Parkinson Secrets
Expert Tips and Interviews on Living with Parkinson's Disease
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Hot Topics in Parkinson’s Disease

Michael Okun Indu Subramanian Jonny Acheson

 

Parkinson Meds: Patch It, Inhale It, Score It, Extend It, 2022 American Academy of Neurology Meeting Updates

The American Academy of Neurology recently held an in-person 2022 meeting in Seattle, Washington— and there were several presentations on new Parkinson’s therapies.

The meeting was billed as the great “neuro-reunion.” Here are 4 Parkinson’s therapies that caught our eye(s). These are also therapies we get asked a lot about in clinic. This group of drugs addresses on’s, off’s and fluctuations.

  • About half of persons with Parkinson’s disease will experience motor fluctuations by 5 years into their disease. 

  • “Off” medication motor symptoms may include tremor, stiffness, slowness and in many cases when “off” persons report challenges when walking. 

  • When “dopamine” medications kick “on,” these motor symptoms frequently improve. 

  • There are also “off” non-motor symptoms such as depression and anxiety— these can improve when the medications kick “on” for some persons with Parkinson’s.

  • We have been stuck for 50 years on levodopa remains as the gold standard Parkinson’s disease medication therapy.

  • What are some of the new approaches folks are trying to move forward as next generation Parkinson’s therapies.

IPX-203: A pill formulation of carbidopa/levodopa

extended-release capsules

  • A new phase III safety and efficacy of IPX203 vs carbidopa-levodopa (CD-LD) immediate-release (IR) was tested and reported on at the AAN.

  • IPX203 showed improvement in “on” time compared to regular release carbidopa/levodopa.

  • It was dosed 3 times a day; compared to 5 times a day for regular release.

  • The on-time improvement was 1.55 more hours of “on” time.

  • My take is we should be cautiously optimistic about IPX-203.

  • Any Parkinson’s medication dosed less frequently would be popular. 

  • Historically, we should keep in mind that similar hopes were dashed when Sinemet CR was released…

  • Let’s wait and see how the results hold up in the general real-world population.

ND0612 Levodopa Patch: Continuous, subcutaneous

levodopa/carbidopa delivery system

  • Safety results from the BeyoND study showed it was safe and were presented at the AAN.

  • Adverse events were in general reversible and manageable.

  • They compared a 16 and 24-hour regimen; and there seemed to be little difference.

  • As of May 2021, there were 64 patients who were still in the study, with a treatment duration of up to 4.6 years.

  • “This drug is a novel solution designed to overcome the main shortcomings of the established oral levodopa/carbidopa treatment—primarily the relatively narrow “therapeutic window” and low gastrointestinal absorption.”

  • Could this be a ticket to reducing motor fluctuations?

  • Not so fast.

  • Will the patch formulation reduce the large number of pills most Parkinson’s disease patients must take each day? 

  • One thing is for sure; the patch formulation will be a welcome addition for those with GI absorption issues and many others; if the results hold up in the real world.

CVT-301: Inhaled levodopa formulation update

  • Inhaled levodopa has now been around a while and is useful for some folks with Parkinson’s.

  • A Phase III trial of CVT-301 was conducted and reported at the American Academy of Neurology.

  • The 84mg of the inhaled levodopa improved motor function.

  • The improvement was measured at 30 minutes post inhalation of a dose.

  • Could be good for folks with gastric absorption issues.

  • In many ways this therapy is already out of the bag as it has been out for a while. “The inhaled levodopa formulation has already made a “splash “for some folks. 

  • What we hear is that early morning off’s and sudden unpredictable off times are a niche for this formulation.  Those who can’t absorb meds through the GI tract may prefer this formulation.

  • Many folks have found that loading the inhaler can be a challenge— we use education and pre-preparation as strategies to overcome this challenge.

TECH MED PILL CUTTER IS ONE EXAMPLE OF MANY DEVICES SOLD TO MANUALLY CUT PILLS.

Scored dopamine tablets

  • Many folks with Parkinson’s need 1/2 or 1/4 tablets of their carbidopa/levodopa.

  • Pre-scored tablets will therefore be a hit.

  • The AAN study not surprisingly showed safety and some benefits.

  • Can the cost be controlled for this “scoring” convenience?

  • Remember you can self-score tablets with tools available in pharmacies or on the internet. 

  • When halving a half pill (into a quarter pill) this may produce a dusty product. The dust or pill fragments can be difficult to measure and to administer. This challenge may prompt the dose to be added to apple sauce, yogurt or another food— which may impact absorption.

  • For this therapy, the test will be a cost-benefit analysis.

Michael Okun