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Hauser RA, Videnovic A, Soares-da-Silva P, Liang GS, Olson K, Jen E, Rocha JF, Klepitskaya O. OFF-times before, during, and after nighttime sleep periods in Parkinson's disease patients with motor fluctuations and the effects of opicapone: A post hoc analysis of diary data from BIPARK-1 and -2. Parkinsonism Relat Disord 2024; 123:106971. [PMID: 38631081 DOI: 10.1016/j.parkreldis.2024.106971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION In BIPARK-1 and BIPARK-2, addition of once-daily opicapone to levodopa/carbidopa significantly reduced daily "OFF"-time relative to placebo in adults with Parkinson's disease (PD) and motor fluctuations. Diary data from these studies were pooled and analyzed post hoc to characterize "OFF"-times around nighttime sleep and to explore the effects of opicapone 50 mg. METHODS "OFF" before sleep (OBS), "OFF during the nighttime sleep period" (ODNSP), early morning "OFF" (EMO), and duration of nighttime sleep and awake periods were analyzed descriptively at baseline. Mean changes from baseline to Week 14/15 (end of double-blind treatment) were analyzed using two-sided t-tests in participants with data for both visits. RESULTS At baseline, 88.3 % (454/514) of participants reported having OBS (34.0 %), ODNSP (17.1 %), or EMO (79.6 %). Those with ODNSP had substantially shorter mean duration of uninterrupted sleep (4.4 h) than the overall pooled population (7.1 h). At Week 14/15, mean decrease from baseline in ODNSP duration was significantly greater with opicapone than with placebo (-0.9 vs. -0.4 h, P < 0.05). In participants with ODNSP at baseline, the decrease in total time spent awake during the night-time sleep period was significantly greater with opicapone than with placebo (-1.0 vs. -0.4 h, P < 0.05), as was the reduction in percent time spent awake during the night-time sleep period (-12.8 % vs. -4.5 %, P < 0.05). CONCLUSION "OFF"-times around nighttime sleep were common in BIPARK-1 and BIPARK-2. Opicapone may improve sleep by decreasing the amount of time spent awake during the night in patients with PD who have night-time sleep period "OFF" episodes.
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Affiliation(s)
- Robert A Hauser
- University of South Florida, Parkinson's Disease & Movement Disorders Center, 4001 E. Fletcher Ave, 6th Floor, Tampa, FL, 33613, USA.
| | - Aleksandar Videnovic
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, 165 Cambridge Street, Suite 650, Boston, MA, 02214, USA
| | - Patrício Soares-da-Silva
- BIAL-Portela & C(a), S.A., À Avenida da Siderurgia Nacional, 4745-457, Coronado, Portugal; University of Porto, Praça Gomes Teixeira, 4099-002, Porto, Portugal
| | - Grace S Liang
- Neurocrine Biosciences, Inc., 12780 El Camino Real, San Diego, CA, 92130, USA
| | - Kurt Olson
- Neurocrine Biosciences, Inc., 12780 El Camino Real, San Diego, CA, 92130, USA
| | - Eric Jen
- Neurocrine Biosciences, Inc., 12780 El Camino Real, San Diego, CA, 92130, USA
| | - José-Francisco Rocha
- BIAL-Portela & C(a), S.A., À Avenida da Siderurgia Nacional, 4745-457, Coronado, Portugal
| | - Olga Klepitskaya
- Neurocrine Biosciences, Inc., 12780 El Camino Real, San Diego, CA, 92130, USA
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Fernandez HH, Macklin EA, Hauser RA, Chou KL, Cakmak YO, Ozsoy B, Fahn S. Intrinsic auricular muscle zone stimulation for Parkinson disease: The EARSTIM-PD Phase II multi-center pilot study results. Parkinsonism Relat Disord 2024; 121:105959. [PMID: 38246833 DOI: 10.1016/j.parkreldis.2023.105959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/09/2023] [Accepted: 12/10/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Studies have suggested that intrinsic auricular muscle zones (IAMZ) stimulation alleviates motor features of Parkinson disease (PD). METHODS A randomized, blinded, active sham-controlled pilot trial was conducted to evaluate the safety and dose-response-time curve of Earstim using a 3-treatment, 3-period crossover design in PD patients experiencing OFF time on levodopa. Treatments were: