Learning About Parkinson’s Disease and OFF Time...Personal Testimonial: Living With Parkinson’s Disease 1 Parkinson’s Disease, its Symptoms, and Treatment Options 2 OFF Time,

PROPERTY OF SUNOVION PHARMACEUTICALS INC. PROPRIETARY AND NONTRANSFERRABLE. NOT FOR FURTHER DISSEMINATION. © 2018 Sunovion Pharmaceuticals Inc. All rights reserved. 10/18 NPC-APL319-18PROPERTY OF SUNOVION PHARMACEUTICALS INC. PROPRIETARY AND NONTRANSFERRABLE. NOT FOR FURTHER DISSEMINATION. © 2018 Sunovion Pharmaceuticals Inc. All rights reserved. 10/18 NPC-APL319-18

Learning About Parkinson’s Diseaseand OFF Time

PROPERTY OF SUNOVION PHARMACEUTICALS INC. PROPRIETARY AND NONTRANSFERRABLE. NOT FOR FURTHER DISSEMINATION. © 2018 Sunovion Pharmaceuticals Inc. All rights reserved. 10/18 NPC-APL319-18

Committed to Making a Difference

What is Little Big Things?

We believe smallinnovations have the potential to make a big impact and improve the lives of people living with Parkinson's.

A Sunovion-sponsored innovation platform for the Parkinson’s Community.

We believe in the power of one person, one idea, one event at a time.

LITTLE BIG THINGS is a trademark of Sunovion Pharmaceuticals Inc.


Placeholder: RML to play RapidHack Sizzle Video NPC-APL031-18


What is a RapidHack?

A 2-day event bringing together patients, advocates, and medical specialists

The goal: come up with ideas for innovative solutions to the complex problems faced by PD patients and caregivers

The RapidHack Challenge: design a product or service that addresses daily challenges and may help PD patients regain a sense of independence


Join Us

Follow us on Facebookhttps://www.facebook.com/LittleBigThings

Register to learn more!https://www.littlebigthings.com


Today You Will Learn About

6

Personal Testimonial: Living With Parkinson’s Disease 1

Parkinson’s Disease, its Symptoms, and Treatment Options2

OFF Time, the Different Types, and How it Could Affect Your Life3

Talking to Your Doctor About Parkinson’s Disease and OFF Time4


Sunovion is Committed to Offering Solutions to Help Manage the Unique Experiences of Parkinson’s Disease

7


8

POLLING QUESTION

What is your current level of understanding of the 4 main types of OFF time?

High degree of understanding

Average degree of understanding

Low degree to no understanding


Personal Testimonial ‒ Living with Parkinson’s Disease

9 PROPERTY OF SUNOVION PHARMACEUTICALS INC. PROPRIETARY AND NONTRANSFERRABLE. NOT FOR FURTHER DISSEMINATION. © 2018 Sunovion Pharmaceuticals Inc. All rights reserved. 10/18 NPC-APL319-18.


Parkinson’s Disease Expert

10

Speaker is a paid consultant of Sunovion Pharmaceuticals Inc.PROPERTY OF SUNOVION PHARMACEUTICALS INC. PROPRIETARY AND NONTRANSFERRABLE. NOT FOR FURTHER DISSEMINATION. © 2018 Sunovion Pharmaceuticals Inc. All rights reserved. 10/18 NPC-APL319-18.


Parkinson’s Disease, its Symptoms, and Treatment Options



Did You Know:

12

1. Fahn S, et al. Chapter 4: Parkinsonism: Clinical features and differential diagnosis. In: Fahn S, Jankovic J, Hallett M, Eds. Principles and Practice of Movement Disorders. 2nd Ed. Edinburgh, UK: W.B. Saunders; 2011:66-92; 2. Parkinson’s Foundation Statistics. http://parkinson.org/Understanding-Parkinsons/Causes-and-Statistics/Statistics. Accessed August 31, 2018 3. AANS. Parkinson’s Disease. http://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Parkinsons-Disease. Accessed March 15, 2018; 4. DeMaagd G, et al. P.T. 2015;40:504-532.

About 1 millionAmericans live with Parkinson’s disease2

~60,000 new cases in the United States each year3

Age (years)20 40 60 80

Average onset is 60 years of age4

Parkinson’s diseaseis a progressive disorder of the nervous system1

~1,000,0002


Motor Symptoms in People with Parkinson’s Disease

13

• Freezing

• Shuffling or slow walking

• Reduced facial expression

• Reduced blink rate

• Small handwriting

• Less hand control

• Soft voice and unclear speech

• Swallowing problems

• Difficulty turning in bed

Tremor

Difficulties with postural reflexes

Slow movement

Other Motor Symptoms

Rigidity

Primary Motor Symptoms

Fahn S, et al. Principles and Practice of Movement Disorders. 2nd Ed. Edinburgh, UK: W.B. Saunders; 2011:66-92.


