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Vekhande C, Hamed M, Tremain G, Mah J, Shetty A, Lazarescu A, Suchowersky O. Levodopa-Carbidopa Intestinal Gel for Parkinson's Disease over 11 years: One Center's "Real-World" Experience. Can J Neurol Sci 2024; 51:379-386. [PMID: 37462070 DOI: 10.1017/cjn.2023.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Levodopa-carbidopa intestinal gel (LCIG) therapy has been shown to be a safe and effective treatment for advanced Parkinson's disease (PD). Limited data are available regarding long-term benefits and complications in Canada. Objective of the study was to review long-term experience and clinical outcomes in PD patients with LCIG therapy over 11 years in a multidisciplinary University clinic setting. METHODS Chart review was done on PD patients with LCIG from 2011 to 2022. Data collected: dosing, UPDRS-III motor scores, OFF times, hours with dyskinesias, MoCA, complications, discontinuation reasons, and nursing time requirements. RESULTS Thirty-three patients received LCIG therapy with a mean follow-up of 3.25±2.09 years. UPDRS-III scores showed reduction of 15% from baseline (mean 35.9) up to 4 years (mean 30.4). Daily OFF time improved from baseline (mean 7.1 ± 3.13 hours) up to 5 years (mean 3.3 ± 2.31 hours; -53.5%; p < 0.048), and dyskinesias remained stable. Nursing time averaged 22 hours per patient per year after PEG-J insertion and titration. Most common complications were PEG-J tube dislodgement and stoma site infection (0-3zero to three events/patient/year). Serious side effects were seen in four (12%) patients resulting in hospitalization and/or death. Nine patients (27.2%) discontinued the treatment due to lack of improved efficacy over oral therapy or development of dementia and 10 (30%) died of causes unrelated to LCIG infusion. CONCLUSION Patients on LCIG showed improved motor function over 5-year follow-up. Serious complications were uncommon. Dedicated nursing time is required by LCIG-trained nurses in a multidisciplinary setting for optimum management.
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Affiliation(s)
- Chetan Vekhande
- Department of Medicine (Neurology), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Moath Hamed
- Department of Neuroscience, NYP Brooklyn, Methodist Hospital, New York, NY, USA
| | - Genise Tremain
- Movement Disorders Program, Kaye Edmonton Clinic, Alberta Heath Services, Edmonton, AB, Canada
| | - Jennifer Mah
- Movement Disorders Program, Kaye Edmonton Clinic, Alberta Heath Services, Edmonton, AB, Canada
| | - Aakash Shetty
- Department of Medicine (Neurology), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Adriana Lazarescu
- Department of Medicine (Gastroenterology), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Oksana Suchowersky
- Department of Medicine (Neurology), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Movement Disorders Program, Kaye Edmonton Clinic, Alberta Heath Services, Edmonton, AB, Canada
- Department of Pediatrics, Psychiatry and Medical Genetics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Wagner MJ, Daniel CP, Plaisance CJ, Borne GE, Ahmadzadeh S, Shekoohi S, Kaye AD. Apomorphine for Parkinson's disease: pharmacologic and clinical considerations. Expert Opin Emerg Drugs 2023; 28:275-281. [PMID: 37909462 DOI: 10.1080/14728214.2023.2278677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/30/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION In Parkinson's disease, dopamine depletion in the basal ganglia leads to symptoms including bradykinesia, gait abnormalities, and cognitive impairment. Even with treatment, the disease course leads to decreases in the amount of dopamine produced and released into the synapse. As dopamine production falls and the treatment course is insufficient to match the metabolic supply and demand, acute 'off' periods develop that cause reemergence of symptoms. Apomorphine is used to reverse these 'off' periods and restore function in patients with Parkinson's. This review will provide clinicians a concise article to read to learn more about apomorphine and its appropriate utilization. AREAS COVERED The research discussed is focused on the history, pharmacokinetics, and mechanism of action of Apomorphine. Its utilization as a treatment for Parkinson's Disease and its comparison to currently utilized drugs is also discussed in this review. We focused on articles published on PubMed and Google Scholar within the last 10 years, but in some instances had to go as far back as 1951 to include early articles published about apomorphine. EXPERT OPINION The expert opinion section focuses on the ways in which apomorphine could be administered in the future to better promote utilization and increase tolerability.
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Affiliation(s)
- Maxwell J Wagner
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| | - Charles P Daniel
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| | - Connor J Plaisance
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| | - Grant E Borne
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
- Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
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Long-term results of carbidopa/levodopa enteral suspension across the day in advanced Parkinson's disease: Post-hoc analyses from a large 54-week trial. Clin Park Relat Disord 2022; 8:100181. [PMID: 36594071 PMCID: PMC9803946 DOI: 10.1016/j.prdoa.2022.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Carbidopa/levodopa enteral suspension (CLES) previously demonstrated reduction in total daily OFF from baseline by over 4 hours in advanced Parkinson's disease patients across 54 weeks. Evidence on CLES's long-term effectiveness on patterns of motor-symptom control throughout the day remains limited. Methods We present post-hoc analyses of a large, open-label study of CLES monotherapy (N = 289). Diary data recorded patients' motor states at 30-minute intervals over 3 days at baseline and weeks 4, 12, 24, 36, and 54. Adjusted generalized linear mixed models assessed changes from baseline at each timepoint for four outcome measures: time to ON without troublesome dyskinesia (ON-woTD) after waking, motor-symptom control as measured by motor states' durations throughout the day, number of motor-state transitions, and presence of extreme fluctuations (OFF to ON with TD). Results Patients demonstrated short-term (wk4) and sustained (wk54) improvement in all outcomes compared to baseline. At weeks 4 and 54, patients were more likely to reach ON-woTD over the course of their day (HR: 1.86 and 2.51, both P < 0.0001). Across 4-hour intervals throughout the day, patients also experienced increases in ON-woTD (wk4: 58-65 min; wk54: 60-78 min; all P < 0.0001) and reductions in OFF (wk4: 50-61 min; wk54: 56-68 min; all P < 0.0001). At weeks 4 and 54, patients' motor-state transitions were reduced by about half (IRR: 0.53 and 0.49, both P < 0.0001), and fewer patients experienced extreme fluctuations (OR: 0.22 and 0.15, both P < 0.0001). Conclusion CLES monotherapy was associated with significant long-term reductions in motor-state fluctuations, faster time to ON-woTD upon awakening, and increased symptom control throughout the day.
