and improved locomotor behaviour reaching statistical significance for levodopa/benserazide doses of 18/4.5 mg/kg and those effects were enhanced in opicapone treated subjects. Opicapone treated subjects as compared vehicle-treated, had markedly reduced erythrocyte catechol-O-methyltransferase activity, significantly increased plasma levodopa levels (1.8-fold higher AUC) with no statistically significant changes in Cmax and significantly reduced 3-OMD AUC and Cmax values (7.8- and 6.8-fold respectively). Opicapone potentiated the improvements in Parkinson's-like symptoms produced by levodopa/benserazide combinations with concomitant increase in plasma levodopa exposure, reduction of plasma 3-O-methyldopa levels and erythrocyte catechol-O-methyltransferase activity, results that were later demonstrated in 2 large Phase 3 studies in Parkinson's disease patients.
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Affiliation(s)
- Maria João Bonifácio
- Department of Research, BIAL-Portela & C(a), S.A, 4745-457, Coronado (S. Mamede & S. Romão), Portugal
| | - Filipa Sousa
- Department of Research, BIAL-Portela & C(a), S.A, 4745-457, Coronado (S. Mamede & S. Romão), Portugal
| | - Patrício Soares-da-Silva
- Department of Research, BIAL-Portela & C(a), S.A, 4745-457, Coronado (S. Mamede & S. Romão), Portugal; Department of Biomedicine, Unit of Pharmacology & Therapeutics, Faculty of Medicine, University of Porto, 4200, Porto, Portugal; MedInUp - Center for Drug Discovery and Innovative Medicines, University of Porto, 4200, Porto, Portugal.
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Ettcheto M, Busquets O, Sánchez-Lopez E, Cano A, Manzine PR, Verdaguer E, Olloquequi J, Auladell C, Folch J, Camins A. The preclinical discovery and development of opicapone for the treatment of Parkinson's disease. Expert Opin Drug Discov 2020; 15:993-1004. [PMID: 32450711 DOI: 10.1080/17460441.2020.1767580] [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] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Opicapone (OPC) is a well-established catechol-O-methyltransferase (COMT) inhibitor that is approved for the treatment of Parkinson's disease (PD) associated with L-DOPA/L-amino acid decarboxylase inhibitor (DDI) therapy allowing for prolonged activity due to a more continuous supply of L-DOPA in the brain. Thus, OPC decreases fluctuation in L-DOPA plasma levels and favors more constant central dopaminergic receptor stimulation, thus improving PD symptomatology. AREAS COVERED This review evaluates the preclinical development, pharmacology, pharmacokinetics and safety profile of OPC. Data was extracted from published preclinical and clinical studies published on PUBMED and SCOPUS (Search period: 2000-2019). Clinical and post-marketing data are also evaluated. EXPERT OPINION OPC is a third generation COMT inhibitor with a novel structure. It has an efficacy and tolerability superior to its predecessors, tolcapone (TOL) and entacapone (ENT). It also provides a safe and simplified drug regimen that allows neurologists to individually adjust the existing daily administration of L-DOPA. OPC is indicated as an adjunctive therapy to L-DOPA/DDI in patients with PD and end-of-dose motor fluctuations who cannot be stabilized on those combinations.
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Affiliation(s)
- Miren Ettcheto
- Departament of Pharmacology, Toxicology and Therapeutic Chemistry, Faculty of Pharmacy and Food Science, University of Barcelona , Barcelona, Spain.,Department of Biochemistry and Biotechnology, Faculty of Medicine and Life Science, University Rovira i Virgili , Reus, Spain.,Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED) , Madrid, Spain.,Institute of Neuroscience, University of Barcelona , Barcelona, Spain
| | - Oriol Busquets
- Departament of Pharmacology, Toxicology and Therapeutic Chemistry, Faculty of Pharmacy and Food Science, University of Barcelona , Barcelona, Spain.,Department of Biochemistry and Biotechnology, Faculty of Medicine and Life Science, University Rovira i Virgili , Reus, Spain.,Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED) , Madrid, Spain.,Institute of Neuroscience, University of Barcelona , Barcelona, Spain
| | - Elena Sánchez-Lopez
- Institute of Neuroscience, University of Barcelona , Barcelona, Spain.,Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona , Barcelona, Spain.,Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Science, University of Barcelona , Barcelona, Spain
| | - Amanda Cano
- Institute of Neuroscience, University of Barcelona , Barcelona, Spain.,Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona , Barcelona, Spain.,Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy and Food Science, University of Barcelona , Barcelona, Spain
| | - Patricia R Manzine
- Departament of Pharmacology, Toxicology and Therapeutic Chemistry, Faculty of Pharmacy and Food Science, University of Barcelona , Barcelona, Spain.,Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED) , Madrid, Spain.,Institute of Neuroscience, University of Barcelona , Barcelona, Spain.,Department of Gerontology, Federal University of São Carlos (Ufscar) , São Carlos, Brazil
| | - Ester Verdaguer
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED) , Madrid, Spain.,Institute of Neuroscience, University of Barcelona , Barcelona, Spain.,Department of Cellular Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona , Barcelona, Spain
| | - Jordi Olloquequi
- Laboratory of Cellular and Molecular Pathology, Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile , Talca, Chile
| | - Carme Auladell
