Levodopa/DDCI and entacapone is the preferred treatment for Parkinson's disease patients with motor fluctuations in routine practice: a retrospective, observational analysis of a large French cohort.
Levodopa is the gold standard drug for the symptomatic control of Parkinson's disease (PD). However, long-term treatment with conventional formulations [levodopa and a dopa decarboxylase inhibitor (DDCI)], is associated with re-emergence of symptoms because of wearing-off and dyskinesia. Treatment with levodopa/DDCI and entacapone extends the half-life of levodopa, avoiding deep troughs in levodopa plasma levels and providing more continuous delivery of levodopa to the brain. In this open-label, retrospective, observational study we investigated the effects of levodopa/DDCI and entacapone therapy in 800 PD patients with motor fluctuations. Levodopa/DDCI and entacapone treatment was assessed as good/very good in improving motor fluctuations (64%) and activities of daily living (ADL; 62%). The therapeutic utility was considered to be good/very good in 70% of cases. Moreover, there was a reduction in levodopa dose in 20% of patients. Neurologists preferred levodopa/DDCI and entacapone compared with increasing levodopa dosage, dose-fractionation or addition of a dopamine agonist (63%, 29% and 23% of patients respectively). Reasons included achieving more continuous dopaminergic stimulation (40%), reducing motor fluctuations (54%) and improving ADL (41%). This analysis reveals the preference of neurologists for levodopa/DDCI and entacapone over conventional levodopa-modification strategies for the effective treatment of PD motor fluctuations in clinical practice.
Damier
P
P
INSERM, CIC04, Nantes, France and CHU Nantes, Clinique Neurologique, Nantes, France. philippe.damier@chu-nantes.fr
Viallet
F
F
Ziegler
M
M
Bourdeix
I
I
Rerat
K
K
D000203:Activities of Daily Living; D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage*; D002396:Catechols / Q000008:administration & dosage*; D004296:Dopa Decarboxylase / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004409:Dyskinesia, Drug-Induced / Q000517:prevention & control; D004791:Enzyme Inhibitors / Q000008:administration & dosage; D005260:Female; D005602:France; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009570:Nitriles / Q000008:administration & dosage*; D010300:Parkinson Disease / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies
D000978:Antiparkinson Agents; D002396:Catechols; D004791:Enzyme Inhibitors; D009570:Nitriles; D007980:Levodopa; C071192:entacapone; D004296:Dopa Decarboxylase