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Bergquist F, Ehrnebo M, Nyholm D, Johansson A, Lundin F, Odin P, Svenningsson P, Dizdar N, Eriksson E. Motor Efficacy of Subcutaneous DIZ102, Intravenous DIZ101 or Intestinal Levodopa/Carbidopa Infusion. Mov Disord Clin Pract 2024; 11:1095-1102. [PMID: 38924339 PMCID: PMC11452806 DOI: 10.1002/mdc3.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/23/2024] [Accepted: 05/13/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND It has been suggested that carbidopa at high blood concentrations may counter the therapeutic effect of levodopa in Parkinson's disease by entering the brain and blocking central levodopa conversion to dopamine. We previously demonstrated equivalent plasma levodopa concentration in patients with Parkinson's disease during 16 h of (1) intravenous carbidopa/levodopa (DIZ101) infusion, (2) subcutaneous carbidopa/levodopa (DIZ102) infusion or (3) intestinal carbidopa/levodopa gel infusion. Plasma levels of carbidopa were however approximately four times higher with DIZ101 and DIZ102 than with LCIG, and higher than those usually observed with oral levodopa/carbidopa. OBJECTIVES To investigate if high carbidopa blood concentrations obtained with parenteral levodopa/carbidopa (ratio 8:1) counter the effect of levodopa on motor symptoms. METHODS Eighteen patients with advanced Parkinson's disease were administered DIZ101, DIZ102, and intestinal levodopa/carbidopa gel for 16 h on different days in randomized order. Video recordings of a subset of the motor examination in the Unified Parkinson's Disease Rating Scale (UPDRS) were evaluated by raters blinded for treatment and time. Motor function was also measured using a wrist-worn device monitoring bradykinesia, dyskinesia, and tremor (Parkinson KinetiGraph). RESULTS There was no tendency for poorer levodopa effect with DIZ101 or DIZ102 as compared to LCIG. CONCLUSION Although DIZ101 or DIZ102 causes approximately four times higher plasma carbidopa levels than LCIG, patients responded equally well to all treatments. The results do not indicate that high plasma carbidopa levels hamper the motor efficacy of levodopa.
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Affiliation(s)
- Filip Bergquist
- Department of PharmacologyUniversity of GothenburgGothenburgSweden
- Sahlgrenska University HospitalGothenburgSweden
| | - Mats Ehrnebo
- Department of Pharmaceutical BiosciencesUppsala UniversityUppsalaSweden
- Ehrnebo Development ABUppsalaSweden
| | - Dag Nyholm
- Department of Medical Sciences, NeurologyUppsala UniversityUppsalaSweden
| | - Anders Johansson
- Department of Clinical NeurosciencesKarolinska InstitutetStockholmSweden
| | - Fredrik Lundin
- Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Per Odin
- Division of Neurology, Department of Clinical SciencesLund UniversityLundSweden
| | - Per Svenningsson
- Department of Clinical NeurosciencesKarolinska InstitutetStockholmSweden
| | - Nil Dizdar
- Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Elias Eriksson
- Department of PharmacologyUniversity of GothenburgGothenburgSweden
- Sahlgrenska University HospitalGothenburgSweden
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Benvenuti L, Di Salvo C, Bellini G, Seguella L, Rettura F, Esposito G, Antonioli L, Ceravolo R, Bernardini N, Pellegrini C, Fornai M. Gut-directed therapy in Parkinson's disease. Front Pharmacol 2024; 15:1407925. [PMID: 38974034 PMCID: PMC11224490 DOI: 10.3389/fphar.2024.1407925] [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: 03/27/2024] [Accepted: 05/17/2024] [Indexed: 07/09/2024] Open
Abstract
Parkinson's disease (PD) is a common and slow-progressing neurodegenerative disorder characterized by motor and non-motor symptoms, including gastrointestinal (GI) dysfunctions. Over the last years, the microbiota-gut-brain (MGB) axis is emerging as a bacterial-neuro-immune ascending pathway that contributes to the progression of PD. Indeed, PD patients are characterized by changes in gut microbiota composition, alterations of intestinal epithelial barrier (IEB) and enteric neurogenic/inflammatory responses that, besides determining intestinal disturbances, contribute to brain pathology. In this context, despite the causal relationship between gut dysbiosis, impaired MGB axis and PD remains to be elucidated, emerging evidence shows that MGB axis modulation can represent a suitable therapeutical strategy for the treatment of PD. This review provides an overview of the available knowledge about the beneficial effects of gut-directed therapies, including dietary interventions, prebiotics, probiotics, synbiotics and fecal microbiota transplantation (FMT), in both PD patients and animal models. In this context, particular attention has been devoted to the mechanisms by which the modulation of MGB axis could halt or slow down PD pathology and, most importantly, how these approaches can be included in the clinical practice.
