Levodopa-Carbidopa Intestinal Gel in Parkinson's Disease: A Systematic Review and Meta-Analysis

Wang, Libo; Li, Jia; Chen, Jiajun

doi:10.3389/fneur.2018.00620

Cited by 37 publications

(44 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nonetheless, currently there are few articles available that analyze the reasons that led to the discontinuation of treatment on large groups of patients. [7][8][9][10] The LCIG therapy became available in Romania in 2009. In 2016 a multicenter study was published analyzing data of the first 113 Romanian patients (9 university teaching hospital centers).…”

Section: Introductionmentioning

confidence: 99%

<p>Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients</p>

Constantin¹,

Szász²,

Orbán-Kis³

et al. 2020

NDT

View full text Add to dashboard Cite

Background: Parkinson's disease (PD) is the second most common progressive neurodegenerative disease. In the advanced stages, the continuous delivery of levodopa (LD) as levodopa-carbidopa intestinal gel (LCIG) has demonstrated significant improvement of motor and nonmotor complications and improvement of the patients' quality of life (QoL). Despite the growing global experience with this treatment, anumber of unsolved practical issues remain, and currently, the data on the reasons that can lead to the discontinuation of LCIG are scarce. Objective: In the present study, we aimed to analyze the causes that led to the discontinuation of LCIG therapy. Methods: In this retrospective study, after 10 years of experience with LCIG as a therapeutic option in advanced PD, we analyzed the data of all dropout cases among the 204 patients that initiated LCIG therapy in two Romanian centers. Results: Of the 204 patients enrolled, 43 patients dropped out. Disease duration until LCIG infusion was significantly longer (11.67±4.98 vs 9.44±3.44) and the overall clinical picture more sever (both regarding motor symptoms and cognitive decline) in dropout patients (compared to patients who continued treatment). The dropout patients also presented significant differences regarding the incidence of polyneuropathy (32.5% vs 11.18%). The main cause of discontinuation was death. Conclusion: The causes of discontinuation from LCIG therapy in Romanian patients are similar to those from other centers; however, the rate of dropouts is somewhat lower. The clinician's experience in selecting and treating the patients in advanced stages of PD can increase therapeutic adherence. Also, the presence of a well-trained caregiver along with the availability of a proper aftercare system is mandatory for maintaining the long-term benefits of the therapy and the overall best outcome possible. Targeted prospective studies are needed to confirm whether a more severe stage of the disease and cognitive impairment at the time of initiation, respectively, the association of polyneuropathy can be considered as predictive factors for dropout.

show abstract

Section: Introductionmentioning

confidence: 99%

<p>Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients</p>

Constantin¹,

Szász²,

Orbán-Kis³

et al. 2020

NDT

View full text Add to dashboard Cite

show abstract

“…Firstly, the replacement of lost dopamine with dopaminergic drugs in 24 h is necessary for the management of motor symptoms alone – regardless of whether these occur nocturnally or during the daytime. Adjunctive medications [ 31 – 33 ], infusion systems such as DuoDopa (carbidopa/levodopa) [ 34 ], continuous dopamine delivery treatments like the transdermal rotigotine patch [ 35 – 39 ], and oral extended release versions of dopamine agents [ 40 , 41 ] have shown significant promise in ameliorating wearing-off effects and symptom fluctuations, in nocturnal as well as daytime symptoms. In a randomized, placebo-controlled study (the RECOVER trial, quality score, 93%), patients with unsatisfactory control of early morning motor symptoms were evaluated on the PDSS-2 and UPDRS III.…”

