Highlights

Essentially in people who are relatively young – it depends a lot on the severity of the symptoms. We changed a bit of our prescribing patterns, so, initially, years ago, we were more keen on using dopamine agonists, more recently we keep starting more and more patients on levodopa, low dose. In general, in elderly people, levodopa is the first choice. In younger patients, meaning people below the age of 60, we may consider a low-dose dopamine agonist first and then add levodopa maybe after, if the symptoms are not well controlled or in case they see some clinical deterioration and then you need to provide improved benefit. In general, in younger patients I tend to use also rasagiline at the beginning, not so much for the motor benefit but just because it is the only drug that has some controversial data, but still there is some data, suggesting a potential slight slowing of the disease progression, so MAO-B, I think they have some benefit.

Well, the motor complications, essentially what we do is – there are essentially two strategies, one is to increase the number of administrations of levodopa maybe from three to four a day, shorten the interval essentially between those, the other one is to add an enzyme inhibitor. One thing is, maybe the one that is – if they are already on an MAO-B inhibitor like rasagiline or selegiline, then we just move straight forward to the catechol-O-methyltransferase inhibitors, opicapone essentially. If they haven’t started any enzyme inhibitor, I prefer to start opicapone as well, but some of my colleagues, they may use an MAO-B.