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Parkinson's Disease Watch Time: 19 mins

touchJOURNAL CLUB Early intervention for Parkinson’s disease motor fluctuations

Watch leading experts discuss the unmet needs for patients with Parkinson’s disease and motor fluctuations, and the impact of opicapone.

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Prof. Dr Georg Ebersbach
Movement Disorders Clinic, Beelitz-Heilstaetten, Beelitz, Germany
Unmet medical needs for patients with Parkinson’s disease and motor fluctuations

Prof. Dr Ebersbach highlights the burden of motor fluctuations in patients with Parkinson’s disease treated with long-term levodopa therapy.1–10 Current strategies for treating motor fluctuations, including COMT inhibitors such as opicapone are also discussed.11,12,15,16

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Interview Questions

In this interview, we asked Prof. Dr Georg Ebersbach the following questions:

  • Please can you outline the limitations of long-term levodopa therapy?
  • Are there any aspects of OFF time, including motor and non-motor symptoms, that patients find most burdensome?
  • What treatments are available to manage levodopa-induced motor fluctuations?
  • Theoretically, how might the COMT inhibitor opicapone have advantages over other COMT inhibitors?
  • The efficacy and safety of opicapone was previously investigated in the BIPARK-I and -II studies – what were the key efficacy and safety results?
About Prof. Dr Georg Ebersbach

Prof. Dr Ebersbach is the chief physician of the neurological specialist hospital for movement disorders and Parkinson’s disease. read more

Prof. Dr Ebersbach completed his medical studies at the Free University of Berlin, then specialist training in the neurological clinic of the Charité and at the neurological university clinic Innsbruck. He undertook foreign scholarships in Houston and Barcelona.

Since 1998, Prof. Dr Ebersbach has been chief physician of the neurological specialist hospital for movement disorders and Parkinson’s in Beelitz-Heilstätten. He is guest lecturer for Neurology at the Charité Berlin and at the University of Potsdam. He is a board member of the Parkinson’s Specialist Clinics Working Group, and was board member of the German Parkinson Society 2011 – 2017. Prof. Dr Ebersbach is a TOP medical practitioner according to “FOCUS list” since 2013. He was awarded the Federal Cross of Merit 1st Class in February 2019.

Prof. Dr Ebersbach has published numerous scientific publications, book chapters and books on Parkinson’s disease and other movement disorders.

 

Disclosures

Honoraria for advisory board and consultancy from AbbVie Pharma, BIAL Pharma, Desitin Pharma, STADA Pharma.

Speaker honoraria from AbbVie Pharma, BIAL Pharma, Britannia Pharma, Desitin Pharma, Licher GmbH, STADA Pharma, Zambon Pharma.

Royalties from Kohlhammer Verlag, Thieme Verlag.

 
Prof. Dr Georg Ebersbach
Movement Disorders Clinic, Beelitz-Heilstaetten, Beelitz, Germany
The impact of opicapone across the MF spectrum: BIPARK-I and –II post hoc analysis

Prof. Dr Ebersbach discusses the results of a post hoc analysis of the BIPARK-I and -II studies,13,14 which investigated the efficacy and safety of the COMT inhibitor, opicapone on motor fluctuations in Parkinson’s disease. Key methods and results to determine the effect of opicapone based on disease duration and level of levodopa therapy are highlighted.

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Interview Questions

In this interview, we asked Prof. Dr Georg Ebersbach the following questions:

  • What was the rationale and objective of this post hoc analysis of the BIPARK-I and -II studies?
  • Which patients were included and how was the impact of disease and treatment duration assessed?
  • Which patient subgroups demonstrated improvements in OFF and ON time?
  • Were there any changes in ON time with troublesome dyskinesia for patient subgroups?
  • What are the implications of these results for the treatment of motor fluctuations?
About Prof. Dr Georg Ebersbach

Prof. Dr Ebersbach is the chief physician of the neurological specialist hospital for movement disorders and Parkinson’s disease. read more

Prof. Dr Ebersbach completed his medical studies at the Free University of Berlin, then specialist training in the neurological clinic of the Charité and at the neurological university clinic Innsbruck. He undertook foreign scholarships in Houston and Barcelona.

Since 1998, Prof. Dr Ebersbach has been chief physician of the neurological specialist hospital for movement disorders and Parkinson’s in Beelitz-Heilstätten. He is guest lecturer for Neurology at the Charité Berlin and at the University of Potsdam. He is a board member of the Parkinson’s Specialist Clinics Working Group, and was board member of the German Parkinson Society 2011 – 2017. Prof. Dr Ebersbach is a TOP medical practitioner according to “FOCUS list” since 2013. He was awarded the Federal Cross of Merit 1st Class in February 2019.

Prof. Dr Ebersbach has published numerous scientific publications, book chapters and books on Parkinson’s disease and other movement disorders.

 

Disclosures

Honoraria for advisory board and consultancy from AbbVie Pharma, BIAL Pharma, Desitin Pharma, STADA Pharma.

Speaker honoraria from AbbVie Pharma, BIAL Pharma, Britannia Pharma, Desitin Pharma, Licher GmbH, STADA Pharma, Zambon Pharma.

Royalties from Kohlhammer Verlag, Thieme Verlag.

