The role of opicapone in the management of Parkinson's disease: an Italian consensus through a combined Nominal Group Technique and Delphi approach

- OBJECTIVE: Opicapone (OPC) is a third-generation peripheral catechol-O-methyl transferase inhibitor (COMT-i) approved as add-on therapy to levodopa/DOPA decarboxylase in-hibitors (DDCI) combinations in Parkinson's dis-ease (PD) patients with end-of-dose motor fluc-tuations. While the OPC effectiveness on mo-tor symptoms is well known, there is still uncer-tainty about the timing of introduction, the man-agement of levodopa dose, and the efficacy on non-motor symptoms (NMS). SUBJECTS AND METHODS: A group of PD experts participated in a consensus activi-ty composed of the Nominal Group Technique (NGT) and the Delphi method to better define the role of OPC. A list of statements was defined with the NGT and voted on through an online Delphi process by a panel of 85 Italian clinicians. RESULTS: 24 statements were selected for the Delphi voting. Most statements (n=15, 62%) reached a consensus. A wide agreement was reached about the efficacy of OPC in treating motor fluctuations, including early morning aki-nesia and nocturnal akinesia. The panel wide-ly agreed about the effectiveness of OPC in ear ly fluctuating patients. The long-lasting inhibi- tory effect of OPC was recognized as an advan- tage over other COMT-i, resulting in a single dai- dose and greater ease of introduction into the levodopa therapeutic regimen. CONCLUSIONS: The efficacy of OPC ob- served in the clinical trials for the management PD patients with motor fluctuations is also ex- perienced in clinical practice. The review of the current positioning of OPC from the late to ear- stages of the disease may represent an im- portant step in the evolution of the PD therapeu- approach.