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This activity has been funded by Acorda Therapeutics. This activity is provided by Touch Medical Communications (TMC) for touchNEUROLOGY.

Parkinson's Disease, Movement Disorders View Time: 24 mins

touchEXPERT BRIEFING The place of on-demand therapy in the treatment of OFF episodes

Watch leading Parkinson’s disease experts discuss the treatment paradigm for OFF and the place of on-demand therapy in it.

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Expert Interviews
The rationale for on-demand therapy use in OFF episodes

Dr Daniel Kremens and Dr Fernando Pagan discuss types of OFF episodes, the impact of these episodes and current approaches to treating OFF.

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In this interview, Dr Fernando Pagan asked Dr Daniel Kremens the following questions:

  • How does the prevalence of OFF episodes change over the course of Parkinson’s disease?
  • What types of OFF episodes may a patient experience?
  • During a typical day, are there any particular times when patients are likely to experience OFF episodes?
  • What impact do OFF episodes have on patients?
  • What are the current options for treating OFF and their limitations?
The place of on-demand therapies in the treatment paradigm for OFF

Dr Fernando Pagan and Dr Daniel Kremens discuss the clinical benefits of on-demand therapy, the current treatment paradigm for OFF and the proposed shift to the earlier use of on-demand therapy.

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In this interview, Dr Daniel Kremens asked Dr Fernando Pagan the following questions:

  • Can you briefly describe what on-demand therapies are?
  • In clinical trials, what benefits have been demonstrated with on-demand therapies?
  • What is the current treatment paradigm for OFF?
  • Several recent articles have suggested that on-demand therapies should be used earlier in the treatment paradigm – please can you outline the proposed shift in treatment paradigm?
  • Is the treatment paradigm for OFF changing with the availability of on-demand therapies and the new proposed treatment algorithm for the earlier use of on-demand therapy?
The clinical implications of on-demand therapy for treating OFF

Dr Drew Falconer answers key questions on when and in which patients on-demand therapy should be used, how on-demand therapies are currently being used and the potential impact of earlier on-demand therapy use.

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In this interview, Dr Drew Falconer was asked the following questions:

  • When should on demand therapy be used e.g. does a patient’s maintenance medication need to be optimized before on-demand therapy can be added?
  • In what patients should on-demand therapy be considered as a treatment option?
  • In your experience, how are on-demand therapies currently used in clinical practice?
  • Are there any current barriers to the use of on-demand therapies?
  • What impact may the earlier use of on-demand therapy have on patients?
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Overview & Learning Objectives

Many patients continue to experience OFF episodes, with negative impact on quality of life and activities of daily living,1–3 despite conventional treatment approaches to OFF.4–6  On-demand therapies can provide as needed relief from ongoing OFF episodes,4–6 although are often only considered for use later in the treatment paradigm.7,8 Several recent articles have discussed the need to consider the earlier use of on-demand therapies in the OFF treatment paradigm.8–10 In this activity, leading experts highlight the rationale, place and the clinical implications of on-demand therapy for OFF episodes.

Learning Objectives

After watching this activity, you should be able to articulate:

  • The rationale for on-demand therapy to treat OFF episodes
  • The clinical implications of on-demand therapy for OFF episodes
  • The place of on-demand therapies in the treatment paradigm for treating OFF episodes
Faculty & Disclosures
Dr Daniel Kremens

Parkinson's Disease and Movement Disorders Center, Thomas Jefferson University, Philadelphia, PA, USA

Dr Kremens is an Associate Professor of Neurology, Co-Director of the Parkinson’s Disease and Movement Disorders Center, and Vice Chair for Education in the Department of Neurology at Jefferson Medical College of Thomas Jefferson University. He completed his medical school training at Jefferson Medical College, followed by a residency in Neurology and fellowship in Movement Disorders at The Hospital of the University of Pennsylvania. His academic interests include neuroprotection and Parkinson’s disease including the non-motor symptoms of Parkinsons disease.

