Objective: We aim to analyze changes in levodopa and dopamine agonists (DA) dosage after introduction of opicapone (OPC) in a daily clinical practice setting.

Background: OPC is a new long-acting, once-daily catechol-O-methyl transferase inhibitor for Parkinson’s Disease (PD) patients with end-of-dose fluctuations. Data from BIPARK I and BIPARK II studies show that levodopa dosage can be maintained below the baseline value or even reduced in some patients after one year of OPC treatment.

Method: We performed a retrospective analysis from our PD outpatient clinic database. 
Fifty-two patients were included in the analysis. Data from dopaminergic treatment were collected from the initial and follow-up visits following introduction of OPC during 2017-2019. We compared levodopa and levodopa-equivalent-dose DA (LED-DA) dosage changes between two groups: PD patients that continued with OPC (“yes-OPC”) vs. those in whom OPC was discontinued (non-OPC).

Results: In total, 52 patients were included in the analysis (70.71±9.35 years old, 55.7% males). The mean disease duration was 9.26 ±5.73 years while the median of UPDRS-III ON score was 15.78 ± 7.4. Half of the patients were at stage 2 of Hoehn and Yahr and 30.8% at stage 2.5. Levodopa dosage at the initial visit (before adding OPC) was 608.70 ± 328.62 mg and LED-AD was 280 ± 118.83 mg (n= 52). After introduction of OPC, sixteen patients experienced adverse events (2 worsening of dyskinesia, 3 anxiety or insomnia, 3 PD worsening, 4 hallucinations, 4 miscellanea).  In the group of “yes-OPC”, 84.61% were taking MAO-B inhibitors and 69.23% “non-OPC” group. When comparing the two groups, levodopa and LED-AD dosage at the baseline visit was 595.50 ± 362.49 mg and 286.05 ± 119.58 respectively in the “yes-OPC” group (n=39), while in the “non-OPC” (n= 13), levodopa dosage was 648.27 ± 201.50 mg and LED-AD was 255.79 ± 12176 mg. Levodopa reduction in the first visit after adding OPC was 81,27 mg in the “yes-OPC” and 73.58 mg in the “non-OPC”. At the last visit (mean follow-up 12.33 ± 7.12 months), levodopa dosage was only increased by 27.83 mg in the “yes-OPC” group. However, in the “non-OPC” group levodopa dosage was increased by 173.01 mg. When analyzing progression of LED-AD, in the “yes-OPC” group LED-AD remained similar (286.36 ± 129.83) but increased in the “non-OPC” group (305.50 ± 183.46).

Conclusion: Opicapone can act as dopamine-sparing therapy in PD patients with end-of-dose motor fluctuations.

References: Ferreira JJ, Lees A, Rocha JF, et al. Opicapone as an adjunct to levodopa in patients with Parkinson’s disease and end-of-dose motor fluctuations: a randomised, double-blind, controlled trial. Lancet Neurol 2016; 15:154-65. Lees AJ, Ferreira J, Rascol O, et al. Opicapone as Adjunct to levodopa therapy in patients with Parkinson’s disease and motor fluctuations. A Randomized clinical trial. JAMA Neurol 2017;74(2): 197-206.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/levodopa-and-dopamine-agonists-dosage-changes-after-opicapone-introduction/