Opicapone: an adjuvant to levodopa in PD therapy

Joaquim Ferreira, MD, PhD, University of Lisbon, Lisbon, Portugal, was interviewed at the European Academy of Neurology (EAN) 2022 Congress in Vienna, Austria, about the best approach for the management of motor fluctuations in Parkinson’s disease (PD) and emerging data for the use of adjunctive therapy as a first-line treatment option in these patients. Prof. Ferreira highlights findings from a study which compared opicapone 50mg to placebo in patients with PD treated with 100mg levodopa. In this particular study, the primary outcome was to analyze the pharmacokinetics of levodopa in patients’ plasma, with clinical data as the secondary outcome. Interestingly, opicapone significantly increased total levodopa exposure, and the pharmacokinetic curve seemed attractive as it suggested a reduction in the risk of dyskinesia and prevention of parkinsonism aggravation. Consequently, it was determined that opicapone works well as an adjuvant to levodopa for motor fluctuations at an early, less severe stage. Additionally, the analysis showed that the number of intakes of levodopa was important in reaping benefits from adding opicapone (i.e., five intakes a day rather than four). There is still a need to learn more about levodopa, including its best starting dose, titration, and daily intake.