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED) , Madrid, Spain.,Institute of Neuroscience, University of Barcelona , Barcelona, Spain.,Department of Cellular Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona , Barcelona, Spain
| | - Jaume Folch
- Department of Biochemistry and Biotechnology, Faculty of Medicine and Life Science, University Rovira i Virgili , Reus, Spain.,Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED) , Madrid, Spain
| | - Antoni Camins
- Departament of Pharmacology, Toxicology and Therapeutic Chemistry, Faculty of Pharmacy and Food Science, University of Barcelona , Barcelona, Spain.,Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED) , Madrid, Spain.,Institute of Neuroscience, University of Barcelona , Barcelona, Spain.,Laboratory of Cellular and Molecular Pathology, Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile , Talca, Chile
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Müller T. Pharmacokinetics and pharmacodynamics of levodopa/carbidopa cotherapies for Parkinson’s disease. Expert Opin Drug Metab Toxicol 2020; 16:403-414. [DOI: 10.1080/17425255.2020.1750596] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Thomas Müller
- Department of Neurology, St. Joseph Hospital Berlin-Weißensee, Berlin, Germany
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Akhtar MJ, Yar MS, Grover G, Nath R. Neurological and psychiatric management using COMT inhibitors: A review. Bioorg Chem 2020; 94:103418. [DOI: 10.1016/j.bioorg.2019.103418] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/27/2019] [Accepted: 10/31/2019] [Indexed: 12/18/2022]
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Kitajima T, Mizote S, Bonifácio MJ, Umemura T, Yoneda K, Moser P, Soares-da-Silva P, Tanaka M. Inhibition of catechol-O-methyltransferase in the cynomolgus monkey by opicapone after acute and repeated administration. Neuropharmacology 2018; 143:282-288. [DOI: 10.1016/j.neuropharm.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/25/2018] [Accepted: 10/01/2018] [Indexed: 11/26/2022]
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Fabbri M, Ferreira JJ, Lees A, Stocchi F, Poewe W, Tolosa E, Rascol O. Opicapone for the treatment of Parkinson's disease: A review of a new licensed medicine. Mov Disord 2018; 33:1528-1539. [PMID: 30264443 DOI: 10.1002/mds.27475] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/09/2018] [Accepted: 05/21/2018] [Indexed: 01/08/2023] Open
Abstract
Catechol-O-methyl transferase inhibitors are currently used as first-line add-on therapy to levodopa for the treatment of end-of-dose motor fluctuations in Parkinson's disease patients, as they increase levodopa bioavailability. Several factors hamper the use of current available catechol-O-methyl transferase inhibitors, that is, the moderate efficacy and multiple dosing for entacapone and the risk of liver toxicity with tolcapone. Opicapone, a new long-acting, peripherally selective, once-daily catechol-O-methyl transferase inhibitor, was recently licensed in Europe. Two phase 3 double-blind clinical trials demonstrated opicapone efficacy in reducing OFF time by an average of about 60 minutes daily compared with placebo, without increasing ON time with troublesome dyskinesias. These effects were also maintained during a subsequent open-label extension consisting of 1-year follow-up. Opicapone showed a good safety profile. From June 2016, Opicapone received the approval for marketing authorization from the European Commission as adjunctive therapy to levodopa/DOPA decarboxylase inhibitors in patients with PD and end-of-dose motor fluctuations. We aimed to review the clinical pharmacological data of opicapone, summarize its clinical efficacy and safety issues, and discuss its potential role in the management of Parkinson's disease. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular, Lisbon, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Andrew Lees
- The National Hospital, Queen Square, London, UK
| | - Fabrizio Stocchi
- University and Institute for Research and Medical Care, IRCCS San Raffaele, Rome, Italy
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Eduardo Tolosa
- Movement Disorder Unit, Neurology Service, Hospital Clínic of Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Olivier Rascol
- Departments of Clinical Pharmacology and Neurosciences, Clinical Investigation Center CIC 1436, NS-Park/FCRIN network and NeuroToul COEN Center, INSERM, CHU de Toulouse, Université de Toulouse 3, Toulouse, France
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Castro Caldas A, Teodoro T, Ferreira JJ. The launch of opicapone for Parkinson's disease: negatives versus positives. Expert Opin Drug Saf 2018; 17:331-337. [PMID: 29415596 DOI: 10.1080/14740338.2018.1433659] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Opicapone is a novel, third generation COMT inhibitor approved for the treatment of Parkinson's disease. Safety and tolerability data is critical to determine the benefit-harm balance and anticipate therapeutic adherence. Areas covered: This review evaluates the tolerability and safety profile of opicapone. These data were extracted from all published clinical trials, including preclinical, phase I, phase II and phase III studies as well as postmarketing data. Opicapone was safe and well tolerated, with frequencies of treatment-emergent adverse events similar to placebo. Expert opinion: Opicapone have shown a good safety and tolerability profile. This adds to its proven efficacy and convenient once-daily administration, supporting a role of opicapone as a first-line therapy for motor complications in Parkinson's disease patients.
