1
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Ineichen C, Baumann-Vogel H, Sitzler M, Baumann CR. The risk of developing motor complications with Levodopa immediate versus dual release upon treatment initiation in Parkinson's disease. Clin Park Relat Disord 2023; 9:100209. [PMID: 38107673 PMCID: PMC10724828 DOI: 10.1016/j.prdoa.2023.100209] [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: 04/19/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Motor complications (MCs) compromise therapy in many patients suffering from Parkinson's Disease. By achieving more physiologic stimulation of dopamine-receptors, the continuous dopamine stimulation hypothesis suggests that longer-acting levodopa formulations may improve outcome. The aim of this study was to compare the duration until onset of MCs and motor disease progression in patients during their treatment initiation with either an immediate (IR) or a combined rapid- and sustained-release (i.e. dual-release; DR) levodopa formulation. Methods Using a sample of 69 patients, we applied time-varying survival regression analyses and linear mixed effect models to analyze the data. The latter involved preprocessing of the data to temporally align the response and predictors, including analyzing the extent of visit irregularity and potential predictors of visit intensity. Results This retrospective study suggests that levodopa-benserazide DR is not superior to levodopa-benserazide IR in affecting duration until MCs and disease progression. Conversely, using DR levodopa-benserazide, similar disease progression was achieved with lower and more constant doses. Conclusions The effects of DR levodopa-benserazide might not be strong enough to delay onset of MCs. The development of more powerful levodopa formulations remains a pressing clinical need.
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Affiliation(s)
- Christian Ineichen
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | - Heide Baumann-Vogel
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | - Matthias Sitzler
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | - Christian R. Baumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
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2
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Masood N, Jimenez-Shahed J. Effective Management of "OFF" Episodes in Parkinson's Disease: Emerging Treatment Strategies and Unmet Clinical Needs. Neuropsychiatr Dis Treat 2023; 19:247-266. [PMID: 36721795 PMCID: PMC9884436 DOI: 10.2147/ndt.s273121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
Motor complications related to the chronic administration of levodopa and failure to prevent the neurodegenerative disease process counterbalance the pivotal discovery of levodopa as the cornerstone of PD treatment. Excellent motor control is offered early during the course of treatment, but this diminishes as pathological changes in the striatum lead to synaptic dopamine levels becoming completely dependent on exogenous dopamine. This non-physiologic stimulation of dopamine receptors eventually manifests as OFF episodes. As no disease modifying therapy exists for PD that can disrupt these pathological changes, most research and treatment focuses on optimization of dopaminergic stimulation of striatal receptors so that they mimic tonic, physiologic stimulation as closely as possible. Strategies focusing on these challenges have included non-pharmacologic approaches, optimizing levodopa pharmacokinetics, using adjunctive treatments including those with non-dopaminergic mechanisms, and implementing rescue therapies. Device aided therapies, including surgery, are also available. In this review, we will focus on effective management of motor symptoms related to OFF periods, including emerging strategies. Unmet clinical needs will be discussed, including non-motor symptoms, targeted molecular therapies and disease modifying therapy.
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Affiliation(s)
- Nbaa Masood
- Department of Neurology, Icahn School of Medicine at Mount Sinai, Mount Sinai West, New York, NY, USA
| | - Joohi Jimenez-Shahed
- Department of Neurology, Icahn School of Medicine at Mount Sinai, Mount Sinai West, New York, NY, USA
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3
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Kretzschmar GC, Targa ADS, Soares-Lima SC, dos Santos PI, Rodrigues LS, Macedo DA, Ribeiro Pinto LF, Lima MMS, Boldt ABW. Folic Acid and Vitamin B12 Prevent Deleterious Effects of Rotenone on Object Novelty Recognition Memory and Kynu Expression in an Animal Model of Parkinson's Disease. Genes (Basel) 2022; 13:genes13122397. [PMID: 36553663 PMCID: PMC9778036 DOI: 10.3390/genes13122397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/10/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Parkinson's disease (PD) is characterized by a range of motor signs, but cognitive dysfunction is also observed. Supplementation with folic acid and vitamin B12 is expected to prevent cognitive impairment. To test this in PD, we promoted a lesion within the substantia nigra pars compacta of rats using the neurotoxin rotenone. In the sequence, the animals were supplemented with folic acid and vitamin B12 for 14 consecutive days and subjected to the object recognition test. We observed an impairment in object recognition memory after rotenone administration, which was prevented by supplementation (p < 0.01). Supplementation may adjust gene expression through efficient DNA methylation. To verify this, we measured the expression and methylation of the kynureninase gene (Kynu), whose product metabolizes neurotoxic metabolites often accumulated in PD as kynurenine. Supplementation prevented the decrease in Kynu expression induced by rotenone in the substantia nigra (p < 0.05), corroborating the behavioral data. No differences were observed concerning the methylation analysis of two CpG sites in the Kynu promoter. Instead, we suggest that folic acid and vitamin B12 increased global DNA methylation, reduced the expression of Kynu inhibitors, maintained Kynu-dependent pathway homeostasis, and prevented the memory impairment induced by rotenone. Our study raises the possibility of adjuvant therapy for PD with folic acid and vitamin B12.
