New form of drug helping some Parkinson’s patients

May 8, 2016
Les Gura, Wake Forest Baptist Healthier

(Photo: Wake Forest Baptist HealthWire/Cameron Dennis)

For more than 40 years, a drug called levodopa has been the most effective treatment for the uncontrolled movements associated with Parkinson’s disease. Many Parkinson’s patients have taken a pill form of the medicine – also known as L-dopa – for years to control their motor fluctuations.

But the pills can lose effectiveness over time, greatly reducing their value for people in the later stages of the disease.

However, there’s a new form of the drug that is making a positive difference for some Parkinson’s patients. Called Duopa, it is delivered continuously by a pump system instead of pills.

“This takes care of the fluctuations in the movement symptoms that advanced Parkinson’s patients experience on a daily basis, and they don’t have to rely on pills while the pump is on,” said movement disorders specialist Dr. Mustafa Saad Siddiqui, an associate professor of neurology at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. “It can mean a very significant improvement in the quality of life of these patients.”

While tremors are the best-known sign of Parkinson's, it also commonly causes muscle rigidity and slowing of movement. There is no cure for the disease, which afflicts approximately a million people in the United States.

In the initial stages of Parkinson’s, the brain still has some neurons capable of producing and storing dopamine. The levodopa pills – which usually contain a drug called carbidopa to reduce nausea and other side effects – give the brain a boost to ensure a sufficient supply of dopamine, thus promoting normal motor control.

But during the disease’s more advanced stages, there aren’t enough neurons left to produce or store enough dopamine. As a result, patients must take more and more levodopa pills in order to supply the brain with adequate levels. At the same time, Parkinson’s causes stomach functions to become slow and unpredictable, which can delay or even prevent the medicine in the pills from leaving the stomach and reaching the bloodstream in the small intestine. Consequently, later-stage Parkinson’s patients are subject to more frequent and more pronounced motor fluctuations.

Duopa has proven capable of addressing those problems.

A gel form of levodopa and carbidopa developed by AbbVie Inc. of North Chicago, Illinois, Duopa is delivered by an external pump directly into the small intestine through a surgically placed tube. The Parkinson’s patient wears a small pouch that holds the pump and a drug cartridge, and the Duopa is delivered continuously at a consistent level for up to 16 hours according to a schedule programmed into the pump.

Siddiqui said he monitored the efficacy of the drug and delivery system in Europe, where it has been in use under the name Duodopa since 2004. He directed the clinical trial of Duopa at Wake Forest Baptist that was part of the multi-center study which led to its approval by the federal Food and Drug Administration in January 2015.

http://www.thenewsstar.com/story/life/2016/05/08/new-form-drug-helping-parkinsons-patients/84026008/?from=global&sessionKey=&autologin=