Objective: To review the clinical use of a newer extended-release levodopa preparation in 50 consecutive patients with PD experiencing motor fluctuations on immediate-release levodopa.

Background: Motor fluctuations are common in PD despite adjunctive medications, partially reflecting the shortened duration of effect of immediate-release levodopa. A newer extended-release levodopa preparation Rytary (Numient) became commercially available in 2015 that can provide more prolonged delivery of levodopa to the plasma. Clinical difficulty in converting to the new preparation has hindered clinical use, and has resulted in some patients discontinuing therapy prior to achieving good clinical response.

Methods: We retrospectively reviewed charts on 50 consecutive patients on Rytary (Numient) for 6 weeks to determine their initial and final dose, clinical response, tolerability, and concomitant medications.

Results: Most patients were converted overnight to a daily dose approximately 1.7-2 times their immediate-release daily dose. Initial dosing was at 5 hour intervals, and dose was adjusted in most patients within 1-7 days. Majority of patients were begun on two dosage capsules, allowing fine titration of dose. Approximately 30% of patients took 4 daytime doses (less than 5 hour interval), and 25% took a fifth dose at bedtime. Almost 40% of patients used a higher first morning dose, and a bedtime dose when used was usually lower dose. Final dose was stabilized within 2-3 weeks in almost 80% of patents, and patients took 1-3 fewer doses than they had with immediate-release levodopa. No effect of dopamine agonist or maoB inhibitor on intiial or final dose was apparent, but patients with prior dyskinesia had a lower initial dose.

Conclusions: Rytary (Numient) provided a longer clinical duration of effect with good tolerability in these patients. Treatment using a dose conversion of 1.7-2 times the immediate-release daily dose initially divided at 5 hour intervals was well tolerated and resulted in clinically benefit on a stable dose usually within 2-3 weeks.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-effect-and-dose-conversion-of-rytary-numient-in-50-consecutive-patients-with-pd-motor-fluctuations/