Posted by Rachel Dolhun, MD, September 13, 2017 on Foxfeed Blog.
The U.S. Food and Drug Administration (FDA) recently approved a new medication for levodopa-induced dyskinesia (Gocovri), making it the fifth new drug for Parkinson’s symptoms in just over two and half years.
This steady flow of market-bound therapies shows no signs of slowing — therapies for sudden “off” periods (when symptoms unexpectedly return) are close to the FDA’s doorstep and levodopa reformulations to smooth out daily fluctuations are completing clinical trials.
New drugs represent the successful culmination of many years, dollars and research volunteers’ efforts, and for people with Parkinson’s, they expand treatment options and potentially provide an alternative route for symptom control.
New therapies bring questions, though, as to whether and how to incorporate them into your regimen. Fenna Phibbs, MD, MPH, associate professor of neurology and director of the Movement Disorders Deep Brain Stimulation Program at Vanderbilt Medical Center, talked with us about these considerations.
The Michael J. Fox Foundation (MJFF): As new Parkinson’s drugs are approved, what should patients know?
Fenna Phibbs (FP): New isn’t necessarily better. Just because a new therapy is approved doesn’t mean it’s right for everyone, or that you have to change your regimen. Know what symptoms each new medication treats so that you can discuss with your doctor whether it’s an appropriate option for you.
If your symptoms are well controlled and you aren’t experiencing bothersome side effects, it’s unlikely you and your doctor will want to switch your medications. If, on the other hand, your symptoms affect your day-to-day living or your medications are not ideal (i.e., they cause significant side effects or require frequent dosing that’s hard to maintain), you may want to contemplate an alternative. (And that may be a new therapy or one that’s been around for a while.)
MJFF: What questions should patients ask when thinking about a new medication?
FP:
- What symptoms does it treat? Do you have these symptoms? If so, are they currently controlled? Or do your medications cause troublesome side effects? (In other words, do you even need to consider this medication for yourself?)
- How much benefit might you get from the medication?
- What are the drug’s potential side effects? Might it interact with other medications?
- How does it work? Is that different from your current therapies?
- What, if any, are the other available options?
- How would you take it? (Would it replace one of your current medications or be added to your regimen?)
- How much does it cost? Does insurance cover it?
MJFF: How do doctors and patients decide if they should try a new therapy?
FP: We work together, but ultimately I defer to my patients because they are the ones who take the medication every day. When symptoms impact quality of life, that may be a good time to discuss change. Change just to make a change isn’t good, so we make sure we know the goal. We decide what symptom we want to address and then, after starting a new therapy, we watch over the next week or two to see whether this improves, worsens or stays the same.
MJFF: Any last thoughts on new therapies?
FP: Always ask your physician about their experiences with new therapies. It can be hard to get a real sense of what a medication could do for you just by reading about it online or hearing its benefits touted on the news. Your doctor can put it in context for your individual situation and relay what they’ve seen when using the medication with other patients.