Experiencia con la infusión continua de levodopa intraduodenal (Duodopa®) en pacientes con enfermedad de Parkinson avanzada en un hospital de segundo nivel asistencial

Abstract

Intraduodenal infusion of levodopa offers an important alternative in treating patients with advanced Parkinson disease.

Can suitable candidates for levodopa/carbidopa intestinal gel therapy be identified using current evidence?

“…With regard to improvement in dyskinesia, trials report increases in ON time with no disabling dyskinesia similar to the reduction in OFF time (4 h/day) [37] , [38] , [41] , [89] . General improvement is consistent in retrospective and prospective studies with follow-up periods of up to 2 years, and significant reductions in ON time with troublesome dyskinesia have also been reported [46] , [48] , [52] , [59] , [61] , [69] , [70] , [72] , [73] , [75] , [79] , [90] . However, this improvement seems to be heterogeneous.…”

“… Study Change in OFF time Change in ON time without dyskinesia Change in ON time with dyskinesia Antonini et al 2007 [44] 9 patients Observational prospective At 12 months, 9.5-fold reduction. (mean reduction from 284 to 30 min; p < 0.01) Reduced by nearly 4-fold at 6 and 12 months (mean reduction from 156 to 40 min; p < 0.01) Antonini et al 2008 [45] 22 patients Observational prospective UPDRS IV item 39 Baseline: 2.6 ± 1.2 After 1 year 1.28 ± 0.5 After 2 years: 1.48 ± 0.8 ( p < 0.05) No changes in dyskinesia duration No changes in dyskinesia duration Eggert et al 2008 [46] 13 patients Observational prospective Percentage of time Baseline: 50 ± 14% After 6 months: 11 ± 7% ( p < 0.01) Percentage of time Baseline: 17 ± 15% After 6 months: 5 ± 6% ( p < 0.01) Santos-García, 2010 [48] 9 patients Observational retrospective 90.9% improvement Daily ON time showed 66.6% improvement Puente et al 2010 [49] 9 patients Observational retrospective Reduced from 9.4 ± 2.1 h to 3.1 ± 2.7 h ( p < 0.05) Daily ON time increased from 6.1 ± 1.9 to 12.0 ± 3.4 h ( p < 0.05) Fasano et al 2012 [52] 14 patients Observational retrospective UPDRS IV item 39 unchanged (− 7.6%) Off duration reduced by 48.6% ( p = 0.00001) Reduced by 38.5% ( p = 0.001) Antonini et al 2013 [59] 73 patients Observational prospective UPDRS IV item 39. OFF time duration Baseline 1.59 ± 0.96 Month 6: 0.85 ± 0.63 ( p < 0.05) Month 12: 1.06 ± 0.73 ( p < 0.05) UPDRS IV item 32.…”

“…The continuous absorption of levodopa/carbidopa achieved with LCIG has been shown to extend ON time maintaining relatively stable plasma drug levels with less extreme peaks and troughs [29] . Most studies have reported positive outcomes in motor complications [22] , [23] , [31] , [35] , [37] , [38] , [39] , [40] , [41] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , with reduced duration of OFF time and increased ON time without disabling dyskinesia ( Table 1 ). Two recent prospective clinical trials, a double-blind, double-dummy study [37] and an open-label baseline-controlled study [41] , reported a reduction in OFF time of approximately 4 h per day from the baseline (12 weeks [37] and 12 months [41] , respectively).…”

“…Studies consistently report a significant reduction in OFF time, leaving little doubt regarding the beneficial effects of LCIG in patients with this complication over long periods of time [22] , [35] , [39] , [41] , [44] , [46] , [47] , [48] , [52] , [59] , [61] , [66] , [68] , [70] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] . Furthermore, some studies suggest that LCIG may improve other OFF time-related PD symptoms, such as dystonic pain [46] , [82] , [83] , [84] and selected patients with morning akinesia and OFF-related dystonia have also been successfully treated with 24-h infusions [46] , [85] .…”

“…However, reductions in the NMSS did not always reach statistical significance [35] . Regarding studies that did not specifically use this scale, a general improvement of 81.8% in NMS was reported in a retrospective study [48] , as well as in more specific NMS (pain, dysphagia, and dysarthria) [47] .…”