Most patients will experience off episodes with disease progression1,2

50% of patients experience OFF episodes after 5 years of levodopa treatment
50% of patients experience OFF episodes after 5 years of levodopa treatment
70% of patients experience OFF episodes beyond 9 years of levodopa treatment.
70% of patients experience OFF episodes beyond 9 years of levodopa treatment.
Despite advancements in treatment and optimization of current regimens, OFF episodes continue to occur4-10

A Morning OFF can disrupt a patient's daily routine11

Patients who experienced morning OFF episodes reported difficulties with12*:

A morning OFF can disrupt a patient's daily routine. Patients who experienced morning OFF episodes reported difficulties with changing their clothes (68%), using the bathroom (44%), being active (43%), and having meals (35%).

*From a survey of more than 2000 Japanese patients with Parkinson's disease.

A morning OFF can disrupt a patient's daily routine. Patients who experienced morning OFF episodes reported difficulties with changing their clothes (68%), using the bathroom (44%), being active (43%), and having meals (35%).

*From a survey of more than 2000 Japanese patients with Parkinson's disease.

Morning OFFs often go unrecognized and undertreated13,14

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References: 1. Thanvi BR, Lo TCN. Long term motor complications of levodopa: clinical features, mechanisms, and management strategies. Postgrad Med J. 2004;80:452-458. 2. Hauser RA, Olanow CW, Dzyngel B, et al. Sublingual apomorphine (APL-130277) for the acute conversion of OFF to ON in Parkinson’s disease. Mov Disord. 2016;31(9):1366-1372. 3. Ahlskog JE, Muenter MD. Frequency of levodopa-related dyskinesias and motor fluctuations as estimated from the cumulative literature. Mov Disord. 2001;16(3):448-458. 4. Pawha R, Stacy MA, Factor SA, et al; for the EASE-PD Adjunct Study Investigators. Ropinirole 24-hour prolonged release: randomized, controlled study in advanced Parkinson disease. Neurology. 2007;68(14):1108-1115. 5. Waters CH, Sethi KD, Hauser RA, et al; for the Zydis Selegiline Study Group. Zydis selegiline reduces off time in Parkinson’s disease patients with motor fluctuations: a 3-month, randomized, placebo-controlled study. Mov Disord. 2004;19(4):426-432. 6. Parkinson Study Group. A randomized placebo-controlled trial of rasagiline in levodopa-treated patients with Parkinson disease and motor fluctuations. Arch Neurol. 2005;62(2):241-248. 7. Rascol O, Brooks DJ, Melamed E, et al; for the LARGO Study Group. Rasagiline as an adjunct to levodopa in patients with Parkinson’s disease and motor fluctuations (LARGO, Lasting effect in Adjunct therapy with Rasagiline Given Once daily, study): a randomised, double-blind, parallel-group trial. Lancet. 2005;365(9463):947-954. 8. Hauser RA, Hsu A, Kell S, et al; for the IPX066 ADVANCE-PD Investigators. Extended-release carbidopa-levodopa (IPX066) compared with immediate-release carbidopa-levodopa in patients with Parkinson’s disease and motor fluctuations: a phase 3 randomised, double-blind trial. Lancet Neurol. 2013;12(4):346-356. 9. Hauser RA, Shulman LM, Trugman JM, et al; for the Istradefylline 6002-US-013 Study Group. Study of istradefylline in patients with Parkinson’s disease on levodopa with motor fluctuations. Mov Disord. 2008;23(15):2177-2185. 10. LeWitt PA, Guttman M, Tetrud JW, et al; for the 6002-US-005 Study Group. Adenosine A2A receptor antagonist istradefylline (KW-6002) reduces “off” time in Parkinson’s disease: a double-blind, randomized, multicenter clinical trial (6002-US-005). Ann Neurol. 2008;63(3):295-302. 11. Ethnography research. Data on file. Sunovion Pharmaceuticals Inc. 12. Onozawa R, Tsugawa J, Tsuboi Y, et al. The impact of early morning off in Parkinson’s disease on patient quality of life and caregiver burden. J Neurol Sci. 2016;364:1-5. 13. Rizos A, Martinez-Martin P, Odin P, et al; on behalf of EUROPAR and the IPDMDS non-Motor PD Study Group. Characterizing motor and non-motor aspects of early-morning off periods in Parkinson’s disease: an international multicenter study. Parkinsonism Relat Disord. 2014;20(11):1231-1235. 14. Lees A, Chaudhuri KR, Isaacson SH. Twenty years of apomorphine therapy – how does it compare with levodopa? Eur Neurol Rev. 2014;9(2):113-119.

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