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Affiliation(s)
- Ana Castro Caldas
- a Neurology Service, Department of Neurosciences , Hospital de Santa Maria , Lisbon , Portugal.,b Neurology Department , Instituto de Medicina Molecular , Lisbon , Portugal.,c Neurology Department , CNS - Campus Neurológico Sénior , Torres Vedras , Portugal
| | - Tiago Teodoro
- b Neurology Department , Instituto de Medicina Molecular , Lisbon , Portugal.,d Neurology Department , St George's, University of London & St George's University Hospitals NHS Foundation Trust , London , United Kingdom
| | - Joaquim J Ferreira
- b Neurology Department , Instituto de Medicina Molecular , Lisbon , Portugal.,c Neurology Department , CNS - Campus Neurológico Sénior , Torres Vedras , Portugal.,e Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine , University of Lisbon , Lisbon , Portugal
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15
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Svetel M, Tomić A, Kresojević N, Kostić V. Pharmacokinetic drug evaluation of opicapone for the treatment of Parkinson’s disease. Expert Opin Drug Metab Toxicol 2018; 14:353-360. [DOI: 10.1080/17425255.2018.1430138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Marina Svetel
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Tomić
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Vladimir Kostić
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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A single- and multiple-dose study to investigate the pharmacokinetics and pharmacodynamics of opicapone, a novel COMT inhibitor, in rat. Neuropharmacology 2017; 125:146-155. [DOI: 10.1016/j.neuropharm.2017.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/10/2017] [Accepted: 07/18/2017] [Indexed: 01/29/2023]
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17
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Bicker J, Fortuna A, Alves G, Soares-da-Silva P, Falcão A. Elucidation of the Impact of P-glycoprotein and Breast Cancer Resistance Protein on the Brain Distribution of Catechol- O-Methyltransferase Inhibitors. Drug Metab Dispos 2017; 45:1282-1291. [PMID: 28916530 DOI: 10.1124/dmd.117.077883] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/13/2017] [Indexed: 12/14/2022] Open
Abstract
P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) are clinically important efflux transporters that act cooperatively at the blood-brain barrier, limiting the entry of several drugs into the central nervous system (CNS) and affecting their pharmacokinetics, therapeutic efficacy, and safety. In the present study, the interactions of catechol-O-methyltransferase (COMT) inhibitors (BIA 9-1059, BIA 9-1079, entacapone, nebicapone, opicapone, and tolcapone) with P-gp and BCRP were investigated to determine the contribution of these transporters in their access to the brain. In vitro cellular accumulation and bidirectional transport assays were conducted in Madin-Darby canine kidney (MDCK) II, MDCK-MDR1, and MDCK-BCRP cells. In vivo pharmacokinetic studies were carried out for tolcapone and BIA 9-1079 in rats, with and without elacridar, a well-known P-gp and BCRP modulator. The results suggest that BIA 9-1079, nebicapone, and tolcapone inhibit BCRP in a concentration-dependent manner. Moreover, with net flux ratios higher than 2 and decreased over 50% in the presence of verapamil or Ko143, BIA 9-1079 was identified as a P-gp substrate while BIA 9-1059, entacapone, opicapone, and nebicapone were revealed to be BCRP substrates. In vivo, brain exposure was limited for tolcapone and BIA 9-1079, although tolcapone crossed the blood-brain barrier at a greater rate and to a greater extent than BIA 9-1079. The extent of brain distribution of both compounds was significantly increased in the presence of elacridar, attesting to the involvement of efflux transporters. These findings provide relevant information and improve the understanding of the mechanisms that govern the access of these COMT inhibitors to the CNS.
