Objective: To determine the efficacy and tolerability of amantadine in Progressive supranuclear palsy (PSP).

Background: PSP is one of the most common atypical parkinsonian disorders, causing progressive disability and early mortality. There are currently no approved drug therapies for PSP. Symptomatic treatment for PSP typically begins with trial of carbidopa-levodopa, but in most cases levodopa is poorly effective and provides only modest benefit. Multiple alternative medications have been tried in PSP, however, mainly in small studies with limited effects, mixed benefits, and adverse reactions. Amantadine is a primary alternative therapy with anecdotal benefit for gait and speech, but lacks evidence in PSP and is fraught with potential adverse effects.

Method: We designed a single center retrospective review from 2011 to 2022 of PSP cases treated with amantadine. Both the UF INFORM database and electronic records were queried to identify cases with sufficient clinical data, pre- and post-amantadine treatment, with minimum window of 6 months. We collected data including diagnoses, demographics, concomitant medications, amantadine dose, and treatment effects, including PSPRS, UPDRS, PSPQol, Beck Depression and Anxiety inventories.

Results: Of 353 PSP cases reviewed, 68 were treated with amantadine, and 44 (22 female) with adequate data. Mean age was 66.4 years, duration of symptoms 3.73 years, and treatment length 8.0 (±10.8) months. 31 participants reported no benefit or worsening of symptoms, whereas 6 indicated improvement, and 7 unclear. Mean change in total PSPRS or axia/gait subscore was not significantly different among these groups. Adverse effects included confusion/hallucinations (6), worsening gait/dizziness (3), and leg edema (1), resulting in early discontinuation of drug.

Conclusion: Although a small percentage of PSP patients tolerated and reported subjective benefit from amantadine, objectively, amantadine did not improve PSPRS scores and may worsen symptoms or cause adverse effects.

References: Portions of this abstract will be presented at the AAN meeting.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-retrospective-review-of-amantadine-in-progressive-supranuclear-palsy/