short (20-min) IAMZ stimulation; long (60-min) IAMZ stimulation; and 20-min active sham stimulation of non-muscular areas. Assessment time points were: prior to treatment, and 20, 40, 60, 90, and 120 min after treatment onset. Primary safety endpoints were adverse events frequency and severity. Primary efficacy endpoint was the change in MDS-UPDRS motor score at 20 min after treatment onset in the IAMZ treatment groups versus sham. RESULTS Forty-six individuals consented; 38 were randomized (average age 64 years, 65 % male, mean 8.2 years from diagnosis). No serious adverse events or significant device-related events occurred. At 20 min after treatment onset, motor improvements did not differ between IAMZ treatments versus sham. However, at 60 min after treatment onset, motor improvement peaked on IAMZ treatments compared to sham (difference: 3.1 [-5.9 to 0.3], p = 0.03). While the difference in 120-min AUC change between IAMZ treatments versus sham was not significant, the short-stimulation IAMZ treatment showed the largest aggregate motor score improvement (AUC = -456 points, 95 % CI -691 to -221) compared to sham. CONCLUSION Earstim was well-tolerated. The greatest motor improvement occurred at 60 min after stimulation onset in the short-stimulation IAMZ treatment, and supports its further study to alleviate OFF periods.
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Affiliation(s)
- Hubert H Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, USA.
| | - Eric A Macklin
- Department of Neurology, Harvard Medical School/Massachusetts General Hospital, USA
| | - Robert A Hauser
- Department of Neurology, University of South Florida School of Medicine, USA
| | - Kelvin L Chou
- Department of Neurology, University of Michigan School of Medicine, USA
| | | | | | - Stanley Fahn
- Department of Neurology, Columbia University School of Medicine, USA
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Katzenschlager R, Poewe W, Rascol O, Trenkwalder C, Deuschl G, Chaudhuri KR, Henriksen T, van Laar T, Lockhart D, Staines H, Lees A. Long-term safety and efficacy of apomorphine infusion in Parkinson's disease patients with persistent motor fluctuations: Results of the open-label phase of the TOLEDO study. Parkinsonism Relat Disord 2021; 83:79-85. [PMID: 33486139 DOI: 10.1016/j.parkreldis.2020.12.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/29/2020] [Accepted: 12/22/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The randomized, double-blind phase (DBP) of the TOLEDO study confirmed the efficacy of apomorphine infusion (APO) in reducing OFF time in PD patients with persistent motor fluctuations despite optimized oral/transdermal therapy. Here we report safety and efficacy results including the 52-week open-label phase (OLP). METHODS All patients completing the 12-week DBP (including those switching early to open-label treatment) were offered OLP entry. The primary objective was the evaluation of long-term safety of APO. RESULTS Eighty-four patients entered the OLP (40 previously on APO, 44 on placebo) and 59 patients (70.2%) completed the study. The safety profile of APO was consistent with experience from extensive clinical use. Common treatment-related adverse events (AEs) were mild or moderate infusion site nodules, somnolence and nausea. Fourteen (16.7%) patients discontinued the OLP due to AEs, those involving >1 patient were infusion site reactions (n = 4) and fatigue (n = 2); hemolytic anemia occurred in one case. Reduction in daily OFF time and improvement in ON time without troublesome dyskinesia were sustained for up to 64 weeks. Pooled data for week 64 (n = 55) showed a mean (SD) change from DBP baseline in daily OFF time of -3.66 (2.72) hours and in ON time without troublesome dyskinesia of 3.31 (3.12) hours. Mean (±SD) daily levodopa-equivalent dose decreased from DBP baseline to week 64 by 543 mg (±674) and levodopa dose by 273 mg (±515). CONCLUSIONS The safety and efficacy of APO infusion were demonstrated with long-term use for persistent motor fluctuations, allowing substantial reductions in oral PD medication.