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Affiliation(s)
- Laura Benvenuti
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Clelia Di Salvo
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Bellini
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luisa Seguella
- Department of Physiology and Pharmacology “V.Erspamer”, Sapienza University of Rome, Rome, Italy
| | - Francesco Rettura
- Unit of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giuseppe Esposito
- Department of Physiology and Pharmacology “V.Erspamer”, Sapienza University of Rome, Rome, Italy
| | - Luca Antonioli
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberto Ceravolo
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nunzia Bernardini
- Unit of Histology and Medical Embryology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carolina Pellegrini
- Unit of Histology and Medical Embryology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Matteo Fornai
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Viljaharju V, Mertsalmi T, Pauls KAM, Koivu M, Eerola‐Rautio J, Udd M, Pekkonen E. Levodopa-Entacapone-Carbidopa Intestinal Gel Treatment in Advanced Parkinson's Disease: A Single-Center Study of 30 Patients. Mov Disord Clin Pract 2024; 11:159-165. [PMID: 38386490 PMCID: PMC10883392 DOI: 10.1002/mdc3.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Levodopa-entacapone-carbidopa intestinal gel (LECIG) is a novel device assisted treatment option for advanced Parkinson's disease (PD). It has been available in Finland since 2020. There is paucity of scientific studies considering LECIG treatment in clinical practice. OBJECTIVES Objectives of this study were to evaluate the changes in medication, adverse events and early discontinuations of LECIG treatment in real life clinical practice. METHODS The records of 30 consecutive patients, who received LECIG between years 2020 and 2022 in Helsinki University Hospital, were retrospectively analyzed. Data considering changes in medication, discontinuations, and adverse events during the first six months of LECIG treatment was collected. RESULTS Mean levodopa equivalent daily dose (LEDD) rose significantly between baseline before LECIG and six months with treatment (1230 mg vs. 1570 mg, P = 0.001). Three patients were discarded during nasojejunal tube test phase and seven discontinued the treatment during six-month follow-up. Most common reasons for discontinuation were difficulty in finding suitable infusion rate and neuropsychiatric problems. Safety issues encountered were similar to those reported with levodopa-carbidopa intestinal gel (LCIG) treatment. One case of rhabdomyolysis due to severe dyskinesia during LECIG treatment was observed. Patients were satisfied with the small size of the pump system. CONCLUSIONS LEDD seems to increase during the first months of LECIG treatment. When compared to studies on LCIG, safety profile of LECIG appears similar, but early discontinuation rate is higher than expected. However, long-term studies are lacking. Only clear advantage to LCIG appears to be the smaller LECIG pump size.
