Parkinson’s Disease Levodopa-Induced Dyskinesia Market Summary
As people age, the occurrence of Parkinson’s disease tends to rise, particularly among the elderly demographic, and given the prolonged duration of the disease in affected individuals, the probability of developing Levodopa-induced Dyskinesia (LID) over time also amplifies. As per DelveInsight’s estimation, Parkinson’s disease Levodopa-induced Dyskinesia cases are expected to increase during the forecast period (2024-2034). In 2023, the total Parkinson’s Disease Levodopa-induced Dyskinesia Treatment Market Size in the US was approximately USD 900 thousand million, and among the EU4 and the UK, Germany held the highest market size at around USD 135 thousand million, followed by France and Italy at approximately USD 115 thousand million and USD 95 thousand million respectively. Japan accounted for nearly 6% of the total Parkinson’s Disease Levodopa-induced Dyskinesia Treatment Market Size in 2023.
Evolving Parkinson’s Disease Levodopa-induced Dyskinesia treatment guidelines may lead to more aggressive initiation of levodopa therapy in Parkinson’s disease patients, particularly in the early stages, which while improving motor symptoms initially, may also increase the risk of developing LID over time. Current treatment typically involves a combination of pharmacological, surgical, and non-pharmacological approaches. Supernus Pharmaceuticals’ GOCOVRI received approval in 2021 for managing OFF episodes in Parkinson’s disease patients treated with levodopa who experience dyskinesia and other motor complications, though reported adverse effects include hallucinations, dizziness, dry mouth, peripheral edema, constipation, falls, and orthostatic hypotension. While several medications and therapeutic approaches are available for managing PD-LID, none are entirely effective for all patients, highlighting the need for continued research into novel therapies targeting dyskinesias specifically.
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Parkinson’s Disease Levodopa-Induced Dyskinesia Overview
Parkinson’s disease (PD) is a life-threatening progressive neurodegenerative disease characterized by severe locomotor impairments, including bradykinesia, tremor, and rigidity. Other abnormalities associated with PD include cognitive defects, psychiatric abnormalities, and the neurodegenerative implications of levodopa-induced dyskinesia (LID). Levodopa (L-DOPA) is highly efficient and used to mitigate PD, but its prolonged use gives rise to motor abnormalities, including dyskinesia, which may be mild at first but can develop into a debilitating symptom affecting patients’ quality of life. More than 50% of patients with PD develop LID after 5 years of continuous treatment with L-DOPA.
LID is clinically heterogeneous, commonly presenting as chorea or choreoathetosis, though myoclonus, akathisia, ballism, and other abnormal movements have also been described. Uncommon forms of LID include akathisia (excessive motor restlessness), a high-stepped overshooting gait, rapid alternating movements (RAM) of legs, blepharospasm, and a mixed pattern of abnormal movements. The pathophysiology of LIDs is likely to involve alterations in the level of postsynaptic dopamine receptors, and development of dyskinesia has been associated with risk factors such as the age of onset of PD, PD severity, duration of levodopa treatment, daily dosage of levodopa, and the use of levodopa versus dopamine agonists.
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Parkinson’s Disease Levodopa-Induced Dyskinesia Diagnosis and Treatment Algorithm
The diagnosis of Parkinson’s disease Levodopa-induced Dyskinesia typically involves a thorough clinical evaluation by a neurologist or movement disorder specialist. Various scales and instruments have been developed to objectively assess LID and its impact on patients’ quality of life, including the Rush Dyskinesia Rating Scale (RDRS), the Unified Dyskinesia Rating Scale, and the Clinical Dyskinesia Rating Scale (CDRS). Instruments such as the Parkinson’s Disease Questionnaire (PDQ-39) and the Parkinson’s Disease Quality of Life Scale are also used to measure the impact of dyskinesia on quality of life, alongside patients’ self-evaluation diaries such as the Hauser diary, though maintaining compliance and accuracy with diary completion can be challenging. Quantitative instrumental techniques, including accelerometers and position transducers, have also been developed to objectively track movements and provide data on dyskinesia severity and frequency.