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Key Words
- ADL, Activities of daily living
- APD, Advanced Parkinson's disease
- CGI-S, Clinical Global Impression of disease severity
- CLES, Carbidopa/levodopa enteral suspension
- Carbidopa/levodopa enteral suspension
- Carbidopa/levodopa intestinal gel
- Duodopa
- Duopa
- Dyskinesia
- HR, Hazard ratio
- IRR, Incidence rate ratio
- Long-term effectiveness
- OFF, “Off” time
- ON, “On” time
- ON-wTD, “On” time with troublesome dyskinesia
- ON-woTD, “On” time without troublesome dyskinesia
- OR, Odds ratio
- PD, Parkinson’s disease
- PEG-J, Percutaneous endoscopic gastrojejunostomy
- Parkinson’s disease
- QoL, Quality of life
- RCT, Randomized controlled trial
- SD, Standard deviation
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Kovács N, Szász J, Vela-Desojo L, Svenningsson P, Femia S, Parra JC, Sanchez-Soliño O, Bergmann L, Gurevich T, Fasano A. Motor and nonmotor symptoms in patients treated with 24-hour daily levodopa-carbidopa intestinal gel infusion: Analysis of the COmedication Study assessing Mono- and cOmbination therapy with levodopa-carbidopa inteStinal gel (COSMOS). Parkinsonism Relat Disord 2022; 105:139-144. [PMID: 36008198 DOI: 10.1016/j.parkreldis.2022.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Patients with advanced Parkinson's disease (APD) commonly experience motor and nonmotor symptoms (NMS) associated with functional limitations and decreased quality of life. We compared motor and nonmotor outcomes in patients with APD receiving 24- versus 16-h levodopa-carbidopa intestinal gel (LCIG). METHODS Data from COSMOS, a large, real-world, retrospective and cross-sectional, observational study on LCIG and comedication in APD were obtained from medical records and a single patient visit for patients receiving 24- and 16-h LCIG infusion. Changes from baseline were evaluated for motor symptoms, NMS, and clinical characteristics. Safety was also assessed. RESULTS Data for 401 patients were included in this subanalysis. At the patient visit there were 35 patients on 24-h LCIG and 366 on 16-h LCIG. "Off" time and dyskinesia (duration and severity) were reduced in both groups. In both LCIG treatment groups, prevalence of most symptoms was reduced. There were significant differences in the change from baseline in severity and frequency of freezing of gait with 24-h LCIG versus 16-h LCIG (p = 0.011 and p = 0.038), severity of urinary symptoms (p = 0.006), and frequency of cognitive impairment (p = 0.014) with 24-h LCIG versus 16-h LCIG. Adverse events were similar for both treatment groups and considered tolerable. CONCLUSIONS LCIG 24-h infusion may be a useful treatment option, when clinically justified, for select patients with APD. CLINICAL TRIAL NUMBER NCT03362879.
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Affiliation(s)
| | - József Szász
- GE Palade University of Medicine, Pharmacy, Science and Technology of Tîrgu Mureș, Emergency Clinical County Hospital Mureș, Tîrgu Mureș, Romania
| | - Lydia Vela-Desojo
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Per Svenningsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | - Tanya Gurevich
- Movement Disorders Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel
| | - Alfonso Fasano
- Edmond J Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada
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Rosebraugh M, Neenan M, Facheris M. Comparability of Foslevodopa/Foscarbidopa Pharmacokinetics in Healthy Asian and White Participants. Clin Pharmacol Drug Dev 2022; 12:407-415. [PMID: 36394144 DOI: 10.1002/cpdd.1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022]
Abstract
This phase 1 study assessed the safety, tolerability, and pharmacokinetics of a single 24-hour continuous subcutaneous dose of foslevodopa/foscarbidopa in healthy adult Japanese (N = 24), Han Chinese (N = 8), and White (N = 24) participants. Three doses of foslevodopa/foscarbidopa were evaluated in healthy participants for this study: 480/24, 960/48, and 1440/72 mg/day. Serial blood samples for measurement of levodopa, carbidopa, foslevodopa, foscarbidopa, and 3-O-methyldopa concentrations were collected for 48 hours after foslevodopa/foscarbidopa administration. Safety and tolerability were assessed throughout the study. Point estimates for ratios of central values indicated that the exposure difference between Japanese and White participants was <10%. The maximum concentration and area under the plasma concentration-time curve for both LD and CD following foslevodopa/foscarbidopa continuous subcutaneous infusion were comparable between Han Chinese and White participants. Point estimates for ratios of central values indicated that the exposure difference between Han Chinese and White participants was <14%. The regimens tested were generally well tolerated, and no new safety issues were identified in this study. There were no clinically meaningful differences in LD and CD exposures or pharmacokinetics following administration of foslevodopa/foscarbidopa among White, Japanese, and Han Chinese participants.
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Szász JA, Constantin VA, Orbán-Kis K, Bancu LA, Ciorba M, Mihály I, Nagy EE, Szász RM, Kelemen K, Simu MA, Szatmári S. Management Challenges of Severe, Complex Dyskinesia. Data from a Large Cohort of Patients Treated with Levodopa-Carbidopa Intestinal Gel for Advanced Parkinson's Disease. Brain Sci 2021; 11:826. [PMID: 34206596 PMCID: PMC8301838 DOI: 10.3390/brainsci11070826] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/12/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In the advanced stages of Parkinson's disease (APD), complex forms of dyskinesia may severely impair the patient's quality of life. OBJECTIVE In the present study, we aimed to analyze the evolution under LCIG therapy of the most important motor fluctuations and complex disabling dyskinesias, including diphasic dyskinesia. METHODS In this retrospective study, we analyzed the characteristics of patients with APD who had at least 30 min of diphasic dyskinesia (DID) in 3 consecutive days, were considered responders and were treated with LCIG in our clinic. Patients were evaluated before and after PEG and at 6, 12 and 18 months, when the changes in the therapy were recorded, and they completed a 7-point Global Patient Impression of Improvement (PGI-I) scale. RESULTS Forty patients fulfilled the inclusion criteria-out of which, 34 performed all visits. There was a substantial difference between the calculated and real LCIG (1232 ± 337 mg vs. 1823 ± 728 mg). The motor fluctuations and most dyskinesias improved significantly after starting LCIG, but an increasing number of patients needed longer daily administrations of LCIG (24 instead of 16 h). CONCLUSIONS Patients with APD with complex dyskinesias must be tested in dedicated hospitals, and they need a special therapeutic approach. The properly adapted LCIG treatment regarding the dose and time of administration completed with well-selected add-on medication should offer improvement for patients who want to or can only choose this DAT vs. others.