Section: Discussionmentioning

confidence: 99%

Social listening – revealing Parkinson’s disease over day and night

Zhang¹,

Meng²,

Li³

et al. 2021

BMC Neurol

View full text Add to dashboard Cite

Background Nocturnal symptoms in Parkinson’s disease are often treated after management of daytime manifestations. In order to better understand the unmet needs of nocturnal symptoms management, we analyzed the characteristics and burden of nocturnal symptoms from patients’ perspectives and explored their changes over time. Overall symptoms (occurring at day or night) were collected to compare whether the unmet needs related to nocturnal symptoms and to overall symptoms are different. Methods We used a Social Listening big-data technique to analyze large amounts of Parkinson’s disease symptoms in dialogues available from social media platforms in 2016 to 2018. These symptoms were classified as either overall symptoms or nocturnal symptoms. We used share of voice (SOV) of symptoms as a proportion of total dialogues per year to reflect the characteristics of symptoms. Negative sentiment score of symptoms was analyzed to find out their related burden. Results We found the SOV for overall motor symptoms was 79% and had not increased between 2016 and 2018 (79%, p = 0.5). The SOV for non-motor symptoms was 69% and had grown by 7% in 2018 (p < 0.01). The SOV for motor complications was 9% and had increased by 6% in 2018 (p < 0.01). The SOV of motor symptoms was larger than non-motor symptoms and motor complications (p < 0.01). The SOV of non-motor symptoms was larger than motor complications (p < 0.01). For nocturnal symptoms, 45% of the analyzed PD population reported nocturnal symptoms in 2018, growing by 6% (p < 0.01). The SOV for nocturnal-occurring motor symptoms was higher than most non-motor symptoms. However, non-motor symptoms had the higher increases and evoked higher negative sentiment regardless of whether they occurred during the day or night. For symptoms that can occur at either day or night, each nocturnal symptom was rated with a higher negative sentiment score than the same symptom during the day. Conclusions The growing SOV and the greater negative sentiment of nocturnal symptoms suggest management of nocturnal symptoms is an unmet need of patients. A greater emphasis on detecting and treating nocturnal symptoms with 24-h care is encouraged.

show abstract

“…LCIG is a well-established and approved therapy designed for continuous infusion into the proximal jejunum via percutaneous endoscopic gastrojejunostomy tube connected to a portable infusion pump [111,112]. Because of its invasive delivery system and associated risks (eg, pain, tube detachment, weight loss), LCIG is indicated for patients with motor fluctuations who have not benefited from other adjunctive treatments [111].…”

Section: Intrajejunalmentioning

confidence: 99%

“…Because of its invasive delivery system and associated risks (eg, pain, tube detachment, weight loss), LCIG is indicated for patients with motor fluctuations who have not benefited from other adjunctive treatments [111]. A systematic review of eight controlled clinical trials showed that LCIG treatment in patients with PD significantly reduced OFF time and related dyskinesias, although it posed a risk of surgical and device-related adverse events [112].…”

Section: Intrajejunalmentioning

confidence: 99%

Clinical implications of gastric complications on levodopa treatment in Parkinson's disease

Pfeiffer

Isaacson

Pahwa

2020

Parkinsonism & Related Disorders

View full text Add to dashboard Cite

Disorders of the gastrointestinal (GI) tract are common and distressing nonmotor symptoms of Parkinson's disease (PD) that can adversely affect levodopa absorption and lead to OFF periods, also known as motor fluctuations. Gastroparesis, which is primarily defined as delayed gastric emptying (DGE), and Helicobacter pylori infection, which is present with increased frequency in PD, are among the most common and important GI disorders reported in PD that may impair oral levodopa absorption and increase OFF time. Symptoms of gastroparesis include nausea, vomiting, postprandial bloating, fullness, early satiety, abdominal pain, and weight loss. DGE has been reported in a substantial fraction of individuals with PD. Symptoms of H. pylori infection include gastritis and peptic ulcers. Studies have found that DGE and H. pylori infection are correlated with delayed peak levodopa plasma levels and increased incidence of motor fluctuations. Therapeutic strategies devised to minimize the potential that gastric complications will impair oral levodopa absorption and efficacy in PD patients include treatments that circumvent the GI tract, such as apomorphine injection, levodopa intestinal gel delivery, levodopa inhalation powder, and deep brain stimulation. Other strategies aim at improving gastric emptying in PD patients, primarily including prokinetic agents.

show abstract

Levodopa-Carbidopa Intestinal Gel in Parkinson's Disease: A Systematic Review and Meta-Analysis

Cited by 37 publications

References 47 publications

<p>Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients</p>

<p>Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients</p>

Social listening – revealing Parkinson’s disease over day and night

Clinical implications of gastric complications on levodopa treatment in Parkinson's disease

Contact Info

Product

Resources

About