GO with less dyskinesia, less OFF time, and more GOOD ON time

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Robust clinical program consisting of 2 Phase 3 studies and a long-term open-label extension (OLE) study1-4

The efficacy and safety of GOCOVRI 274 mg QHS were evaluated in 2 Phase 3, randomized, placebo-controlled trials:

Study 11,3,5

24-week study

121 PD patients* with dyskinesia GOCOVRI (n = 63), placebo (n = 58)

Study 22,3,5

12-week study

75 PD patients* with dyskinesia GOCOVRI (n = 37), placebo (n = 38)

Study design

  • Phase 3 randomized, placebo-controlled
  • 274 mg GOCOVRI®, QHS
  • Baseline PD medications including levodopa were held constant

Primary endpoint

  • Change in UDysRS total score from baseline to week 12

Secondary endpoints

  • Change from baseline to week 12 in ON time without troublesome dyskinesia and OFF time based on patient home diary data

Long-term open-label study4

100 weeks, N = 223

  • Open-label
  • 274 mg GOCOVRI®, QHS
  • Adjustments to baseline PD medications including levodopa were allowed
  • Evaluated long-term safety, and tolerability

See Full Study Results

*Patients who had at least 1 hour of troublesome dyskinesia time during the day and at least mild functional impact because of dyskinesia.5

The Unified Dyskinesia Rating Scale (UDysRS) is a standardized clinical research tool that uses both patient historical and objective measurements to assess presence of dyskinesia and its impact on daily activities. Total scores range from 0 to 104 points, with higher scores indicating more severe dyskinesia.6

Dyskinesia = ON time with troublesome dyskinesia.

Pooled Studies at Baseline3,5

Graphic showing UDysRS total score of 40.1 points over 104.

UDysRS total score:

40.1

points (mean)

Illustration of a person shaking.

ON time with troublesome dyskinesia:

4.9

hours (mean)

Illustration of a person sitting on a chair.

OFF time:

2.8

hours (mean)

Illustration of a person walking outside next to a tree.

GOOD ON time:

8.4

hours (mean)

GOOD ON time = ON time without troublesome dyskinesia.

DYSKINESIA ENDPOINT (PRIMARY)3

41% improvement in dyskinesia with GOCOVRI® (in UDysRS from baseline) without adjustments to existing dopaminergic medications3,7

Pooled results: mean improvement in UDysRS total score at week 12 (mean baseline of all patients, 40.1)3,7

Percent improvement from baseline calculated using MMRM statistics model.3

Adapted from Elmer et al.

OFF TIME ENDPOINT (SECONDARY)§,3,7

21% reduction in OFF time with GOCOVRI® (from baseline) without adjustments to existing dopaminergic medications3,7

Pooled results: mean reduction in OFF time at week 12 (mean baseline of all patients: 2.8 hours)3,7

§Derived from patient diary data.

Adapted from Elmer et al.

SECONDARY ENDPOINT||,3

+3.8-hour increase in GOOD ON time with GOCOVRI® (from baseline) without adjustments to existing dopaminergic medications¶,#,3,7

Pooled results: mean increase in GOOD ON time at week 12 (mean baseline of all patients: 8.4 hours)3,7

||Derived from patient diary data.

GOOD ON time = ON time without troublesome dyskinesia. All patients, including those taking placebo, were on a stable regimen of anti-Parkinson’s disease medication.3

#Pooled patient diary results from studies 1 and 2 at 12 weeks.1-3

Adapted from Elmer et al.

More GOOD ON time throughout the day due to reductions in both dyskinesia and OFF time3,7,8

Increased GOOD ON time: results from pooled patient diary data at week 127,8

Pie charts showing hours of GOOD ON time, OFF time, and dyskinesia with GOCOVRI at baseline and week 12.

Pooled placebo values (hours) for dyskinesia, OFF time, GOOD ON time, at baseline and Week 12, respectively: 5.2, 2.6, 8.1, and 3.1, 3.1, 9.6.

**GOOD ON time = ON time without troublesome dyskinesia.

††Dyskinesia defined as ON time with troublesome dyskinesia.

RESULTS FROM A POST-HOC ANALYSIS OF DIARY DATA

Exploring whether reductions in daily episodes increased continuous GOOD ON time9

Sample diary plot for a single patient throughout the waking day9

Sample diary plot for a single patient through the waking day.

**GOOD ON time = ON time without troublesome dyskinesia.

††Dyskinesia defined as ON time with troublesome dyskinesia.

RESULTS FROM A POST-HOC ANALYSIS OF DIARY DATA

Exploratory analysis assessed the impact of GOCOVRI on dyskinesia and OFF time on continuous GOOD ON time9

Post-hoc analysis of patient diary plots (N = 162) representing 1 day at baseline and week 12‡‡,9

Results from a post-hoc analysis of patient diary data (after).
Results from a post-hoc analysis of patient diary data (before).

Adapted from Hauser et al.

**GOOD ON time = ON time without troublesome dyskinesia.

††Dyskinesia defined as ON time with troublesome dyskinesia.

