Opicopone is a compt inhibitor that’s a drug that is in a category of of medication that helps the effect of levodopa so briefly this is a category of drugs that prevents the degradation of levodopa essentially enhancing its effect and prolonging its activity so it’s an addition to this category the previous drugs um already um used before the arrival of
Ongentius were in pacopone and tolcapone so this is a more a recent edition although it’s been around for a couple of years now and it is one of the agents that is now officially recommended by the um mds evidence-based committee um and other organizations as treatment for motor fluctuations in parkinson’s so as all of these the drugs in this category doesn’t
Work by itself it does have an effect when it’s given um with carbidopa levodopa so it won’t do anything otherwise um it has some advantages potentially one of them is the fact that it’s administered only once a day whereas impact bone is administered with every dose of cardiovalido dopa and polka bone is administered three times a day um tolcapon is actually
Used less now because it has um some risks of liver toxicity so it makes the management a little bit more difficult because there’s a lot of monitoring involved opicon has actually been studied in several trials a couple of large phase three trials called the bipark studies by pacquiao by part two assessed the effect of the drug both compared to the placebo and
As an active comparative comparator with antacabone with one of the other uh pre-existing drugs in this category and it showed a positive effect so it showed formally non-inferiority to entapone and clearly superiority to placebo with significant reductions in off time so the effect you’re looking for when you’re using these drugs is reduction in fluctuations and
Specifically here is a reduction in off time um throughout the day so those reductions um for both doses there’s a 25 milligram the 50 milligram dose um have been significant with the 50 milligram dose the reductions in off time have been more than 100 minutes in a day so that’s significant that’s um more than an hour and a half of off time taken away so that’s
A beneficial effect for the patients so the main outcomes we’re looking for is a reduction in fluctuations as i mentioned before so the reduction in off time is the primary goal here uh and it is the primary effect that has been demonstrated in the trials so this is something that is useful particularly um in advanced disease or patients start to fluctuate and
They uh move between on uh on state and off state and particularly when they also develop dyskinesia and there’s this up and down fluctuation with the off states being particularly troublesome an argument can be made for it being used earlier as well to um achieve a longer duration of action of liver dopa but really the primary use right now is in patients with
Fluctuations with off state the drug has been overall safe and well tolerated the main side effect has been dyskinesia which is somewhat expected right so you get more duration of action of levodopa so there’s a higher chance of on dyskinesia and there is post marketing data coming in now that’s confirming this profile there haven’t been any surprising adverse
Events as far as i know so um i think it’s a very useful addition to the therapeutic armamentarium in parkinson’s and as i mentioned it is recommended as one of the agents i do see some significant advantages particularly with the one’s daily administration since this is going to be used in a population of parkinson’s patients who are in a lot of medications
There’s a lot of doses being administered so if we can get away with fewer doses of at least some of the drugs that’s always a positive thing the reason for my lack of experience has to do mostly with the small size of my practice and with the fact that the drug is relatively new um just clarifying that um i think the pretty much everybody who has fluctuations
And then as the disease progresses uh 5-10 years into the disease a significant proportion of patients will have fluctuations so i i could say without looking at the latest epidemiology uh perhaps half the patients would benefit from a drug in this category and then the uh in the half the patients in that state like when they um advanced in the disease and they
They have significant fluctuations so this is a good option to use for management or fluctuations there are several lines of approach to management of fluctuations right so if we go with drug management with this category of cmt inhibitors i would put this high on the list of potential agents to use obviously the management of fluctuations is a complex approach
So you start with managing the administration of levodopa itself and you try lower doses given more times throughout the day you treat dyskinesia specifically you look at other options like deep brain stimulation which allows reduction in medication can smooth out the fluctuations but within this spectrum as i mentioned um a bigger bone is specifically mentioned
In the guidelines as one of the potentially beneficial options you
Transcribed from video
OGENTYS With Levodopa/Carbidopa to Reduce 'Off' Time in Parkinson's Disease By PracticeUpdate
