Abstract

OPICAPONE: A NOVEL THIRD GENERATION COMT ADJUNCT FOR WEARING OFF IN PARKINSON’S DISEASE

Akhil L. L.*, Soumya R. V. and Prasobh G. R.

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Abstract

Opicapone is a potent, reversible, and peripherally-acting thirdgeneration inhibitor of catechol-o-methyltransferase (COMT), an enzyme involved in the breakdown of various catecholamines including dopamine. In June 2016, the European Commission granted a marketing authorization valid throughout the European Union for OPC, indicated as adjunct therapy to levodopa and decarboxylase inhibitors in adult patients with Parkinson's disease and end-of-dose motor fluctuations. In April 2020, the FDA approved the use of Opicapone as adjunctive treatment to levodopa/carbidopa in patients with Parkinson‟s disease (PD) experiencing “off” episodes. Opicapone is marketed as, under the brand name Ongentys as once-daily oral capsules. Almost all individuals with Parkinson‟s disease whom are treated with levodopa plus a dopa decarboxylase (DDC) inhibitor (e.g. carbidopa) will develop motor complications in time. The initial step in the management is changing the levodopa/DDC inhibitor dosage and the use of adjunct drugs. Various options include supplementing with a dopamine agonist, a monoamine oxidase B inhibitor (Selegiline, Rasagiline), a catechol-O- methyl transferase (COMT) inhibitor, or Amantadine, or using a modified-release formulation of levodopa. The newest adjunctive option is Opicapone. This drug is a peripherally selective reversible COMT inhibitor that offers the benefit of a duration of action exceeding 24h, allowing for once-daily administration. Opicapone demonstrates the lowest risk for cytotoxicity in comparison with other catechol-O-methyltransferase inhibitors. This review encompasses the clinical pharmacology, adverse effects, interactions and dosage of Opicapone- a future boon to PD.

Keywords: Parkinson?s disease, Opicapone, COMT inhibitor.