Clinical Management of Patients With Advanced Parkinson’s Disease Treated With Continuous Intestinal Infusion of levodopa/carbidopa

Santos‐García, Diego; Castrillo, Juan Carlos Martínez; Periz, V. Puente; Urgorri, Agustín Seoane; Díez, Servando Fernández; León, V. Benita; Baldivieso, Beatriz Udaeta; Perillo, Antonia Campolongo; Pérez, Natividad Mariscal

doi:10.2217/nmt-2016-0011

Cited by 11 publications

(6 citation statements)

References 73 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, treatment patterns in routine practice are likely to vary between countries and centres. Several publications have provided detailed guidance on patient selection, dose conversion factors, and dose titration and adjustment [ 53 – 55 ], and with this guidance and experience, longer-term LCIG dose adjustment is relatively straightforward [ 56 , 57 ]. The individualisation of LCIG treatment regimens over time may be an important factor for maintaining the long-term reductions in ‘off’-time presented in this review.…”

Section: Discussionmentioning

confidence: 99%

The Long-Term Impact of Levodopa/Carbidopa Intestinal Gel on ‘Off’-time in Patients with Advanced Parkinson’s Disease: A Systematic Review

et al. 2021

View full text Add to dashboard Cite

Introduction Levodopa/carbidopa intestinal gel (LCIG; carbidopa/levodopa enteral suspension) has been widely used and studied for the treatment of motor fluctuations in levodopa-responsive patients with advanced Parkinson’s disease (PD) when other treatments have not given satisfactory results. Reduction in ‘off’-time is a common primary endpoint in studies of LCIG, and it is important to assess the durability of this response. This systematic literature review was conducted to qualitatively summarise the data on the long-term effects of LCIG therapy on ‘off’-time. Methods Studies were identified by searching PubMed, EMBASE and Ovid on 30 September 2019. Studies were included if they reported on patients with PD, had a sample size of ≥ 10, LCIG was an active intervention and ‘off’-time was reported for ≥ 12 months after initiation of LCIG treatment. Randomised clinical trials, retrospective and prospective observational studies, and other interventional studies were included for selection. Data were collected on: ‘off’-time (at pre-specified time periods and the end of follow-up), study characteristics, Unified Parkinson’s Disease Rating Scale (UPDRS) II, III and IV total scores, dyskinesia duration, quality of life scores, non-motor symptoms and safety outcomes. Results Twenty-seven studies were included in this review. The improvement in ‘off’-time observed shortly after initiating LCIG was maintained and was statistically significant at the end of follow-up in 24 of 27 studies. ‘Off’-time was reduced from baseline to end of follow-up by 38–84% and was accompanied by a clinically meaningful improvement in quality of life. Stratified analysis of ‘off’-time demonstrated mean relative reductions of 47–82% at 3–6 months and up to 83% reduction at 3–5 years of follow-up. Most studies reported significant improvements in activities of daily living and motor complications. Most frequent adverse events were related to the procedure or the device. Conclusion In one of the largest qualitative syntheses of published LCIG studies, LCIG treatment was observed to provide a durable effect in reducing ‘off’-time. Infographic Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01747-1.

show abstract

Section: Discussionmentioning

confidence: 99%

The Long-Term Impact of Levodopa/Carbidopa Intestinal Gel on ‘Off’-time in Patients with Advanced Parkinson’s Disease: A Systematic Review

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Statistically significant data reported that the cause of therapy discontinuation in LCIG include the number of years that the patient had PD, fatigue caused by prolonged symptoms, and unfavorable events for therapeutic path continuation 15,16. This continued worsening in symptoms subsequently leads to evaluation of alternative therapeutic options by the multidisciplinary team, always taking into consideration the patient's quality of life 16,17…”

Section: Resultsmentioning

confidence: 99%

“…15,16 This continued worsening in symptoms subsequently leads to evaluation of alternative therapeutic options by the multidisciplinary team, always taking into consideration the patient's quality of life. 16,17…”

