Quote:
Originally Posted by johnt
Therapies that give PwPs better control of levodopa levels (and, hence, dopamine) are to be welcomed. But I do have a number of concerns about the levodopa inhaler's practical use.
A PwP suffering regular "off" periods is likely to be under-medicated. The fact that this state of affairs has been allowed to occur indicates poor medical management of the disease. For instance, a typical 6 monthly schedule of visits to the neurologist is too infrequent for some PwP to be able to titrate doses upward fast enough as required by the progression of the disease. The inhaler may help, but it would seem better to solve the problem by conventional means, by increasing the dose or increasing the frequency of the doses.
John
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I have to respectfully disagree with you on much of what you stated. Multiple studies have shown that about 50% of PWP report they have periodic "wearing off" phenomenon after anywhere for 5 - 10 years. It is as high as 80% for later stage patients. When I was presenting at the FDA last year, they had research that showed that many patients consider the inability to smoothly control their motor fluctuation symptoms as the worst problem they have. At the WPC in September I was in meetings where practically every person there said they experience periodic "wearing off" and motor fluctuation. Sure, PWP need to constantly be adjusting their medication protocols and timing. But, controlling the "off" phenomenon goes way beyond that. A great example is exactly what you said about the outside variables, such as what and when we eat, interacting with the on-off cycle. This fact alone means that people will experience periodic offs.
With regard to "addiction", this inhalable formation has been tested now on hundreds of PWP, many who have been on it now for several years. There is absolutely no evidence of "addiction" to date. However, even if it were, I would guess that those people that I've met who experience severe on-off fluctuations would choose to still use a quick and easy solution rather than to continue suffering. As Soccertese said, "advanced pd'ers with optimized drug dosing need a better rescue option than injectable apomorphine", which is currently the only available option. Sublingual apomorphine will be available soon (likely FDA approval), and that will give PWP another option. However, there seems to be more side effects with that as opposed to the levodopa inhaler. Both will be a good addition for mid to late stage PWP.