Objective: To evaluate the effect of istradefylline on daytime sleepiness and sleep disturbances as well as motor symptoms in patients with Parkinson’s disease (PD) in an open-label, 3-month study.

Background:

Istradefylline is a selective adenosine A2A receptor antagonist, which improves daily “off time” and motor symptoms in patients with PD. However, the effect of istradefylline on non-motor symptoms, such as sleep/wake problems, has not been well investigated.

Methods: This study is a single center, 3-month open-label study. Twenty levodopa-treated PD patients (age, 71.8±4.7 years; disease duration, 7.8±5.1 years) complicated by wearing off phenomenon were included in this study. Those who scored 23 or less on the Mini–Mental State Examination were excluded. Participants received istradefylline 20-40 mg/day once daily (morning) over a 3-month period. Epworth Sleepiness Scale (ESS), PD sleep scale (PDSS)-2 and PD Questionnaire (PDQ-8) were administered at baseline, 2 weeks, 1 month, 2 months and 3 months. At baseline and 3 months, patients were evaluated on the MDS-UPDRS part III and IV.

Results:

Eighteen patients (90%) completed the study. At 3 months, the scores of MDS-UPDRS part III (-5.4, p<0.001) and part IV (-2.8, p<0.001) improved and off time reduced significantly (-55 min, p<0.001). ESS score decreased significantly at 3 months (-2.9, p=0.039). PDQ-8 score unchanged at 3 months (-1.2, p=0.79). No significant changes were observed in PDSS-2 score at 3 months (-2.2, p=0.22).

Conclusions:

Istradefylline significantly improved motor symptoms and reduced off time as well as daytime sleepiness in PD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/istradefylline-for-daytime-sleepiness-and-sleep-disturbances-in-patients-with-parkinsons-disease-an-open-label-3-month-study/