Disclosures: Dr Kremens serves as a consultant for Abbott, AbbVie, ACADIA, Acorda, Adamas, Allergan, Amneal, Avion, GE Healthcare, Kyowa Kirin, Lundbeck, Merz, Neurocrine, Sunovion, Supernus, Teva, and UCB. He has received research support from Acorda, Enterin, Revance and Voyager.

Dr Fernando Pagan

Movement Disorders Program, Georgetown University Hospital, Washington, DC, USA

Dr Pagan is a Professor of Neurology and Vice Chairman for the Department of Neurology, Georgetown University Hospital. He completed his medical school training at Georgetown University School of Medicine, followed by an internship and residency at the same institution. His areas of interest include movement disorder and Parkinson’s disease.

Disclosures: Dr Pagan has been a consultant/speaker for Acorda, Adamas. Amneal, Merz, Kyowa Kirin, Sunovion, Teva. US World Meds, Supernus. Scientific Advisory or Data Safety Monitoring board for Abbvie. Serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Parkinsonism and related Disorders. Dr Pagan has stock in Keiferx. The institution of Dr Pagan has received research support from US World Meds. The institution of Dr Pagan has received research support from Novartis.

Dr Drew Falconer

Inova Parkinson's and Movement Disorders Center, Alexandria, VA, USA

Dr Falconer is a fellowship-trained movement disorders specialist who specializes in advanced care of patients with Parkinson’s disease, essential tremor, and other movement disorders. He serves as assistant professor at the UVA School of Medicine Inova campus. He speaks nationally on various topics in Movement Disorders and is a respected national educator in Parkinson’s disease and deep brain stimulation.

Disclosures: Dr Falconer has received consultancy or speaker fees from Abbott Laboratories, Abbvie, Amneal, Acorda, GE HealthCare, Kyowa Kirin, Neurocrine, Supernus and Sunovion. Dr Falconer also receives compensation as an FTC and Justice Department subject matter expert.

  1. Hechtner MC, Vogt T, Zöllner Y, et al. Quality of life in Parkinson's disease patients with motor fluctuations and dyskinesias in five European countries. Parkinsonism Relat Disord 2014;20(9):969-74.
  2. Matthews H, Stamford J, Saha R, et al. Exploring Issues Around Wearing-off and Quality of Life: The OFF-PARK Survey of People with Parkinson's Disease and their Care Partners. J Parkinsons Dis 2015;5(3):533-9.
  3. Rodríguez-Violante M, Ospina-García N, Dávila-Avila NM, et al. Motor and non-motor wearing-off and its impact in the quality of life of patients with Parkinson's disease. Arq Neuropsiquiatr 2018;76(8):517-21.
  4. Obeso JA, Olanow CW, Rodriguez-Oroz MC, et al. Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med 2001;345(13):956-63.
  5. Olanow CW, Kieburtz K, Odin P, et al. Continuous intrajejunal infusion of levodopa-carbidopa intestinal gel for patients with advanced Parkinson's disease: a randomised, controlled, double-blind, double-dummy study. Lancet Neurol 2014;13(2):141-9.
  6. Stowe R, Ives N, Clarke CE, et al. Meta-analysis of the comparative efficacy and safety of adjuvant treatment to levodopa in later Parkinson's disease. Mov Disord 2011;26(4):587-98.
  7. Armstrong MJ, Okun MS. Diagnosis and Treatment of Parkinson Disease: A Review. Jama 2020;323(6):548-60.
  8. Isaacson SH, Pagan FL, Lew MF, et al. Should "on-demand" treatments for Parkinson's disease OFF episodes be used earlier? Clin Park Relat Disord 2022;7:100161.
  9. Hauser RA, LeWitt PA, Comella CL. On demand therapy for Parkinson's disease patients: Opportunities and choices. Postgrad Med 2021;133(7):721-7.
  10. Olanow CW, Poewe W, Rascol O, et al. On-Demand Therapy for OFF Episodes in Parkinson's disease. Mov Disord 2021;36(10):2244-53.

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