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The Relationship between COMT Genotype and the Clinical Effectiveness of Tolcapone, a COMT Inhibitor, in Patients with Parkinson's Disease

Chong, Derek J*; Suchowersky, Oksana*; Szumlanski, Carol; Weinshilboum, Richard M; Brant, Rolin; Campbell, Norm R. C‡§

Original Articles
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Patients with Parkinson's Disease (PD) have a variable response to tolcapone, a catechol-O-methyltransferase (COMT) inhibitor. In addition, a subset of patients develop severe diarrhea as a side effect. Two codominant alleles for the COMT gene exist, coding for low and high activity, resulting in low-, medium-, and high-activity genotypes. This study investigates the relationship between this variation in genotype and clinical effects in patients with PD taking tolcapone. To investigate the relationship between COMT polymorphism and clinical response, 24 patients who completed tolcapone clinical trials provided blood samples for COMT genotype analysis. Change in levodopa dose and United Parkinson Disease Rating Scale (UPDRS) Part III (motor subscale) were analyzed at baseline, at 1–2 weeks, and 6 months after initiation of tolcapone. Genotype analysis was performed on seven patients who had diarrhea as a side effect. There was no significant correlation between genotype and improvement in UPDRS score (p = 0.29) according to a linear models approach that adjusted for the subject's severity of PD, tolcapone dose (either 100 or 200 mg three times daily) and initial differences in baseline scores. No significant difference was seen in change in daily levodopa intake and genotype. There was also no relation between diarrhea and COMT genotype. These results indicate that, in the treatment of Parkinson's disease, COMT genotype is not a major contributor to the clinical response to tolcapone.

Departments of *Clinical Neurosciences, †Community Health Sciences, ‡Pharmacology and Therapeutics, and §Medicine, University of Calgary, Calgary, Alberta, Canada; and ∥Department of Pharmacology, Mayo Clinic, Rochester, Minnesota, USA

Address correspondence and reprint requests to Norm R.C. Campbell, Department of Medicine, Faculty of Medicine, The University of Calgary, 3330 Hospital Drive, N.W., Calgary, Alberta, Canada, T2N 4N1.

© 2000 Lippincott Williams & Wilkins, Inc.