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Affiliation(s)
- József Attila Szász
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| | - Viorelia Adelina Constantin
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- Doctoral School, ”Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timișoara, Romania
| | - Károly Orbán-Kis
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| | - Ligia Ariana Bancu
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
- 1st Clinic of Internal Medicine, Târgu Mures County Emergency Clinical Hospital, 540142 Târgu Mureș, Romania
| | - Marius Ciorba
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
- Department of Gastroenterology, Târgu Mures County Emergency Clinical Hospital, 540142 Târgu Mureș, Romania
| | - István Mihály
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| | - Előd Ernő Nagy
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
- Laboratory of Medical Analysis, Clinical County Hospital Mures, 540142 Târgu Mureș, Romania
| | - Róbert Máté Szász
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| | - Krisztina Kelemen
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| | - Mihaela Adriana Simu
- Department of Neurology II, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timișoara, Romania;
- ”Pius Branzeu” Emergency Clinical County Hospital, 300723 Timișoara, Romania
| | - Szabolcs Szatmári
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
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Population pharmacokinetics of levodopa gel infusion in Parkinson's disease: effects of entacapone infusion and genetic polymorphism. Sci Rep 2020; 10:18057. [PMID: 33093598 PMCID: PMC7582154 DOI: 10.1038/s41598-020-75052-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022] Open
Abstract
Levodopa-entacapone-carbidopa intestinal gel (LECIG) provides continuous drug delivery through intrajejunal infusion. The aim of this study was to characterize the population pharmacokinetics of levodopa following LECIG and levodopa-carbidopa intestinal gel (LCIG) infusion to investigate suitable translation of dose from LCIG to LECIG treatment, and the impact of common variations in the dopa-decarboxylase (DDC) and catechol-O-methyltransferase (COMT) genes on levodopa pharmacokinetics. A non-linear mixed-effects model of levodopa pharmacokinetics was developed using plasma concentration data from a double-blind, cross-over study of LCIG compared with LECIG in patients with advanced Parkinson’s disease (n = 11). All patients were genotyped for rs4680 (polymorphism of the COMT gene), rs921451 and rs3837091 (polymorphisms of the DDC gene). The final model was a one compartment model with a high fixed absorption rate constant, and a first order elimination, with estimated apparent clearances (CL/F), of 27.9 L/h/70 kg for LCIG versus 17.5 L/h/70 kg for LECIG, and apparent volume of distribution of 74.4 L/70 kg. Our results thus suggest that the continuous maintenance dose of LECIG, on a population level, should be decreased by approximately 35%, to achieve similar drug exposure as with LCIG. An effect from entacapone was identified on all individuals, regardless of COMT rs4680 genotype. The individuals with higher DDC and COMT enzyme activity showed tendencies towards higher levodopa CL/F. The simultaneous administration of entacapone to LCIG administration results in a 36.5% lower apparent levodopa clearance, and there is a need for lower continuous maintenance doses, regardless of patients’ COMT genotype.
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Constantin VA, Szász JA, Orbán-Kis K, Rosca EC, Popovici M, Cornea A, Bancu LA, Ciorba M, Mihály I, Nagy E, Szatmári S, Simu M. Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients. Neuropsychiatr Dis Treat 2020; 16:1835-1844. [PMID: 32801718 PMCID: PMC7395851 DOI: 10.2147/ndt.s256988] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/25/2020] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Viorelia Adelina Constantin
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - József Attila Szász
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
- Department of Neurology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Károly Orbán-Kis
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
- Department of Physiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Elena Cecilia Rosca
- Department of Neurology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Neurology, “Pius Branzeu” Emergency Clinical County Hospital, Timisoara, Romania
| | | | - Amalia Cornea
- Department of Neurology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Neurology, “Pius Branzeu” Emergency Clinical County Hospital, Timisoara, Romania
| | - Ligia Ariana Bancu
- Department of Internal Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
- 1 Clinic of Internal Medicine, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
| | - Marius Ciorba
- Department of Internal Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
- Department of Gastroenterology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
| | - István Mihály
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
- Department of Physiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Előd Nagy
- Department of Biochemistry and Environmental Chemistry, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
- Laboratory of Medical Analysis, Clinical County Hospital Mureș, Târgu Mureș, Romania
| | - Szabolcs Szatmári
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, Târgu Mureș, Romania
- Department of Neurology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Mihaela Simu
- Department of Neurology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Neurology, “Pius Branzeu” Emergency Clinical County Hospital, Timisoara, Romania
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Zhang XR, Jiang ZY, Zhang ZR, Chen HJ, Wu K, He JC, Xie CL. The Advantages of Levodopa-Carbidopa Intestinal Gel for Patients with Advanced Parkinson's Disease: A Systematic Review. Drug Des Devel Ther 2020; 14:845-854. [PMID: 32161444 PMCID: PMC7050037 DOI: 10.2147/dddt.s229621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/24/2020] [Indexed: 11/23/2022] Open
Abstract
Background Levodopa-carbidopa intestinal gel (LCIG) is a new type of administration that results in steadier levodopa plasma concentrations in advanced Parkinson's disease (PD) patients and effectively reduces poor mobility and dyskinesia. Methods Electronic databases were searched up to January 1, 2018. The inclusion criteria for this review were as follows: LCIG vs oral medication in advanced PD patients. Results Five trials, with a total of 198 patients, met all the inclusion criteria. The quality score of these studies ranged from 3 to 5. Two clinical trials showed that compared with oral medication, LCIG had a better treatment effect on on-time with troublesome dyskinesia (TSD) (p = 0.02) and on-time without TSD (p < 0.00001) in advanced PD patients. In addition, four of the 5 studies showed that the LCIG may have better efficacy than oral medication for improving the scores of the UPDRS, and two studies found that LCIG demonstrated better efficacy for improving the PDQ-39 scores. The video recording results indicated a potential decline in both dyskinesia and the "off" state in LCIG-treated patients. The incidence of adverse events was not significantly different between the LCIG and oral medication groups. Conclusion Compared with oral treatment, LCIG exerts its effectiveness, mostly by reducing the time of on-time with TSD, increasing the time of on-time without TSD and scores of UPDRS and PDQ-39. It is suggesting that LCIG was likely to be a new type of administration used in clinical applications. However, due to methodological flaws, these findings should be viewed with caution, and more RCTs are needed in the field to complement our findings.
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Affiliation(s)
- Xing-Ru Zhang
- The Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China
| | - Zhi-Yu Jiang
- The Department of General Surgery, The Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou 310000, People's Republic of China
| | - Zeng-Rui Zhang
- Department of Neurology, Huzhou Central Hospital, Huzhou 313000, People's Republic of China
| | - Hui-Jun Chen
- The Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China
| | - Ke Wu
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China
| | - Jin-Cai He
- The Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China
| | - Cheng-Long Xie
- The Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China
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11
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Saqlain M, Alam M, Rönnegård L, Westin J. Investigating Stochastic Differential Equations Modelling for Levodopa Infusion in Patients with Parkinson's Disease. Eur J Drug Metab Pharmacokinet 2019; 45:41-49. [PMID: 31595429 PMCID: PMC6994552 DOI: 10.1007/s13318-019-00580-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Levodopa concentration in patients with Parkinson's disease is frequently modelled with ordinary differential equations (ODEs). Here, we investigate a pharmacokinetic model of plasma levodopa concentration in patients with Parkinson's disease by introducing stochasticity to separate the intra-individual variability into measurement and system noise, and to account for auto-correlated errors. We also investigate whether the induced stochasticity provides a better fit than the ODE approach. METHODS In this study, a system noise variable is added to the pharmacokinetic model for duodenal levodopa/carbidopa gel (LCIG) infusion described by three ODEs through a standard Wiener process, leading to a stochastic differential equations (SDE) model. The R package population stochastic modelling (PSM) was used for model fitting with data from previous studies for modelling plasma levodopa concentration and parameter estimation. First, the diffusion scale parameter (σw), measurement noise variance, and bioavailability are estimated with the SDE model. Second, σw is fixed to certain values from 0 to 1 and bioavailability is estimated. Cross-validation was performed to compare the average root mean square errors (RMSE) of predicted plasma levodopa concentration. RESULTS Both the ODE and the SDE models estimated bioavailability to be approximately 75%. The SDE model converged at different values of σw that were significantly different from zero. The average RMSE for the ODE model was 0.313, and the lowest average RMSE for the SDE model was 0.297 when σw was fixed to 0.9, and these two values are significantly different. CONCLUSIONS The SDE model provided a better fit for LCIG plasma levodopa concentration by approximately 5.5% in terms of mean percentage change of RMSE.