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Affiliation(s)
- Gabriela Canalli Kretzschmar
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, PR, Brazil
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, PR, Brazil
| | - Adriano D. S. Targa
- Laboratory of Neurophysiology, Department of Physiology, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, PR, Brazil
| | - Sheila Coelho Soares-Lima
- Molecular Carcinogenesis Program, National Cancer Institute, Research Coordination, Rio de Janeiro 20231-050, RJ, Brazil
| | - Priscila Ianzen dos Santos
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, PR, Brazil
| | - Lais S. Rodrigues
- Laboratory of Neurophysiology, Department of Physiology, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, PR, Brazil
| | - Daniel A. Macedo
- Laboratory of Neurophysiology, Department of Physiology, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, PR, Brazil
| | - Luis Felipe Ribeiro Pinto
- Molecular Carcinogenesis Program, National Cancer Institute, Research Coordination, Rio de Janeiro 20231-050, RJ, Brazil
| | - Marcelo M. S. Lima
- Laboratory of Neurophysiology, Department of Physiology, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, PR, Brazil
| | - Angelica Beate Winter Boldt
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, PR, Brazil
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná (UFPR), Centro Politécnico, Jardim das Américas, Curitiba 81531-990, PR, Brazil
- Correspondence: ; Tel.: +55-(41)-3361-1553
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4
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Schofield C, Chaudhuri KR, Carroll C, Sharma JC, Pavese N, Evans J, Foltynie T, Reichmann H, Zurowska L, Soares-da-Silva P, Lees A. Opicapone in UK clinical practice: effectiveness, safety and cost analysis in patients with Parkinson's disease. Neurodegener Dis Manag 2022; 12:77-91. [PMID: 35313124 DOI: 10.2217/nmt-2021-0057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This subanalysis of the OPTIPARK study aimed to confirm the effectiveness and safety of opicapone in patients with Parkinson's disease and motor fluctuations in clinical practice specifically in the UK and to assess the impact of opicapone on treatment costs. Methods: Patients received opicapone added to levodopa for 6 months. Clinical outcomes were assessed at 3 and 6 months and treatment costs at 6 months. Results: Most patients' general condition improved at 3 months, with sustained improvements reported at 6 months. Opicapone improved motor and non-motor symptoms at both timepoints, was generally well tolerated and reduced total treatment costs by GBP 3719. Conclusion: Opicapone added to levodopa resulted in clinical improvements and reduced treatment costs across UK clinical practice.
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Affiliation(s)
- Christine Schofield
- Research & Development Unit (Neurology), Royal Cornwall Hospitals Trust, Truro, Cornwall, TR1 3HD, UK
| | - K Ray Chaudhuri
- Parkinson's Foundation Centre of Excellence, King's College Hospital & NIHR Biomedical Research Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, WC2R 2LS, UK
| | - Camille Carroll
- University of Plymouth, Faculty of Health, Plymouth, Devon, PL6 8BX, UK
| | - Jagdish C Sharma
- Lincoln County Hospital, University of Lincoln, Lincoln, LN2 5QY, UK
| | - Nicola Pavese
- Clinical Ageing Research Unit, Newcastle University, Newcastle University, Newcastle Upon Tyne, NE4 5PL, UK
| | - Jonathan Evans
- Department of Neurology, Nottingham University NHS Trust, Nottingham, NG7 2UH, UK
| | - Thomas Foltynie
- Unit of Functional Neurosurgery, National Hospital for Neurology & Neurosurgery, London, WC1N 3BG, UK
| | - Heinz Reichmann
- Department of Neurology, University of Dresden, 01069, Dresden, Germany
| | - Laura Zurowska
- Medical Affairs Department, BIAL - Pharma UK Ltd, Windsor, SL4 3BL, UK
| | - Patrício Soares-da-Silva
- BIAL - Portela & Ca S.A., 4745-457 Coronado (S. Romão e S. Mamede), Portugal.,MedInUP, Center for Drug Discovery & Innovative Medicines, University of Porto, 4099-002 Porto, Portugal
| | - Andrew Lees
- University College London, Reta Lila Weston Institute & The National Hospital, Queen Square, London, WC1N 1PJ, UK
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5
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Müller T. GOCOVRI ® (amantadine) extended-release capsules in Parkinson's disease. Neurodegener Dis Manag 2021; 12:15-28. [PMID: 34918543 DOI: 10.2217/nmt-2021-0028] [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: 11/21/2022] Open
Abstract
Amantadine is an old, antiviral compound, which moderately improves motor behavior in Parkinson's disease. Its current resurgence results from an innovative, delayed uptake and extended release amantadine hydrochloride capsule, given at bedtime once daily. It is the only approved compound for reduction of involuntary movements, so called dyskinesia, in fluctuating orally levodopa treated patients. It additionally ameliorates 'off'-intervals characterized by impaired motor behavior. These beneficial effects result from higher and more continuous brain delivery of amantadine. Future clinical research is warranted on preventive effects of this amantadine capsule combined with enzyme blockers of central monoamine oxidase B and peripheral catechol-O-methyltransferase on motor complications in orally levodopa treated patients, as all these pharmacological principles support the concept of continuous dopamine substitution.
