Effectiveness and safety of opicapone in Parkinson's disease patients with motor fluctuations: The OPTIPARK open-label study

BACKGROUND: The efficacy and safety of opicapone, a once-daily catechol-O-methyltransferase inhibitor, have been established in two large randomized, placebo-controlled, multinational pivotal trials. Still, clinical evidence from routine practice is needed to complement the data from the pivotal trials. METHODS: OPTIPARK (NCT02847442) was a prospective, open-label, single-arm trial conducted in Germany and the UK under clinical practice conditions. Patients with Parkinson’s disease and motor fluctuations were treated with opicapone 50 mg for 3 (Germany) or 6 (UK) months in addition to their current levodopa and other antiparkinsonian treatments. The primary endpoint was the Clinician’s Global Impression of Change (CGI-C) after 3 months. Secondary assessments included Patient Global Impressions of Change (PGI-C), the Unified Parkinson’s Disease Rating Scale (UPDRS), Parkinson’s Disease Questionnaire (PDQ-8), and the Non-Motor Symptoms Scale (NMSS). Safety assessments included evaluation of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs). RESULTS: Of the 506 patients enrolled, 495 (97.8%) took at least one dose of opicapone. Of these, 393 (79.4%) patients completed 3 months of treatment. Overall, 71.3 and 76.9% of patients experienced any improvement on CGI-C and PGI-C after 3 months, respectively (full analysis set). At 6 months, for UK subgroup only (n = 95), 85.3% of patients were judged by investigators as improved since commencing treatment. UPDRS scores at 3 months showed statistically significant improvements in activities of daily living during OFF (mean ± SD change from baseline: − 3.0 ± 4.6, p < 0.0001) and motor scores during ON (− 4.6 ± 8.1, p < 0.0001). The mean ± SD improvements of − 3.4 ± 12.8 points for PDQ-8 and -6.8 ± 19.7 points for NMSS were statistically significant versus baseline (both p < 0.0001). Most of TEAEs (94.8% of events) were of mild or moderate intensity. TEAEs considered to be at least possibly related to opicapone were reported for 45.1% of patients, with dyskinesia (11.5%) and dry mouth (6.5%) being the most frequently reported. Serious TEAEs considered at least possibly related to opicapone were reported for 1.4% of patients. CONCLUSIONS: Opicapone 50 mg was effective and generally well-tolerated in PD patients with motor fluctuations treated in clinical practice. TRIAL REGISTRATION: Registered in July 2016 at clinicaltrials.gov (NCT02847442)

Demographic, clinical and antibody characteristics of patients with digital ulcers in systemic sclerosis: data from the DUO Registry

OBJECTIVES: The Digital Ulcers Outcome (DUO) Registry was designed to describe the clinical and antibody characteristics, disease course and outcomes of patients with digital ulcers associated with systemic sclerosis (SSc). METHODS: The DUO Registry is a European, prospective, multicentre, observational, registry of SSc patients with ongoing digital ulcer disease, irrespective of treatment regimen. Data collected included demographics, SSc duration, SSc subset, internal organ manifestations, autoantibodies, previous and ongoing interventions and complications related to digital ulcers. RESULTS: Up to 19 November 2010 a total of 2439 patients had enrolled into the registry. Most were classified as either limited cutaneous SSc (lcSSc; 52.2%) or diffuse cutaneous SSc (dcSSc; 36.9%). Digital ulcers developed earlier in patients with dcSSc compared with lcSSc. Almost all patients (95.7%) tested positive for antinuclear antibodies, 45.2% for anti-scleroderma-70 and 43.6% for anticentromere antibodies (ACA). The first digital ulcer in the anti-scleroderma-70-positive patient cohort occurred approximately 5 years earlier than the ACA-positive patient group. CONCLUSIONS: This study provides data from a large cohort of SSc patients with a history of digital ulcers. The early occurrence and high frequency of digital ulcer complications are especially seen in patients with dcSSc and/or anti-scleroderma-70 antibodies

Conceptualising alcohol consumption in relation to long-term health conditions: Exploring risk in interviewee accounts of drinking and taking medications

BACKGROUND: Alcohol use is a major contributor to the burden of disease, including long-term non-communicable diseases. Alcohol can also interact with and counter the effects of medications. This study addresses how people with long term conditions, who take multiple medications, experience and understand their alcohol use. The study objective is to explore how people conceptualise the risks posed to their own health from their concurrent alcohol and medicines use. METHODS AND FINDINGS: Semi-structured interviews were conducted with a sample of 24 people in the North of England taking medication for long term conditions who drank alcohol twice a week or more often. Transcripts were analysed using a modified framework method with a constructionist thematic analysis. Alcohol was consumed recreationally and to aid with symptoms of sleeplessness, stress and pain. Interviewees were concerned about the felt effects of concurrent alcohol and medicines use and sought ways to minimise the negative effects. Interviewees associated their own drinking with short-term reward, pleasure and relief. Risky drinking was located elsewhere, in the drinking of others. People made experiential, embodied sense of health harms and did not seem aware of, or convinced by, (or in some cases appeared resigned to) future harms to their own health from alcohol use. The study has limitations common to exploratory qualitative studies. CONCLUSIONS: Health risk communication should be better informed about how people with long-term health conditions perceive health outcomes over time, and how they adopt experience-based safety strategies in contexts in which alcohol consumption is heavily promoted and weakly regulated, whilst medicines adherence is expected. Supporting people to make active and informed connections between medicines, alcohol and potential personal health harms requires more than a one-way style of risk communication if it is to be perceived as opening up rather than restricting choice

