From the Guidelines
Opicapone is generally preferred over entecapone for the treatment of Parkinson's disease patients experiencing "wearing-off" symptoms due to its once-daily dosing and greater potency in inhibiting catechol-O-methyltransferase (COMT) [no direct study provided]. When considering the treatment of Parkinson's disease, it's essential to weigh the benefits and drawbacks of each medication.
- Entecapone and opicapone are both COMT inhibitors used as adjunctive treatments for Parkinson's disease patients.
- Opicapone has a once-daily dosing regimen, which may improve medication adherence compared to entecapone's multiple daily dosing.
- The provided evidence does not directly compare entecapone and opicapone, but it discusses the importance of COMT inhibitors in reducing homocysteine levels in PD patients treated with levodopa 1.
- Entecapone, as a COMT inhibitor, may help limit the increase in plasma homocysteine levels associated with levodopa treatment, although this is closely linked to vitamin B12 and folate status 1.
- Ultimately, the choice between entecapone and opicapone should be based on individual patient needs and factors such as dosing convenience, cost, and potential side effects.
- Common side effects for both medications include nausea, diarrhea, and worsening of dyskinesia, and neither should be used as monotherapy.
- Dose adjustments of concurrent levodopa may be necessary when starting either COMT inhibitor to prevent excessive dopaminergic effects.
From the Research
Comparison of Entecapone and Opicapone
- Both entecapone and opicapone are catechol-O-methyltransferase (COMT) inhibitors used as adjunctive treatments to levodopa/carbidopa in patients with Parkinson's disease (PD) experiencing off episodes 2, 3, 4, 5, 6.
- Opicapone has been shown to be superior to placebo and noninferior to entacapone in reducing time spent in the off state 2, 4, 6.
- Opicapone offers the advantage of once-daily dosing, which can improve adherence and reduce the risk of adverse events in patients with PD 2, 3, 4, 5, 6.
- The most common adverse events reported with opicapone include dyskinesias, constipation, hypotension/syncope, increased blood creatine kinase, and decreased weight 2, 3, 4.
- Entecapone is not mentioned as having a once-daily dosing regimen in the provided studies, which may be a disadvantage compared to opicapone 2, 3, 4, 5, 6.
Efficacy and Safety
- Opicapone has been shown to be effective and generally well-tolerated as an adjunctive therapy to levodopa/DDCI in adults with PD and end-of-dose motor fluctuations 3, 4, 6.
- Opicapone has a favorable side effect profile and can increase exposure to levodopa, reducing "off" time in patients with PD 5.
- No new unexpected safety concerns were identified with opicapone after approximately 1.4 years of treatment, with no serious cases of hepatotoxicity reported in clinical trials 4.