Long-term intraduodenal infusion of a water based levodopa-carbidopa dispersion in very advanced Parkinson's disease

Nilsson, Daniel; Hansson, Lennart; Johansson, Kenth; Nyström, Christer; Paalzow, Lennart; Sm, Aquilonius

doi:10.1111/j.1600-0404.1998.tb00633.x

Cited by 96 publications

(38 citation statements)

References 18 publications

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“…This preparation is used for continuous intraintestinal infusion of levodopa and may be able to reduce "off " time and dyskinesia. 489 Unpredictable "off " episodes. Most levodopa-treated patients with PD with motor fluctuations experience predictable "off " periods that occur when the beneficial effect of a given dose of levodopa wears off (see earlier).…”

Section: Pharmacologic Management Of Advanced Pd Patientsmentioning

confidence: 99%

“…298,299,416 Continuous infusion of either levodopa or a dopamine agonist (apomorphine and lisuride) has been tested in patients with advanced PD and consistently been reported to reduce the frequency of motor complications. [488][489][490][491] In one prospective study, patients randomized to receive a continuous subcutaneous infusion of lisuride had significant reductions in both "off " time and dyskinesia compared with patients receiving standard oral dopaminergic medications (figure 23). 492 Benefits persisted throughout the 4-year duration of follow-up.…”

Section: Disadvantagesmentioning

confidence: 99%

“…[488][489][490][491] Most of these studies have been open-label and uncontrolled, but one prospective study showed that patients randomized to receive continuous subcutaneous infusion of lisuride had significantly fewer "off " periods than did those randomized to remain on standard oral levodopa therapy. 492 Interestingly, reduced "off " time in this study was also associated with significant reduction in dyskinesia.…”

Section: Pharmacologic Management Of Advanced Pd Patientsmentioning

confidence: 99%

See 2 more Smart Citations

The scientific and clinical basis for the treatment of Parkinson disease (2009)

Olanow¹,

Stern²,

Sethi³

2009

Neurology

771

658

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Parkinson disease (PD) is an age-related neurodegenerative disorder that affects as many as 1-2% of persons aged 60 years and older. With the aging of the population, the frequency of PD is expected to increase dramatically in the coming decades. Current therapy is largely based on a dopamine replacement strategy, primarily using the dopamine precursor levodopa. However, chronic treatment is associated with the development of motor complications, and the disease is inexorably progressive. Further, advancing disease is associated with the emergence of features such as freezing, falling, and dementia which are not adequately controlled with dopaminergic therapies. Indeed, it is now appreciated that these nondopaminergic features are common and the major source of disability for patients with advanced disease. Many different therapeutic agents and treatment strategies have been evaluated over the past several years to try and address these unmet medical needs, and many promising approaches are currently being tested in the laboratory and in the clinic. As a result, there are now many new therapies and strategic approaches available for the treatment of the different stages of PD, with which the treating physician must be familiar in order to provide patients with optimal care. This monograph provides an overview of the management of PD patients, with an emphasis on pathophysiology, and the results of recent clinical trials. It is intended to provide physicians with an understanding of the different treatment options that are available for managing the different stages of the disease and the scientific rationale of the different approaches. 1 PD is the second most common neurodegenerative disorder, with an average age at onset of about 60 years. An estimated 5 million people throughout the world have PD, with 1 million individuals each in the United States and in Europe with the disorder. PD affects approximately 0.3% of the population and 1% to 2% of those older than 60 years.2 With the aging of the population and the substantial increase in the number of at-risk individuals older than 60 years, it is anticipated that the prevalence of PD will increase dramatically in the coming decades.

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Section: Pharmacologic Management Of Advanced Pd Patientsmentioning

confidence: 99%

Section: Disadvantagesmentioning

confidence: 99%

Section: Pharmacologic Management Of Advanced Pd Patientsmentioning

confidence: 99%

See 1 more Smart Citation

The scientific and clinical basis for the treatment of Parkinson disease (2009)

Olanow¹,

Stern²,

Sethi³

2009

Neurology

771

658

View full text Add to dashboard Cite

show abstract

“…12,13,[35][36][37][38][39][40][41][42][43][44][45][46] Most studies so far have focused on motor symptoms. The general finding is that LCIG provides more time in motor states near normal performance and less time in 'off' and dyskinetic states as compared to conventional optimised therapy.…”

Section: Long-term Efficacy With Levodopa/carbidopa Intestinal Gel Inmentioning

confidence: 99%

Long-term Efficacy and Safety with Continuous Dopaminergic Stimulation Pump Treatments in Parkinson’s Disease