 
Dr Mónica Kurtis
Hospital Ruber Internacional Madrid, Spain
Implications of the BIPARK-I and –II post hoc analysis

Dr Kurtis discusses the implications of the BIPARK-I and -II post hoc analysis including patient selection considerations,11,17–19 outstanding questions in the role of opicapone in the treatment of motor fluctuations20 and unmet needs that remain in Parkinson’s disease in general.21,22

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Interview Questions

In this interview, we asked Dr Mónica Kurtis the following questions:

  • Based on the results of the BIPARK-I and -II post hoc analysis, are there any implications for when opicapone therapy should be initiated for motor fluctuations?
  • Are there any more data required to determine the benefit of opicapone in early-stage motor fluctuations?
  • Are there any patient groups where the benefit of opicapone for motor fluctuations is less certain?
  • How do you weigh the benefits alongside the risk and limits of opicapone treatment?
  • What unmet needs remain for patients with motor fluctuations?
About Dr Mónica Kurtis

Dr Mónica Kurtis completed her first two years of undergraduate studies at Princeton University and finished her degree in Biological Sciences at the University of Edinburgh. She then returned to Spain, graduating from the University of Navarra School of Medicine, after spending one year as an Erasmus Scholar at the Université Paul Sabatier in Toulouse, France. read more

Dr Kurtis completed her neurology residency at the Clínico San Carlos Hospital in Madrid. She continued her training in New York and performed a clinical and neurophysiology fellowship in movement disorders at New York-Presbyterian Hospital-Columbia and Cornell. She has published dozens of peer reviewed articles and book chapters and presented clinical research in a wide range of topics in movement disorders. She is an active member of the International Parkinson and Movement Disorders Society, holding posts in the education and scales committees. She is particularly interested in novel methods of diagnosis and treatment for dystonia, Parkinson disease and functional movement disorders.

 

Disclosures

Honoraria from Bial, the International Movement Disorders Society, the Parkinson World Coalition. 

Consulting fees from Bial, Abbvie and Gondola Medical Technologies.

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Overview & Learning Objectives
Overview

Patients with Parkinson’s disease treated long-term with levodopa develop OFF periods characterised by motor fluctuations,1–4 which decreases health-related quality of life for patients and care partners.5–10 The once-daily COMT inhibitor, opicapone, increases the bioavailability of levodopa, leading to a more continuous delivery11,12 . In the BIPARK-I and -II studies opicapone decreased  OFF-time and increased ON-time.13,14  We interviewed one of the authors of a recent post hoc analysis of the BIPARK-I and -II studies13,14  on the key methods and results to determine the impact of opicapone across the motor fluctuation spectrum, in addition to a leading expert on the wider implications of the results for patients.

Learning Objectives

After watching this activity, participants should be better able to:

  • Recognise the burden of motor fluctuations in Parkinson’s disease and the need to optimise treatment to ensure the best possible disease outcomes.
  • Describe the key results from the post hoc analysis of the BIPARK studies including the efficacy of opicapone throughout the entire spectrum of motor fluctuations.
  • Understand the implications of these results for clinical practice, including the potential for early intervention on motor fluctuations in PD.
References
References
  1. Fackrell R, et al. Neurodegener Dis Manag. 2018;8(5):349-360.
  2. Katzenschlager R, et al. Neurology. 2008;71(7):474-80.
  3. Verschuur CVM, et al. N Engl J Med. 2019;380(4):315-324.
  4. Olanow CW, et al. Lancet Neurol. 2006;5(8):677-87.
  5. Stocchi F, et al. Parkinsonism Relat Disord. 2014;20(2):204-211.
  6. Chapuis S, et al. Mov Disord 2005; 20(2): 224-30.
  7. Rascol O, et al. J Neural Transm (Vienna) 2015. 122(10): 1447-55.
  8. Grimbergen YA, et al. J Parkinsons Dis 2013; 3(3): 409-13.
  9. Mosley PE, et al. J Geriatr Psychiatry Neurol 2017; 30(5): 235-52.
  10. Onozawa R, et al. J Neurol Sci 2016; 364: 1-5.
  11. EMA 2016. Available at: https://www.ema.europa.eu/en/documents/product-information/ongentys-epar-product-information_en.pdf (accessed September 2021).
  12. Stocchi F, et al. Eur Neurol. 2010;63(5):257-66.
  13. Ferreira JJ, et al. Lancet Neurol. 2016;15(2):154-165.
  14. Lees AJ, et al. JAMA Neurol. 2017;74(2):197-206.
  15. Pahwa R, Lyons KE. Curr Med Res Opin. 2009;25(4):841-9.
  16. Konta B, Frank W. GMS Health Technol Assess. 2008;4:Doc05.
  17. Han JW, et al. J Korean Med Sci. 2018;33(47):e300.
  18. Meder D, et al. Neuroimage. 2019;190:79-93.
  19. Zhu K, et al. Parkinsonism Relat Disord. 2016;33:51-57.
  20. Osig C, et al. J Neural Transm (Vienna). 2016;123(1):57-64.
  21. Rukavina K et al. Expert Rev Neurother. 2021;21(3):335-352.
  22. Sharpe G, et al. Front Neurol. 2020;11:576569.
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