Anti-inflammatory Components from Functional Foods for Obesity

Obesity, defined as excessive fat accumulation that may impair health, has been described throughout human history, but it has now reached epidemic proportions with the WHO estimating that 39% of the world’s adults over 18 years of age were overweight or obese in 2016. Obesity is a chronic low-grade inflammatory state leading to organ damage with an increased risk of common diseases including cardiovascular and metabolic disease, non-alcoholic fatty liver disease, osteo-arthritis and some cancers. This inflammatory state may be influenced by adipose tissue hypoxia and changes in the gut microbiota. There has been an increasing focus on functional foods and nutraceuticals as treatment options for obesity as drug treatments are limited in efficacy. This chapter summarises the importance of anthocyanin-containing fruits and vegetables, coffee and its components, tropical fruit and food waste as sources of phytochemicals for obesity treatment. We emphasise that preclinical studies can form the basis for clinical trials to determine the effectiveness of these treatments in humans

Responsibility, recreation, and gender: a systematic review of middle-aged non-problematised drinkers’ constructions of their alcohol consumption

Emma Muhlack, Jaklin Eliott, Annette Braunack-Mayer, Drew Carter & Nicholas Morfid

Mass Transfer of Anthocyanins during Extraction from Pre-Fermentative Grape Solids under Simulated Fermentation Conditions: Effect of Convective Conditions

The colour of red wine is largely determined by the concentration of anthocyanins that are extracted from grape skins during fermentation. Because colour is a key parameter in determining the overall quality of the finished product, understanding the effect of processing variables on anthocyanin extraction is critical for producing a red wine with the desired sensorial characteristics. In this study, the effect of convective conditions (natural and forced) on the mass transfer properties of malvidin-3-glucoside (M3G) from pre-fermentative grape solids was explored at various liquid phase conditions representing stages of fermentation. A mathematical model that separates solid and liquid phase mass transfer parameters was applied to experimental extraction curves, and in all cases, provided a coefficient of determination exceeding 0.97. Calculated mass transfer coefficients indicated that under forced convective conditions, the extraction process was controlled by internal diffusion whereas under natural convection, both internal diffusion and liquid-phase mass transfer were relevant in determining the overall extraction rate. Predictive simulations of M3G extraction during active fermentation were accomplished by incorporating the current results with a previously developed fermentation model, providing insight into the effect of a dynamic liquid phase on anthocyanin extraction

Modelling of Catechin Extraction from Red Grape Solids under Conditions That Simulate Red Wine Fermentation

Digital control systems are well established in many industries and could find application in the wine sector. Of critical importance to red wine quality, the efficient and targeted extraction of polyphenols from red grape solids during alcoholic fermentation could be a focus for automation. Smart technologies such as model predictive control (MPC) or fuzzy logic appear ideal for application in a complex process such as wine polyphenol extraction, but require mathematical models that accurately describe the system. The aim of this study was to derive and validate a model describing the extraction of catechin (a representative polyphenol) from red grape solids under simulated fermentation conditions. The impact of ethanol, fermentable sugar, and temperature on extraction rate was determined, with factor conditions chosen to emulate those present in industry practice. A first-order approach was used to generate an extraction model based on mass conservation that incorporated temperature and sugar dependency. Coefficients of determination (R2) for all test scenarios exceeded 0.94, indicating a good fit to the experimental data. Sensitivity analysis for the extraction rate and internal cross-validation showed the model to be robust, with a small standard error in cross-validation (SECV) of 0.11 and a high residual predictive deviation (RPD) of 17.68. The model that was developed is well suited to digital technologies where low computational overheads are desirable, and industrial application scenarios are presented for future implementation of the work

Modelling the Mass Transfer Process of Malvidin-3-Glucoside during Simulated Extraction from Fresh Grape Solids under Wine-Like Conditions

Extraction of grape components is a key consideration for red winemaking. The impact of changing process variables on mass transfer properties of anthocyanins from fresh pre-fermentative red grape solids under forced convective conditions was explored using the dominant red grape anthocyanin, malvidin-3-glucoside (M3G) as a model solute. A two level full factorial design was implemented to investigate effects of temperature, sugar and ethanol on mass transfer properties. Factor levels were chosen to simulate conditions found at various points during the maceration and fermentation steps of the red winemaking process. A rigorous mathematical model was developed and applied to experimental extraction curves, allowing the separation of mass transport properties in liquid and solid phases in a wine-like system, for the first time. In all cases, the coefficient of determination exceeded 0.92, indicating good agreement between experimental and mathematically-solved M3G concentrations. For the conditions studied, internal mass transfer was found to limit M3G extraction and changes to the liquid phase composition and temperature influence the distribution constant. Surface response models of mass transfer parameters were developed to allow future simulations of fermentation scenarios aimed at maximising the extraction potential of M3G