Treatment typically involves a combination of pharmacological, surgical, and non-pharmacological approaches aimed at managing motor symptoms and improving quality of life. Dopaminergic medications, COMT inhibitors, amantadines, and others are used to help reduce dyskinesias while maintaining motor control. Treatment strategy includes identifying the type of dyskinesia and tailoring treatment accordingly: peak-dose dyskinesia is treated mainly by reducing individual doses of levodopa and adding amantadine and dopamine agonists, while off-period dystonia often responds to baclofen and botulinum toxin injections. Diphasic dyskinesias are the most difficult to treat, particularly in patients with young-onset PD, and while fractionation of levodopa dosage is the most frequently utilized strategy, many patients require DBS to control troublesome motor fluctuations and LIDs.
Parkinson’s Disease Levodopa-Induced Dyskinesia Market Players
Parkinson’s Disease Levodopa-Induced Dyskinesia companies include:
- PharmaTher Inc.
- Neurolixis SAS
- Gala laboratories
- Bukwang Pharmaceutical
- Contera Pharma
- Vistagen
- Ipsen Pharma
- Newron Pharmaceuticals
- Zambon Pharmaceuticals
- Celon Pharma SA
- And Others
Parkinson’s Disease Levodopa-Induced Dyskinesia Epidemiology
As per DelveInsight’s analysis, in 2023, there were approximately 600 thousand patients developing Parkinson’s disease Levodopa-induced Dyskinesia in the 7MM, out of which the US accounted for nearly 300 thousand cases. These cases are expected to increase during the forecast period (2024-2034), driven by advancements in medical understanding, diagnostic methodologies, and heightened awareness surrounding Parkinson’s disease.
Key Findings:
- In 2023, among the EU4 and the UK, Germany accounted for the highest number of patients developing Parkinson’s disease Levodopa-induced Dyskinesia at approximately 67 thousand, followed by France and Italy with nearly 56 thousand and 47 thousand respectively
- In 2023, around 240 thousand Parkinson’s disease Levodopa-induced Dyskinesia-affected individuals in the US were associated with peak-dose dyskinesia, 88 thousand with off-period dystonia, and 59 thousand with diphasic dyskinesia
- These cases are expected to change by 2034 owing to the aging population likely to experience Parkinson’s disease Levodopa-induced Dyskinesia
- In 2023, Japan accounted for approximately 6% of cases of patients developing Parkinson’s disease Levodopa-induced Dyskinesia, of which nearly 35 thousand, 13 thousand, and 8 thousand individuals were associated with peak-dose dyskinesia, off-period dystonia, and diphasic dyskinesia respectively
- These cases in Japan are expected to increase during the forecast period with the prevalence of the aging population, and with longer disease duration, more patients are likely to experience complications such as LID
Parkinson’s Disease Levodopa-Induced Dyskinesia Market Outlook
Therapeutic options for managing Parkinson’s disease Levodopa-induced Dyskinesia include non-pharmacological treatments as well as oral pharmaceutical agents. US FDA approved GOCOVRI (amantadine) extended-release capsules in 2017 as the first drug for treating PD patients receiving levodopa-based therapy, and later in 2021, the FDA also approved GOCOVRI extended-release tablets as an adjunctive treatment to levodopa/carbidopa in patients with PD experiencing off episodes. Although several drugs have been approved for treating PD patients, no drug except GOCOVRI is approved specifically for Parkinson’s disease Levodopa-induced Dyskinesia. Nevertheless, continuous efforts are being made by pharma companies to bring novel therapies that can meet the needs of Parkinson’s disease Levodopa-induced Dyskinesia patients.
According to DelveInsight, the overall Parkinson’s Disease Levodopa-induced Dyskinesia Market Dynamics are anticipated to change during the forecast period (2024-2034), owing to the expected launch of emerging therapies, increasing awareness among healthcare providers and patients, technological advancements in diagnostic techniques, and the rising aging population in the 7MM. These market size figures are expected to change during the forecast period driven by ongoing research and development efforts that may lead to the discovery of more effective medications and therapies for treating Parkinson’s disease Levodopa-induced Dyskinesia.
Marketed Parkinson’s Disease Levodopa-Induced Dyskinesia Drugs
- GOCOVRI (amantadine) – Supernus Pharmaceuticals
GOCOVRI contains amantadine in an extended-release formulation for oral use; the active ingredient is amantadine hydrochloride, chemically known as tricycle decan-1-amine, hydrochloride, or 1-adamantanamine hydrochloride. The mechanism by which amantadine exerts efficacy in treating dyskinesia in patients with PD, or as adjunctive treatment to levodopa/carbidopa in patients with PD experiencing “off” episodes, is unknown, though it might work by reducing excessive glutamatergic activity, which contributes to dyskinesia and OFF. Amantadine may have direct and indirect effects on dopamine neurons and exerts dopaminergic-like side effects, such as hallucinations and dizziness, in humans.