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Affiliation(s)
- Joana Bicker
- Laboratory of Pharmacology, Faculty of Pharmacy (J.B., A.Fo., A.Fa.), and Center for Neuroscience and Cell Biology (J.B., A.Fo., G.A., A.Fa.), University of Coimbra, Coimbra, Portugal; Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal (G.A.); Department of Research and Development, BIAL, Sao Mamede do Coronado, Portugal (P.S.-d.S.); and Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal (P.S.-d.S.)
| | - Ana Fortuna
- Laboratory of Pharmacology, Faculty of Pharmacy (J.B., A.Fo., A.Fa.), and Center for Neuroscience and Cell Biology (J.B., A.Fo., G.A., A.Fa.), University of Coimbra, Coimbra, Portugal; Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal (G.A.); Department of Research and Development, BIAL, Sao Mamede do Coronado, Portugal (P.S.-d.S.); and Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal (P.S.-d.S.)
| | - Gilberto Alves
- Laboratory of Pharmacology, Faculty of Pharmacy (J.B., A.Fo., A.Fa.), and Center for Neuroscience and Cell Biology (J.B., A.Fo., G.A., A.Fa.), University of Coimbra, Coimbra, Portugal; Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal (G.A.); Department of Research and Development, BIAL, Sao Mamede do Coronado, Portugal (P.S.-d.S.); and Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal (P.S.-d.S.)
| | - Patrício Soares-da-Silva
- Laboratory of Pharmacology, Faculty of Pharmacy (J.B., A.Fo., A.Fa.), and Center for Neuroscience and Cell Biology (J.B., A.Fo., G.A., A.Fa.), University of Coimbra, Coimbra, Portugal; Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal (G.A.); Department of Research and Development, BIAL, Sao Mamede do Coronado, Portugal (P.S.-d.S.); and Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal (P.S.-d.S.)
| | - Amílcar Falcão
- Laboratory of Pharmacology, Faculty of Pharmacy (J.B., A.Fo., A.Fa.), and Center for Neuroscience and Cell Biology (J.B., A.Fo., G.A., A.Fa.), University of Coimbra, Coimbra, Portugal; Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal (G.A.); Department of Research and Development, BIAL, Sao Mamede do Coronado, Portugal (P.S.-d.S.); and Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal (P.S.-d.S.)
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Scott LJ. Opicapone in Parkinson’s disease: a profile of its use. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-017-0419-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lees AJ, Ferreira J, Rascol O, Reichmann H, Stocchi F, Tolosa E, Poewe W. Opicapone for the management of end-of-dose motor fluctuations in patients with Parkinson's disease treated with L-DOPA. Expert Rev Neurother 2017; 17:649-659. [PMID: 28580819 DOI: 10.1080/14737175.2017.1336086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Opicapone is a third generation, highly potent and effective catechol O‑methyltransferase (COMT) inhibitor that optimizes the pharmacokinetics and bioavailability of L-DOPA therapy. Areas covered: In this review, the authors describe the preclinical and clinical development of opicapone. In PD patients with motor fluctuations, once daily opicapone administration was well-tolerated and consistently reduced OFF-time and increased ON-time without increasing the frequency of troublesome dyskinesia, and these benefits were maintained over at least a year of continued open-label therapy. Expert commentary: With its convenient once-daily regimen, adjunct opicapone should be considered as an effective option for use in L-DOPA treated PD patients experiencing motor fluctuations.
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Affiliation(s)
- Andrew J Lees
- a Reta Lila Weston Institute for Neurological Studies, UCL , London , UK
| | - Joaquim Ferreira
- b Centro de Estudos Egas Moniz , Hospital de Santa Maria , Lisbon , Portugal
| | - Olivier Rascol
- c Departments of Clinical Pharmacology and Neurosciences, Clinical Investigation Center CIC 1436, NS-Park/FCRIN network and NeuroToul COEN Center , INSERM, Toulouse University Hospital and Toulouse3 University , Toulouse , France
| | - Heinz Reichmann
- d Department of Neurology , Technische Universitaet Dresden , Dresden , Germany
| | - Fabrizio Stocchi
- e Institute of Neurology , IRCCS San Raffaele Pisana , Rome , Italy
| | - Eduardo Tolosa
- f Neurology Service, Centro de Investigación Biomódica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, IDIBAPS , Universitat de Barcelona , Barcelona , Spain
| | - Werner Poewe
- g Department of Neurology , Innsbruck Medical University , Innsbruck , Austria
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Abstract
Oral opicapone (Ongentys(®)), a potent, third-generation, long-acting, peripheral catechol-O-methyltransferase (COMT) inhibitor, is approved as adjunctive treatment to levodopa (L-Dopa)/dopa-decarboxylase inhibitor (DDCI) therapy in adults with Parkinson's disease (PD) and end-of-dose motor fluctuations who cannot be stabilized on those combinations. In 14- to 15-week, double-blind, multinational trials and in 1-year, open-label extension studies in this patient population, opicapone was an effective and generally well tolerated adjunctive therapy to L-Dopa plus a DDCI and other PD therapy. During the double-blind phase, adjunctive opicapone 50 mg once daily provided significantly greater improvements in motor fluctuations than placebo, with these improvements noninferior to those with entacapone. These beneficial improvements in motor fluctuations with opicapone were maintained in patients who continued adjunctive opicapone during the extension studies, with patients who switched from placebo or entacapone to opicapone experiencing significant improvements in motor fluctuations during this year. No new unexpected safety concerns were identified after ≈1.4 years' treatment with opicapone, with no serious cases of hepatotoxicity reported in clinical trials. With its convenient once-daily regimen, oral opicapone is an emerging COMT inhibitor option for use as adjunctive therapy to L-Dopa/DDCI therapy in adults with PD and end-of dose motor fluctuations who cannot be stabilized on those combinations.
