Marketa Marvanova, PharmD, PhD, BCGP, BCPP, FASCP
CPNP Program Committee Member
Parkinson disease (PD) currently affects ~1 million individuals in the U.S.; and every year about 50,000 individuals in the U.S. are diagnosed with PD, typically those over the age of 60 years. There is currently no cure or proven disease-modifying treatment, and only palliative treatment is available for management of motor and non-motor symptoms. Motor fluctuations are important complications of long-term therapy with carbidopa/levodopa and advanced PD. Delayed-on period, carbidopa/levodopa dose-failure, random on-off periods and peak-dose dyskinesia in advanced stages of PD are difficult to manage and have a significant impact on quality of life and patient’s functionality.
In recent years, new formulations and methods of delivery of carbidopa/levodopa (e.g., intestinal carbidopa/levodopa gel, inhalation levodopa, subcutaneous infusion of carbidopa/levodopa, and various extended-release formulations), apomorphine (i.e., sublingual film, subcutaneous infusion), and amantadine (extended-release and controlled-release) and new agents belonging to selective adenosine A2A receptor antagonists (istradefylline), MAO-B inhibitor (saphinamide) and COMT inhibitor (opicapone) have been developed and approved to aid in the management of PD motor complications. These newly-approved medications and additional agents currently undergoing phase III clinical trials should or will be part of the clinical “toolbox” for management of motor symptoms and complications in advanced PD.
Clinicians providing care for an individual with PD should be familiar with these new pharmacologic modalities and should know when and how to use them when designing an individualized care plan for their patient to meet the individual’s current needs. It is crucial that clinicians providing direct care or consultation services for individuals with PD be knowledgeable about new strategies to promote optimal quality of life for those suffering from disabling motor complications in order to achieve high-quality PD care. To assist clinicians in navigating new treatment options for motor fluctuation in Parkinson disease, Dr. Daniel Claassen will be speaking on April 21, 2021 at the 24th CPNP Annual Meeting to be held virtually. Dr. Claassen currently serves as an Associate Professor of Neurology at Vanderbilt University and specializes in caring for patients with neurodegenerative disorders.
The specific objectives for Dr. Claassen’s session include:
- Describe motor fluctuations in Parkinson disease (PD), and understand their impact on quality of life.
- Discuss available non-pharmacologic and pharmacologic treatment strategies for management of motor fluctuations.
- Understand the role of newly approved pharmacological treatment options and agents in phase III trials in the management of motor fluctuations.
- Given an individual clinical scenario, develop a pharmacotherapy plan and patient education strategy for an individual with PD motor fluctuations.
View course information
- Beitz JM. Parkinson's disease: a review.Front Biosci (Schol Ed). 2014 Jan 1;6:65-74.
- Chaudhuri KR. NPJ Parkinsons Dis. 2016;2:16023.
- Grosset DG, Dhall R, Gurevich T, et al. Inhaled levodopa in Parkinson's disease patients with OFF periods: A randomized 12-month pulmonary safety study. Parkinsonism Relat Disord. 2020;71:4‐10.
- Hauser et al. Extended-release carbidopa-levodopa (IPX066) compared with immediate-release carbidopa-levodopa in patients with Parkinson's disease and motor fluctuations: a phase 3 randomized, double-blind trial. Lancet Neurol. 2013;12(4):346-356.
- http://tools.aan.com/professionals/practice/guidelines/PD_Motor_Fluctuations_Sum.pdf . Accessed on October 12, 2020.
- Opicapone as Adjunct to Levodopa Therapy in Patients With Parkinson Disease and Motor Fluctuations: A Randomized Clinical Trial. Jama Neurol. 2017;74(2):197-206. DOI: 10.1001/jamaneurol.2016.4703. PubMed PMID: 28027332..
- Pharmacokinetics and efficacy of a novel formulation of carbidopa-levodopa (Accordion Pill) in Parkinson's disease. Parkinsonism Relat Disord. 2019;65:131-138. DOI: 10.1016/j.parkreldis.2019.05.032. PubMed PMID: 31176632..
- Okun MS. NEJM Journal Watch 2017. Available at: https://neuroderm.com/resources-2/. Accessed on October 12, 2020.
- Olanow CW, Factor SA, Espay AJ, et al. Apomorphine sublingual film for off episodes in Parkinson's disease: a randomised, double-blind, placebo-controlled phase 3 study. Lancet Neurol. 2020;19(2):135‐144.
- Olanow CW et al. Continuous intrajejunal infusion of levodopa-carbidopa intestinal gel for patients with advanced Parkinson's disease: a randomized, controlled, double-blind, double-dummy study. Lancet Neurol. 2014;13(2):141-149.
- P Hauser RA, Shulman LM, Trugman JM, et al. Study of istradefylline in patients with Parkinson’s Disease on levodopa with motor fluctuations. Mov Disord. 2008;23(15):2177-2185.
- Amantadine extended release for levodopa-induced dyskinesia in Parkinson's disease (EASED Study). Mov Disord. 2015;30(6):788-95. DOI: 10.1002/mds.26159. PubMed PMID: 25650051..
- ADS-5102 (Amantadine) Extended-Release Capsules for Levodopa-Induced Dyskinesia in Parkinson Disease (EASE LID Study): A Randomized Clinical Trial. Jama Neurol. 2017;74(8):941-949. DOI: 10.1001/jamaneurol.2017.0943. PubMed PMID: 28604926..
- Parkinson disease. Nat Rev Dis Primers. 2017;3(1). DOI: 10.1038/nrdp.2017.13. PubMed PMID: 28332488..
- Assessment of Safety and Efficacy of Safinamide as a Levodopa Adjunct in Patients With Parkinson Disease and Motor Fluctuations: A Randomized Clinical Trial. Jama Neurol. 2017;74(2):216-224. DOI: 10.1001/jamaneurol.2016.4467. PubMed PMID: 27942720..