Objective: This four-week open-label observational study describes the effect of introducing a microtablet dose dispenser and adjusting doses based on objective free-living motor symptom monitoring in Parkinson’s disease (PD).

Background: Individualization of levodopa doses and dose intervals is central in pharmacological management of advanced PD. To optimize levodopa efficacy it would be desirable to monitor the change in effect duration and adapt the dosing regimen accordingly, both in relation to duration and effect size. One of the most common approaches – dose fractioning – is well established, but there are few studies of the efficacy of this approach. In recent years two commercial systems for objective motor symptom monitoring have been introduced, the Parkinson Kinetigraph (PKG) and the Kinesia platform. An outspoken purpose of these systems is that they can be used to aid treatment adjustments.

Methods: Twenty-eight outpatients with PD on stable levodopa treatment with dose intervals of ≤4h had their daytime doses of levodopa replaced with levodopa/carbidopa microtablets, 5/1.25 mg (LC-5) delivered from a dose dispenser device with programmable reminders. The microtablets allow small dose adjustments. After two weeks, doses were adjusted based on PKG accelerometry recordings and a confirmatory interview.

Results: Twenty-four participants completed the study per protocol. The daily levodopa dose was increased by 15% (112 mg, P<0.001) from period 1 to 2 and the dose interval was reduced by 12% (22 minutes, P=0.003). The treatment adherence to LC-5 was high in both periods. The MDS-UPDRS parts II and III, disease specific quality of life (PDQ-8), wearing-off symptoms (WOQ-19) and non-motor symptoms (NMS Quest) improved after dose titration, but the generic quality of life measure EQ-5D-5L did not. Blinded expert evaluation of accelerometry results demonstrated improvement in 60% of subjects and worsening in 25%.

Conclusions: The introduction of a levodopa microtablet dispenser and accelerometry aided dose adjustments improve PD symptoms and quality of life in the short term.

References: D. Johansson, A. Ericsson, A. Johansson, A. Medvedev, D. Nyholm, F. Ohlsson, M. Senek, J. Spira, I. Thomas, J. Westin, F. Bergquist, Individualization of levodopa treatment using a microtablet dispenser and ambulatory accelerometry, CNS Neuroscience & Therapeutics. 2018 (1):9.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/individualization-of-levodopa-treatment-using-a-microtablet-dispenser-and-ambulatory-accelerometry/