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21
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Pires AO, Teixeira FG, Mendes-Pinheiro B, Serra SC, Sousa N, Salgado AJ. Old and new challenges in Parkinson's disease therapeutics. Prog Neurobiol 2017; 156:69-89. [PMID: 28457671 DOI: 10.1016/j.pneurobio.2017.04.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 03/15/2017] [Accepted: 04/20/2017] [Indexed: 02/06/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by the degeneration of dopaminergic neurons and/or loss od neuronal projections, in several dopaminergic networks. Current treatments for idiopathic PD rely mainly on the use of pharmacologic agents to improve motor symptomatology of PD patients. Nevertheless, so far PD remains an incurable disease. Therefore, it is of utmost importance to establish new therapeutic strategies for PD treatment. Over the last 20 years, several molecular, gene and cell/stem-cell therapeutic approaches have been developed with the aim of counteracting or retarding PD progression. The scope of this review is to provide an overview of PD related therapies and major breakthroughs achieved within this field. In order to do so, this review will start by focusing on PD characterization and current treatment options covering thereafter molecular, gene and cell/stem cell-based therapies that are currently being studied in animal models of PD or have recently been tested in clinical trials. Among stem cell-based therapies, those using MSCs as possible disease modifying agents for PD therapy and, specifically, the MSCs secretome contribution to meet the clinical challenge of counteracting or retarding PD progression, will be more deeply explored.
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Affiliation(s)
- Ana O Pires
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - F G Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - B Mendes-Pinheiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Sofia C Serra
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - António J Salgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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22
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Rodrigues FB, Ferreira JJ. Opicapone for the treatment of Parkinson’s disease. Expert Opin Pharmacother 2017; 18:445-453. [DOI: 10.1080/14656566.2017.1294683] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Filipe B Rodrigues
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Huntington’s Disease Centre, Institute of Neurology, University College London, London, UK
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
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23
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Annus Á, Vécsei L. Spotlight on opicapone as an adjunct to levodopa in Parkinson's disease: design, development and potential place in therapy. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:143-151. [PMID: 28123288 PMCID: PMC5234693 DOI: 10.2147/dddt.s104227] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Parkinson's disease (PD) is a progressive, chronic, neurodegenerative disease characterized by rigidity, tremor, bradykinesia and postural instability secondary to dopaminergic deficit in the nigrostriatal system. Currently, disease-modifying therapies are not available, and levodopa (LD) treatment remains the gold standard for controlling motor and nonmotor symptoms of the disease. LD is extensively and rapidly metabolized by peripheral enzymes, namely, aromatic amino acid decarboxylase and catechol-O-methyltransferase (COMT). To increase the bioavailability of LD, COMT inhibitors are frequently used in clinical settings. Opicapone is a novel COMT inhibitor that has been recently approved by the European Medicines Agency as an adjunctive therapy to combinations of LD and aromatic amino acid decarboxylase inhibitor in adult PD patients with end-of-dose motor fluctuations. We aimed to review the biochemical properties of opicapone, summarize its preclinical and clinical trials and discuss its future potential role in the treatment of PD.
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Affiliation(s)
- Ádám Annus
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged
| | - László Vécsei
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged; MTA-SZTE Neuroscience Research Group, Szeged, Hungary
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Fabbri M, Rosa MM, Ferreira JJ. Clinical pharmacology review of opicapone for the treatment of Parkinson's disease. Neurodegener Dis Manag 2016; 6:349-62. [DOI: 10.2217/nmt-2016-0022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Two catechol-O-methyl transferase inhibitors are currently used as add-on therapy to levodopa for the amelioration of end-of-dose motor fluctuations in Parkinson's disease patients: entacapone, which has moderate efficacy and requires multiple dosing, and tolcapone, which has a poor safety profile. Opicapone (OPC) is a novel, long-acting, peripherally selective, once daily, third-generation catechol-O-methyl transferase inhibitor. Two Phase III clinical trials demonstrated OPC efficacy in reducing OFF-time by an average of about 60 min daily compared with placebo, without increasing ON-time with troublesome dyskinesias, with a good drug safety profile. In June 2016, the European Commission granted a marketing authorization valid throughout the European Union for OPC, indicated as adjunctive of levodopa decarboxylase inhibitors in adult patients with Parkinson's disease and end-of-dose motor fluctuations.