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13
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Safety and Tolerability of Pharmacotherapies for Parkinson’s Disease in Geriatric Patients. Drugs Aging 2019; 36:511-530. [DOI: 10.1007/s40266-019-00654-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Rosebraugh M, Kalluri HV, Liu W, Locke C, Sidhu D, Han J, Benesh J. Levodopa-carbidopa intestinal gel high concentration formulation is clinically bioequivalent to commercial formulation. Pharmacol Res Perspect 2019; 7:e00473. [PMID: 30977301 PMCID: PMC6452870 DOI: 10.1002/prp2.473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/19/2019] [Indexed: 11/12/2022] Open
Abstract
A new levodopa-carbidopa intestinal gel (LCIG) system featuring a higher levodopa/carbidopa (LD/CD) concentration and viscosity, LCIG-HV, is being developed to reduce the intrajejunal volume of LD/CD that is administered as compared to the current commercial formulation, LCIG-LV. This study characterizes the LCIG-HV formulation and compares it to the LCIG-LV formulation via dissolution testing and a clinical pharmacokinetic bioequivalence study. In vitro release profiles of LD/CD were determined using a USP Dissolution Apparatus 2 with 500 mL of phosphate buffer (pH 4.5) operating at 25 RPM. A single dose, open-label study was conducted according to a two-period, randomized, crossover design in 28 healthy subjects. The point estimate (PE) of the levodopa Cmax geometric mean for the LCIG-HV formulation was 4% higher than that of the LCIG-LV formulation. PEs of levodopa AUCt and AUCinf geometric means were comparable for both formulations. PEs of carbidopa Cmax , AUCt and AUCinf geometric means for the LCIG-HV formulation were 3%-5% higher than those of the LCIG-LV formulation. For both formulations, the median Tmax for levodopa was 1.0 and 3.0 hours for carbidopa. The levodopa half-life harmonic mean was 1.6 hour for both formulations. The carbidopa half-life harmonic mean was 1.9 and 2.0 hour, respectively, for the LCIG-HV and LCIG-LV formulations. Cmax , AUCt and AUCinf of LD/CD carbidopa were comparable for both formulations. The current study demonstrates that the LCIG-LV and LCIG-HV formulations are clinically bioequivalent for LD/CD according to FDA guidance. However, the dissolution method was over discriminatory of formulation differences.
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Affiliation(s)
| | | | - Wei Liu
- AbbVie Inc.North Chicagollinois
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15
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Wang L, Li J, Chen J. Levodopa-Carbidopa Intestinal Gel in Parkinson's Disease: A Systematic Review and Meta-Analysis. Front Neurol 2018; 9:620. [PMID: 30104997 PMCID: PMC6077236 DOI: 10.3389/fneur.2018.00620] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/10/2018] [Indexed: 01/11/2023] Open
Abstract
Background: Levodopa has been widely used and regarded as the most effective therapy for Parkinson's disease (PD), but long-term treatment with oral levodopa may result in motor fluctuations and involuntary movements (dyskinesias). There is evidence to suggest that Continuous infusion of levodopa-carbidopa intestinal gel (LCIG) can effectively manage motor and non-motor complications in PD, but clinical studies investigating this have yielded inconsistent results. This systematic review and meta-analysis was performed to examine the efficacy and safety of LCIG for patients with PD. Methods: A systematic search was conducted to retrieve published data in the EMBASE, PubMed, and the Cochrane Library up to March 2018. Both efficiency and safety of LCIG were analyzed using pooled standardized mean differences (SMDs) or odds ratio (ORs) with 95% confidence interval (CIs). Results: Eight trials with 384 PD patients were included in the present study. Compared with the control group, LCIG significantly decreased off-time (SMD, −1.19; 95% CI, −2.25 to −0.12; p = 0.003) and increased on-time without troublesome dyskinesia (SMD, 0.55; 95% CI, 0.20 to 0.90; p = 0.002). However, no significant difference of LCIG was found in on-time with troublesome dyskinesia. There were no significant differences in UPDRS, Hoehn & Yahr and PDQ-39 scores. Besides, no significant differences in the drop-out and adverse effects. Conclusions: Continuous delivery of LCIG may offer a promising option for PD patients. More randomized double-blind controlled studies with large sample sizes were needed to further confirm the efficacy and safety of LCIG for PD patients.
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Affiliation(s)
- Libo Wang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jia Li
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jiajun Chen
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
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Population pharmacokinetics of levodopa/carbidopa microtablets in healthy subjects and Parkinson's disease patients. Eur J Clin Pharmacol 2018; 74:1299-1307. [PMID: 29882153 PMCID: PMC6132549 DOI: 10.1007/s00228-018-2497-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/29/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Low dose, dispersible, levodopa/carbidopa microtablets with an automatic dose dispenser have been developed to facilitate individualized levodopa treatment. The aim of this study was to characterize the pharmacokinetics (PK) of levodopa and carbidopa after microtablet administration, and evaluate the impact of potential covariates. METHODS The population PK analysis involved data from 18 healthy subjects and 18 Parkinson's disease patients included in two single-dose, open-label levodopa/carbidopa microtablet studies. The analysis was carried out using non-linear mixed effects modeling. Bodyweight was included on all disposition parameters according to allometric scaling. Potential influence of additional covariates was investigated using graphical evaluation and adjusted adaptive least absolute shrinkage and selection operator. RESULTS Dispositions of levodopa and carbidopa were best described by a two- and one-compartment model respectively. Double-peak profiles were described using two parallel absorption compartments. Levodopa apparent clearance was found to decrease with increasing carbidopa dose (15% lower with 75 compared to 50 mg of carbidopa) and disease stage (by 18% for Hoehn and Yahr 1 to 4). Carbidopa apparent clearance was found to decrease with age (28% between the age of 60 and 80 years). An external evaluation showed the model to be able to reasonably well predict levodopa concentrations following multiple-dose microtablet administration in healthy subjects. CONCLUSIONS The presented models adequately described the PK of levodopa and carbidopa, following microtablet administration. The developed model may in the future be combined with a pharmacokinetic-pharmacodynamic target and used for individualized dose selection, utilizing the flexibility offered by the microtablets.