Non-motor Symptoms in People with Parkinson’s Disease

14

• Depression/sadness

• Fatigue

• Anxiety/panic attacks

• Slowness of thinking

• Memory problems

• Pain

• Inability to stay still

• Burning sensations

• Restless legs

Sensory

• Lightheadedness

• Constipation

• Poor bladder control

• Drenching sweats

• Shortness of breath

Autonomic Mood/Thinking

Martínez-Fernández R, et al. Mov Disord. 2016;31:1080-1094.


Gastrointestinal (GI) Symptoms in People with Parkinson’s Disease

15*Assessed in patients with early stage Parkinson’s disease. Poirier AA, et al. Parkinsons Dis. 2016;2016:6762528. doi: 10.1155/2016/6762528.

GI symptoms may be present in 60% to 80% of patients with Parkinson s disease*

GI Symptoms May Include: • Constipation• Difficulty swallowing• Excess saliva• Impaired emptying of stomach

contents into intestines

ExperienceGI Symptoms

Do Not Experience GI Symptoms


16

POLLING QUESTION

Which of these symptoms of Parkinson’s disease do you experience?

Motor symptoms

Non-motor symptoms

Motor and non-motor symptoms


Dopamine and Parkinson’s Disease

17

1. Best JA, et al. Theor Biol Med Model. 2009;6:1-20; 2. Politis M, et al. Neuroimage Clin. 2017;16:455-460; 3. Fahn S, Jankovic J, Hallett M. Chapter 4: Parkinsonism: Clinical features and differential diagnosis. In: Fahn S, Jankovic J, Hallett M, Eds. Principles and Practice of Movement Disorders. 2nd Ed. Edinburgh, UK: W.B. Saunders; 2011:66-92.

• Dopamine carries signals between brain cells (neurons)1

• These signals may impact movement and other, non-motor functions1

• In Parkinson’s disease, neurons that make dopamine die off, resulting in less dopamine2

– The reasons for this are still unclear3

Dopaminergic Neuron1

Dopamine Receptors

Dopamine

Levodopa

Dopaminergic Neuron1


What Medications Are Used to Treat Parkinson’s Disease?

18

Imitate dopamine• Dopamine agonists

Enhance dopamine• Levodopa-containing medications

Slow down the breakdown of levodopa• MAO-B inhibitors• COMT inhibitors

MAO-B, monoamine oxidase B; COMT, catechol-O-methyltransferase. Factor SA. Neurotherapeutics. 2008;5(2):164-180.


Potential Difficulties with Orally Swallowed Levodopa*

These gut-related factors may slow or prevent medicationfrom reaching the brain.1

*Levodopa is the gold standard for treating patients with Parkinson’s disease.41. Poewe W, et al. Clin Interv Aging. 2010;5:229-238; 2. Müller T, et al. Clin Neuropharmacol. 2006;29:61-67; 3. Tan AH, et al. Parkinsonism Relat Disord. 2014;20:535-540. 4. Nishijima H, et al. Front Neurosci. 2016;10(575):1-9.19

Swallowing problems are common in patients with PD1

High-protein meals may interfere with how well levodopa is absorbed1

Reduced gastric emptying results in lower medication levels in the blood and the brain2

The growth of bacteria in the gut may interfere with how well medicationsare absorbed3


OFF Time, the Different Types, andHow it Could Affect Your Life

20

PROPERTY OF SUNOVION PHARMACEUTICALS INC. PROPRIETARY AND NONTRANSFERRABLE. NOT FOR FURTHER DISSEMINATION. © 2018 Sunovion Pharmaceuticals Inc. All rights reserved. 10/18 NPC-APL319-18.


Parkinson’s Disease Symptoms: “ON” Versus “OFF”

21 1. Olanow WC, et al. Neurology. 2009;72(Suppl 4):S1-S136; 2. Chou KL, et al. Parkinsonism Relat Disord. 2018;51:9-16.

ON

OFF

When you feel your Parkinson’s disease symptoms are improved by your medication, this is considered to be an ON time1,2

When symptoms reappear or worsen, you are experiencing an OFF time1,2


As Parkinson’s Disease Progresses, OFF Times May Become More Common1,2

22

.

Early Parkinson’s Disease

642LevodopaTime (h)

ON Time

ON With Dyskinesias (Involuntary Muscle Movements)

OFF Time

Clin

ical

Effe

ct

This graph shows a hypothetical patient with early PD. The line indicates the patient’s response to a dose of levodopa.

1. Olanow C. et al. Harrison's Principles of Internal Medicine, 19e. New York, NY: McGraw-Hill; 2014.2. Obeso JA, et al. Neurology. 2000;55(11 Suppl 4):S13-S20.Olanow C. et al. Harrison's Principles of Internal Medicine, 19/E. New York, NY: McGraw-Hill; 2014; Copyright © McGraw-Hill Education. Adapted with permission.



23

.

642LevodopaTime (h)

ON Time

OFF Time

Moderate Parkinson’s DiseaseC

linic

al E

ffect


This graph shows a hypothetical patient with moderate PD. The line indicates the patient’s response to a dose of levodopa.




