Entacapone is a highly potent, reversible, peripherally acting catechol-O-methyl transferase (COMT) inhibitor that is used as an adjunct to L-dopa in the treatment of patients with Parkinson disease (PD). Nevertheless, the consequence of the long-lasting inhibition of COMT by entacapone has never been investigated. We assessed the variation of the soluble red blood cell (S-RBC)-COMT activity after 3 months of chronic treatment by entacapone.
Twelve consecutive white PD patients (3 women and 9 men; mean age, 65.7 ± 2.4 years) with l-dopa-related motor fluctuations were assessed. Entacapone 200 mg was given in combination with each scheduled l-dopa/dopa decarboxylase inhibitor dose (range, 3-5 doses daily). The S-RBC-COMT activity was determined both before entacapone administration (baseline) and twice, respectively, after 1 and 3 months treatment with entacapone, that is, on morning, after at least a 12-hour withdrawal of entacapone and l-dopa and before the following first daily administration.
Mean baseline S-RBC-COMT activity was 0.72 ± 0.09 pmol/min per milligram (range, 0.30-1.29 pmol/min per milligram) of protein. After 3 months, the level increased significantly in all PD patients from 0.72 ± 0.09 pmol/min per milligram (range, 0.30-1.29 pmol/min per milligram) to 1.19 ± 0.13 pmol/min per milligram (range, 0.58-2.14 pmol/min per milligram) of protein (P < 0.01), which corresponds to a mean increase of 72.9 ± 9.2% (range, 24%-146%).
Our findings suggest that a long-lasting inhibition of the COMT may limit the efficacy of entacapone by development of a tolerance. Moreover, one may assume that an abrupt withdrawal of the treatment will be followed by a dramatic worsening of motor disability.