Predictors of Time to Discontinuation of Levodopa-Carbidopa Intestinal Gel Infusion: A Retrospective Cohort Study

Abstract

Background: Continuous intra-duodenal infusion of levodopa-carbidopa intestinal gel (LCIG) is a well-established therapy for patients with advanced Parkinson's disease (PD) suffering from motor complications despite optimized treatment with oral dopaminomimetics. However, time to discontinuation of treatment with LCIG varies considerably between patients, ranging from a few months to more than ten years. To improve the selection of candidates for LCIG, knowledge of prognostic factors is of paramount importance. Objective: To explore baseline predictors of time to discontinuation of LCIG. Methods: In this two-center retrospective cohort study, we reviewed the medical files of 98 PD patients treated with LCIG between April 2006 and December 2015 (53% male; mean age: 66.2 years; mean disease duration: 12.3 years). Baseline patient characteristics were used as covariates in Cox regression models. Results: During follow-up (mean observation time: 2.6 years; range: 0.1-9.3) eighteen patients discontinued treatment (18.4%), while seven patients died (7.1%). Median duration of treatment with LCIG, estimated with Kaplan-Meier analysis, was 7.8 years (95% CI: 6.7-9.0). Disease duration (in years) at baseline was a statistically significant predictor of time to discontinuation of LCIG (HR: 0.85; 95% CI: 0.75-0.96, p = 0.006). All other characteristics studied, e.g. age >70 years, did not show statistically significant associations with the total duration of treatment with LCIG. Conclusion: Our findings show a low overall rate of discontinuation of LCIG infusion, with a median duration of treatment of 7.8 years. Shorter disease duration at baseline appeared to be a predictor of earlier discontinuation of LCIG.

Single‐Center Study of 103 Consecutive Parkinson's Disease Patients with Levodopa‐Carbidopa Intestinal Gel

“…[7][8][9][10][11] However, there are relatively few studies considering longterm features of the LCIG treatment. [12][13][14][15][16][17] Studies have found an average duration of 7 to 8 years of LCIG infusion 13,14 and a high…”

“…18,19 Some authors have reported a group of patients who discontinue the treatment early on. 13,20,21 Others have found somewhat conflicting risk-factors for discontinuation such as longer 14 or shorter 13 duration of PD before initiation of the infusion and female gender. 14,16 Here, we report single-center findings including changes in medication, treatment duration, and adverse events of patients treated with the LCIG-infusion based on data analysis of 103 consecutive PD patients treated with LCIG at Helsinki University Hospital between July 2006 and May 2020.…”

Long-Term Persistence and Monotherapy with Device-Aided Therapies: A Retrospective Analysis of an Israeli Cohort of Patients with Advanced Parkinson’s Disease

“…However, a retrospective examination of medical records for patients receiving CSAI for at least 6 months found that the most common reason for discontinuation was troublesome dyskinesia, and many younger patients transitioned to DBS following CSAI therapy [27]. A recent retrospective analysis of patients who received LCIG for an average of 2.6 years found that the most common reasons for discontinuation were device-related side effects and less efficacy than expected by the patient [28]. In another retrospective study, the discontinuation rate was 21% during an average of 22 months of LCIG treatment, with death and poor compliance being the primary reasons; device-related complications and complications with percutaneous endoscopic gastrojejunostomy occurred, but did not lead to the discontinuation of LCIG [29].…”

A knotty problem: phytobezoar and small bowel occlusion as a complication of a gastro-jejunal catheter for continuous Duodopa infusion: a case report

“…There are as of yet no standardized protocols guiding the timing of tube replacements, which could potentially aid in preventing PEG-J-related complications in an already fragile population. Device complications are a known cause of LICG discontinuation [ 12 ] and avoiding them could help prolong effective treatment in certain patients.…”