Abstract
BackgroundOpicapone, a recently introduced catechol‐o‐methyl transferase (COMT) inhibitor has the advantage of being administered once daily, and has pharmacokinetic data to indicate it offers a greater degree of COMT inhibition than entacapone. Although trial data indicate it is non‐inferior to entacapone, there are no data to indicate whether it offers any clinical advantages.MethodsIn this audit, we present data from 57 individuals prescribed opicapone at the National Hospital for Neurology and Neurosurgery, Queen Square who had either not tolerated or reported insufficient benefit following previous prescription of entacapone.ResultsA total of 20 of 57 patients switched directly from entacapone to opicapone (“entacapone switchers”) whereas 37 of 57 patients had previously discontinued entacapone because of lack of benefit or adverse events (“entacapone failures”). A total of 21 of 57 (37%) patients stopped opicapone prior to 6 months. A total of 7 of 20 (35%) “entacapone switchers” experienced adverse events with opicapone of which 5 stopped the drug prior to the 6 month evaluation of efficacy. A total of 23 of 37 (62%) “entacapone failures” reported adverse events of which 16 stopped the drug. Among 36 of 57 (63%) patients who continued to use opicapone at 6 months, there was an improvement in OFF time of ~2 hours per day as measured by interview.ConclusionsWe conclude that opicapone can be an effective additional treatment for wearing off in Parkinson's disease (PD) in a subgroup of patients. The use of opicapone in our cohort with prior entacapone exposure, however, was associated with higher rates of adverse effects and treatment discontinuation than reported in published trial data of COMT inhibitor naïve patients.
Highlights
Opicapone, a recently introduced catechol-o-methyl transferase (COMT) inhibitor has the advantage of being administered once daily, and has pharmacokinetic data to indicate it offers a greater degree of COMT inhibition than entacapone
Among the group of patients who discontinued opicapone prior to 6 months, it was not possible to retrospectively quantify how many, and to what extent they had attempted to adjust their L-dopa regime before discontinuing opicapone. The aim of this audit was to identify whether opicapone may play a useful role in the management of Parkinson’s disease (PD) patients with end-of dose motor fluctuations who had not had adequate symptom control despite previous prescription of entacapone. These “real world audit data,” differ from the population that has been studied in randomized trials given their previous exposure to COMT inhibition, as well as because of differing inclusion–exclusion criteria
We found that a majority of patients responded well to opicapone and have a clinically relevant improvement of OFF time
Summary
A recently introduced catechol-o-methyl transferase (COMT) inhibitor has the advantage of being administered once daily, and has pharmacokinetic data to indicate it offers a greater degree of COMT inhibition than entacapone. Results: A total of 20 of 57 patients switched directly from entacapone to opicapone (“entacapone switchers”) whereas 37 of 57 patients had previously discontinued entacapone because of lack of benefit or adverse events (“entacapone failures”). A total of 21 of 57 (37%) patients stopped opicapone prior to 6 months. A total of 7 of 20 (35%) “entacapone switchers” experienced adverse events with opicapone of which 5 stopped the drug prior to the 6 month evaluation of efficacy. A total of 23 of 37 (62%) “entacapone failures” reported adverse events of which 16 stopped the drug. The use of opicapone in our cohort with prior entacapone exposure, was associated with higher rates of adverse effects and treatment discontinuation than reported in published trial data of COMT inhibitor naïve patients
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