{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T12:39:02Z","timestamp":1779367142548,"version":"3.53.0"},"reference-count":24,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Dutch national Parkinson\u2019s disease patient association"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Neurol Disord"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec><jats:title>Background:<\/jats:title><jats:p> Limited treatment options with a rapid onset of action are available to treat off episodes in Parkinson\u2019s disease (PD) patients. Therefore, the development of rapid onset formulations, for instance with levodopa, is warranted, which was the reason to investigate an inhalable formulation of levodopa. <\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives:<\/jats:title><jats:p> The primary objective was to determine the duration until maximum effect is reached of inhaled levodopa on the improvement of motor function of PD patients. The secondary objective was to compare the time until maximal effect and the maximal effect of inhaled levodopa versus oral levodopa. <\/jats:p><\/jats:sec><jats:sec><jats:title>Design:<\/jats:title><jats:p> Open-label randomized two-way one-period crossover trial. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p> Nine PD patients in the \u2018off state\u2019 received one dose of inhaled levodopa (90\u2009mg) from Cyclops\u00ae and one dose of levodopa orodispersible tablet (100\u2009mg) on two consecutive days in a randomized order. A timed tapping test, Timed Up and Go test (TUG test) and Movement Disorders Society Unified Parkinson\u2019s Disease Rating Scale (MDS-UPDRS) III score were performed pre-dose and on set time points up to 90\u2009min post-dose as measure for motor function. In addition, blood samples were taken for a pharmacokinetic evaluation ( T<jats:sub>max<\/jats:sub>, C<jats:sub>max<\/jats:sub> and area under the concentration time curve (AUC) 0\u20133\u2009h). <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> The maximal effect of inhaled levodopa was reached at 30\u2009min (tapping test), at 75\u2009min (TUG test) and at 60\u2009min (UPDRS III). The positive effect on the UPDRS was statistically significant within 20\u2009min after inhalation. After oral administration, C<jats:sub>max<\/jats:sub> and AUC 0\u20133\u2009h were found to be significant higher ( p\u2009=\u20090.028 and p\u2009=\u20090.028, respectively) than after pulmonary administration. T<jats:sub>max<\/jats:sub> was achieved significantly ( p\u2009=\u20090.028) faster after inhalation. The motor function examinations showed a similar maximum clinical improvement after pulmonary and oral administration and although not significant, inhaled levodopa results in a shorter median duration to maximum clinical effect for the TUG and timed finger-tapping test compared with oral administration (TUG: inhalation 55.0 and oral 67.5\u2009min, timed finger-tapping test: inhalation 35.0 and oral 57.5\u2009min). After the levodopa inhalation, there were no adverse events observed and no significant differences found in long-function parameters. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion:<\/jats:title><jats:p> Inhaled levodopa from Cyclops<jats:sup>\u00ae<\/jats:sup> shows promising data as a rescue therapy for PD patients with off episodes, not responsive to the current oral therapies. <\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration:<\/jats:title><jats:p> The study protocol was approved by the local ethics board \u2018Regionale toetsingscommissie pati\u00ebntgebonden onderzoek\u2019 (RTPO) in Leeuwarden, The Netherlands (approval number RTPO1019). The study was registered in in the Dutch trial register (LTR) with identification number NL6876. From 5 March 2024 on, the research data on onderzoekmetmensen.nl are known as \u2018Overview of Medical Research in the Netherlands\u2019 (OMON). This means the use of the name LTR has thus been dropped. Now, it is registered in the OMON with the same identification number (NL6876, Effectiveness of inhaled levodopa in PD | Research with human participants (onderzoekmetmensen.nl)). All patients provided written informed consent. <\/jats:p><\/jats:sec>","DOI":"10.1177\/17562864241289207","type":"journal-article","created":{"date-parts":[[2024,10,26]],"date-time":"2024-10-26T01:55:21Z","timestamp":1729907721000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Therapeutic effect of an inhaled levodopa dry powder formulation on off episodes in patients with Parkinson\u2019s disease"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2978-8000","authenticated-orcid":false,"given":"Lara","family":"de Jong","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy, Martini Hospital Groningen, Van Swietenplein 1, Groningen 9728 NT, The Netherlands"},{"name":"Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Luinstra","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Martini Hospital Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela Francesca","family":"Aalbers","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Martini Hospital Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alide Johanna","family":"Wijma-Vos","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Martini Hospital Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5468-8811","authenticated-orcid":false,"given":"Emile","family":"D\u2019Angremont","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University Medical Centre 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