Levodopa-Carbidopa Intestinal Gel Infusion Therapy in Advanced Parkinson's Disease: Single Middle Eastern Center Experience

Abstract

Background: Levodopa therapy in Parkinson's disease (PD) is often associated with disabling motor and non-motor complications in patients with advanced disease due to the variable absorption of levodopa because of an irregular or erratic emptying of the gastric content. Methods: Prospective single movement disorder center study using pre-set selection criteria, unified PD scale (UPDRS III), non-motor symptoms scale (NMSS), and PD questionnaire-8 (PDQ-8) to evaluate the efficacy, safety, and long-term treatment outcomes using levodopa-carbidopa intestinal gel (LCIG) infusion in patients with advanced PD, who were followed up every 6 months. Results: Twenty patients were recruited over a period of 6 years. Disease duration prior to LCIG infusion ranged from 5 to 18 years (mean 11.4 ± 4.2). The mean follow-up time on LCIG therapy was 48.5 ± 23.2 months (range 11-83 months). Mean ‘off' time, UPDRS III, NMSS, and PDQ-8 improvement were statistically significant. Two patients dropped out and 66.7% of patients required tube replacement. Conclusion: LCIG infusion monotherapy demonstrated significant improvement in reducing the ‘off' time, reducing levodopa-induced dyskinesia, and improving non-motor symptoms and quality of life. This therapy is recommended for patients in whom motor fluctuations are inadequately treated with traditional oral PD therapy.

Burden of non‐motor symptoms in Parkinson's disease patients predicts improvement in quality of life during treatment with levodopa‐carbidopa intestinal gel

“…Similar improvements of NMSs and QoL were demonstrated in two other open‐label studies with smaller patient collectives over a 12‐month and a mean 48‐month follow‐up period .…”

Response of non-motor symptoms to levodopa in late-stage Parkinson's disease: Results of a levodopa challenge test

“…It could be interesting to investigate the acute effect on NMS of levodopa-carbidopa intestinal gel (LCIG) among LSPD patients. In fact, some recent reports suggest an improvement of some NMS such as sleep/fatigue, pain, gastrointestinal and urinary symptoms , as assessed by the NMSS, during a chronic treatment with LCIG [31][32][33], the quality of evidence for reduction of NMS is still considered low [34] and no study have been specifically addressed to LSPD patients .…”

Long‐term safety and efficacy of levodopa‐carbidopa intestinal gel in advanced Parkinson's disease

“…Previous long‐term LCIG safety and efficacy studies were limited by retrospective or registry study design and small data sets . Recently, larger randomized, controlled, and open‐label prospective studies demonstrated the safety and efficacy of LCIG treatment through 1 year, and safety was demonstrated for an average of 2 years in an open‐label extension study .…”