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Thomas I, Alam M, Nyholm D, Senek M, Westin J. Individual dose-response models for levodopa infusion dose optimization. Int J Med Inform 2018; 112:137-142. [PMID: 29500011 DOI: 10.1016/j.ijmedinf.2018.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVE To achieve optimal effect with continuous infusion treatment in Parkinson's disease (PD), the individual doses (morning dose and continuous infusion rate) are titrated by trained medical personnel. This study describes an algorithmic method to derive optimized dosing suggestions for infusion treatment of PD, by fitting individual dose-response models. The feasibility of the proposed method was investigated using patient chart data. METHODS Patient records were collected at Uppsala University hospital which provided dosing information and dose-response evaluations. Mathematical optimization was used to fit individual patient models using the records' information, by minimizing an objective function. The individual models were passed to a dose optimization algorithm, which derived an optimized dosing suggestion for each patient model. RESULTS Using data from a single day's admission the algorithm showed great ability to fit appropriate individual patient models and derive optimized doses. The infusion rate dosing suggestions had 0.88 correlation and 10% absolute mean relative error compared to the optimal doses as determined by the hospital's treating team. The morning dose suggestions were consistency lower that the optimal morning doses, which could be attributed to different dosing strategies and/or lack of on-off evaluations in the morning. CONCLUSION The proposed method showed promise and could be applied in clinical practice, to provide the hospital personnel with additional information when making dose adjustment decisions.
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Affiliation(s)
- Ilias Thomas
- Department of Micro-data analysis, Dalarna University, Falun, 79 131, Sweden.
| | - Moudud Alam
- Department of Micro-data analysis, Dalarna University, Falun, 79 131, Sweden
| | - Dag Nyholm
- Dept. of Neuroscience, Neurology, Uppsala University, Uppsala, 751 85, Sweden
| | - Marina Senek
- Dept. of Neuroscience, Neurology, Uppsala University, Uppsala, 751 85, Sweden
| | - Jerker Westin
- Department of Micro-data analysis, Dalarna University, Falun, 79 131, Sweden
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Othman AA, Rosebraugh M, Chatamra K, Locke C, Dutta S. Levodopa-Carbidopa Intestinal Gel Pharmacokinetics: Lower Variability than Oral Levodopa-Carbidopa. JOURNAL OF PARKINSONS DISEASE 2018; 7:275-278. [PMID: 28211816 PMCID: PMC5438475 DOI: 10.3233/jpd-161042] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In a double-blind, double-dummy, double-titration Phase 3 trial in advanced Parkinson’s disease (PD) patients, the efficacy and safety of Levodopa-carbidopa intestinal gel (LCIG) infusion were characterized relative to immediate-release oral levodopa-carbidopa (LC-oral) treatment. We present in this report the comparative pharmacokinetic profiles of LCIG and LC-oral from this pivotal study. The results presented in this report clearly demonstrate that LCIG results in lower variability and fluctuations in levodopa and carbidopa plasma concentrations compared to LC-oral. The superior pharmacokinetic profiles with LCIG were consistent with its improved efficacy compared to LC-oral as demonstrated in this study.
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Affiliation(s)
- Ahmed A Othman
- Clinical Pharmacology and Pharmacometrics, AbbVie, North Chicago, IL, USA
| | - Matthew Rosebraugh
- Clinical Pharmacology and Pharmacometrics, AbbVie, North Chicago, IL, USA
| | - Krai Chatamra
- Former Employee of Neuroscience Development, AbbVie, North Chicago, IL, USA
| | - Charles Locke
- Clinical Pharmacology and Pharmacometrics, AbbVie, North Chicago, IL, USA
| | - Sandeep Dutta
- Former Employee of Clinical Pharmacology and Pharmacometrics, AbbVie, North Chicago, IL, USA
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Catalán MJ, Antonini A, Calopa M, Băjenaru O, de Fábregues O, Mínguez-Castellanos A, Odin P, García-Moreno JM, Pedersen SW, Pirtošek Z, Kulisevsky J. Can suitable candidates for levodopa/carbidopa intestinal gel therapy be identified using current evidence? eNeurologicalSci 2017; 8:44-53. [PMID: 29260038 PMCID: PMC5730910 DOI: 10.1016/j.ensci.2017.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 01/24/2023] Open
Abstract
Advanced Parkinson's disease (APD) is characterized by increased functional disability, caused by motor complications, the presence of axial symptoms, and emergent disease- and drug-related non-motor symptoms. One of the advanced therapies available is intrajejunal infusion of levodopa/carbidopa intestinal gel (LCIG); however, patient selection for this treatment is sometimes difficult, particularly because of overlapping indications with other alternatives. In recent years, strong evidence has supported the use of LCIG in treating motor fluctuations associated with APD, and several clinical studies provide emerging evidence for additional benefits of LCIG treatment in certain patients. This article provides an overview of the published literature on the benefits, limitations, and drawbacks of LCIG in relation to PD symptoms, the psychosocial impact of the disease, and the quality of life of patients, with the aim of determining candidates for whom treatment with LCIG would be beneficial. According to current evidence, patients with APD (defined as inability to achieve optimal control of the disease with conventional oral treatment), a relatively well-preserved cognitive-behavioral status, and good family/caregiver would count as suitable candidates for LCIG treatment. Contraindications in the opinion of the authors are severe dementia and active psychosis.
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Key Words
- APD, Advanced Parkinson's disease
- DBS, Deep brain stimulation
- Duodopa
- ICD, Impulse control disorders
- Intrajejunal infusion of levodopa/carbidopa intestinal gel
- LCIG, Levodopa-carbidopa intestinal gel
- Motor symptoms
- NMS, Non-motor symptoms
- NMSS, Non-motor symptoms scale
- Non-motor symptoms
- PD, Parkinson's disease
- PDSS, Parkinson's disease sleep scale
- PEG, Percutaneous endoscopic gastrostomy
- Parkinson's disease
- QoL, Quality of life
- Quality of life
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Affiliation(s)
- Maria José Catalán
- Parkinson and Movement Disorders Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences, IRCCS Hospital San Camillo, Venice, Italy
| | | | - Ovidiu Băjenaru
- University of Medicine and Pharmacy "Carol Davila" Bucharest - University Emergency Hospital, Department of Neurology, Bucharest, Romania
| | - Oriol de Fábregues
- Vall d'Hebron University Hospital, Neurology Service, Movement Disorders Unit, Autonomous University of Barcelona, Neurodegenerative Diseases Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Adolfo Mínguez-Castellanos
- Complejo Hospitalario Universitario de Granada, Instituto de Investigación Biosanitaria "ibs. Granada,", Granada, Spain
| | - Per Odin
- Skåne University Hospital, Lund University, Lund, Sweden.,Klinikum-Bremerhaven, Bremerhaven, Germany
| | | | | | | | - Jaime Kulisevsky
- Hospital Santa Creu i Sant Pau, Ciberned, Universitat Autònoma de Barcelona, Universitat Oberta de Catalunya, Barcelona, Spain
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Montgomery ML, Miner NK, Soileau MJ, McDonald DK. Placement of the AbbVie PEG-J tube for the treatment of Parkinson's disease in the interventional radiology suite. Proc (Bayl Univ Med Cent) 2017; 29:420-422. [PMID: 27695184 DOI: 10.1080/08998280.2016.11929495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The primary treatment for Parkinson's disease is dopaminergic stimulation. Although levodopa has historically been administered orally, maintaining a predictable plasma concentration of the drug is challenging. As a result, enteral administration of carbidopa/levodopa (Duopa) has emerged as a promising tool in the treatment of the disease. This requires placement of an enteric catheter, two of which have been approved by the Food and Drug Administration for delivery of Duopa. The approved tubes are placed using the "peroral" or "pull" technique, a method traditionally requiring endoscopy. This technical note describes placement of the AbbVie PEG-J tube by means of the peroral route while utilizing only sonographic and fluoroscopic guidance. After placing an orogastric tube and achieving percutaneous access to the stomach under fluoroscopic visualization, a snare catheter is advanced through the percutaneous access into the stomach. The orogastric tube is engaged with the snare and retracted, bringing the attached snare with it to the mouth. The AbbVie PEG tube is attached to the snare, pulled back down the esophagus and into the stomach before being retracted through the percutaneous access to the skin. Finally, the AbbVie J tube is advanced through the gastrostomy tube into the proximal jejunum and attached with the provided connectors. As demonstrated, the AbbVie PEG-J tube can be placed safely and effectively using a percutaneous image-guided technique without the use of an endoscope.
