Spanish expert consensus statement on the use of inhaled levodopa for the treatment of fluctuations in Parkinson's disease.

INTRODUCTION

The majority of Parkinson's disease (PD) patients undergoing treatment with levodopa (LD) -the first-line therapy for motor manifestations in PD- experience OFF episodes, characterized by symptom exacerbation. Inhaled LD is an on-demand therapy aimed at managing OFF episodes.

METHODS

A scientific committee comprising six PD experts developed statements regarding inhaled LD based on evidence and their clinical practice experience. Using a two-round Delphi study, these statements were evaluated on a Likert scale ranging from 1 (completely disagree) to 9 (completely agree) by a panel of Spanish neurologists specialising in the management of PD patients. Consensus was considered achieved if ≥ 66.67% of responses fell within the same tertile as the median response for each statement ([1-3] disagreement, [4-6] neutral, [7-9] agreement).

RESULTS

Forty-four statements across six thematic areas were developed. A total of 48 experts were invited to participate in the Delphi study, with participation rates of 91.7% in the first round and 83.3% in the second. After two rounds, consensus was reached in agreement on 40 out of 44 statements (91%). There was a high degree of expert consensus on the utility of inhaled LD for the rapid and reliable on-demand treatment of both motor and non-motor fluctuations in PD patients.

CONCLUSIONS

Inhaled LD was deemed a useful, effective, and safe on-demand treatment for OFF episodes in PD.