Objective: To explore the benefit of Opicapone (OPC) add-on to levodopa-carbidopa intestinal gel (LCIG) in different phenotypes of Parkinson’s Disease (PD) patients.

Background: LCIG monotherapy reduced disabling motor fluctuations and/or levodopa-induced dyskinesias in advanced PD. The addition of long-acting inhibition of catechol‐O‐methyl transferase (COMT) could theoretically offer further pharmacokinetic optimization of LCIG, improving the motor symptoms as well as reducing the LCIG-induced dyskinesias and drug-related costs. Opicapone (OPC) has a single-day dose administration, improves levodopa availability, and reduces levodopa equivalent dose (LED).

Method: Seven patients on LCIG and OPC were analyzed. OPC was added to LCIG  in patients 1-2 because of the narrow therapeutic window (diphasic dyskinesias, moderate early morning and post-meal off), in patients 3-4 for night akinesia, and moderate peripheral neuropathy.
Patients 5-7 already assumed OPC at LCIG implant.

Results: Patients 1-4 on LCIG (mean±DS duration treatment 64.3±31.7months) plus OPC (mean±DS duration treatment 8.5±1.3 months), obtained a significant reduction of continuous dose (-0,95 ml/h) leading to amelioration of AIMS (mean±DS: 5.8±2.74.3±1.5) and UPDRS IV (mean±DS: 5.5±1.33.0±1.2). Besides, patients 3-4 improved with OPC on motor symptoms (UPDRS III 1512 and 1410); both patients discontinued OPC for hallucinations worsening after 7 and 9 months, respectively. OPC was used in patients 5-7 since the LCIG test phase with nasoduodenal tube, allowing to reduce the continuous dose (-0,4 ml/h) and consequently to better control the pre-existing pick-dose levodopa-dyskinesias. Although LED reduction, UPDRS III remained stable, UPDRS II (10.6±5.8 8.9±6.1), IV (4.3±1.5 2.3±1.5), and AIMS (5.0±4.3 3.3±2.8) decreased compared to pre-LCIG.
A better outcome was obtained in the three patients (5-7) already on OPC at the implant even though, they had a lower follow-up (8±2months) and less troublesome dyskinesias before LCIG, compared to patients 1-4.

Conclusion: OPC might be a helpful add-on drug to LCIG infusion for motor fluctuations in different PD phenotypes (dyskinetic patients as akinetic ones). In our experience, the addition since the test phase might be a good future option for a better outcome.

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