Long-term effectiveness of levodopa-carbidopa intestinal gel on motor and non-motor symptoms in advanced Parkinson’s disease: results of the Italian GLORIA patient population

Abstract

Introduction The GLORIA registry included 375 advanced Parkinson’s disease (PD) patients and evaluated the efficacy and safety of a 24-month levodopa-carbidopa intestinal gel (LCIG) treatment in routine medical care. This analysis focuses on the Italian population, 60 patients treated with LCIG in 7 specialised PD care centres. Methods Hours of “Off” and “On” time were assessed with a modified version of the Unified Parkinson’s Disease Rating Scale (UPDRS) part IV items 39 and 32. Motor fluctuations, dyskinesia, non-motor symptoms, quality of life and safety were evaluated. Results Overall, 42 (70%) out of 60 patients completed the registry. LCIG treatment reduced “Off” time (− 3.3 ± 2.7 h at month 24 (M24), P < 0.0001), increased “On” time with dyskinesia (− 2.6 ± 5.2 h at M12, P = 0.0160), and improved UPDRS II and UPDRS III total scores at M24 (− 4.5 ± 10.6, P = 0.0333 and − 4.9 ± 11.7, P = 0.0229, respectively), Non-Motor Symptom Scale (NMSS) total score (− 21.8 ± 28.5, P < 0.0001) and Parkinson’s Disease Questionnaire-8 item (PDQ-8) total score (− 12.5 ± 23.9, P = 0.0173) versus previous oral therapy. Adverse drug reactions (ADR) possibly or probably related to treatment were reported in 16 (28.6%) patients. Decreased weight (7.1%), polyneuropathy (7.1%) and abdominal pain (5.4%) were the most frequent ADRs while device malfunction (5.4%) and medical device change (5.4%) were the most reported device complaints. Conclusions LCIG improved motor fluctuations, non-motor symptoms and quality of life over 24 months while tolerability was consistent with the established safety profile.

From the Gut to the Brain and Back: Therapeutic Approaches for the Treatment of Network Dysfunction in Parkinson's Disease

“…As a consequence, striatal dopaminergic neurons are stimulated in a sustained manner that reduces the occurrence of "off" periods while increasing the "on" time without dyskinesia. Although there are few large-scale evaluations of the long-term efficacy and safety of LCIG [89][90][91], this treatment may have specific www.videleaf.com benefits on freezing of gait and global axial signs [100][101][102][103][104]. Improvements have also been observed on non-motor symptoms such as sleep/fatigue, urinary and sexual functions, gastrointestinal motility and cognitive and affective comorbidities [105][106][107].…”

Initial Experience of the Levodopa–Entacapone–Carbidopa Intestinal Gel in Clinical Practice

“…The infusion via an intestinal tube immediately provides levodopa at the absorption site, rendering stable levodopa concentrations in plasma and thereby continuous drug delivery to the brain [ 2 ]. LCIG efficiently reduces motor fluctuations and dyskinesias [ 3 ], but also some non-motor fluctuations [ 4 ]. It thereby increases the quality of life in patients with fluctuating responses to oral dopaminergic drugs [ 5 ] and has the potential to serve the patients for many years, like the other device-aided therapies, subcutaneous apomorphine infusion and deep brain stimulation (DBS) [ 6 ].…”