title: 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.
abstract: 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.
authors.affiliation: INSERM, CIC04, Nantes, France and CHU Nantes, Clinique Neurologique, Nantes, France. philippe.damier@chu-nantes.fr
authors.forename: P
authors.initials: P
authors.lastname: Damier
authors.forename: F
authors.initials: F
authors.lastname: Viallet
authors.forename: M
authors.initials: M
authors.lastname: Ziegler
authors.forename: I
authors.initials: I
authors.lastname: Bourdeix
authors.forename: K
authors.initials: K
authors.lastname: Rerat
mesh_terms: 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
chemical_list: D000978:Antiparkinson Agents; D002396:Catechols; D004791:Enzyme Inhibitors; D009570:Nitriles; D007980:Levodopa; C071192:entacapone; D004296:Dopa Decarboxylase