On Target with “OFF” Therapies: An Exploration of New Agents and Strategies for Parkinson’s Disease (Credit Expired)

Program Description

Levodopa, the gold standard treatment for Parkinson’s disease (PD), is associated with a variety of complications and side effects including motor fluctuations and “OFF” periods. The armamentarium for OFF management is continually expanding, with 8 new therapies approved in just the past 6 years ranging from novel carbidopa-levodopa (C/L) formulations to a variety of adjunctive mechanisms. Availability of multiple therapies coupled with a lack of head-to-head comparisons presents a challenge to clinicians as to how to choose from among these options.

This program features the comparative management strategies of PD specialists and review of the published data supporting their treatment choices. Five PD specialists responded to a series of case-based and practical questions to elucidate their perspectives on the current management of OFF episodes including the use of recently approved agents. The results and their implications for clinical practice will be discussed to clarify and enhance understanding of the contemporary therapeutic landscape and how the strategies of PD specialists can inform and guide routine practice.

Target Audience

This activity is intended for neurologists, movement disorder specialists, nurse practitioners, physician assistants, and other healthcare professionals involved in the care of patients with PD.

Learning Objectives

Upon completion of the educational activity, participants should be able to:

  1. Identify common challenges with traditional levodopa therapy in PD and novel strategies to modify its delivery to better assess how and for whom to utilize these therapeutic approaches.
  2. Evaluate differences between traditional and recently approved COMT inhibitors to determine their appropriate application as add-on therapy for C/L patients experiencing “OFF” periods.
  3. Describe outcomes data and clinical experience with adjunct agents with dopaminergic versus non-dopaminergic mechanisms for the management of breakthrough disease to elucidate appropriate patient selection for and administration of each agent.
  4. Discuss the role of “on-demand” therapies in the management of “OFF” episodes and novel formulations/delivery modalities in order to safely and effectively incorporate these strategies into routine clinical management.
Course summary
Course opens: 
Course expires: 

   Robert A. Hauser, MD, MBA, FAAN (Chair)
   Director, USF Health Byrd Parkinson's Disease and Movement Disorders Center
   Professor of Neurology, Molecular Pharmacology, and Physiology
   University Of South Florida
   Tampa, Florida


   Irene Malaty, MD, FAAN

   Medical Director, Parkinson Foundation Center of Excellence at UF
   Barbara Padgett Dein Professor of Neurology
   University of Florida
   Gainesville, Florida

   Laxman Bahroo, DO, FAAN
   Director, Residency Program
   Associate Professor, Department of Neurology
   Georgetown University
   Washington, DC

image   John Morgan, MD, PhD
   Professor, Department of Neurology and Director
   Parkinson's Foundation Center of Excellence
   Movement and Memory Disorder Programs
   Augusta University
   Augusta, Georgia

image   Pinky Agarwal, MD, FAAN
   Movement Disorders Neurologist, Booth Gardner Parkinson’s Care Center
   Chair, Department of Medicine Evergreen Health
   Clinical Professor
   University of Washington School of Medicine
   Kirkland, Washington

Credit for this program has expired. The accreditation information below is based on the activity release date.

Jointly provided by Postgraduate Institute for Medicine and Efficient LLC

Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine (PIM) and Efficient LLC. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Designation Statement

PIM designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Conflict of Interest


PIM requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Planners' and Managers' Disclosure

PIM planners and managers have nothing to disclose. Efficient LLC planners and managers have nothing to disclose.

Faculty Disclosures

Dr. Hauser reported the following financial relationships:

  • Consulting Fees: AbbVie, Acadia, Acorda, Adamas, Alterity, Amneal, Aptinyx, Britannia, Cerevance, Curium, Enterin, Inhibikase, Jazz, KeiferRX, Kyowa Kirin, Lundbeck, Merck, Merz, Neurocrine, Novus, Pharma Two B, Pharmather, Revance, Roche, Sage, Scion NeuroStim, Sio Gene Therapies, Sunovion, Supernus, Tolmar, US WorldMeds, Vivifi
  • Fees for Non-CE Services: AbbVie, Accorda, Adamas, Amneal, Kyowa Kirin, Neurocrine, Sunovion
  • Contracted Research: AbbVie, Axovant, Biogen, Bukwang, Cavion, Centrogene, Cerevance, Cerevel, Cynapsus, Enterin, F. Hoffmann-La Roche, Genentech, Global Kinetics, Impax Specialty Pharma, Intec, Integrative Research Laboratories (Sweden AB), Jazz, Michael J. Fox Foundation, Neuraly, NeuroDerm, Neurocrine, Northwestern University, Pfizer, Pharma Two B, Revance, Sanofi US, Sun Pharma Advanced Research, Sunovion, UCB SPRL

Dr. Malaty reported the following financial relationships:

  • Royalty: Robert Rose Publishers
  • Contracted Research: AbbVie, Boston Scientific, Eli Lilly, Neuroderm, Prilenia, Revance, Teva

Dr. Bahroo reported the following financial relationships:

  • Consulting Fees: Acorda, Amneal, Ipsen, Neurocrine, Jazz, Supernus, Sunovion
  • Fees for Non-CE Services: AbbVie, Acadia, Acorda, Adamas, Amneal, Ipsen, Kyowa Kirin, Neurocrine, Sunovion, Supernus

Dr. Morgan reported the following financial relationships:

  • Consulting fees: Acadia, Amneal, Avion, Biogen, Eisai, Kyowa Kirin, Sunovion
  • Fees for Non-CE Services: Acadia, Amneal, Biogen, Kyowa Kirin, Sunovion

Dr. Agarwal reported the following financial relationships:

  • Consulting fees: Sunovion, Cala Health, Amneal, Kyowa Kirin, Acadia, XWPharma
  • Fees for Non-CE Services: Sunovion, Adamas, Amneal, Kyowa Kirin, Supernus, Avion Pharmaceuticals, Acadia
  • Contracted Research: Acadia, Addex Therapeutics, Annexeon, Astellas, Biogen, Centogene, Denali, Eli Lilly, Merck, Roche, Supernus, Syneos
  • Ownership Interest: Adamas, Affimed, Agile Therapeutics, Akers Biosciences, Aldeyra, Altimmune, Antares Pharma, Applied Genetic Technologies, Aptinyx, Aquestive, Arbutus, Aris, Atossa, Aurinia, Avid, Aytu, Cassava, Catalyst, Cellectar, Chefs WHSE, Chiasma, Citius, Clean Energy Fuels, Corcept, Corvus, Curis, Eiter, Epizyme, Eyegate, Fortress Biotech, Fuel Tech, Fuel Cell Energy, Generex Biotech, Genetic Technologies, Genprex, GLU Mobile, Harvard Biosciences, Intellia, Izea Worldwide, Kempharm, Lannet, Lantronix, Lightpath Technologies, Marinus, Moneygram Intl, Oncosec Med, Orion Energy Systems, Ovid Therapeutics, Phasebio Pharma, Pieris Phama, Pulmatrix, Recro Pharma, Rigel, Sesen Bio, Sientra, Siga Tech, Smith Micro Software, Soleno, Spectrum, Strata Skin Sciences, Strongbridge Biopharma, Taitron Componennts, Teekay Tankers, TG Therapeutics, Vaalco Energy, VBI Vaccines, Viridian, VTU, Yumanity

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

Commercial Support

This activity is supported by educational grants from AbbVie, Kyowa Kirin, and Supernus.


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