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Affiliation(s)
- Vili Viljaharju
- Department of NeurologyHelsinki University HospitalHelsinkiFinland
- Department of Clinical Neurosciences (Neurology)University of HelsinkiHelsinkiFinland
| | - Tuomas Mertsalmi
- Department of NeurologyHelsinki University HospitalHelsinkiFinland
- Department of Clinical Neurosciences (Neurology)University of HelsinkiHelsinkiFinland
| | - K. Amande M. Pauls
- Department of NeurologyHelsinki University HospitalHelsinkiFinland
- Department of Clinical Neurosciences (Neurology)University of HelsinkiHelsinkiFinland
| | - Maija Koivu
- Department of NeurologyHelsinki University HospitalHelsinkiFinland
- Department of Clinical Neurosciences (Neurology)University of HelsinkiHelsinkiFinland
| | - Johanna Eerola‐Rautio
- Department of NeurologyHelsinki University HospitalHelsinkiFinland
- Department of Clinical Neurosciences (Neurology)University of HelsinkiHelsinkiFinland
| | - Marianne Udd
- Department of Gastroenterological SurgeryHelsinki University HospitalHelsinkiFinland
| | - Eero Pekkonen
- Department of NeurologyHelsinki University HospitalHelsinkiFinland
- Department of Clinical Neurosciences (Neurology)University of HelsinkiHelsinkiFinland
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Rinaldi D, Imbalzano G, Galli S, Bianchini E, Ledda C, De Carolis L, Zibetti M, Lopiano L, Pontieri FE, Artusi CA. The impact of dysphagia in Parkinson's disease patients treated with levodopa/carbidopa intestinal gel. Parkinsonism Relat Disord 2023; 109:105368. [PMID: 36933499 DOI: 10.1016/j.parkreldis.2023.105368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Dysphagia is common in advanced phases of Parkinson disease (PD), and is a risk factor for aspiration pneumonia. Nonetheless, dysphagia has been poorly investigated in PD patients treated with levodopa-carbidopa intestinal gel (LCIG). We aimed to analyze the impact of dysphagia on mortality in LCIG treated patients and its relationship with other PD disability milestones. METHODS We retrospectively evaluated 95 consecutive PD patients treated with LCIG. Kaplan-Meier and log-rank test were used to compare mortality in patients with dysphagia from others. Cox regression was used to estimate the impact of dysphagia, age, disease duration, and Hoehn and Yahr (H&Y) on mortality in the entire cohort. Finally, univariate and multivariate regression analyses were used to estimate the association between dysphagia and age, disease duration, H&Y, hallucinations, and dementia. RESULTS A significantly higher mortality rate was observed in patients with dysphagia. In the Cox model, dysphagia was the only feature significantly associated with mortality (95%CI 2.780-20.609; p < 0.001). Univariate analyses showed a significant correlation between dysphagia and dementia (OR: 0.387; p:0.033), hallucinations (OR: 0.283; p:0.009), and H&Y score (OR: 2.680; p < 0.001); in the multivariate analysis, only the H&Y stage was associated with the presence of dysphagia (OR: 2.357; p:0.003). CONCLUSION Dysphagia significantly increased the risk of death in our cohort of LCIG-treated patients, independently from other relevant features such as age, disease duration, dementia, and hallucinations. These findings support the management of this symptom as a priority in the advanced PD stages, even in people treated with LCIG.
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Affiliation(s)
- Domiziana Rinaldi
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Via di Grottarossa, 1035-00189, Roma, Italy; Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU City of Health and Science, Turin, Italy
| | - Silvia Galli
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Via di Grottarossa, 1035-00189, Roma, Italy
| | - Edoardo Bianchini
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Via di Grottarossa, 1035-00189, Roma, Italy
| | - Claudia Ledda
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU City of Health and Science, Turin, Italy
| | - Lanfranco De Carolis
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Via di Grottarossa, 1035-00189, Roma, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU City of Health and Science, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU City of Health and Science, Turin, Italy
| | - Francesco Ernesto Pontieri
- Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso, Sapienza Università di Roma, Via di Grottarossa, 1035-00189, Roma, Italy; Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; SC Neurologia 2U, AOU City of Health and Science, Turin, Italy.
