Continuous subcutaneous levodopa-carbidopa for the treatment of advanced Parkinson's disease: is it an improvement on other delivery?
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INTRODUCTION: Parkinson's disease (PD) is the second most common neurodegenerative disease and is growing in prevalence and disability. The standard treatment for PD is oral levo-dopa (LD) with carbidopa (CD). As PD progresses, despite higher doses of LD/CD, plasma levels of LD fluctuate, and may be associated with motor fluctuations and dyskinesia. AREAS COVERED: The development of two new subcutaneous preparations of LD/CD (ND0612 and ABBV-951) for the treatment of motor fluctuations in PD is described in detail. Both reduce motor fluctuations and dyskinesia with minor infusion site adverse events. A third subcutaneous preparation, DIZ102, is in early-stage development. EXPERT OPINION: The premise for using continuous release LD in advanced PD is that steady state levels of LD will prevent motor fluctuations/dyskinesia, but this is not the whole story, and will limit the benefits of subcutaneous continuous release LD. With its present pump system ND0612 cannot be used as monotherapy, whereas ABBV-951 can be. Having to combine with oral LD/CD will complicate the use of ND0612. Both ND0612 and ABBV-951 only cause modest reductions in OFF time. It is not clear whether these subcutaneous preparations will have more benefits than the intestinal gel, which also reduces OFF time and dyskinesia.
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Expert Opinion on Drug Delivery
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This is an Accepted Manuscript version of the following article, accepted for publication in Expert Opinion on Drug Delivery. Sheila A Doggrell (2023) Continuous subcutaneous levodopa-carbidopa for the treatment of advanced Parkinson’s disease: is it an improvement on other delivery?, Expert Opinion on Drug Delivery, DOI: 10.1080/17425247.2023.2253146. It is deposited under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Neurology and neuromuscular diseases
Clinical pharmacology and therapeutics
Pharmacology and pharmaceutical sciences
ABBV-951
DIZ102
ND0612
advanced parkinson’s disease
intestinal levodopa gel
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Doggrell, SA, Continuous subcutaneous levodopa-carbidopa for the treatment of advanced Parkinson's disease: is it an improvement on other delivery?, Expert Opinion on Drug Delivery, 2023