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Affiliation(s)
- Margherita Fabbri
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Mario M Rosa
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Laboratory of Clinical Pharmacology & Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Joaquim J Ferreira
- Clinical Pharmacology Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Laboratory of Clinical Pharmacology & Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- CNS – Campus Neurológico Sénior, Torres Vedras, Portugal
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25
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Bicker J, Alves G, Fortuna A, Soares-da-Silva P, Falcão A. A new PAMPA model using an in-house brain lipid extract for screening the blood-brain barrier permeability of drug candidates. Int J Pharm 2016; 501:102-11. [PMID: 26836708 DOI: 10.1016/j.ijpharm.2016.01.074] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 01/27/2016] [Accepted: 01/28/2016] [Indexed: 01/16/2023]
Abstract
The determination of the permeability of drug candidates across the blood-brain barrier (BBB) is a fundamental step during drug discovery programs. The parallel artificial membrane permeability assay (PAMPA) is a high throughput screening tool applied to evaluate the passive permeability and adapted to predict BBB penetration. Herein, a new PAMPA model was developed using an in-house brain lipid extract capable of discriminating BBB permeable from non-permeable compounds. The apparent permeability (Papp) of 18 reference molecules and 10 test compounds was assessed and compared with phosphatidylcholine and commercial porcine polar brain lipid (PBL). The physicochemical selectivity of the in-house brain lipid extract was demonstrated by correlating Papp values with physicochemical properties and its predictive capacity estimated by establishing in vitro-in vivo correlations. The strong correlations achieved between 2% (w/v) in-house lipid extract and PBL for reference (r(2)=0.77) and test compounds (r(2)=0.94) support an equivalent discriminatory capacity and validate the presented model. Moreover, PAMPA studies performed with PBL and in-house lipid extract exhibited a higher correlation with the in vivo parameter logBB (r(2)=0.76 and r(2)=0.72, respectively) than phosphatidylcholine (r(2)=0.51). Overall, the applied lipid extraction process was reproducible, economical and provided lipid extracts that can be used to reliably assess BBB permeation.
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Affiliation(s)
- Joana Bicker
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; CNC-Center for Neuroscience and Cell Biology, University of Coimbra, 3004-517 Coimbra, Portugal
| | - Gilberto Alves
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, 3004-517 Coimbra, Portugal; CICS-UBI-Health Sciences Research Centre, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilhã, Portugal
| | - Ana Fortuna
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; CNC-Center for Neuroscience and Cell Biology, University of Coimbra, 3004-517 Coimbra, Portugal
| | - Patrício Soares-da-Silva
- Department of Research and Development, BIAL, Av. da Siderurgia Nacional, 4745- 457, S. Mamede do Coronado, Portugal; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Amílcar Falcão
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; CNC-Center for Neuroscience and Cell Biology, University of Coimbra, 3004-517 Coimbra, Portugal.
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26
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Rocha JF, Ferreira JJ, Falcão A, Santos A, Pinto R, Nunes T, Almeida L, Soares-da-Silva P. Effect of 3 Single-Dose Regimens of Opicapone on Levodopa Pharmacokinetics, Catechol-O-Methyltransferase Activity and Motor Response in Patients With Parkinson Disease. Clin Pharmacol Drug Dev 2015; 5:232-40. [PMID: 27163503 DOI: 10.1002/cpdd.217] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 08/04/2015] [Indexed: 12/16/2022]
Abstract
This study determined the effects of single doses of opicapone (OPC), a novel third-generation catechol-O-methyltransferase (COMT) inhibitor, on levodopa and 3-O-methyl-levodopa (3-OMD) pharmacokinetics (PK), COMT activity and motor fluctuations in patients with Parkinson disease (PD). Subjects received, in a double-blind manner, 25, 50, and 100 mg OPC or placebo (PLC) in 4 separate treatment periods. The washout period between doses was at least 10 days. During each period, the OPC/PLC capsules were to be coadministered with the morning dose of 100/25 mg levodopa/carbidopa (LC) or levodopa/benserazide (LB) on day 3. In relation to PLC, levodopa exposure increased 3.7%, 16.4%, and 34.8% following 25, 50, or 100 mg OPC, respectively. Maximum S-COMT inhibition (Emax ) ranged from 67.8% (25 mg OPC) to 100% (100 mg OPC). Peak and extent of S-COMT inhibition were dose-dependent. Maximum decrease in the plasma 3-OMD was observed following administration of 100 mg OPC. Opicapone administered concomitantly with standard-release 100/25 mg LC or LB improved motor performance. Treatments were generally well tolerated and safe. It was concluded that OPC is a new COMT inhibitor that significantly decreased COMT activity and increased systemic exposure to levodopa in PD patients with motor fluctuations.