‡‡Patients are organized in descending order of number of episodes reported at Week 12 (with baseline reordered to match, so that patient order is the same at baseline and Week 12).9

AT WEEK 129:

57.1%

of patients receiving GOCOVRI reported no episodes of dyskinesia (vs. 24.7% with placebo)

27.3%

reported no OFF time (vs. 20.0% with placebo)

19.5%

reported no dyskinesia nor OFF time (vs. 3.5% with placebo)

A retrospective, subgroup analysis of patient diary data9:

  • Included only patients with baseline and Week 12 diaries (n = 162/196)
  • Evaluated the frequency, prevalence, and duration of episodes of troublesome dyskinesia and OFF time
  • Analyzed the effect of GOCOVRI® on these episodes
    - Episodes are defined as time spent in a PD diary motor state (dyskinesia or OFF time) before entering another state

Limitations of this analysis9:

  • Only analyzed preexisting data derived from a population with at least mild dyskinesia at baseline
  • Did not include patients who withdrew from the study prematurely
  • Did not include tools for capturing the intensity of clinical states

Due to these limitations, this analysis may not be applicable to a more generalized PD population, and no formal conclusions can be drawn.

Reductions in motor complication scores were maintained for all groups, regardless of previous therapy, for the full 2 years of the OLE4,10

This study's real-world design permitted treatment with and adjustment of concomitant PD treatments. The lack of a blinded control group reduced the certainty that study findings were due to GOCOVRI. No formal comparisons can be made between GOCOVRI and other treatment regimens.

Line graph showing open label extension study results.

MDS-UPDRS Part IV measures motor complications within the last week, including:

  • Time spent with dyskinesia (0-4 pts)
  • Functional impact of dyskinesia (0-4 pts)
  • Time spent in OFF dystonia (0-4 pts)
  • Motor fluctuations:

    - Time spent in motor fluctuations (0-4 pts)

    - Functional impact of motor fluctuations (0-4 pts)

    - Complexity of motor fluctuations (0-4 pts)

Hear OLE Insights From
Dr. Kremens

§§MDS-UPDRS Part IV captures changes in dyskinesia and OFF symptoms with a higher score, indicating an increase in severity (maximum score of 24).

‖‖Number of patients enrolling directly from the double-blind were at baseline and at week 100, respectively: continuing GOCOVRI 60, 37; previously on placebo: 78, 42; DBS: 61, 41; previously on amantadine IR: 32, 20.

What safety data does GOCOVRI have?

Take a closer look at the safety profile of GOCOVRI outlined in the Phase 3 clinical trials and the long-term OLE study.

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Important Safety Information

IMPORTANT SAFETY INFORMATION AND INDICATION

CONTRAINDICATIONS

GOCOVRI is contraindicated in patients with creatinine clearance below 15 mL/min/1.73 m2.

WARNINGS AND PRECAUTIONS

Falling Asleep During Activities of Daily Living and Somnolence: Patients treated with Parkinson’s disease medications have reported falling asleep during activities of daily living. If a patient develops daytime sleepiness during activities that require full attention (e.g., driving a motor vehicle, conversations, eating), GOCOVRI should ordinarily be discontinued or the patient should be advised to avoid potentially dangerous activities.

Suicidality and Depression: Monitor patients for depression, including suicidal ideation or behavior. Prescribers should consider whether the benefits outweigh the risks of treatment with GOCOVRI in patients with a history of suicidality or depression.

Hallucinations/Psychotic Behavior: Patients with a major psychotic disorder should ordinarily not be treated with GOCOVRI because of the risk of exacerbating psychosis. Observe patients for the occurrence of hallucinations throughout treatment, especially at initiation and after dose increases.

Dizziness and Orthostatic Hypotension: Monitor patients for dizziness and orthostatic hypotension, especially after starting GOCOVRI or increasing the dose.

Withdrawal-Emergent Hyperpyrexia and Confusion: Rapid dose reduction or abrupt discontinuation of GOCOVRI, may cause an increase in the symptoms of Parkinson’s disease or cause delirium, agitation, delusions, hallucinations, paranoid reaction, stupor, anxiety, depression, or slurred speech. Avoid sudden discontinuation of GOCOVRI.

Impulse Control/Compulsive Behaviors: Patients may experience urges (e.g. gambling, sexual, money spending, binge eating) and the inability to control them. It is important for prescribers to ask patients or their caregivers about the development of new or increased urges. Consider dose reduction or stopping medications.

ADVERSE REACTIONS

The most common adverse reactions (>10%) were hallucination, dizziness, dry mouth, peripheral edema, constipation, fall, and orthostatic hypotension.

INDICATION

GOCOVRI® (amantadine) extended release capsules is indicated:

  • For the treatment of dyskinesia in patients with Parkinson’s disease receiving levodopa-based therapy, with or without concomitant dopaminergic medications
  • As adjunctive treatment to levodopa/carbidopa in patients with Parkinson’s disease experiencing “off” episodes

It is not known if GOCOVRI is safe and effective in children.

Please see full Prescribing Information and Patient Information.

