Do your patients accept OFF time to avoid dyskinesia?
Motor complications can develop early and frequently in the general PD population1
More than 50% developed motor complications within 5 years of diagnosis1
Of those, more than 1 in 4 experience both motor fluctuations and dyskinesia1
Which motor complication is more bothersome to your patients?
In a 2020 survey of healthcare providers (HCPs) and patients, the majority of HCPs prioritized treating OFF time vs. dyskinesia. However, the majority of patients who experience both prioritized managing dyskinesia.2
As motor complications emerge and levodopa adjustments are made, patients may accept a trade-off between OFF time and dyskinesia.3
Now, as motor complications emerge, you and your patients don't have to compromise between OFF time and dyskinesia.4
When motor complications occur, it may be beneficial to consider adding an NMDA, N-methyl-D-aspartate, antagonist (glutamatergic pathway) to complement the current dopaminergic treatment regimen.*,5
*The mechanism by which amantadine exerts efficacy in the treatment of dyskinesia and OFF time in patients with PD is unknown.4
Understanding the role of glutamate in PD
Dopamine is only part of the story when it comes to controlling motor complications.5
Reducing glutamate hyperactivity through the NMDA receptor could be critical to reducing dyskinesia and OFF time†,5
NMDA. A synthetic amino acid C5N9NO4 that binds selectively to a subset of glutamate receptors on neurons.14
†The mechanism by which amantadine exerts efficacy in the treatment of dyskinesia and OFF time in patients with PD is unknown.4
How amantadine is believed to work
AMANTADINE IS AN NMDA ANTAGONIST USED IN PD TREATMENT‡,15,16
- Amantadine is used for symptomatic treatment for PD and can reduce levodopa-induced dyskinesia and OFF time15,18,19
- The mechanism by which amantadine exerts efficacy in the treatment of dyskinesia and OFF time in patients with PD is unknown4
- May work by reducing excessive glutamatergic activity, which contributes to dyskinesia and OFF time7
- Amantadine may have direct and indirect effects on dopamine neurons; it exerts dopaminergic-like side effects such as hallucinations and dizziness in humans15
- Common daily dosing of amantadine HCl IR in PD is 100 mg BID15
‡Amantadine is a low-affinity, noncompetitive NMDA antagonist, which means inhibition of the NMDA channel occurs at a different binding site than the active site where the substrate binds.15-17
Do you have patients with PD like these?
Dyskinesia and OFF time are affecting their daily lives. See their stories and why you may want to consider GOCOVRI.
Matt's motor complications are affecting his success as a salesperson.
"I have these involuntary neck movements from dyskinesia or freezing from OFF time. They distract me and my clients. When I try to control them, they only seem to get worse."
How can Matt manage motor symptoms starting from young onset PD?
Matt is a people person who knows his field inside out. It made him a natural to become a salesperson for his company. This is the job he's been working toward his whole career.
Communicating with clients under pressure—virtually and in-person—is essential to his job.
Matt can never be sure what the day will bring. At one key meeting, his dyskinesia was particularly noticeable; at another, he was experiencing OFF episodes. His confidence is shattered.
- Initiated with Azilect 1 mg QID, then added Sinemet 25 mg/100 mg TID. Later, he started experiencing OFF episodes and a fourth dose of Sinemet was added daily
- Matt's OFF episodes have improved a little with an increased Sinemet dose, but his dyskinesia is increasing and he is having more motor complications throughout the day
- Azilect 1 mg QID
- Sinemet 25 mg/100 mg QID
Betty’s motor complications make daily tasks challenging.
"My neurologist told me increasing my dose of Sinemet would make my dyskinesia worse. Is this really the best my treatment can get?"
Must Betty accept OFF episodes to avoid dyskinesia?
These were the years Betty and her husband had worked so hard for. She hoped to spend retirement gardening and going to her grandkids' games.
Betty had been struggling with OFF episodes, and her doctor increased her levodopa. But now, she's starting to experience dyskinesia—and it’s getting in the way of everything she and her husband want to do.
She feels guilty about not being able to start their next chapter together.
- Started on Sinemet 25 mg/100 mg TID, then went to QID
- One year later, added Comtan 200 mg QID for OFF episodes
- Sinemet 25 mg/100 mg QID
- Comtan 200 mg QID–but she is starting to experience dyskinesia
Tom’s motor complications make it difficult for him to get out and socialize.
"I retired from work, not life. But I’m afraid to speak to my doctor about my dyskinesia because I don’t want her to reduce my levodopa dose."
Must Tom accept dyskinesia to avoid OFF episodes?
Tom is a textbook extrovert—the type of guy who tells great stories and loves seeing friends.
Lately though, Tom and his wife, Jean, have been turning down a lot of invitations.
At a recent gathering with buddies, his dyskinesia caused him to have trouble using utensils, embarrassing him. He’s isolating more and more, which worries his wife.
- Was initiated on Mirapex ER at diagnosis, but later discontinued due to side effects
- Tried amantadine IR early on and it worked for tremor
- Experiences pronounced dyskinesia at various times throughout the day
- Rytary 3 capsules 36.25 mg/145 mg TID
- Amantadine IR 100 mg BID
Joe’s motor complications are getting in the way of teaching.
"My slow reaction times and difficulty getting up and standing in front of the class make it hard for me to teach."
How can Joe better manage his OFF episodes?
Joe is the type of teacher few students forget. He loves to teach—which is clear from his spirited, animated style.
These days, though, Joe is just trying to get through class himself.
Visibly struggling with slow movement and tremor by the end of the period, Joe feels more like a distraction than an educator. Embarrassed, he now mostly lectures from his desk.
- Started on Sinemet 25 mg/100 mg TID
- After 1 year, his tremor and slowness were not as well controlled, and his dose was increased to 25 mg/100 mg QID
- Sinemet 25 mg/100 mg QID
What efficacy data does GOCOVRI have?
GOCOVRI is backed by 2 Phase 3 clinical trials. These studies assessed the ability of GOCOVRI to reduce dyskinesia (primary endpoint), reduce OFF time (secondary endpoint), and increase GOOD ON time (secondary endpoint).4,19,20
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