AAN 2025 | An analysis of the efficacy of extended-release carbidopa-levodopa in Parkinson’s disease
Stuart Isaacson, MD, Director of the Parkinson’s Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, discusses an analysis of CREXONT, an extended-release formulation of carbidopa-levodopa, for the treatment of Parkinson’s disease. The analysis showed that patients were more likely to awaken with an ‘on’ motor state when taking CREXONT compared with immediate-release carbidopa-levodopa. This interview took place at the 77th American Academy of Neurology (AAN) Annual Meeting in San Diego, CA.
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Transcript
Levodopa has been the mainstay of our treatment strategies for Parkinson’s disease since the late 1960s and there have been a number of attempts of trying to improve its absorption in the gut and trying to extend its duration of benefit of each individual dose. But some of the extended release formulations that have been developed have been plagued by formulation problems or by problems with absorption or other reasons...
Levodopa has been the mainstay of our treatment strategies for Parkinson’s disease since the late 1960s and there have been a number of attempts of trying to improve its absorption in the gut and trying to extend its duration of benefit of each individual dose. But some of the extended release formulations that have been developed have been plagued by formulation problems or by problems with absorption or other reasons. A new extended release formulation has been studied over the past almost eight or 10 years now and we’ve recently received regulatory approval from the FDA earlier this year or late in 2024. This extended release formulation called CREXONT has an interesting part of his formulation that includes a mucoadhesive polymer. Mucoadhesive polymer is in there because it’s coated these pellets and they’re able to get into the small intestine where levodopa is absorbed by the large neutral amino acid transporter. And it’s able to then adhere to the gut lumen for hours, allowing carbidopa and levodopa to be released and absorbed the levodopa to be absorbed over hours maintaining plasma levels for five or six hours and then extending the duration of benefit of each individual dose, allowing fewer doses a day and allowing for a longer duration of benefit from each dose. So we’re interested in looking at this because many people use this two or three times a day but it can be used up to four times a day and when you’re using a longer duration benefit we wondered would it last overnight and would people have a benefit even when they awoke in the morning prior to taking their first dose. So we looked specifically at this awakening time and and tried to determine the motor state whether they were ‘on’ or whether they were ‘off’ when they awoke. And demonstrated that with CREXONT patients had a greater percent chance of waking up on if they’re on CREXONT than when it was compared to when they were still using their immediate release a shorter duration of benefit carbidopa levodopa. So that was a nice post-hoc analysis of the primary data that had been already presented and published to demonstrate that using longer duration of benefit relying on this novel mucoadhesive polymer that’s in this extended release CREXONT formulation can can extend overnight in many patients and improve their awakening symptoms and on state.
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