Michigan’s First DUOPA Patient at Mercy Health

October 2, 2015 6:12 pm

?????????????????????????????Mercy Health Hauenstein Neurosciences is the first Movement Disorders Center in Michigan to offer Parkinson’s disease patients DUOPA, an enteral suspension of Parkinson’s medication, carbidopa/levodopa, which is delivered continuously by a pump through a tube in the small intestine placed through an outpatient procedure, performed by a gastroenterologist.

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Barbara Pickut, MD

In the advanced stages of Parkinson’s disease, patients may begin to experience “off” time, or periods of tremor, poor mobility, slowness and stiffness. Taking medication orally can be a challenge for Parkinson’ s patients, as symptoms can turn on suddenly, like a light switch. Oral medications take time to be absorbed and are not as effective after traveling through the entire digestive system. In Parkinson’s disease patients, the spontaneous emptying of the stomach becomes delayed and unpredictable, which can affect the timing of when orally administered medicines leave the stomach and are absorbed in the small intestine.

“With DUOPA, we are using golden standard medication typically prescribed for Parkinson’s patients, but the DUOPA delivery mechanism enables us to administer this in a much more efficient and effective manner,” said Barbara Pickut, MD, MPH Medical Director of the Parkinson’s and Movement Disorders Program at Mercy Health Hauenstein Neurosciences. “Rather than the patient ingesting a pill once every two hours and waiting for the medication to kick in, this enteral suspension goes immediately into the small intestine, where it is absorbed and sent to the brain for a more continuous relief from symptoms.

“Having the brain exposed to peaks and troughs of medicine may not be the best manner to treat Parkinson’s,” continued Pickut about the benefits of DUOPA. “Through the DUOPA, we can help people with Parkinson’s stay out of an overmedicated state, which can cause dyskinesia, or unwanted movement. Patients can be on DUOPA and experience its benefits for the rest of their lives. The patients we treated with the DUOPA in Belgium were pleased with the outcome: an enhanced quality of life. Many of them kept working, swimming and doing their daily activities. The therapeutic window for Parkinson’s patients widens with DUOPA.”

Although DUOPA is new to the United States, it is not new for Pickut, who began leading DUOPA studies 15 years ago and treating people with Parkinson’s in Belgium, where the drug has been approved for more than a decade. AbbVie, the pharmaceutical distributor of DUOPA, has had Pickut train other physicians in the administration of DUOPA as the company prepared for its introduction in the US market and clinical trials.

“It’s like a New Hope, You Know?”
“This is the first time in a long time that I can do this,” said Dianne Sheldon, 68, as she opens a yogurt container in a clinical exam room at Mercy Health Hauenstein Neurosciences on Monday, August 31, 2015.

Sheldon is the first patient with Parkinson’s in Michigan to receive DUOPA through a small pump that dispenses an appropriate amount of medication, slowly into her small intestine, as her brain needs it. On this day, Dr. Pickut and her staff were fine tuning the device’s medication allocation to see what the appropriate levels were for Sheldon.

“The muscle spasms from Parkinson’s are so bad I often can’t do anything,” said Sheldon. “The pain will shut off my brain, and I lose my train of thought. You give up on hope. I felt so hopeless.”

Sheldon was first diagnosed with Parkinson’s disease 13 years ago. Over time, the spasms, tremors and pain have gotten so bad that Sheldon is unable to live independently, or even under the care of her supportive family members. A little over a year ago, she moved into an assisted living center.

With the DUOPA administered at a continuous level for the first time, Sheldon will no longer have to wait for the medication to “kick in” before she can relax. Parkinson’s symptoms often occur like a lightbulb going on and off, displaying themselves immediately as medication begins to wear off.

“I haven’t been able to use my legs in a year,” said Sheldon, who is currently confined to a wheelchair, due to her advanced Parkinson’s. “I am so excited with DUOPA; I have set goals to be able to function on my own. I want to be able to dress myself, move around by myself, wheel myself in my wheelchair.”

Sheldon wants to help others know that there is hope.

DUOPA is an option for Parkinson’s patients who have advanced Parkinson’s disease. Since its FDA-approval in January 2015, DUOPA is being introduced around the country only to leading Movement Disorder Centers. AbbVie, the distributor, needs to ensure that treating centers, like Mercy Health Hauenstein Neurosciences, have advanced multidisciplinary care teams equipped to help support the administration and monitoring of DUOPA.

Facts about Parkinson’s Disease:

  • Average age of diagnosis is 60.
  • According to the Parkinson’s Disease Foundation: Parkinson’s disease is a movement disorder that is chronic and progressive, meaning that symptoms continue and worsen over time.
  • Its major symptoms vary from person to person, but can include tremor, slowness of movements, limb stiffness, and difficulties with gait and balance. The cause of the disease is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage the symptoms.
  • Movement symptoms worsen as patients reach the advanced stages of Parkinson’s disease due to continued loss of dopamine producing neurons. These patients’ increased motor symptoms can be unpredictable and difficult to control.
  • In the greater Grand Rapids area, there may be upwards to 3,000 people living with Parkinson’s. This is a conservative estimate.



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