Neurology and Preclinical Neurological Studies - Original Article

Journal of Neural Transmission

, Volume 121, Issue 4, pp 357-366

Efficacy of levodopa/carbidopa/entacapone versus levodopa/carbidopa in patients with early Parkinson’s disease experiencing mild wearing-off: a randomised, double-blind trial

  • Eduardo TolosaAffiliated withNeurology Service, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic, IDIBAPS, Universitat de Barcelona Email author 
  • , Basilio HernándezAffiliated withNovartis Farmacéutica
  • , Gurutz LinazasoroAffiliated withPoliclínica Gipuzkoa
  • , Juan José López-LozanoAffiliated withClínica Ruber
  • , Pablo MirAffiliated withHospital Virgen del RocíoCentro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas CIBERNED
  • , José MareyAffiliated withHospital Universitario A Coruña
  • , Jaime KulisevskyAffiliated withHospital de Sant Pau

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Abstract

To compare the efficacy and safety of levodopa/carbidopa/entacapone (LCE) with levodopa/carbidopa (LC) on Parkinson’s disease (PD) patients with mild, or only minimally disabling motor complications. A prospective 3-month, multicentre, parallel-group, double-blind, and randomised phase IV study was performed. The primary endpoint was to assess the efficacy of LCE compared to LC on ADLs using the UPDRS part II. Secondary endpoints were assessed by the UPDRS (I, III and IV) scores, QUICK and PDQ-39 questionnaires, and patient and investigator clinical global impression (CGI). Ninety-five patients were randomly assigned to treatment with LCE (100/25/200 or 150/37.5/200 mg tablets, n = 46) or LC (100/25 mg tablets, n = 49), at the same levodopa dose that were administered before randomization. Treatment with LCE resulted in significantly greater improvement in UPDRS part II (ADLs) scores compared to treatment with LC (adjusted mean difference between groups of −1.5 points) (p = 0.0288). Amelioration was also observed in UPDRS part III scores (p = 0.010), and CGI (patient and investigator) scores (p = 0.015, and p = 0.028, respectively). LCE and LC were generally well tolerated with 78 % of subjects completing the study. Most AEs (50 % in LCE and 71.4 % in LC) were classified as mild. No serious AEs were related to the treatment. Treatment with LCE results in improved efficacy compared to LC in PD patients with mild, or minimally disabling motor fluctuations, maintaining a good safety and tolerability profile.

Keywords

Parkinson disease Wearing-off UPDRS Quick questionnaire