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Bergquist F, Ehrnebo M, Nyholm D, Johansson A, Lundin F, Odin P, Svenningsson P, Hansson F, Bring L, Eriksson E, Dizdar N. Pharmacokinetics of Intravenously (DIZ101), Subcutaneously (DIZ102), and Intestinally (LCIG) Infused Levodopa in Advanced Parkinson Disease. Neurology 2022; 99:e965-e976. [PMID: 35705502 PMCID: PMC9519246 DOI: 10.1212/wnl.0000000000200804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Intestinal levodopa/carbidopa gel infusion (LCIG) is superior to oral treatment in advanced Parkinson disease. The primary objective of this trial was to investigate whether continuous subcutaneous or intravenous infusion with a continuously buffered acidic levodopa/carbidopa solution yields steady-state plasma concentrations of levodopa that are equivalent in magnitude, and noninferior in variability, to those obtained with LCIG in patients with advanced Parkinson disease. METHODS A concentrated acidic levodopa/carbidopa (8:1) solution buffered continuously and administered intravenously (DIZ101) or subcutaneously (DIZ102) was compared with an approved LCIG in a randomized, 3-period crossover, open-label, multicenter trial. Formulations were infused for 16 hours to patients with Parkinson disease who were using LCIG as their regular treatment. Patients were recruited from several university neurology clinics but came to the same phase I unit for treatment. Pharmacokinetic variables and safety including dermal tolerance are reported. The primary outcomes were bioequivalence and noninferior variability of DIZ101 and DIZ102 vs LCIG with respect to levodopa plasma concentrations. RESULTS With dosing adjusted to estimated bioavailability, DIZ101 and DIZ102 produced levodopa plasma levels within standard bioequivalence limits compared with LCIG in the 18 participants who received all treatments. Although the levodopa bioavailability for DIZ102 was complete, it was 80% for LCIG. Therapeutic concentrations of levodopa were reached as quickly with subcutaneous administration of DIZ102 as with LCIG and remained stable throughout the infusions. Owing to poor uptake of LCIG, carbidopa levels in plasma were higher with DIZ101 and DIZ102 than with the former. All individuals receiving any of the treatments (n = 20) were included in the evaluation of safety and tolerability. Reactions at the infusion sites were mild and transient. DISCUSSION It is feasible to rapidly achieve high and stable levodopa concentrations by means of continuous buffering of a subcutaneously administered acidic levodopa/carbidopa-containing solution. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov identifier: NCT03419806. Registration first posted on February 5, 2018, first patient enrolled on February 16, 2018.
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Affiliation(s)
- Filip Bergquist
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden.
| | - Mats Ehrnebo
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Dag Nyholm
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Anders Johansson
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Fredrik Lundin
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Per Odin
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Per Svenningsson
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Fredrik Hansson
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Leif Bring
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Elias Eriksson
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
| | - Nil Dizdar
- From the Department of Pharmacology (F.B., E.E.), University of Gothenburg; Neurology (F.B.), Sahlgrenska University Hospital, Göteborg; Department of Pharmaceutical Biosciences (M.E.), Uppsala University; Pharm Assist Sweden AB (M.E.), Uppsala; Department of Neuroscience (D.N.), Uppsala University; Department of Clinical Neurosciences (A.J., P.S.), Karolinska Institutet (A.J., P.S.), Solna; Department of Biomedical and Clinical Sciences (F.L., N.D.), Linköping University (F.L., N.D.); Neurology (P.O.), Department of Clinical Sciences, Lund University; CTC Clinical Trial Consultants AB (F.H.), Uppsala; and Dizlin Pharmaceuticals (L.B.) Gothenburg, Sweden
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Long-term safety, discontinuation and mortality in an Italian cohort with advanced Parkinson's disease on levodopa/carbidopa intestinal gel infusion. J Neurol 2022; 269:5606-5614. [PMID: 35876875 PMCID: PMC9309989 DOI: 10.1007/s00415-022-11269-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Abstract
Introduction Levodopa/carbidopa intestinal gel (LCIG) is an effective treatment in patients with advanced Parkinson’s disease (PD) with consolidated evidence of clinical efficacy. However, only few studies have assessed long-term safety, causes of discontinuation, mortality, and relative predictors. Methods We conducted a retrospective analysis of 79 PD patients treated with LCIG between 2005 and 2020 in two Italian Neurological Centers, recording all adverse events (AEs), including weight loss (WL). Kaplan–Meier curve was used to estimate the time to discontinuation and survival. Cox proportional hazard model was employed to identify predictors of discontinuation and mortality, while Pearson’s correlation was used to analyze predictors of WL. Results The average follow-up was 47.7 ± 40.5 months and the median survival from disease onset was 25 years. There were three cases of polyradiculoneuropathy Guillain–Barre syndrome-like, all occurred in the early years of LCIG treatment. Twenty-five patients died (32%), 18 on LCIG (including one suicide) and seven after discontinuation. The mean WL was 3.62 ± 7.5 kg, which correlated with levodopa dose at baseline (p = 0.002), levodopa equivalent daily dose (LEDD) baseline (p = 0.017) and off-duration (p = 0.0014), but not dyskinesia. Peristomal complications emerged as a negative predictor of discontinuation (p = 0.008). Conclusions LCIG has a relatively satisfactory long-term safety profile and efficacy and a relatively low rate of discontinuation. Peristomal complications may represent a predictor of longer duration of therapy. According to the mortality analysis, LCIG patients show a long lifespan. Delaying the initiation of LCIG does not affect the sustainability of LCIG therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11269-7.
