BACKGROUND: Patients with Parkinson’s disease (PD) develop potentially disabling “OFF” episodes—periods when symptoms worsen or reemerge—that may be treated with on-demand therapies.
OBJECTIVE: We evaluated patient treatment experiences with PD “OFF” episodes and preferences for on-demand treatment approaches.
METHODS: US adults (1875 years [y]) with a self-reported physician diagnosis of PD for 5y or <5y with “OFF” episodes on levodopa were recruited via online panels, physician referrals, online support groups, and targeted advertising to participate in an online survey. The survey gave instructions for use of hypothetical on-demand “OFF” episode treatments administered via injection, inhalation, and dissolvable sublingual film and asked participants about treatment preferences. It also asked about their experience with currently available on-demand treatments (apomorphine hydrochloride injection [Apokyn] and inhaled levodopa powder [Inbrija]).
RESULTS: Among the 300 participants, 60% were male with a mean age of 59y. Most participants (98%) experienced “OFF” episodes, with 50% having ≥1 episode/day and 90% having ≥1 episode/week. Among participants who had ever taken apomorphine hydrochloride injection (n=54) or inhaled levodopa powder (n=54), 57% and 59%, respectively, were currently taking those medications. When “OFF” episodes occur, participants most commonly reported waiting until symptoms dissipate or until their next dose of maintenance medication (53%). They also reported taking their next, partial, or extra dose of maintenance medication, calling their doctor, or taking an “OFF” episode medication. When presented with hypothetical on-demand “OFF” episode treatments, 76% of participants rated a dissolvable sublingual film as “easy” or “very easy” to potentially administer without assistance, compared with administration by injection (28%) or inhalation (59%). Of 298 participants with at least some interest in on-demand “OFF” episode treatment, preference ranking for medication administration was dissolvable sublingual film with potential mouth/lip sores (47%), inhaled medicine with potential cough or mild respiratory infection (31%), and injection with potential site reactions (18%).
CONCLUSIONS: More than half of participants with on-demand treatment experience for PD-related “OFF” episodes were currently using those treatments. For hypothetical on-demand treatment, a dissolvable sublingual film was rated as the easiest potential route of administration without assistance and, despite potential side effects, was preferred over injection or inhalation.
