In a nutshell
This study investigated whether increasing the doses of carbidopa/levodopa treatment improves the outcomes of patients with Parkinson's disease. Researchers suggested that higher doses of carbidopa together with levodopa and entacapone should be considered as an option for the treatment of patients with Parkinson's disease.
Some background
Parkinson’s disease (PD) is a chronic disorder that affects brain cells. This is associated with symptoms such as tremors, muscle rigidity, and impaired balance. The standard treatment for these patients is a combination of levodopa and carbidopa. However, levodopa is associated with secondary effects. Moreover, over time, symptoms come back (often worse) between the daily doses. This is called "wearing off". To prevent this, entacapone has been used since it prolongs the effect of levodopa. However, the addition of entacapone may affect the balance of levodopa/carbidopa therapy.
It is not known if by increasing the doses of carbidopa/levodopa together with entacapone can reduce the "off" periods in patients treated for PD.
Methods & findings
This study included information about 117 patients with PD and "off" periods. These patients received 65 or 105mg of carbidopa in combination with 75, 100, 125 or 150 mg of levodopa and 200mg of entacapone.
Before starting the study the average daily wearing off time was 5.3 hours. Changes in the wearing off period were seen when carbidopa was increased to 65 mg (1.53 hours) and to 105 mg (1.57 hours). The standard treatment doses showed to be associated with "off" periods of 0.91 hours.
No differences were seen between treatments in safety and tolerability. The most common mild treatment-related effect was nausea, dizziness, decreased drug effect and dyskinesia (abnormal, uncontrollable movements). Severe negative effects were diarrhea and heart disease.
The bottom line
This study concluded that treatment with increased doses of carbidopa/levodopa plus entacapone is associated with improved wearing off times.
The fine print
This study had a short follow-up period. Further studies are needed.
Published By :
Neurology
Date :
Mar 01, 2019
