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Entacapone in the treatment of Parkinson's disease.
Lancet Neurol. 2005 Jun; 4(6):366-70.LN

Abstract

BACKGROUND

The development of fluctuations in motor response and involuntary movements commonly complicate the treatment of Parkinson's disease (PD). Catechol-O-methyltransferase (COMT) inhibitors delay the breakdown of levodopa, which leads to an increase in levodopa bioavailability and more stable concentrations of plasma levodopa. The addition of a COMT inhibitor therefore combines the rapid onset of levodopa with prolonged efficacy, and theoretically provides a more continuous stimulation of dopamine receptors with reduced risk of motor complications. Randomised, controlled trials have shown that in patients with PD who have motor fluctuations, the addition of the COMT-inhibitor entacapone results in an improvement in motor fluctuations, particularly of the "wearing-off" type, with about 1.0-1.7 h more on-time and less off-time per day, reduced required levodopa dose, modest improvement in motor and disability scores (mean total unified PD rating scale [UPDRS] scores of about 4.5), and in some but not all studies improvement of health-related quality of life [HRQOL] scores.

RECENT DEVELOPMENTS

Patients with stable PD, without motor fluctuations, also have improved HRQOL scores on treatment with entacapone in addition to levodopa with a dopa-decarboxylase inhibitor. However, in a recent large multicentre study, UPDRS motor and disability scores were not improved despite significant improvements in HRQOL scores. The disparity between results on clinical rating scales and HRQOL scores suggests that these scales give different and potentially complementary information on health status changes in PD, and that entacapone provides benefit that may not be captured with standard clinical rating scales. Whether entacapone combined with levodopa can delay dyskinesia or motor fluctuations in patients with untreated PD is unknown; however, in animal studies, a decrease in motor complications has been reported in drug-naive animals given frequent doses of levodopa combined with entacapone. WHERE NEXT?: Clinical studies are underway to address the hypothesis that motor complications in PD can be delayed if entacapone is given from the start of treatment. Until the results of these trials are available, entacapone is indicated as a useful adjunct to levodopa in the symptomatic treatment of patients with PD with and without motor fluctuations. In addition, future trials should specifically assess the effect of entacapone on HRQOL in PD.

Authors+Show Affiliations

University Department of Clinical Neurosciences, Royal Free and University College Medical School, London, UK. a.schrag@medsch.ucl.ac.uk <a.schrag@medsch.ucl.ac.uk>

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

15907741

Citation

Schrag, Anette. "Entacapone in the Treatment of Parkinson's Disease." The Lancet. Neurology, vol. 4, no. 6, 2005, pp. 366-70.
Schrag A. Entacapone in the treatment of Parkinson's disease. Lancet Neurol. 2005;4(6):366-70.
Schrag, A. (2005). Entacapone in the treatment of Parkinson's disease. The Lancet. Neurology, 4(6), 366-70.
Schrag A. Entacapone in the Treatment of Parkinson's Disease. Lancet Neurol. 2005;4(6):366-70. PubMed PMID: 15907741.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Entacapone in the treatment of Parkinson's disease. A1 - Schrag,Anette, PY - 2005/5/24/pubmed PY - 2005/6/23/medline PY - 2005/5/24/entrez SP - 366 EP - 70 JF - The Lancet. Neurology JO - Lancet Neurol VL - 4 IS - 6 N2 - BACKGROUND: The development of fluctuations in motor response and involuntary movements commonly complicate the treatment of Parkinson's disease (PD). Catechol-O-methyltransferase (COMT) inhibitors delay the breakdown of levodopa, which leads to an increase in levodopa bioavailability and more stable concentrations of plasma levodopa. The addition of a COMT inhibitor therefore combines the rapid onset of levodopa with prolonged efficacy, and theoretically provides a more continuous stimulation of dopamine receptors with reduced risk of motor complications. Randomised, controlled trials have shown that in patients with PD who have motor fluctuations, the addition of the COMT-inhibitor entacapone results in an improvement in motor fluctuations, particularly of the "wearing-off" type, with about 1.0-1.7 h more on-time and less off-time per day, reduced required levodopa dose, modest improvement in motor and disability scores (mean total unified PD rating scale [UPDRS] scores of about 4.5), and in some but not all studies improvement of health-related quality of life [HRQOL] scores. RECENT DEVELOPMENTS: Patients with stable PD, without motor fluctuations, also have improved HRQOL scores on treatment with entacapone in addition to levodopa with a dopa-decarboxylase inhibitor. However, in a recent large multicentre study, UPDRS motor and disability scores were not improved despite significant improvements in HRQOL scores. The disparity between results on clinical rating scales and HRQOL scores suggests that these scales give different and potentially complementary information on health status changes in PD, and that entacapone provides benefit that may not be captured with standard clinical rating scales. Whether entacapone combined with levodopa can delay dyskinesia or motor fluctuations in patients with untreated PD is unknown; however, in animal studies, a decrease in motor complications has been reported in drug-naive animals given frequent doses of levodopa combined with entacapone. WHERE NEXT?: Clinical studies are underway to address the hypothesis that motor complications in PD can be delayed if entacapone is given from the start of treatment. Until the results of these trials are available, entacapone is indicated as a useful adjunct to levodopa in the symptomatic treatment of patients with PD with and without motor fluctuations. In addition, future trials should specifically assess the effect of entacapone on HRQOL in PD. SN - 1474-4422 UR - https://www.unboundmedicine.com/medline/citation/15907741/Entacapone_in_the_treatment_of_Parkinson's_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1474-4422(05)70098-3 DB - PRIME DP - Unbound Medicine ER -
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