Section: Resultsmentioning

confidence: 99%

The Prephase Nursing in Levodopa Carbidopa Intestinal Gel Therapy

Lezzi

Lupo

Lezzi

et al. 2022

Journal of Neuroscience Nursing

View full text Add to dashboard Cite

INTRODUCTION:Parkinson disease (PD) affects approximately 1% of women and men worldwide, particularly older than 60 years. It is a multisystem and neurodegenerative disease with genetics and environmental factors that result in deficits in the production of neurotransmitters, including dopamine. The levodopa-carbidopa intestinal gel (LCIG) system delivers a continuous infusion of levodopa directly into the proximal small intestine via percutaneous endoscopic jejunostomy, largely bypassing gastric emptying and absorption problems and producing more stable plasma concentrations of levodopa, eliminating the development of motor complications (dyskinesias). The aim of this review was to summarize scientific evidence on the nursing role that, together with the multidisciplinary team, made the patient's choice in this therapeutic path (pre-LCIG phase). METHODS: A literature review was carried out, conducted on the MEDLINE databases (through PubMed), The Cochrane Library, Google Scholar, and CINAHL (through EBSCO). Relevant articles for the topic were found to identify indexed primary studies that investigated the relationship between the nurse and the patient/caregiver with PD who undertakes treatment with LCIG according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. RESULTS: Nineteen studies were included in the review. The selected studies suggested how the pre-LCIG phase of patient choice and the subsequent education and training could avoid selection errors for these therapeutic paths. CONCLUSION: Trained and specialized nursing staff who carry out an adequate pre-LCIG phase associated to the multidisciplinary team improved the choice of the patient and the start of treatment and, consequently, the quality of life of PD patients.

show abstract

“…This problem might be resolved by increased morning and continuous LCIG flow or by using ER L-DOPA or DA agonists during bedtime [ 179 ]. Despite the presence of the above AEs, LCIG can also be successfully used in older, advanced PD patients [ 180 ], although there is a significant risk of therapy discontinuation due to the presence of AEs [ 98 ].…”

Section: Resultsmentioning

confidence: 99%

Current Knowledge on the Background, Pathophysiology and Treatment of Levodopa-Induced Dyskinesia—Literature Review

Hutny

Hofman

Klimkowicz‐Mrowiec

et al. 2021

JCM

View full text Add to dashboard Cite

Levodopa remains the primary drug for controlling motor symptoms in Parkinson’s disease through the whole course, but over time, complications develop in the form of dyskinesias, which gradually become more frequent and severe. These abnormal, involuntary, hyperkinetic movements are mainly characteristic of the ON phase and are triggered by excess exogenous levodopa. They may also occur during the OFF phase, or in both phases. Over the past 10 years, the issue of levodopa-induced dyskinesia has been the subject of research into both the substrate of this pathology and potential remedial strategies. The purpose of the present study was to review the results of recent research on the background and treatment of dyskinesia. To this end, databases were reviewed using a search strategy that included both relevant keywords related to the topic and appropriate filters to limit results to English language literature published since 2010. Based on the selected papers, the current state of knowledge on the morphological, functional, genetic and clinical features of levodopa-induced dyskinesia, as well as pharmacological, genetic treatment and other therapies such as deep brain stimulation, are described.

show abstract

Clinical Management of Patients With Advanced Parkinson’s Disease Treated With Continuous Intestinal Infusion of levodopa/carbidopa

Cited by 11 publications

References 73 publications

The Long-Term Impact of Levodopa/Carbidopa Intestinal Gel on ‘Off’-time in Patients with Advanced Parkinson’s Disease: A Systematic Review

The Long-Term Impact of Levodopa/Carbidopa Intestinal Gel on ‘Off’-time in Patients with Advanced Parkinson’s Disease: A Systematic Review

The Prephase Nursing in Levodopa Carbidopa Intestinal Gel Therapy

Current Knowledge on the Background, Pathophysiology and Treatment of Levodopa-Induced Dyskinesia—Literature Review

Contact Info

Product

Resources

About