Objective: To explore amantadine IR utilization patterns in the French COPARK study.

Background: Immediate release (IR) amantadine is marketed for the treatment of early and advanced Parkinson Disease (PD) for 50 years, while novel extended release formulations are now reaching the market. Very few data are available regarding the utilization patterns of amantadine IR in clinical practice.

Method: The COPARK study included 683 idiopathic, non-demented PD patients followed at specialized and non-specialized out-patient neurological clinics. All patients were assessed once (baseline), out of which 401 (59%) were assessed at a second visit after a median of 22.7 months of follow-up. All patients were assessed in a standardized manner: demographics, treatments, Unified PD Rating Scale (UPDRS), and Hospital Anxiety and Depression Scale.

Results: At baseline, amantadine was prescribed to 61/683 (9%) patients with a mean dose of 201.6 mg/day (range 100 to 300 mg/day). Amantadine IR was initiated after a median of 7 years from PD diagnosis (>5 years in 71% of cases), and the duration of treatment was less than 2 years in 59% of patients. Patients on amantadine IR showed more frequent dyskinesias (logistic regression Odds Ratio, 95% CI= 3.72, 1.95-7.08) and higher UPDRS I.2 -hallucinations- score (1.57, 1.08-2.29). In the subset of patients analyzed twice, amantadine IR was prescribed in 33/401 (8%) patients at baseline and 54/401 (14%) 2 years later (p=0.001). Among the 33 patients that were on amantadine at baseline, 9 (27%) stopped amantadine, 5 (15%) increased the dose, 6 (18%) reduced the dose, and 13 (40%) stayed at the same doses. Treatment was initiated in 30/54 patients (55%). Patients who were started on or increased amantadine IR daily dose (n=35) had more LIDs at baseline (7.02, 3.09-15.90) and higher MMSE score at follow-up (1.37, 1.06-1.79). Undergoing neurosurgery for PD was the only factor related to stopping or down titrating amantadine (22.02, 4.24-114.44, n=15).

Conclusion: In this cohort, amantadine was used in less than 10% of the patients, LIDs being its main indication. Amantadine use frequency increased during follow-up. Main treatment indication was LIDs, and patients with higher MMSE scores during follow-up were treated preferentially.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/utilization-patterns-of-amantadine-in-parkinsons-disease-patients-enrolled-in-the-french-copark-study/