BACKGROUND: The introduction of carbidopa-levodopa extended-release (CD-LD ER) capsules (Rytary®) did not go as smoothly as expected, largely due to difficulty around dose conversion from available immediate-release (IR) levodopa (LD) formulations. The dose conversion table in the CD-LD ER prescribing information was similar to the table used in the pivotal clinical trial and is considered by many prescribing HCPs to be less than optimal. By the end of the dose conversion period in that trial, dosing in 76% of subjects was adjusted for symptom control; roughly 60% of patients required a higher dose and about half required more frequent administration than the recommended TID dosing. OBJECTIVE: The primary objective of our nationwide (US) survey was to determine the dose conversion strategy most commonly employed by CD-LD ER frequent prescribers. The survey also aimed to explore additional features regarding CD-LD ER use in clinical practice. METHODS: A survey consisting of 21 multiple-choice questions was developed and administered to experts in the use of CD-LD ER, based on prescription volume. RESULTS: Of the 394 HCPs who were invited to participate, 90 (23%) HCPs completed the survey. All respondents were aware of the dose conversion table; the largest group did not find the table to be helpful and did not use it to convert patients to CD-LD ER. The most common strategy in calculating the CD-LD ER dose was based on the total daily LD IR dose, with the majority of that group initiating dose conversion by doubling the total daily LD dose from CD-LD IR and administering CD-LD ER one less time per day. CONCLUSION: Overall, most survey respondents agreed that a good starting point for CD-LD ER conversion could be doubling the daily LD IR dose and administering it one time less frequently. Moreover, rapid patient follow-up after initial dose conversion to allow for further dose adjustments plays a critical role in achieving success. Gaining experience over time is important for satisfactory conversion.
BACKGROUND: The introduction of carbidopa-levodopa extended-release (CD-LD ER) capsules (Rytary®) did not go as smoothly as expected, largely due to difficulty around dose conversion from available immediate-release (IR) levodopa (LD) formulations. The dose conversion table in the CD-LD ER prescribing information was similar to the table used in the pivotal clinical trial and is considered by many prescribing HCPs to be less than optimal. By the end of the dose conversion period in that trial, dosing in 76% of subjects was adjusted for symptom control; roughly 60% of patients required a higher dose and about half required more frequent administration than the recommended TID dosing. OBJECTIVE: The primary objective of our nationwide (US) survey was to determine the dose conversion strategy most commonly employed by CD-LD ER frequent prescribers. The survey also aimed to explore additional features regarding CD-LD ER use in clinical practice. METHODS: A survey consisting of 21 multiple-choice questions was developed and administered to experts in the use of CD-LD ER, based on prescription volume. RESULTS: Of the 394 HCPs who were invited to participate, 90 (23%) HCPs completed the survey. All respondents were aware of the dose conversion table; the largest group did not find the table to be helpful and did not use it to convert patients to CD-LD ER. The most common strategy in calculating the CD-LD ER dose was based on the total daily LD IR dose, with the majority of that group initiating dose conversion by doubling the total daily LD dose from CD-LD IR and administering CD-LD ER one less time per day. CONCLUSION: Overall, most survey respondents agreed that a good starting point for CD-LD ER conversion could be doubling the daily LD IR dose and administering it one time less frequently. Moreover, rapid patient follow-up after initial dose conversion to allow for further dose adjustments plays a critical role in achieving success. Gaining experience over time is important for satisfactory conversion.
Authors: Robert A Hauser; Aaron L Ellenbogen; Leo Verhagen Metman; Ann Hsu; Martin J O'Connell; Nishit B Modi; Hsuan-Ming Yao; Sherron H Kell; Suneel K Gupta Journal: Mov Disord Date: 2011-07-13 Impact factor: 10.338
Authors: Robert A Hauser; Ann Hsu; Sherron Kell; Alberto J Espay; Kapil Sethi; Mark Stacy; William Ondo; Martin O'Connell; Suneel Gupta Journal: Lancet Neurol Date: 2013-02-26 Impact factor: 44.182
Authors: Alberto J Espay; Fernando L Pagan; Benjamin L Walter; John C Morgan; Lawrence W Elmer; Cheryl H Waters; Pinky Agarwal; Rohit Dhall; William G Ondo; Kevin J Klos; Dee E Silver Journal: Neurol Clin Pract Date: 2017-02
Authors: Paul A Nausieda; Ann Hsu; Lawrence Elmer; Ramon A Gil; Joerg Spiegel; Carlos Singer; Sarita Khanna; Robert Rubens; Sherron Kell; Nishit B Modi; Suneel Gupta Journal: J Parkinsons Dis Date: 2015 Impact factor: 5.568