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Affiliation(s)
- Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Klinik Donaustadt, Vienna, Austria.
| | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
| | - Olivier Rascol
- Université de Toulouse 3, INSERM, CHU de Toulouse, Centre D'Investigation Clinique CIC1436, Réseau NS-PARK/F-CRIN, Centre Expert Parkinson de Toulouse, Centre COEN NeuroToul, Department of Clinical Pharmacology and Neurosciences, Toulouse University Hospital, Toulouse, France.
| | - Claudia Trenkwalder
- Department of Neurosurgery, University Medical Centre Goettingen and Centre of Parkinsonism and Movement Disorders, Elena Hospital, Kassel, Germany.
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Christian-Albrechts University, Kiel, Germany.
| | - K Ray Chaudhuri
- Parkinson Foundation Centre of Excellence, Kings College Hospital, Denmark Hill Campus, London, UK.
| | - Tove Henriksen
- Movement Disorder Clinic, Bispebjerg Hospital, Copenhagen, Denmark.
| | - Teus van Laar
- Department of Neurology, University Medical Centre, Groningen, the Netherlands.
| | | | | | - Andrew Lees
- University College London Institute of Neurology, Queen Square, London, UK.
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Ferreira JJ, Lees A, Rocha JF, Poewe W, Rascol O, Soares-da-Silva P. Long-term efficacy of opicapone in fluctuating Parkinson's disease patients: a pooled analysis of data from two phase 3 clinical trials and their open-label extensions. Eur J Neurol 2019; 26:953-960. [PMID: 30681754 PMCID: PMC6593852 DOI: 10.1111/ene.13914] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/21/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to evaluate the efficacy of the catechol-O-methyltransferase inhibitor opicapone (25 and 50 mg) as adjunct therapy to levodopa in a pooled population of Parkinson's disease patients who participated in the pivotal double-blind trials of opicapone and their 1-year open-label extensions. METHODS Data (placebo, opicapone 25 mg and opicapone 50 mg) from the BIPARK-1 and BIPARK-2 double-blind and open-label studies were combined. The studies had similar designs, eligibility criteria and assessment methods. The primary efficacy variable in both double-blind studies was the change from baseline in absolute OFF time based on patient diaries. RESULTS Double-blind treatment with opicapone (25 and 50 mg) significantly reduced absolute daily OFF time from a baseline of 6.1-6.6 h. The mean (and 95% confidence interval) treatment effect versus placebo was -35.1 (-62.1, -8.2) min (P = 0.0106) for the 25 mg dose and -58.1 (-84.5, -31.7) min (P < 0.0001) for the 50 mg dose. Reductions in OFF time were mirrored by significant increases in ON time without troublesome dyskinesia (P < 0.05 and P < 0.0001 for the 25 and 50 mg doses, respectively). No significant differences were observed for ON time with troublesome dyskinesia. Patient diary results from the open-label phase indicated a maintenance of effect for patients previously treated with opicapone 50 mg. The group previously treated with the 25 mg dose benefitted with further optimization of therapy during the open-label phase, whilst switching from placebo to opicapone led to significant reductions in OFF time and increased ON time. CONCLUSIONS Over at least 1 year of open-label therapy, opicapone consistently reduced OFF time and increased ON time without increasing the frequency of troublesome dyskinesia.
