Personalized Medicine Approach in Treating Parkinson’s Disease, Using Oral Administration of Levodopa/Carbidopa Microtablets in Clinical Practice

Abstract

Background: The most effective symptomatic treatment in Parkinson’s disease (PD) is levodopa in standard doses. However, as the disease progresses, there may be a need for a more personalized approach and fine tuning, in accordance with the patients’ needs. This study aims to evaluate the individual experience of levodopa/carbidopa 5/1.25 mg microtablets (LC-5) in clinical practice with respect to efficacy, tolerability, and usability. The method used was as follows: patients answered a questionnaire concerning the effect and usability of LC-5, and their medical records were reviewed. Regarding results, thirty-five survey responses were obtained, and 29 patients’ medical records were reviewed. The LC-5 dose dispenser usability was generally rated positively and facilitated medication adherence. The majority (85%) of patients reported symptom improvement while using LC-5, compared with previous standard treatments. These results suggest that LC-5 therapy is generally well-tolerated, with favorable patient-reported efficacy and user friendliness, as well as the possibility for an individualized, fine-tuned PD treatment. Further studies with a prospective design and larger study population are needed to confirm the results.

Off-time Treatment Options for Parkinson’s Disease

“…The dose is released from the dispenser, preferably into a glass of water where the microtablets are immediately dispersed. The dispenser is equipped with an alarm to facilitate treatment adherence and an optional diary-like function for self-reporting, allowing the individualization and fine tuning of the dose size and interval, as well as a more stable LD plasma concentration compared to standard LD formulation [ 85 ]. Of note, in Sweden, LC-5 is reimbursed only for patients with PD who would otherwise be treated with apomorphine or LD infusions.…”

Levodopa-Carbidopa Intestinal Gel in Advanced Parkinson’s Disease: Observations and Dilemmas after 10 Years of Real-Life Experience

“…Improving the adverse pharmacokinetics of levodopa is a constant challenge [15][16][17], with several alternatives widely used. Further positive effects are expected from the introduction of the new peripheral catechol-O-methyltransferase inhibitor (COMT-i) opicapone [18] and the reversible monoamine oxidase B inhibitor (MAO-Bi) and glutamate modulator safinamide [19,20].…”

Optimizing Treatment of Parkinson’s Disease

“…van Poppelen et al provide a single-center case series and a systematic review suggesting that a change of therapy, including add-on advanced treatment, often results in improved outcome when the first treatment is insufficient [5]. Interestingly, such examples are given also by other authors in this issue [2,6].…”

“…However, while the work towards a cure for PD continues, improvements in current symptomatic treatments are having an immediate (or soon to come) impact on disease burden for patients with PD and their caregivers. This Special Issue is dedicated to the optimization of PD treatment and contains several examples of the individualization of treatments with standard PD drugs based on novel sensor and information technology [1][2][3], as well as studies of factors important for making individualized decisions for advanced treatment with continuous dopaminergic drug infusion and deep brain stimulation, DBS [1,[4][5][6]. Several symptoms of PD can be difficult to treat and both the review of gastrointestinal dysfunction and the systematic review of the effect of foot orthoses and shoes in PD address some of those areas [7,8].…”

“…Another example, using the oral route of administration, is the dispersible levodopa/carbidopa microtablet formulation, which is approved in a few European countries, and enables dose adjustments in steps of 5 mg of levodopa. The report by Grétarsdóttir et al shows that PD patients may find this treatment efficacious and user-friendly [2].…”