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Affiliation(s)
- Thomas Müller
- Department of Neurology, St. Joseph Hospital Berlin-Weißensee, Gartenstr. 1, Berlin, 13088, Germany
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6
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Lin SJ, Tai L, Huang YJ, Uang YS, Ho Y, Hsu KY, Wang LH. Effect of catechin and commercial preparation of green tea essence on the pharmacokinetics of l-dopa in rabbits. Biomed Chromatogr 2021; 35:e5227. [PMID: 34388856 DOI: 10.1002/bmc.5227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/17/2021] [Accepted: 08/03/2021] [Indexed: 11/09/2022]
Abstract
The aim of this study was to investigate drug interactions of L-dopa/carbidopa with catechin and green tea essence in rabbits following the simultaneous administration via an intramuscular injection of catechin or via an intragastric route for green tea essence with L-dopa/carbidopa. The results indicated that catechin at doses of 10, 20 and 50 mg/kg increased the area under the plasma concentration-time curve from time zero to the time of the last quantifiable concentration (AUC0-t ) of L-dopa by about 69, 78 and 42%, respectively. The metabolic ratios of the AUC0-t for 3-O-methyldopa (3-OMD)/L-dopa significantly decreased by about 56, 68 and 76% (P < 0.05), respectively. In addition, a single dose of 5/1.25 mg/kg L-dopa/carbidopa was co-administrated with 150 mg/kg green tea essence via an intragastric route with an oral-gastric tube. Comparing the related pharmacokinetic parameters of L-dopa, the clearance and metabolic ratio of L-dopa decreased by 20 and 19% (P < 0.05), respectively. In conclusion, catechin and green tea essence can significantly affect the metabolism of L-dopa by the catechol-O-methyltransferase (COMT) metabolic pathway. Catechin can enhance L-dopa bioavailability, and both catechin and green tea essence decreased 3-OMD formation. Therefore, catechin and green tea essence may increase L-dopa efficacy for Parkinson's disease treatment.
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Affiliation(s)
- Shwu-Jiuan Lin
- School of Pharmacy, Taipei Medical University, Taipei, Taiwan.,PhD Program in Clinical Drug Development of Herbal Medicine, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Lily Tai
- Rosetta Pharmamate Co. Ltd., Taipei, Taiwan
| | - Yu-Jie Huang
- School of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Yow-Shieng Uang
- Rosetta Pharmamate Co. Ltd., Taipei, Taiwan.,Graduate Institute of Pharmacognosy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Yih Ho
- School of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Kuang-Yang Hsu
- School of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Li-Hsuan Wang
- School of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan
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7
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Abstract
Parkinson’s Disease (PD) is a complex neurodegenerative disorder that mainly results due to the loss of dopaminergic neurons in the substantia nigra of the midbrain. It is well known that dopamine is synthesized in substantia nigra and is transported to the striatumvianigrostriatal tract. Besides the sporadic forms of PD, there are also familial cases of PD and number of genes (both autosomal dominant as well as recessive) are responsible for PD. There is no permanent cure for PD and to date, L-dopa therapy is considered to be the best option besides having dopamine agonists. In the present review, we have described the genes responsible for PD, the role of dopamine, and treatment strategies adopted for controlling the progression of PD in humans.
