BENGALURU: Parkinson’s disease (PD) has no cure, and the symptoms get worse as the disease progresses with the patient age. In the most advanced stage of PD, called end-stage or stage 5, patients may experience severe motor symptoms, making it difficult for them to even stand or walk.
However, there is some hope as the drug Produodopa is believed to be a breakthrough in treatment of advanced PD. Parkinson’s disease is a progressive neurological disorder characterised by the loss of dopamine production in the brain, resulting in debilitating symptoms such as impaired movement and rigidity. Dopamine is a chemical that helps transmit messages between the parts of the brain and nerves that control movement. The new treatment involves using a pump to steadily release the medicine into the bloodstream round the clock.
Recently approved in the US and Europe, Produodopa provides continuous infusion therapy that maintains table dopamine levels, helping to alleviate the severe motor fluctuations experienced by many patients.
However, despite its promise, the drug is yet to be introduced in India, as experts point to regulatory hurdles and safety concerns as the main reasons for the delay.
Produodopa combines two drugs - foslevodopa and foscarbidopa - that work to increase dopamine levels in the brain and help control symptoms. The drug works by turning foslevodopa into dopamine, said Dr Hema Krishna P, consultant neurology and movement disorders, at Aster CMI Hospital. In India, the prevalence of PD has been reported to range from about 15-43 cases per one lakh individuals, as per studies. With its large and aging population, India is expected to have one of the world’s highest absolute numbers of Parkinson’s cases, posing a significant public health challenge.
A notable trend in India is the early onset of Parkinson’s disease, with 40–45% of patients developing motor symptoms before the age of 50. This is markedly younger than global averages, where the average onset tends to occur a decade later.
Unlike traditional medications, Produodopa is not meant for early-stage patients but is targeted at those with advanced Parkinson’s and severe motor fluctuations.
Instead of taking pills, patients receive the medication through a pump, which delivers a steady dose throughout the day, helping to maintain stable dopamine levels and reduce symptom fluctuations, Dr Hema added. Health experts, however, warn that like other Parkinson’s drugs, Produodopa can cause side effects, including reactions at the infusion site, hallucinations, falls, and anxiety, as well as common levodopa-related issues like dyskinesia (involuntary movements) and low blood pressure.
Experts say that in advanced stages of PD, many patients need over 20 pills daily and the medicines’ effect is not smooth, leading to fluctuation of motor symptoms with “On” stage during which symptoms of PD reduce and sometimes patient has excessive movements like dyskinesia, and “Off ” stage during which the effect of drugs wanes off and the patient has severe symptoms.
Dr Soniya Tambe, consultant neurology at Kauvery Hospitals, said though Produodopa has demonstrated efficacy in clinical trials, it may have side effects of typical dopaminergic treatments such as dyskinesias, nausea, arrhythmia, and orthostatic hypotension,she added.