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Affiliation(s)
- Mark L Montgomery
- Departments of Radiology (Montgomery, McDonald) and Neurology (Soileau), Baylor Scott and White Health, Temple, Texas; and Texas A&M Health Science Center College of Medicine, Temple, Texas (Montgomery, Miner, Soileau, McDonald)
| | - Noel K Miner
- Departments of Radiology (Montgomery, McDonald) and Neurology (Soileau), Baylor Scott and White Health, Temple, Texas; and Texas A&M Health Science Center College of Medicine, Temple, Texas (Montgomery, Miner, Soileau, McDonald)
| | - Michael J Soileau
- Departments of Radiology (Montgomery, McDonald) and Neurology (Soileau), Baylor Scott and White Health, Temple, Texas; and Texas A&M Health Science Center College of Medicine, Temple, Texas (Montgomery, Miner, Soileau, McDonald)
| | - Douglas K McDonald
- Departments of Radiology (Montgomery, McDonald) and Neurology (Soileau), Baylor Scott and White Health, Temple, Texas; and Texas A&M Health Science Center College of Medicine, Temple, Texas (Montgomery, Miner, Soileau, McDonald)
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Lowin J, Sail K, Baj R, Jalundhwala YJ, Marshall TS, Konwea H, Chaudhuri KR. The cost-effectiveness of levodopa/carbidopa intestinal gel compared to standard care in advanced Parkinson's disease. J Med Econ 2017; 20:1207-1215. [PMID: 28895769 DOI: 10.1080/13696998.2017.1379411] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is an incurable, progressive neurological condition, with symptoms impacting movement, walking, and posture that eventually become severely disabling. Advanced PD (aPD) has a significant impact on quality-of-life (QoL) for patients and their caregivers/families. Levodopa/carbidopa intestinal gel (LCIG) is indicated for the treatment of advanced levodopa-responsive PD with severe motor fluctuations and hyper-/dyskinesia when available combinations of therapy have not given satisfactory results. AIMS To determine the cost-effectiveness of LCIG vs standard of care (SoC) for the treatment of aPD patients. METHODS A Markov model was used to evaluate LCIG vs SoC in a hypothetical cohort of 100 aPD patients with severe motor fluctuations from an Irish healthcare perspective. Model health states were defined by Hoehn & Yahr (H&Y) scale-combined with amount of time in OFF-time-and death. SoC comprised of standard oral therapy ± subcutaneous apomorphine infusion and standard follow-up visits. Clinical efficacy, utilities, and transition probabilities were derived from published studies. Resource use was estimated from individual patient-level data from Adelphi 2012 UK dataset, using Irish costs, where possible. Time horizon was 20 years. Costs and outcomes were discounted at 4%. Both one-way and probabilistic sensitivity analyses were conducted. RESULTS The incremental cost-effectiveness ratio for LCIG vs SOC was €26,944/quality adjusted life year (QALY) (total costs and QALYs for LCIG vs SoC: €537,687 vs €514,037 and 4.37 vs 3.49, respectively). LCIG is cost-effective at a payer threshold of €45,000. The model was most sensitive to health state costs. CONCLUSION LCIG is a cost-effective treatment option compared with SoC in patients with aPD.
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Affiliation(s)
| | | | | | | | | | | | - K R Chaudhuri
- d National Parkinson Foundation Centre of Excellence, King's College Hospital and King's College London , London , UK
- e University Hospital Lewisham , London , UK
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Kataoka H, Sawada Y, Namizaki T, Shimozato N, Yoshiji H, Ueno S. Intrajejunal Infusion of Levodopa-Carbidopa Gel Can Continuously Reduce the Severity of Dropped Head in Parkinson's Disease. Front Neurol 2017; 8:547. [PMID: 29085331 PMCID: PMC5650705 DOI: 10.3389/fneur.2017.00547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 09/27/2017] [Indexed: 02/04/2023] Open
Abstract
Dropped head can occur in patients with Parkinson’s disease and make their quality of life unpleasant because they cannot obtain a frontal view. The pathophysiologic involvement of dopamine agonist or central or peripheral mechanisms has been proposed. Levodopa therapy with the withdrawal of dopamine agonists was sometimes effective, but the effect in most patients did not persist for the entire day. We describe a patient with Parkinson’s disease whose dropped head responded throughout the day to the continuous intrajejunal infusion of levodopa-carbidopa intestinal gel (LCIG). During off-periods before treatment with LCIG, severe akinesia and freezing of gait were evident, and she could not continuously obtain a frontal view because of the dropped head. About 20 min after the intrajejunal infusion of LCIG, these features remarkably improved, and she could obtain a frontal view. The angle of dropped head was improved from 39.39 to 14.04°. This case suggests that infusion of LCIG can reduce the severity of dropped head for a longer period than oral levodopa.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Yasuhiko Sawada
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Tadashi Namizaki
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Naotaka Shimozato
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Hitoshi Yoshiji
- Third Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Satoshi Ueno
- Department of Neurology, Nara Medical University, Kashihara, Japan
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Virhammar J, Nyholm D. Levodopa-carbidopa enteral suspension in advanced Parkinson's disease: clinical evidence and experience. Ther Adv Neurol Disord 2016; 10:171-187. [PMID: 28344656 DOI: 10.1177/1756285616681280] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The duration of action of oral levodopa becomes shorter as Parkinson's disease (PD) progresses. Patients with advanced PD may develop potentially disabling motor fluctuations and abnormal involuntary movement (dyskinesia), which cannot be managed with optimized oral or transdermal PD medications. The progressively worsening symptoms can have a substantial impact on the patient quality of life (QoL). Levodopa-carbidopa intestinal gel (LCIG) is delivered continuously via a percutaneous endoscopic gastrostomy with a jejunal extension (PEG-J). LCIG is licensed for the treatment of levodopa-responsive advanced PD in individuals experiencing severe motor fluctuations and dyskinesia when available combinations of antiparkinsonian medications have not given satisfactory results. Initial evidence for the efficacy and tolerability of LCIG came from a number of small-scale studies, but recently, three prospective studies have provided higher quality evidence. A 12-week double-blind comparison of LCIG with standard levodopa therapy, a 52-week open-label study extension of the double-blind study, and a 54-week open-label safety study, demonstrated significant improvements in 'off' time and 'on' time without troublesome dyskinesia, and QoL measures that were maintained in the longer term. There are also observations that LCIG may be effective treatment for nonmotor symptoms (NMS) although the evidence is limited. There is a need for further research on the efficacy of LCIG in reducing NMS, dyskinesia and improving QoL. This review surveys the clinical evidence for the effectiveness and tolerability of LCIG in the management of advanced PD and highlights some practical considerations to help optimize treatment.