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8
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Jiang DQ, Li MX, Jiang LL, Chen XB, Zhou XW. Comparison of selegiline and levodopa combination therapy versus levodopa monotherapy in the treatment of Parkinson's disease: a meta-analysis. Aging Clin Exp Res 2020; 32:769-779. [PMID: 31175606 DOI: 10.1007/s40520-019-01232-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/23/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Selegiline or levodopa treatment has been suggested as a therapeutic method for Parkinson's disease (PD) in many clinical trial reports. However, the combined effects of two drugs still remain controversial. The aim of this report was to evaluate the clinical efficacy and safety of selegiline plus levodopa (S + L) combination therapy in the treatment of PD compared to that of L monotherapy, to provide a reference resource for rational drug use. METHODS Randomized controlled trials (RCTs) of S + L for PD published up to September, 2018 were searched. Mean difference (MD), odds ratio (OR), and 95% confidence interval (CI) were calculated and heterogeneity was assessed with the I2 test. Sensitivity analysis was also performed. The outcomes measured were as follows: the unified Parkinson's disease rating scale (UPDRS) scores, modified Webster score, adverse events and mortality. RESULTS Fourteen RCTs with 2008 participants were included. Compared with L monotherapy, the pooled effects of S + L combination therapy on UPDRS score were (eleven trials; MD - 7.00, 95% CI - 8.35 to - 5.65, P < 0.00001) for total UPDRS score (nine trials; MD - 5.74, 95% CI - 7.71 to - 3.77, P < 0.00001) for motor UPDRS score (seven trials; MD - 1.61, 95% CI - 2.18 to - 1.04, P < 0.00001) for activities of daily living UPDRS score (three trials; MD - 0.38, 95% CI - 0.61 to - 0.14, P = 0.002) for mental UPDRS score. The Webster score showed significant decrease in the S + L combination therapy compared to L monotherapy (four trials; MD - 5.71, 95% CI - 7.11 to - 4.32, P < 0.00001). Compared with L monotherapy, S + L combination therapy did not increase the number of any adverse events significantly in PD patients (ten trials; OR 1.58, 95% CI 0.83-3.00, P = 0.16). CONCLUSIONS S + L combination therapy is superior to L monotherapy for the improvement of clinical symptoms in PD patients. Moreover, the safety profile of S + L combination therapy is comparable with that of L monotherapy.
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Affiliation(s)
- De-Qi Jiang
- Department of Biology and Pharmacy, Yulin Normal University, Jiaoyudong Road No.1303, Yuzhou District, Yulin, 537000, Guangxi, China
- Guangxi Key Laboratory of Agricultural Resources Chemistry and Biotechnology, Yulin, 537000, China
| | - Ming-Xing Li
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Li-Lin Jiang
- Department of Biology and Pharmacy, Yulin Normal University, Jiaoyudong Road No.1303, Yuzhou District, Yulin, 537000, Guangxi, China
| | - Xiao-Bai Chen
- Department of Biology and Pharmacy, Yulin Normal University, Jiaoyudong Road No.1303, Yuzhou District, Yulin, 537000, Guangxi, China
| | - Xing-Wen Zhou
- Department of Biology and Pharmacy, Yulin Normal University, Jiaoyudong Road No.1303, Yuzhou District, Yulin, 537000, Guangxi, China.
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9
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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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10
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Müller T, Möhr JD. Recent Clinical Advances in Pharmacotherapy for Levodopa-Induced Dyskinesia. Drugs 2020; 79:1367-1374. [PMID: 31332769 DOI: 10.1007/s40265-019-01170-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Onset of involuntary movement patterns of the face, body and limbs are known as dyskinesia. They mostly appear in association with long-term levodopa (L-dopa) therapy in patients with Parkinson's disease. Consequences include patient distress, caregiver embarrassment and reduced quality of life. A severe intensity of this motor complication may result in troublesome disability; however, patients typically prefer motor behaviour with slight, non-troublesome dyskinesia to 'OFF' states. Pharmacotherapy of dyskinesia is complex. Continuous nigrostriatal postsynaptic dopaminergic receptor stimulation may delay onset of L-dopa-associated dyskinesia, while non-physiological, 'pulsatile' receptor stimulation facilitates appearance of dyskinesia. In the past, there have been many clinical trial failures with compounds that were effective in animal models of dyskinesia. Only the N-methyl-D-aspartate antagonist amantadine has shown moderate antidyskinetic effects in small well-designed clinical studies. Amantadine is an old antiviral compound, which moderately improves impaired motor behaviour. Recently, there has been a resurgence of its use due to the US Food and Drug Administration approval of an extended-release (ER) amantadine formulation for treatment of L-dopa-induced dyskinesia. This pharmacokinetic innovation improved dyskinesia and 'OFF' states in pivotal trials, with a once-daily oral application in the evening. Amantadine ER provides higher and more continuous amantadine plasma bioavailability than conventional immediate-release formulations, which require administration up to three times daily.