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Vidović M, Rikalovic MG. Alpha-Synuclein Aggregation Pathway in Parkinson's Disease: Current Status and Novel Therapeutic Approaches. Cells 2022; 11:cells11111732. [PMID: 35681426 PMCID: PMC9179656 DOI: 10.3390/cells11111732] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 01/27/2023] Open
Abstract
Following Alzheimer’s, Parkinson’s disease (PD) is the second-most common neurodegenerative disorder, sharing an unclear pathophysiology, a multifactorial profile, and massive social costs worldwide. Despite this, no disease-modifying therapy is available. PD is tightly associated with α-synuclein (α-Syn) deposits, which become organised into insoluble, amyloid fibrils. As a typical intrinsically disordered protein, α-Syn adopts a monomeric, random coil conformation in an aqueous solution, while its interaction with lipid membranes drives the transition of the molecule part into an α-helical structure. The central unstructured region of α-Syn is involved in fibril formation by converting to well-defined, β-sheet rich secondary structures. Presently, most therapeutic strategies against PD are focused on designing small molecules, peptides, and peptidomimetics that can directly target α-Syn and its aggregation pathway. Other approaches include gene silencing, cell transplantation, stimulation of intracellular clearance with autophagy promoters, and degradation pathways based on immunotherapy of amyloid fibrils. In the present review, we sum marise the current advances related to α-Syn aggregation/neurotoxicity. These findings present a valuable arsenal for the further development of efficient, nontoxic, and non-invasive therapeutic protocols for disease-modifying therapy that tackles disease onset and progression in the future.
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Affiliation(s)
- Marija Vidović
- Laboratory for Plant Molecular Biology, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Vojvode Stepe 444a, 11042 Belgrade, Serbia
- Correspondence: ; Tel.: +38-16-4276-3221
| | - Milena G. Rikalovic
- Environment and Sustainable Development, Singidunum Univeristy, Danijelova 32, 11010 Belgrade, Serbia;
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8
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Habet S. Clinical Pharmacology of Entacapone (Comtan) From the FDA Reviewer. Int J Neuropsychopharmacol 2022; 25:567-575. [PMID: 35302623 PMCID: PMC9352175 DOI: 10.1093/ijnp/pyac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 02/11/2022] [Accepted: 03/17/2022] [Indexed: 11/14/2022] Open
Abstract
This new drug application was first submitted to the US Food and Drug Administration (FDA) by the Orion Corporation from Finland on January 2, 1998. The final clinical pharmacology review was completed on September 3, 1999. Entacapone is a potent and specific peripheral catechol-O-methyltransferase inhibitor. It has been shown to improve the clinical benefits of levodopa plus an aromatic L-amino acid decarboxylase inhibitor when given to patients with Parkinson's disease and end-of-dose deterioration in the response to levodopa (the "wearing-off" phenomenon). The drug indication is for Parkinson's disease as an adjunct therapy to levodopa/carbidopa. This is a combination drug with carbidopa (aromatic amino acid decarboxylation inhibitor) and entacapone. It is rapidly absorbed after oral administration of a single dose, with peak time generally reached within 1 hour. It is noted that no accumulation of plasma entacapone was detected after 8 daily doses. The maximum daily dose is 2000 mg. In this paper, the clinical pharmacology review of the drug is presented from the perspective of a clinical pharmacologist who reviewed this new drug application at the FDA. It should be noted that all the information in this paper is publicly available on the FDA website and in its literature.