24

.

642LevodopaTime (h)

ON Time


OFF Time

Advanced Parkinson’s DiseaseC

linic

al E

ffect

This graph shows a hypothetical patient with advanced PD. The line indicates the patient’s response to a dose of levodopa.



Main Types of OFF Time

25

Morning OFF

Wearing OFF

Delayed ON

Unpredictable OFF

Chou KL, et al. Parkinsonism Relat Disord. 2018;51:9-16

?


26

POLLING QUESTION

Do you experience OFF time in the morning?

Yes

No



27

Morning OFF

Wearing OFF

Delayed ON

Unpredictable OFF

Chou KL, et al. Parkinsonism Relat Disord. 2018;51:9-16

?


28

POLLING QUESTION

Do you experience wearing OFF?

Yes

No



29 Chou KL, et al. Parkinsonism Relat Disord. 2018;51:9-16

Morning OFF

Wearing OFF

Delayed ON

Unpredictable OFF?


30

POLLING QUESTION

Do you experience unpredictable OFF time?

Yes

No



31 Chou KL, et al. Parkinsonism Relat Disord. 2018;51:9-16

Morning OFF

Wearing OFF

Delayed ON

Unpredictable OFF?


32

POLLING QUESTION

Do you experience dose failure or partial ON?

Yes

No


Patients with Parkinson’s Disease May Have Several OFF Times Each Day

33

Based on a 2014 survey conducted by the Michael J. Fox Foundation of approximately 3000 patients with Parkinson’s disease. Survey data did not specify the patients’ levels of PD severity. Patients’ treatment regimens were unknown. Michael J. Fox Foundation for Parkinson’s Research. Executive summary: survey of Parkinson’s patients and their off time experience.

92% of patients report ≥1 OFF time 40% of patients report

≥3 OFF times

64% of patients had 2+ hours of OFF time each day20% of patients report

≥4 OFF times


34

POLLING QUESTION

On average, how many OFF times do you experience per day?

0

1 to 2

3 to 4

5 or more


35

POLLING QUESTION

On average, how much of a delay does morning OFF time causein your day?

No delay

1 hour or less

1–2 hours

More than 2 hours


Exercise May Improve Many Parkinson’s Disease Symptoms

361. Snider, J, et al. Parkinsonism Relat Disord. 2015;21:1227-1231; 2. Prodoehl J, et al. Neurorehab Neural Repair. 2015;29:112-122; 3. Park A, et al. Parkinsonism Relat Disord. 2014;20:106-111.

Increasing sedentary behavior has been linked to more severe Parkinson’s disease motor symptoms1

Exercise may improve balance, mobility, depression, and overall qualityof life2,3

Exercise may have the potential to slow Parkinson’s disease progression, but more research in humans is needed3


Talking to Your Doctor AboutParkinson’s Disease and OFF Time



The Ball Is in Your Court: Be Empowered to Speak to Your Doctor and Ask Questions

38

Tell your doctor about all your motor and non-motor symptomsand when they are happening

What should I do if my medication beginsto wear OFF before my next dose?

Can I take my medication whenOFF symptoms begin to occur even if it

is not time for the next dose?

How long should it take my medicationto start working?

What if I take a dose and nothing happens?

Speak to your doctor at each office visitabout your Parkinson’s disease and

if you are experiencing OFF time

Should my medication be workingthe same throughout the day?


39

POLLING QUESTION

Does your doctor ask about OFF time routinely?

Yes

No


Key Takeaways

40

Parkinson’s disease is a progressive disorder of the nervous system that affects about 1 million Americans

Patients with Parkinson’s disease may experience OFF time, associated with both motor and non-motor symptoms

OFF time may become more frequent as the disease progresses

Because there are different types of OFF time, it is important to talk to your doctor about your symptoms and when you are experiencing OFF time

Parkinson’s Foundation Statistics. http://parkinson.org/Understanding-Parkinsons/Causes-and-Statistics/Statistics. Accessed August 31, 2018


41

POLLING QUESTION

After attending this educational session, how has your levelof OFF time understanding changed?

Significantly increased

Somewhat increased

Little or not increased


What Questions Do You Have?



Thank You!

Remember to visit www.LittleBigThings.com for more information!

SUNOVION and are registered trademarks of Sumitomo Dainippon Pharma Co., Ltd.Sunovion Pharmaceuticals Inc. is a U.S. subsidiary of Sumitomo Dainippon Pharma Co., Ltd.LITTLE BIG THINGS is a trademark of Sunovion Pharmaceuticals Inc. Sunovion Pharmaceuticals Inc., 84 Waterford Drive, Marlborough, MA 01752 © 2018 Sunovion Pharmaceuticals Inc. All rights reserved. 10/18 NPC-APL319-18

Documents

Learning About Parkinson’s Disease and OFF Time...Personal Testimonial: Living With Parkinson’s Disease 1 Parkinson’s Disease, its Symptoms, and Treatment Options 2 OFF Time,