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Affiliation(s)
- J J Ferreira
- Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Torres Vedras, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
| | - A Lees
- Reta Lila Weston Institute, University College London, London, UK
| | - J-F Rocha
- Department of Research and Development, BIAL - Portela & Ca SA, S. Mamede do Coronado, Portugal
| | - W Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - O Rascol
- Clinical Investigation Centre CIC1436, Departments of Clinical Pharmacology and Neurosciences, NS-Park/FCRIN Network, University Hospital of Toulouse, INSERM, University Toulouse 3, Toulouse, France
| | - 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.,Center for Drug Discovery and Innovative Medicines, MedInUP, University Porto, Porto, Portugal
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Zhang Z, Shao M, Chen S, Liu C, Peng R, Li Y, Wang J, Zhu S, Qu Q, Zhang X, Chen H, Sun X, Wang Y, Sun S, Zhang B, Li J, Pan X, Zhao G. Adjunct rasagiline to treat Parkinson's disease with motor fluctuations: a randomized, double-blind study in China. Transl Neurodegener 2018; 7:14. [PMID: 29988514 PMCID: PMC6026338 DOI: 10.1186/s40035-018-0119-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 06/19/2018] [Indexed: 02/05/2023] Open
Abstract
Background The use of adjunct rasagiline in levodopa-treated patients with Parkinson’s disease and motor fluctuations is supported by findings from large-scale clinical studies. This study is to investigate the efficacy and safety of adjunct rasagiline in Chinese patients with Parkinson’s disease, as a product registration study. Methods This 16-week, randomized, double-blind, parallel-group, multicenter, placebo-controlled study of rasagiline 1 mg/day included levodopa-treated patients with Parkinson’s disease and motor fluctuations. The primary efficacy endpoint was mean change from baseline in total daily OFF time over 16 weeks. Secondary endpoints were Clinical Global Impressions – Improvement (CGI-I), and change in Unified Parkinson’s Disease Rating Scale (UPDRS) Activities of daily living (ADL) and Motor scores. Patient well-being (EQ-5D), and the frequency of adverse events were also assessed. Results In total, 324 levodopa-treated patients were randomized to rasagiline 1 mg/day (n = 165) or placebo (n = 159). Over 16 weeks, rasagiline statistically significantly reduced the mean [95% confidence interval] total daily OFF time versus placebo (− 0.5 h [− 0.92, − 0.07]; p = 0.023). There were also statistically significant improvements versus placebo in CGI-I (− 0.4 points [− 0.61, − 0.22]; p < 0.001), UPDRS-ADL OFF (− 1.0 points [− 1.75, − 0.27]; p = 0.008), and UPDRS-Motor ON (− 1.6 points [− 3.05, − 0.14]; p = 0.032) scores, as well as the EQ-5D utility index (p < 0.05). Rasagiline was safe and well tolerated. Conclusions In levodopa-treated Chinese patients with Parkinson’s disease and motor fluctuations, adjunct rasagiline 1 mg/day statistically significantly reduced OFF time, and improved daily function and overall well-being, versus placebo. Consistent with findings in other countries, adjunct rasagiline was proven efficacious and well tolerated in Chinese patients. Trial registration number NCT01479530. Registered 22 November 2011.
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Affiliation(s)
- Zhenxin Zhang
- 1Department of Neurology, Peking Union Medical College Hospital, 53 Dongdan N St, Dongcheng, Beijing, China
| | - Ming Shao
- 2Department of Neurology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shengdi Chen
- 3Department of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chunfeng Liu
- 4Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rong Peng
- 5Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yansheng Li
- 6Department of Neurology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian Wang
- 7Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Suiqiang Zhu
- 8Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiumin Qu
- 9Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoying Zhang
- 10Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haibo Chen
- 11Department of Neurology, Beijing Hospital, Beijing, China
| | - Xiangru Sun
- 12Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yanping Wang
- 13Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shenggang Sun
- 14Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Baorong Zhang
- 15Department of Neurology, The Second Affiliated hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou China
| | - Jimei Li
- 16Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaoping Pan
- 17Department of Neurology, Guangzhou First People's Hospital, Guangzhou, China
| | - Gang Zhao
- 18Department of Neurology, Xijing Hospital, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, China
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Elkurd MT, Bahroo LB, Pahwa R. The role of extended-release amantadine for the treatment of dyskinesia in Parkinson's disease patients. Neurodegener Dis Manag 2018; 8:73-80. [PMID: 29564954 DOI: 10.2217/nmt-2018-0001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Levodopa is the most efficacious treatment for Parkinson's disease (PD). Long-term treatment with levodopa is limited due to dyskinesia. Dyskinesia in PD can be socially and functionally disabling. Extended-release amantadine (amantadine ER) is the first approved medication for the treatment of dyskinesia. When it is given at bedtime, it reaches plasma concentration approximately twice the level achieved by amantadine immediate release. Amantadine ER reduces the severity and duration of dyskinesia during the day, reduces OFF time and increases ON time without troublesome dyskinesia. The most common side effects are hallucination, dizziness, orthostatic hypotension and pedal edema. This review discusses the safety and efficacy of amantadine ER in dyskinesia in PD patients.
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Affiliation(s)
- Mazen T Elkurd
- Department of Neurology, Medstar Georgetown University Hospital, Georgetown, Washington DC, USA
| | - Laxman B Bahroo
- Department of Neurology, Medstar Georgetown University Hospital, Georgetown, Washington DC, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, KS, USA
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