Busk¹,

Johansson²,

Nyholm³

2011

European Neurological Review

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Continuous dopaminergic stimulation (CDS) is important for symptom control in advanced stages of Parkinson's disease (PD). The most efficacious approaches are pump treatments with dopaminergic drugs: subcutaneous infusion of the dopamine receptor agonist apomorphine and intestinal infusion of levodopa/carbidopa gel. Both methods decrease motor fluctuations in long-term follow-ups, including parkinsonian and dyskinetic states, when compared to conventional optimised oral therapy. Also non-motor symptoms may be improved. Adverse drug reactions are usually less pronounced although high levodopa doses, which are common with levodopa/carbidopa infusion, may cause hyperhomocysteinaemia and cobalamin deficiency. Technical complications are specific for each infusion strategy. Formation of subcutaneous nodules is the most common problem with apomorphine infusion. Dislocation of the intestinal tube is the most common problem with levodopa/carbidopa infusion. Both pump treatments may be used for 24-hour infusion in selected patients. The long-term experience is reviewed. To conclude, CDS pump treatments may be successfully used for several years in advanced PD. KeywordsApomorphine, continuous dopaminergic stimulation, infusion, levodopa/carbidopa, Parkinson's disease, pump The background is a combination of a number of findings, mainly that:• striatal dopaminergic stimulation is fairly constant in a healthy brain;• striatal dopaminergic stimulation in PD is pulsatile when oral levodopa is used; • pulsatile dopaminergic stimulation causes motor fluctuations and dyskinesias; and • continuous administration of dopaminergic agents may decrease motor fluctuations and reverse dyskinesias.PD is associated with a more widespread pathology than nigro-striatal degeneration and CDS is not the remedy for all problems. But there is firm evidence that continuous dopaminergic drug delivery, probably providing CDS, produces a significant benefit compared to conventional therapy in patients with advanced PD. The evidence mainly stems from studies of levodopa and apomorphine infusions.

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“…For this reasons, strategies have been designed to enhance the availability in the cerebral level and to increase the medication's plasma half-life with the passage of the years; for instance, sustained action LD was created, and it was associated with inhibitors of catechol-O-methyltransferase (COMT), like Entacapone and Tolcapone. Another strategy is the alternative dosage forms that have been employed for PD advanced patients, for example, it is used the continuous intraduodenal infusion method to maintain drug stable concentrations, thus, reducing the fluctuations [9,10].…”

Section: Introductionmentioning

confidence: 99%

The assessment of pharmacoeconomic studies quality of Levodopa’s use for the management of Parkinson’s diseases, 2010-2015

Gutiérrez

Becerra

Rojas

2017

Rev. colomb. cienc. quim. farm.

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SummaryLevodopa (LD) has been the first choice in the management of Parkinson's disease (PD), since its introduction in the drug market; however, its prolonged use is related to the occurrence of motor complications, affecting the functionality and quality of life. Parkinson's disease is one of the most frequent among the neurodegenerative diseases in the world, and it is expected that the number of people who suffer it, will increase due to global population aging. The PD represents, nowadays and for the future, a high economic burden from all perspectives, including patients, payers, and society. So it is necessary to know about the use of LD in its treatment and to realize the quality of pharmacoeconomic studies in the past five years, to identify reliable sources of information related to the costs and benefits of this medication to contribute in making decisions. The aim of this paper is to assess the methodological quality of pharmacoeconomic studies related to the use of LD in PD, specifically those that are identified as cost-utility studies, applying the QHES instrument. A total of 19 articles were found, of which 5 met the inclusion criteria and were subjected to examination. The average overall score obtained after the evaluation was 77.2 out of 100, making evident a good quality of studies according to the method used.Keywords: Levodopa, Parkinson's disease, cost-utility, methodological quality, QHES (Quality of Health Economic Studies). La Levodopa (LD) ha sido desde su introducción en el mercado la primera elección en el manejo de la enfermedad de Parkinson (EP); sin embargo, su uso prolongado está relacionado con la aparición de complicaciones motoras, afectándose la funcionalidad y calidad de vida. La EP es una de las enfermedades neurodegenerativas que se presenta con mayor frecuencia en el mundo y se espera que el número de personas que la padecen aumente, debido al envejecimiento poblacional a nivel mundial. La EP representa, actualmente y a futuro, una alta carga económica desde todas las perspectivas, incluyendo: pacientes, pagadores y la sociedad; por lo cual es necesario conocer el uso de la LD en el tratamiento de la misma y lograr determinar la calidad de los estudios farmacoeconómicos realizados en los últimos cinco años, para identificar fuentes fiables de información relacionadas con los costos y los beneficios de este medicamento que aporten en la toma de decisiones. El objetivo de este artículo es evaluar la calidad metodológica de los estudios farmacoeconómicos relacionados con el uso de la LD en la EP, específicamente aquellos que se cataloguen como estudios de costo-utilidad, aplicando el instrumento QHES. Se encontraron en total 19 artículos, de los cuales cinco cumplieron los criterios de inclusión y fueron sometidos al respectivo análisis. El puntaje global promedio obtenido posterior a la evaluación fue de 77,2 sobre 100, haciendo evidente una buena calidad de los estudios de acuerdo con el método utilizado.Palabras clave: Levodopa, enfermedad de Parkinson, costo-utilidad, ca...

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Long-term intraduodenal infusion of a water based levodopa-carbidopa dispersion in very advanced Parkinson's disease

Cited by 96 publications

References 18 publications

The scientific and clinical basis for the treatment of Parkinson disease (2009)

The scientific and clinical basis for the treatment of Parkinson disease (2009)

Long-term Efficacy and Safety with Continuous Dopaminergic Stimulation Pump Treatments in Parkinson’s Disease

The assessment of pharmacoeconomic studies quality of Levodopa’s use for the management of Parkinson’s diseases, 2010-2015

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