Emerging Parkinson’s Disease Levodopa-Induced Dyskinesia Drugs
Several Parkinson’s Disease Levodopa-induced Dyskinesia companies are working robustly on new therapies, including NLX-112 (Neurolixis SAS/Gala laboratories), JM-010 (Bukwang Pharmaceutical/Contera Pharma), KETARX (ketamine) (PharmaTher), AV-101 (Vistagen), and others anticipated to positively influence the Parkinson’s disease Levodopa-induced Dyskinesia market size during the forecast period (2024-2034).
- JM-010 – Bukwang Pharmaceutical/Contera Pharma
JM-010 is a combination of buspirone, a 5-HT1A agonist, and zolmitriptan, a 5-HT1B/5-HT1D agonist, acting as a dual molecular switch by which the target efficacies of two existing and safe medications are fine-tuned to treat disease. JM-010 targets central mechanisms underlying the development of dyskinesia in PD and has successfully demonstrated efficacy and safety in preclinical studies, as well as in Phase I clinical safety and Phase II clinical proof of concept studies. JM-010 is being evaluated in Phase II clinical studies in Europe and the US.
- NLX-112 (befiradol) – Neurolixis SAS/Gala Laboratories
NLX-112 (also known as befiradol or F13640) is a novel compound that activates serotonin 5-HT1A receptors. Inhibition of serotonergic neurons is a promising strategy to diminish dyskinesia in PD, achievable by targeting serotonin 5-HT1A receptors, which inhibit serotonergic function. NLX-112 is highly effective in reducing abnormal movements in animal models of PD, and based on these data, Neurolixis has conducted clinical trials in PD patients who exhibit LID. The company completed a Phase II clinical trial for Parkinson’s disease Levodopa-induced Dyskinesia, which indicated NLX-112 was well tolerated in patients and significantly reduced their dyskinesias. Neurolixis is now looking to advance development of NLX-112 in larger clinical trials.
Parkinson’s Disease Levodopa-Induced Dyskinesia Drugs Market Insights
Commonly used drug classes in the treatment of Parkinson’s disease, including Levodopa-induced Dyskinesia, encompass a range of therapeutic options. Dopamine agonists like pramipexole (Mirapex) and ropinirole (Requip) emulate dopamine’s brain actions, often serving as supplementary or initial therapy in younger PD patients, and by alleviating motor symptoms, they potentially delay LID onset compared to levodopa. Levodopa preparations, often combined with carbidopa (Sinemet), stand as the foremost treatment for managing PD’s motor symptoms, though prolonged usage might provoke dyskinesias, including LID. Monoamine Oxidase-B (MAO-B) inhibitors such as selegiline (Eldepryl, Zelapar) and rasagiline (Azilect) impede dopamine breakdown by inhibiting MAO-B, possibly extending dopamine’s effects and decreasing LID risk. Catechol-O-methyltransferase (COMT) inhibitors like entacapone (Comtan) and tolcapone (Tasmar) extend levodopa’s effects by blocking COMT, typically as an adjunct to levodopa to manage motor fluctuations and indirectly influence LID. Anticholinergics, though capable of reducing tremors and muscle rigidity in PD, are less commonly used due to risks of cognitive decline and hallucination exacerbation.
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Conclusion
The response to levodopa and the development of dyskinesias vary widely among PD patients – some individuals may experience dyskinesias early in the disease course, while others may develop them after years of levodopa therapy, making prediction and effective management challenging. The Parkinson’s Disease Levodopa-induced Dyskinesia market is expected to witness meaningful change through 2034, driven by the rising prevalence of Parkinson’s disease, an aging population, evolving treatment guidelines, and advancements in diagnostic techniques. While GOCOVRI remains the only approved therapy specifically for Parkinson’s disease Levodopa-induced Dyskinesia, emerging candidates such as NLX-112, JM-010, KETARX, and AV-101 hold promise to expand the treatment landscape. As research progresses, the Parkinson’s Disease Levodopa-induced Dyskinesia market is expected to see continued growth and transformation, creating opportunities for stakeholders while addressing the long-term needs of patients living with this condition.
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