EAN 2022 | Adjunctive MAO-B or COMT inhibitors to optimize levodopa treatment in PD
The most commonly used Parkinson’s disease (PD) treatment is the replacement of dopamine with its levodopa precursor. Angelo Antonini, MD, PhD, University of Padua, Padua, Italy, discusses strategies to optimize levodopa treatment in PD patients with motor fluctuations. Monoamine oxidase-B (MAO-B) and catechol-o-methyl transferase (COMT) are enzymes involved in the metabolism and regulation of dopamine availability. Adding a COMT or MAO-B inhibitor to levodopa therapy has been shown to prolong levodopa’s effectiveness, reduce the amount of levodopa required to control the symptoms, and minimize motor fluctuations. Therefore, their use can be beneficial for managing motor complications, improving patients’ quality of life, and treatment adherence. This interview took place at the European Academy of Neurology (EAN) 2022 Congress in Vienna, Austria.
Transcript (edited for clarity)
Essentially, when you have a patient who has developed these fluctuations, I think the use of enzyme inhibitors will be quite desirable. Simply because we know that if you can block the catechol-O-methyltransferase enzyme that is responsible of degradation of levodopa in the liver, you can extend the levodopa bioavailability by about 20, 25%, which is a considerable number and in many patients is already sufficient to provide more stability even if they are only on three, maximum four, doses a day...
Essentially, when you have a patient who has developed these fluctuations, I think the use of enzyme inhibitors will be quite desirable. Simply because we know that if you can block the catechol-O-methyltransferase enzyme that is responsible of degradation of levodopa in the liver, you can extend the levodopa bioavailability by about 20, 25%, which is a considerable number and in many patients is already sufficient to provide more stability even if they are only on three, maximum four, doses a day. Equally, if you use other enzyme inhibitors, particularly MAO-B for instance, you can provide an additional benefit by extending dopamine availability in the brain. So, really I think particularly the young generations of neurologists and doctors should try to think a bit outside the box and think that it is not just managing Parkinson’s about increasing the number of tablets of levodopa until people take it one every two or three hours, which makes the condition of the patient not necessarily better but certainly has a negative impact on the quality of life because you have to remember every two hours to take a tablet. Rather, keeping the treatment schedule simple may actually provide a clinical benefit and at the same time increase adherence and keep the quality of life of the people with Parkinson’s a lot better for a longer period.
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