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Levodopa-entacapone-carbidopa intestinal gel in Parkinson's disease: A randomized crossover study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.ORCID iD: 0000-0001-9776-7715
2017 (English)In: Movement Disorders, ISSN 0885-3185, E-ISSN 1531-8257, Vol. 32, no 2, p. 283-286Article in journal (Refereed) Published
Abstract [en]

BackgroundThe addition of oral entacapone to levodopa-carbidopa intestinal gel treatment leads to less conversion of levodopa to 3-O-methyldopa, thereby increasing levodopa plasma concentration. The objective of this study was to compare systemic levodopa exposure of the newly developed levodopa-entacapone-carbidopa intestinal gel after a 20% dose reduction with levodopa exposure after the usual levodopa-carbidopa intestinal gel dose in a randomized crossover trial in advanced Parkinson's disease patients. MethodsIn this 48-hour study, 11 patients treated with levodopa-carbidopa intestinal gel were randomized to a treatment sequence. Blood samples were drawn at prespecified times, and patient motor function was assessed according to the treatment response scale. ResultsSystemic exposure of levodopa did not differ significantly between treatments (ratio, 1.10 [95% confidence interval, 0.951-1.17]). Treatment response scale scores did not significantly differ between treatments (P=0.84). ConclusionsLevodopa-entacapone-carbidopa intestinal gel allowed a lower amount of levodopa administration and was well tolerated. Long-term studies are needed to confirm the results.

Place, publisher, year, edition, pages
2017. Vol. 32, no 2, p. 283-286
Keyword [en]
Parkinson's disease, clinical trials, randomized, levodopa infusion, pharmacotherapy
National Category
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-317042DOI: 10.1002/mds.26855ISI: 000395645900018PubMedID: 27987231OAI: oai:DiVA.org:uu-317042DiVA, id: diva2:1080165
Available from: 2017-03-09 Created: 2017-03-09 Last updated: 2018-02-28Bibliographically approved
In thesis
1. New Approaches for Levodopa Treatment in Parkinson’s Disease
Open this publication in new window or tab >>New Approaches for Levodopa Treatment in Parkinson’s Disease
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Parkinson’s disease (PD) is characterized by degeneration of dopaminergic cells, which results in dopamine depletion. Levodopa is the most effective symptomatic treatment, however, disease progression along with the unfavorable pharmacokinetics of levodopa makes the disease increasingly difficult to treat with time.

This thesis focuses on two new approaches of levodopa treatments, the levodopa/carbidopa microtablets and the levodopa/entacapone/carbidopa intestinal gel, developed for patients with advanced PD.

To evaluate the microtablet pharmacokinetics and pharmacodynamics in advanced PD patients, a clinical study was conducted. Higher levodopa maximum plasma concentration and systemic exposure was observed in patients compared to healthy volunteers. A high variability, with respect to response and duration of effect, was found, highlighting the importance of individual assessment of motor function to optimize treatment effect. A population pharmacokinetic model for levodopa and carbidopa was developed and the impact of covariates were investigated on the pharmacokinetics. Disease stage and increasing carbidopa dose were found to decrease levodopa apparent clearance. Carbidopa apparent clearance was found to decrease with age. An observational study was conducted, including patients treated with microtablets, in order to evaluate the treatment in clinical practice. A majority reported that the dose dispenser simplified their treatment and improved adherence, while the motor function, with respect to bradykinesia and non-troublesome dyskinesia, was mainly improved or unchanged.

To investigate the pharmacokinetics and pharmacodynamics of the newly developed levodopa/entacapone/carbidopa intestinal gel treatment, a clinical trial was conducted, where it was compared to the conventional levodopa/carbidopa infusion. The new treatment was found to allow a lower amount of levodopa administration without worsening the treatment effect. An increasing plasma concentration was observed, and a population model was developed for investigation of appropriate dose adjustments. The conclusion was that the continuous maintenance dose could be decreased by approximately 35%, on a population level, compared to the patients’ usual dose on the conventional treatment. An effect from entacapone was identified in all individuals, regardless of catechol-O-methyl transferase genotype (rs4680).

To conclude, both new treatments are promising alternatives to current strategies and the developed models may in the future be used for model-based treatment optimization.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 84
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1437
Keyword
Parkinson’s disease, Pharmacokinetics, Pharmacodynamics, Population modeling, Levodopa, Carbidopa, Entacapone, Microtablets, Intestinal infusion
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-343036 (URN)978-91-513-0256-0 (ISBN)
Public defence
2018-04-20, Rudbeckssalen, Dag Hammarskjölds väg 20, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2018-03-27 Created: 2018-02-28 Last updated: 2018-04-24

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Senek, MarinaNielsen, Elisabet I.Nyholm, Dag

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