Opicapone efficacy and tolerability in Parkinson's disease patients reporting insufficient benefit/failure of entacapone

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Abstract

© 2020 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC. on behalf of International Parkinson and Movement Disorder Society. Background: 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. Although trial data indicate it is non-inferior to entacapone, there are no data to indicate whether it offers any clinical advantages. Methods: In 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. 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. 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. Conclusions: We 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.