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Affiliation(s)
- José-Francisco Rocha
- Department of Research and Development, BIAL - Portela & Cª - S.A., Coronado, Portugal
| | - Joaquim J Ferreira
- Neurological Clinical Research Unit, Institute of Molecular Medicine, Lisbon, Portugal
| | - Amílcar Falcão
- Department of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Ana Santos
- Department of Research and Development, BIAL - Portela & Cª - S.A., Coronado, Portugal
| | - Roberto Pinto
- Department of Research and Development, BIAL - Portela & Cª - S.A., Coronado, Portugal.,Department of Pharmacology & Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Teresa Nunes
- Department of Research and Development, BIAL - Portela & Cª - S.A., Coronado, Portugal
| | - Luis Almeida
- Department of Pharmacology & Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,Health Sciences Department, University of Aveiro, Aveiro, Portugal, University Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
| | - Patrício Soares-da-Silva
- Department of Research and Development, BIAL - Portela & Cª - S.A., Coronado, Portugal.,Department of Pharmacology & Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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Falcão A, Rocha JF, Santos A, Nunes T, Soares-da-Silva P. Opicapone pharmacokinetics and pharmacodynamics comparison between healthy Japanese and matched white subjects. Clin Pharmacol Drug Dev 2015; 5:150-61. [PMID: 27138028 DOI: 10.1002/cpdd.213] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 06/30/2015] [Indexed: 02/06/2023]
Abstract
Opicapone (OPC) is a novel third-generation catechol-O-methyltransferase (COMT) inhibitor. This randomized, double-blind, parallel, placebo-controlled and multiple ascending dose study in 3 sequential groups of up to 38 (19 Japanese plus 19 white subjects) aimed to compare the pharmacokinetics (PK) and pharmacodynamics (PD; COMT activity) of opicapone between healthy Japanese and matched white subjects. Enrolled subjects received a once-daily morning administration of OPC (5, 25, or 50 mg) or placebo for 10 days, with plasma and urine concentrations of opicapone and its metabolites measured up to 144 hours postdose, including S-COMT activity. Geometric mean ratios (GMRs) and confidence intervals (95%CIs) for the main PK and PD parameters of OPC were evaluated between populations. Both the PK and PD of OPC were similar in the Japanese and white populations. Overall, only minimal differences were noted between the 2 populations, which were not deemed to be statistically significant. When both populations were separated based on their COMT genotype, the observed PK and PD differences were also negligible. In conclusion, the PK and PD profiles of OPC were similar in the Japanese and white populations. Thus, ethnicity and COMT polymorphisms had no significant impact on the OPC PK and PD in the conditions of the study.
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Affiliation(s)
- Amílcar Falcão
- Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, Coimbra, Portugal
| | - José Francisco Rocha
- Department of Research & Development, BIAL - Portela & Cª - S.A., Mamede do Coronado, Portugal
| | - Ana Santos
- Department of Research & Development, BIAL - Portela & Cª - S.A., Mamede do Coronado, Portugal
| | - Teresa Nunes
- Department of Research & Development, BIAL - Portela & Cª - S.A., Mamede do Coronado, Portugal
| | - Patrício Soares-da-Silva
- Department of Research & Development, BIAL - Portela & Cª - S.A., Mamede do Coronado, Portugal.,Department of Pharmacology & Therapeutics, Faculty of Medicine, University Porto, Porto, Portugal.,MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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dos Santos Passos C, Klein-Júnior LC, de Mello Andrade JM, Matté C, Henriques AT. The catechol-O-methyltransferase inhibitory potential of Z-vallesiachotamine by in silico and in vitro approaches. REVISTA BRASILEIRA DE FARMACOGNOSIA-BRAZILIAN JOURNAL OF PHARMACOGNOSY 2015. [DOI: 10.1016/j.bjp.2015.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
Levodopa remains the most potent drug to treat motor symptoms in Parkinson's disease (PD); however, motor fluctuations and levodopa-induced dyskinesia that occur with long-term use restrict some of its therapeutic value. Despite these limitations, the medical treatment of PD strives for continuous relief of symptoms using different strategies throughout the course of the illness: increasing the half-life of levodopa, using 'levodopa-sparing agents' and adding non-dopaminergic drugs. New options to 'improve' delivery of levodopa are under investigation, including long-acting levodopa, nasal inhalation and continuous subcutaneous or intrajejunal administration of levodopa. Long-acting dopamine agonists were recently developed and are undergoing further comparative studies to investigate potential superiority over the immediate-release formulations. Non-dopaminergic drugs acting on adenosine receptors, cholinergic, adrenergic, serotoninergic and glutamatergic pathways are newly developed and many are being evaluated in Phase II and Phase III trials. This article focuses on promising novel therapeutic approaches for the management of PD motor symptoms and motor complications. We will provide an update since 2011 on new formulations of current drugs, new drugs with promising results in Phase II and Phase III clinical trials, old drugs with new possibilities and some new potential strategies that are currently in Phase I and II of development (study start date may precede 2011 but are included as study is still ongoing or full data have not yet been published). Negative Phase II and Phase III clinical trials published since 2011 will also be briefly mentioned.