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Affiliation(s)
- Thomas Müller
- Department of Neurology, St. Joseph Hospital Berlin-Weißensee, Gartenstr. 1, 13088, Berlin, Germany.
| | - Jan-Dominique Möhr
- Department of Neurology, St. Joseph Hospital Berlin-Weißensee, Gartenstr. 1, 13088, Berlin, Germany
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11
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Müller T, Thiede HM. Bound, free, and total L-dopa measurement in plasma of Parkinson's disease patients. J Neural Transm (Vienna) 2019; 126:1417-1420. [PMID: 31396704 DOI: 10.1007/s00702-019-02057-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/03/2019] [Indexed: 11/28/2022]
Abstract
Peaks and troughs of levodopa in plasma contribute to pulsatile postsynaptic dopamine receptor stimulation in patients with Parkinson's disease. Measurement of levodopa plasma levels mostly only considers the total levodopa plasma concentration. Objectives were to determine bound, free, and total plasma levodopa and to investigate their correlations to each other. We employed reversed-phase high-performance liquid chromatography combined with electrochemical detection. Bound levodopa was computed as difference between total and free L-dopa values. Close correlations between free and total (R = 0.93, p < 0.0001), bound and total (R = 0.91, p < 0.0001) plasma levodopa appeared. A considerable variability of levodopa concentrations occurred. The ratio between bound and free levodopa did not differ in patients with a higher and lower oral daily levodopa dosing. Free, bound, and total levodopa plasma levels are closely related. Estimation of the total levodopa level only seems to be meaningful.
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Affiliation(s)
- Thomas Müller
- Department of Neurology, St. Joseph Hospital Berlin-Weißensee, Gartenstr. 1, 13088, Berlin, Germany.
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12
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Müller T, Kuhn W, Möhr JD. Evaluating ADS5102 (amantadine) for the treatment of Parkinson's disease patients with dyskinesia. Expert Opin Pharmacother 2019; 20:1181-1187. [PMID: 31058557 DOI: 10.1080/14656566.2019.1612365] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Amantadine is an old, antiviral compound that moderately ameliorates impaired motor behaviour in Parkinson's disease. Its current resurgence results from the novel retarded release amantadine hydrochloride formulation, ADS5102, which has also received approval for the treatment of levodopa-related involuntary movements known as dyskinesia. Areas covered: This non-systematic, narrative drug evaluation discusses the value of ADS5102 for patients with Parkinson's disease. ADS5102 is orally applied once daily in the evening. This capsule provides higher and more continuous amantadine plasma concentrations than conventional amantadine immediate release formulations with their two to three times daily intake plan. Expert opinion: ADS5102 was superior to placebo in clinical trials. They aimed for the amelioration of motor complications, particularly at 'OFF' periods and with dyskinesia in fluctuating levodopa treated patients with Parkinson's disease. Side effects and tolerability were similar to the well-known effects of conventional amantadine formulations. ADS5102 simplifies treatment and improves compliance problems in the long run. The marketing of ADS5102 outside the US will be complex for return of research costs and investments required for its manufacturing. Indeed, worldwide institutional price regulation scenarios often only consider new therapeutic mode of actions as being innovative as opposed to old drugs with improved pharmacokinetic behaviour.
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Affiliation(s)
- Thomas Müller
- a Department of Neurology , St. Joseph Hospital , Berlin , Germany
| | - Wilfried Kuhn
- b Department of Neurology , Leopoldina-Hospital Schweinfurt , Schweinfurt , Germany
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13
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Müller T, Möhr JD. Efficacy of carbidopa-levodopa extended-release capsules (IPX066) in the treatment of Parkinson Disease. Expert Opin Pharmacother 2018; 19:2063-2071. [DOI: 10.1080/14656566.2018.1538355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Thomas Müller
- Department of Neurology, St. Joseph Hospital Berlin-Weißensee , Berlin, Germany
| | - Jan-Dominique Möhr
- Department of Neurology, St. Joseph Hospital Berlin-Weißensee , Berlin, Germany
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