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Affiliation(s)
- Johan Virhammar
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University Hospital, 751 85 Uppsala, Sweden
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Politis M, Sauerbier A, Loane C, Pavese N, Martin A, Corcoran B, Brooks DJ, Ray-Chaudhuri K, Piccini P. Sustained striatal dopamine levels following intestinal levodopa infusions in Parkinson's disease patients. Mov Disord 2016; 32:235-240. [PMID: 27859651 DOI: 10.1002/mds.26848] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The objective of this study was to investigate in vivo the ability of levodopa/carbidopa intestinal gel infusions to produce sustained striatal dopamine levels and to improve clinical outcomes in Parkinson's disease patients. METHODS Six advanced Parkinson's disease patients had serial [11 C]raclopride PET to assess levodopa/carbidopa intestinal gel infusion-induced rises in striatal dopamine as reflected by a fall in dopamine-D2/3 receptor availability. Parkinson's disease patients had baseline scan OFF-dopaminergic stimulation and 2 scans following initiation of levodopa/carbidopa intestinal gel infusions. Striatal D2/3 binding was measured in striatal subregions corresponding to sensorimotor, limbic, and cognitive/associative function. RESULTS Mean striatal [11 C]raclopride nondisplaceable binding potential decreased by 14.0% to 16.7% in sensorimotor, 12.0%-14.4% in limbic, and 8.7%-11.6% in cognitive/associative function subregions at 1- to 10-hour points (P < 0.01). Sensorimotor subregion [11 C]raclopride nondisplaceable binding potential reductions correlated with reductions in Unified Parkinson's Disease Rating Scale Part III scores over the course of the infusion (r = 0.81; P < 0.05). CONCLUSIONS Levodopa/carbidopa intestinal gel infusions generate a stable rise in striatal dopamine levels and are associated with improvements in motor manifestations. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Marios Politis
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,Parkinson's Centre of Excellence, Department of Neurology, King's College Hospital Foundation Trust, London, UK.,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Anna Sauerbier
- Parkinson's Centre of Excellence, Department of Neurology, King's College Hospital Foundation Trust, London, UK.,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Clare Loane
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,Memory Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU
| | - Nicola Pavese
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK.,Department of Nuclear Medicine, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne Martin
- Parkinson's Centre of Excellence, Department of Neurology, King's College Hospital Foundation Trust, London, UK
| | - Benjamin Corcoran
- Department of Nuclear Medicine, King's College Hospital Foundation Trust, London, UK
| | - David J Brooks
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK.,Department of Nuclear Medicine, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Division of Neurology, Newcastle University, Newcastle upon Tyne, UK
| | - K Ray-Chaudhuri
- Parkinson's Centre of Excellence, Department of Neurology, King's College Hospital Foundation Trust, London, UK.,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Paola Piccini
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
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Abstract
Levodopa remains the most effective treatment for Parkinson's disease and is considered the gold standard therapy. However, disease progression and changes in the gastrointestinal tract result in a declining window of treatment response in a majority of patients. Efforts have been made recently to improve levodopa bioavailability either by developing more effective oral formulations or by innovating routes of administration (intestinal infusion, transcutaneous or inhaled levodopa). IPX066 is a novel levodopa-carbidopa (LD/CD) oral formulation combining immediate-release (IR) and extended-release (ER) LD/CD recently approved in the USA and the EU. Levodopa-carbidopa intestinal gel (LCIG) is an approved therapy consisting of a suspension of levodopa and carbidopa infused directly into the proximal jejunum via a percutaneous endoscopic gastrojejunostomy (PEG-J) tube through a portable infusion pump. Ongoing studies are evaluating the 'accordion pill' (AP09004), an ER LD/CD formulation with gastroretentive properties. ND0612 is a proprietary liquid formulation of LD/CD that enables subcutaneous administration via a small patch-pump device, and CVT-301 is a levodopa inhalation powder with rapid onset of action; both are currently in active studies. Other novel formulations have been discontinued, including DM-1992, which is a bilayer formulation containing an IR LD/CD layer and an ER LD/CD layer with gastroretentive properties, and XP21279, a novel oral levodopa prodrug that is absorbed from the small and large intestine by high-capacity nutrient transporters expressed throughout the gastrointestinal system. ODM-101 is a new oral formulation of levodopa/carbidopa/entacapone that contains a higher amount of carbidopa (65 or 105 mg), but no active studies are underway. The current review aims to summarize the pharmacokinetic aspects, clinical efficacy, and potential adverse events of novel levodopa formulations currently available or under development.
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Rizek P, Kumar N, Jog MS. An update on the diagnosis and treatment of Parkinson disease. CMAJ 2016; 188:1157-1165. [PMID: 27221269 DOI: 10.1503/cmaj.151179] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Philippe Rizek
- Department of Clinical Neurological Sciences, Western University, London, Ont
| | - Niraj Kumar
- Department of Clinical Neurological Sciences, Western University, London, Ont
| | - Mandar S Jog
- Department of Clinical Neurological Sciences, Western University, London, Ont.
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27
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Othman AA, Chatamra K, Mohamed MEF, Dutta S, Benesh J, Yanagawa M, Nagai M. Jejunal Infusion of levodopa-carbidopa intestinal gel versus oral administration of levodopa-carbidopa tablets in japanese subjects with advanced Parkinson's disease: pharmacokinetics and pilot efficacy and safety. Clin Pharmacokinet 2016; 54:975-84. [PMID: 25875940 PMCID: PMC4559582 DOI: 10.1007/s40262-015-0265-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background and Objective Oral levodopa-carbidopa (LC-oral) treatment in advanced Parkinson’s disease (PD) is associated with motor complications due to large fluctuations in levodopa plasma concentrations. Levodopa–carbidopa intestinal gel (LCIG) provides individualized continuous levodopa–carbidopa delivery through intrajejunal infusion. This study evaluated the pharmacokinetics, safety, and efficacy of LCIG relative to LC-oral in Japanese subjects with advanced PD. Methods Subjects with advanced PD were converted from their anti-PD medications to individually optimized doses of LC-oral (10:1 levodopa:carbidopa ratio) for 28 days (baseline; period 1) followed by switching to intrajejunal infusion of LCIG (4:1 ratio) for 21 days (period 2). Pharmacokinetics, adverse events (AEs), and efficacy were assessed. Results Eight patients were enrolled. Six received LCIG and four reported at least one AE [most common: fall (33.3 %), dyskinesia (33.3 %)]; one discontinued due to an AE. The average daily dose was 1230/123 and 1370/342 mg levodopa/carbidopa for LC-oral and LCIG, respectively, at the end of each period. The degree of fluctuation and intra-subject variability of levodopa plasma concentrations were 5.5- and 4-fold lower, respectively, with LCIG than with LC-oral. Levodopa bioavailability was 99 % for LCIG relative to LC-oral. Compared with baseline, LCIG decreased “Off” time (2.68 h, P = 0.002) and increased “On” time without troublesome dyskinesia (2.35 h, P = 0.006) in the PD Diary©. With the small sample size, no statistically significant changes were seen on other efficacy endpoints. Conclusions In Japanese subjects with advanced PD, LCIG resulted in an improved pharmacokinetic profile that appeared to be associated with reduced motor complications compared with LC-oral. These results extend previous findings in mainly Caucasian populations.