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30
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Ferreira JJ, Rocha JF, Falcão A, Santos A, Pinto R, Nunes T, Soares-da-Silva P. Effect of opicapone on levodopa pharmacokinetics, catechol-O-methyltransferase activity and motor fluctuations in patients with Parkinson's disease. Eur J Neurol 2015; 22:815-25, e56. [DOI: 10.1111/ene.12666] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/15/2014] [Indexed: 11/29/2022]
Affiliation(s)
- J. J. Ferreira
- Neurological Clinical Research Unit; Institute of Molecular Medicine; Lisbon Portugal
| | - J.-F. Rocha
- Department of Research and Development; BIAL - Portela & Cª SA; S. Mamede do Coronado Portugal
| | - A. Falcão
- Department of Pharmacology; Faculty of Pharmacy; University Coimbra; Coimbra Portugal
| | - A. Santos
- Department of Research and Development; BIAL - Portela & Cª SA; S. Mamede do Coronado Portugal
| | - R. Pinto
- Department of Research and Development; BIAL - Portela & Cª SA; S. Mamede do Coronado Portugal
- Department of Pharmacology and Therapeutics; Faculty of Medicine; University Porto; Porto Portugal
| | - T. Nunes
- Department of Research and Development; BIAL - Portela & Cª SA; S. Mamede do Coronado Portugal
| | - P. Soares-da-Silva
- Department of Research and Development; BIAL - Portela & Cª SA; S. Mamede do Coronado Portugal
- Department of Pharmacology and Therapeutics; Faculty of Medicine; University Porto; Porto Portugal
- MedInUP − Center for Drug Discovery and Innovative Medicines; University of Porto; Porto Portugal
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Bonifácio MJ, Torrão L, Loureiro AI, Palma PN, Wright LC, Soares-da-Silva P. Pharmacological profile of opicapone, a third-generation nitrocatechol catechol-O-methyl transferase inhibitor, in the rat. Br J Pharmacol 2015; 172:1739-52. [PMID: 25409768 DOI: 10.1111/bph.13020] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/06/2014] [Accepted: 11/11/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Catechol-O-methyltransferase (COMT) is an important target in the levodopa treatment of Parkinson's disease; however, the inhibitors available have problems, and not all patients benefit from their efficacy. Opicapone was developed to overcome those limitations. In this study, opicapone's pharmacological properties were evaluated as well as its potential cytotoxic effects. EXPERIMENTAL APPROACH The pharmacodynamic effects of opicapone were explored by evaluating rat COMT activity and levodopa pharmacokinetics, in the periphery through microdialysis and in whole brain. The potential cytotoxicity risk of opicapone was explored in human hepatocytes by assessing cellular ATP content and mitochondrial membrane potential. KEY RESULTS Opicapone inhibited rat peripheral COMT with ED50 values below 1.4 mg⋅kg(-1) up to 6 h post-administration. The effect was sustained over the first 8 h and by 24 h COMT had not returned to control values. A single administration of opicapone resulted in increased and sustained plasma levodopa levels with a concomitant reduction in 3-O-methyldopa from 2 h up to 24 h post-administration, while tolcapone produced significant effects only at 2 h post-administration. The effects of opicapone on brain catecholamines after levodopa administration were sustained up to 24 h post-administration. Opicapone was also the least potent compound in decreasing both the mitochondrial membrane potential and the ATP content in human primary hepatocytes after a 24 h incubation period. CONCLUSIONS AND IMPLICATIONS Opicapone has a prolonged inhibitory effect on peripheral COMT, which extends the bioavailability of levodopa, without inducing toxicity. Thus, it exhibits some improved properties compared to the currently available COMT inhibitors.
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Affiliation(s)
- M J Bonifácio
- Department of Research and Development, BIAL - Portela & Cª, S.A., São Mamede do Coronado, Portugal
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Abstract
Despite advances in the treatment of Parkinson's disease there are still many unmet needs, including neuroprotection, treatment of motor complications, treatment of dyskinesia, treatment of psychosis, and treatment of nondopaminergic symptoms. In this review, I highlight the obstacles to develop a neuroprotective drug and some of the treatment strategies recently approved or still in clinical trials designed to meet these unmet needs.
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Affiliation(s)
- Fabrizio Stocchi
- Institute for Research and Medical Care, IRCCS San Raffaele, Via della Pisana 235, 00163, Rome, Italy,
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