Objective: To assess the clinical benefit induced by opicapone (OPC) as an add-on therapy to levodopa in fluctuating Parkinson’s disease (PD) patients with special focus on the PD phenotype that can obtain the best clinical benefit and the impact on dyskinesias.

Background: In controlled clinical trials, the addition of OPC to levodopa has demonstrated to reduce motor fluctuations (MF), increased ON time without troublesome dyskinesias and improved quality of life in patients with PD. However, there are few data concerning the clinical benefit produced by OPC in the real clinical practice and the PD phenotype that might obtain the best clinical benefit with less adverse events.

Method: OPTIMO was an observational and retrospective study conducted in Spain. The inclusion period lasted 12 months. Clinical data were collected before the start of treatment with OPC and between 3 and 7 months post-treatment. Adverse effects were documented, with particular focus on the development of dyskinesias

Results: 245 patients were enrolled (mean age, 67.7 years; mean time of PD evolution, 8.3 years; and mean levodopa daily dose, 620.7 mg). Patients presented mainly a rigid akinetic phenotype (41.9% ); followed by a tremor predominant type (33.6%)  and mixed phenotype (19,7%). Most PD patients had stage II of Hoehn and Yahr (63.9%). Treatment with OPC reduced the percentage of patients with wearing-off MF (98% vs. 61.6%), delayed-on (p=0.010), non-on (p=0.027) and non-motor fluctuations (p=0.010). The daily OFF-time was significantly reduced (143 vs. 67.9 minutes). The 74.2% of patients described clinical improvement in MF, with no worsening of dyskinesias in 64.6%. No significant increase in ON-time with dyskinesias was observed. Only 8.6% of patients experienced OPC-related adverse events. OPC-induced motor benefit and adverse events were similar in the different PD phenotypes (p=0.327).

Conclusion: These results confirm the findings of previous clinical trials, demonstrating that, in routine clinical practice, OPC significantly reduces motor and non-motor fluctuations without a significant increase in severity of dyskinesias, along with a good tolerance profile. In addition, we showed that the best OPC-induced motor benefit is not associated with a specific PD phenotype

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-benefit-of-opicapone-in-patients-with-different-parkinson-disease-phenopytes-the-optimo-study/