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Affiliation(s)
- Ahmed A Othman
- Clinical Pharmacology and Pharmacometrics, AbbVie, 1 North Waukegan Road, Building AP13A-3, North Chicago, IL, 60064, USA,
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Greig SL. Carbidopa/levodopa enteral suspension in advanced Parkinson’s disease: a guide to its use. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0297-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jiménez-Jiménez FJ, Alonso-Navarro H, García-Martín E, Agúndez JAG. Advances in understanding genomic markers and pharmacogenetics of Parkinson's disease. Expert Opin Drug Metab Toxicol 2016; 12:433-48. [PMID: 26910127 DOI: 10.1517/17425255.2016.1158250] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The inheritance pattern of Parkinson's disease (PD) is likely multifactorial (owing to the interplay of genetic predisposition and environmental factors). Many pharmacogenetic studies have tried to establish a possible role of candidate genes in PD risk. Several studies have focused on the influence of genes in the response to antiparkinsonian drugs and in the risk of developing side-effects of these drugs. AREAS COVERED This review presents an overview of current knowledge, with particular emphasis on the most recent advances, both in case-control association studies on the role of candidate genes in the risk for PD as well as pharmacogenetic studies on the role of genes in the development of side effects of antiparkinsonian drugs. The most reliable results should be derived from meta-analyses of case-control association studies on candidate genes involving large series of PD patients and controls, and from genome-wide association studies (GWAS). EXPERT OPINION Prospective studies of large samples involving several genes with a detailed history of exposure to environmental factors in the same cohort of subjects, should be useful to clarify the role of genes in the risk for PD. The results of studies on the role of genes in the development of side-effects of antiparkinsonian drugs should, at this stage, only be considered preliminary.
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Affiliation(s)
| | | | | | - José A G Agúndez
- b Department of Pharmacology , University of Extremadura , Cáceres , Spain
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Li LS, Liu CZ, Xu JD, Zheng LF, Feng XY, Zhang Y, Zhu JX. Effect of entacapone on colon motility and ion transport in a rat model of Parkinson’s disease. World J Gastroenterol 2015; 21:3509-3518. [PMID: 25834315 PMCID: PMC4375572 DOI: 10.3748/wjg.v21.i12.3509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 11/05/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the effects of entacapone, a catechol-O-methyltransferase inhibitor, on colon motility and electrolyte transport in Parkinson’s disease (PD) rats.
METHODS: Distribution and expression of catechol-O-methyltransferase (COMT) were measured by immunohistochemistry and Western blotting methods. The colonic smooth muscle motility was examined in vitro by means of a muscle motility recording device. The mucosal electrolyte transport of PD rats was examined by using a short-circuit current (ISC) technique and scanning ion-selective electrode technique (SIET). Intracellular detection of cAMP and cGMP was accomplished by radioimmunoassay testing.
RESULTS: COMT was expressed in the colons of both normal and PD rats, mainly on the apical membranes of villi and crypts in the colon. Compared to normal controls, PD rats expressed less COMT. The COMT inhibitor entacapone inhibited contraction of the PD rat longitudinal muscle in a dose-dependent manner. The β2 adrenoceptor antagonist ICI-118,551 blocked this inhibitory effect by approximately 67% (P < 0.01). Entacapone increased mucosal ISC in the colon of rats with PD. This induction was significantly inhibited by apical application of Cl- channel blocker diphenylamine-2, 2’-dicarboxylic acid, basolateral application of Na+-K+-2Cl-co-transporter antagonist bumetanide, elimination of Cl- from the extracellular fluid, as well as pretreatment using adenylate cyclase inhibitor MDL12330A. As an inhibitor of prostaglandin synthetase, indomethacin can inhibit entacapone-induced ISC by 45% (P < 0.01). When SIET was applied to measure Cl- flux changes, this provided similar results. Entacapone significantly increased intracellular cAMP content in the colonic mucosa, which was greatly inhibited by indomethacin.
CONCLUSION: COMT expression exists in rat colons. The β2 adrenoceptor is involved in the entacapone-induced inhibition of colon motility. Entacapone induces cAMP-dependent Cl- secretion in the PD rat.
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LeWitt PA. Levodopa therapy for Parkinson's disease: Pharmacokinetics and pharmacodynamics. Mov Disord 2014; 30:64-72. [PMID: 25449210 DOI: 10.1002/mds.26082] [Citation(s) in RCA: 215] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 10/09/2014] [Accepted: 10/16/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Peter A LeWitt
- Parkinson's Disease and Movement Disorders Center, Henry Ford Hospital, West Bloomfield, Michigan, and the Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Ondo W. IPX066 , a mixed immediate/sustained-release levodopa preparation for Parkinson's disease. Expert Opin Pharmacother 2014; 15:2081-5. [PMID: 25146967 DOI: 10.1517/14656566.2014.950224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION L-DOPA has long been the 'gold standard' treatment for Parkinson's disease (PD), but suffers from poor oral bioavailability and rapid pharmacokinetic elimination. A longer acting preparation has long been sought. AREAS COVERED We conducted PubMed search for IPX066 and reviewed abstracts from meetings that included the topic of PD. IPX066 is a novel mixed immediate release (IR) and sustained-release levodopa preparation designed to prolong the clinical effect of a single dose. Pharmacokinetic studies demonstrate similar time to peak dose as regular IR L-DOPA, but a longer duration of time with > 50% of peak dose. This contrasts with available controlled release preparations that have a delay to onset. Clinic trials in fluctuating PD patients show that IPX066 provided more 'on' time despite fewer daily doses, compared to IR L-DOPA. As expected, it was also superior to placebo in early PD. However, it is not known whether it can achieve l-DOPA levels that are continuous enough to delay the onset of fluctuations when given early in the disease. EXPERT OPINION Although not a radical advance in L-DOPA therapy, the drug will clearly have a role in more advanced patients taking multiple L-DOPA doses and may have a role as first-line therapy when starting l-DOPA.
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Affiliation(s)
- William Ondo
- University of Texas Health Science Center , 6410 Fannin St, Suite 1014, Houston, TX 77030 , USA +1 832 325 7080 ;
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