CVT-301 for Parkinson's disease: dose and effect size issues

The addition of a dopamine agonist, amine oxidase (flavin-containing) B inhibitor, or catechol-O-methyltransferase inhibitor partly reduces daily duration of off episodes, but some patients remain impaired to a point that justifies the use of complex, aggressive, expensive, and inconvenient device-based therapies. [...]safer, cheaper, and more potent and convenient treatments are needed. Many patients wake up in an off state and must wait up to 60 min or longer before feeling the beneficial effects of their first oral LD-DCI dose. [...]inhaling CVT-301 at such time seems appealing. Post-hoc analyses of off-time responders rather than UPDRS responders might facilitate understanding of the specific target population. [...]CVT-301 should be compared with apomorphine subcutaneous injections, which significantly improve UPDRS scores by 10–20 units within 20 min after administration.10–12 Inhaling a drug is more convenient that using a penjet.