Abbreviations: DBS, deep brain stimulation; IR, immediate release; LS, least squares; MDS-UPDRS, Movement Disorder Society-Unified Parkinson's Disease Rating Scale; MMRM, mixed model repeated measure; OLE, open-label extension; PD, Parkinson's disease; QHS, once at bedtime; SE, standard error; UDysRS, Unified Dyskinesia Rating Scale.

References: 1. Pahwa R, Tanner CM, Hauser RA, et al. ADS-5102 (amantadine) extended-release capsules for levodopa-induced dyskinesia in Parkinson disease (EASE LID Study). JAMA Neurol. 2017;74(8):941-949. doi:10.1001/jamaneurol.2017.0943 2. Oertel W, Eggert K, Pahwa R, et al. Randomized, placebo-controlled trial of ADS-5102 (amantadine) extended-release capsules for levodopa-induced dyskinesia in Parkinson's disease (Ease LID 3). Mov Disord. 2017;32(12):1701-1709. doi:10.1002/mds.27131 3. Elmer LW, Juncos JL, Singer C, et al. Pooled analyses of phase III studies of ADS-5102 (amantadine) extended-release capsules for dyskinesia in Parkinson's disease. CNS Drugs. 2018;32(4):387-398. doi:10.1007/s40263-018-0498-4 4. Tanner CM, Pahwa R, Hauser RA, et al. EASE LID 2: a 2-year open-label trial of Gocovri (amantadine) extended release for dyskinesia in Parkinson's disease. J Parkinsons Dis. 2020;10(2):543-558. i:10.3233/JPD-191841 5. GOCOVRI® (amantadine). Prescribing Information. Adamas Pharma LLC. 6. Goetz CG, Nutt JG, Stebbins GT. The Unified Dyskinesia Rating Scale: presentation and clinimetric profile. Mov Disord. 2008;23(16):2398-2403. doi:10.1002/mds.22341 7. Data on file. Adamas Pharma LLC. 8. Hauser RA, Walsh RR, Pahwa R, et al. Amantadine ER (Gocovri®) significantly increases ON time without any dyskinesia: pooled analyses from pivotal trials in Parkinson's disease. Front Neurol. 2021;12:645706. doi:10.3389/fneur.2021.645706 9. Hauser RA, Kremens DE, Elmer LW, et al. Prevalence of dyskinesia and OFF by 30-minute intervals through the day and assessment of daily episodes of dyskinesia and OFF: novel analyses of diary data from Gocovri pivotal trials. J Parkinsons Dis. 2019;9(3):591-600. doi:10.3233/JPD-181565 10. Isaacson SH, Fahn S, Pahwa R, et al. Parkinson's patients with dyskinesia switched from immediate release amantadine to open-label ADS-5102. Mov Disord Clin Pract. 2018;5:183-190. doi:10.1002/mdc3.12595

Important Safety Information

IMPORTANT SAFETY INFORMATION AND INDICATION

CONTRAINDICATIONS

GOCOVRI is contraindicated in patients with creatinine clearance below 15 mL/min/1.73 m2.

WARNINGS AND PRECAUTIONS

Falling Asleep During Activities of Daily Living and Somnolence: Patients treated with Parkinson’s disease medications have reported falling asleep during activities of daily living. If a patient develops daytime sleepiness during activities that require full attention (e.g., driving a motor vehicle, conversations, eating), GOCOVRI should ordinarily be discontinued or the patient should be advised to avoid potentially dangerous activities.

Suicidality and Depression: Monitor patients for depression, including suicidal ideation or behavior. Prescribers should consider whether the benefits outweigh the risks of treatment with GOCOVRI in patients with a history of suicidality or depression.

Hallucinations/Psychotic Behavior: Patients with a major psychotic disorder should ordinarily not be treated with GOCOVRI because of the risk of exacerbating psychosis. Observe patients for the occurrence of hallucinations throughout treatment, especially at initiation and after dose increases.

Dizziness and Orthostatic Hypotension: Monitor patients for dizziness and orthostatic hypotension, especially after starting GOCOVRI or increasing the dose.

Withdrawal-Emergent Hyperpyrexia and Confusion: Rapid dose reduction or abrupt discontinuation of GOCOVRI, may cause an increase in the symptoms of Parkinson’s disease or cause delirium, agitation, delusions, hallucinations, paranoid reaction, stupor, anxiety, depression, or slurred speech. Avoid sudden discontinuation of GOCOVRI.

Impulse Control/Compulsive Behaviors: Patients may experience urges (e.g. gambling, sexual, money spending, binge eating) and the inability to control them. It is important for prescribers to ask patients or their caregivers about the development of new or increased urges. Consider dose reduction or stopping medications.

ADVERSE REACTIONS

The most common adverse reactions (>10%) were hallucination, dizziness, dry mouth, peripheral edema, constipation, fall, and orthostatic hypotension.

INDICATION

GOCOVRI® (amantadine) extended release capsules is indicated:

  • For the treatment of dyskinesia in patients with Parkinson’s disease receiving levodopa-based therapy, with or without concomitant dopaminergic medications
  • As adjunctive treatment to levodopa/carbidopa in patients with Parkinson’s disease experiencing “off” episodes

It is not known if GOCOVRI is safe and effective in children.

Please see full Prescribing Information and Patient Information.