Objective: Objectives: 1. Efficacy – Opicapone 50mg qd. to determine effectiveness of optimal dose for switching. 2. Tolerability and safety – compare symptoms and adverse events.

Background: Opicapone is a third-generation, potent catechol-O-methyltransferase inhibitor (COMTI) with once-daily dosing recently approved for treatment in patients with motor fluctuating Parkinson’s disease(PD). The question was “Does overnight switching allow for a safe and rapid transition from entacapone to opicapone in Korean PD patients without requiring gradual dose escalation?”

Method: 1. Inclusion: PD pts stabilized on entacapone 200mg tid with levodopa & other medications. 2. Exclusion: Pts. with prior exposure to opicapone. 3. Intervention/Assessment: Conversion from entacapone 600mg/day to opicapone 50mg once daily for 4 weeks and then follow up(±2days) after switching, Off time, three phase BP for detection of orthostatic hypotension(OH), and other adverse events(AEs) and treatment emergent AEs(TEAEs) compared before and after conversion(table 1).

Results: : Twenty subjects(M:F=8:12) with a mean age of 64 years and mean disease duration of 3.8years(mean H&Y stage 2.5) completed study. All of twenty participants completed the study without discontinuation. There were no clinically significant changes in adverse outcome measures. Twelve patients(60%) preferred opicapone due primarily to reducing fluctuating dyskinesia(“off” time and peak dose dyskinesia reduction,(-24 minutes). Three patients(15%) preferred opicapone due mostly to convenience of once-daily dosing. Neither new dyskinesia nor safety concerns were observed(table 2, Fig).

Conclusion: An overnight switching of entacapone to opicapone is safe and well tolerated. The majority of subjects preferred opicapone due to reducing off time with peak dose dyskinesia and the convenience.

References: Effectiveness of opicapone and switching from entacapone in fluctuating Parkinson disease Joaquim J. Ferreira, MD, Andrew J. Lees, MD, Werner Poewe, MD, Olivier Rascol, MD, Jos´e-Francisco Rocha, BSc, Birgit Keller, Dipl-Stat, and Patricio Soares-da-Silva, MD. Neurology® 2018;90:e1849-e1857

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MDS Abstracts - https://www.mdsabstracts.org/abstract/safety-and-tolerability-of-overnight-switching-from-eetacapone-to-opicapone-in-fluctuating-parkinsons-disease-an-open-label-preliminary-trial-in-koreans/