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Affiliation(s)
- Sam Habet
- Correspondence: Sam Habet, PharmD, PhD, ABCP, FCP, 9175 Bealls Farm Road, Frederick, MD 21704, USA (). Present address: Clinical Pharmacist, Department of Pharmacy, Sinai Hospital (LifeBridge Health) 2401 W. Belvedere Avenue, Baltimore, MD 21215, USA
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9
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Viljaharju V, Mertsalmi T, Pauls KAM, Koivu M, Eerola-Rautio J, Udd M, Pekkonen E. Single-Center Study of 103 Consecutive Parkinson's Disease Patients with Levodopa-Carbidopa Intestinal Gel. Mov Disord Clin Pract 2022; 9:60-68. [PMID: 35005066 DOI: 10.1002/mdc3.13361] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 11/06/2022] Open
Abstract
Background Levodopa-carbidopa intestinal gel (LCIG) effectively reduces off time and dyskinesia and increases on time in advanced Parkinson's disease (PD). However, patients with LCIG-infusion experience frequent complications and some discontinue treatment early on. Objectives The objectives of this study were to find predictive factors for early dropout from the LCIG infusion, analyze the treatment burden on the tertiary health care system, and explore changes in medication during the LCIG treatment. Methods LCIG-infusion was administrated to 103 patients between July 2006 and May 2020 at the Helsinki University Hospital, accumulating 350 years of follow-up data. We evaluated, retrospectively, changes in medication during treatment, discontinuation of the infusion, and adverse events from the patient records. Results Living alone was a predictive factor for early dropout (OR = 3.88; 95% CI = 1.03-14.66; P = 0.045). The treatment burden on the tertiary health care system increased after the initiation of LCIG infusion mostly because of common complications related to the infusion system (median change of in- and out-patient visits +1, P = 0.03). Mean levodopa equivalent daily dose (LEDD) rose from baseline to 6 months (1246.7 vs. 1684.9, P = 0.001) and stabilized thereafter. Patients commonly switched from "polypharmacy" to "LCIG-only" or "LCIG + oral levodopa" medication-groups during long-term treatment. Conclusions Recurrent complications related to the infusion system increase the treatment burden on tertiary healthcare system after the initiation of LCIG-infusion. Most patients continue long-term with the infusion. Few patients discontinue infusion during the first year after initiation and living alone appears to be a risk factor for this outcome.
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Affiliation(s)
- Vili Viljaharju
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
| | - Tuomas Mertsalmi
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
| | - K Amande M Pauls
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
| | - Maija Koivu
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
| | - Johanna Eerola-Rautio
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
| | - Marianne Udd
- Department of Gastroenterological Surgery Helsinki University Hospital Helsinki Finland
| | - Eero Pekkonen
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
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10
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Predictive Value of Ambulatory Objective Movement Measurement for Outcomes of Levodopa/Carbidopa Intestinal Gel Infusion. J Pers Med 2022; 12:jpm12010027. [PMID: 35055343 PMCID: PMC8781512 DOI: 10.3390/jpm12010027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/19/2021] [Accepted: 12/28/2021] [Indexed: 12/12/2022] Open
Abstract
Patients with Parkinson's disease that may benefit from device-assisted therapy can be identified with guidelines like Navigate PD. The decision to offer advanced treatment and the choice of treatment modality are, however, not straightforward, and some patients respond less favorably to a chosen therapy. Measurements with the Parkinson Kinetigraph (PKG) can detect motor fluctuations and could therefore predict patients that respond better or worse to intestinal levodopa/carbidopa gel infusion (LCIG). In a retrospective analysis of 45 patients that had been selected to start LCIG between 2014 and 2020, the effects of baseline PKG and clinical characteristic on the outcome were determined with ordinal regression. Although all patients had been found to have handicapping medication-related symptom fluctuations, patients without clear objective off fluctuations in the baseline PKG had low odds ratio for success. Lower odds for success were also found with increasing age, whereas gender, medication intensity and baseline PKG summary scores (median bradykinesia and dyskinesia scores, fluctuation dyskinesia score and percent time with tremor) had no significant effect. Absence of easily identified off-periods in the PKG has a negative prognostic value for the effect of LCIG and could prompt noninvasive infusion evaluation before surgery.
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11
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Pauls KAM, Toppila J, Koivu M, Eerola-Rautio J, Udd M, Pekkonen E. Polyneuropathy monitoring in Parkinson's disease patients treated with levodopa/carbidopa intestinal gel. Brain Behav 2021; 11:e2408. [PMID: 34758207 PMCID: PMC8671764 DOI: 10.1002/brb3.2408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/06/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Levodopa-carbidopa-intestinal-gel (LCIG) infusion is an effective treatment for advanced PD with motor fluctuations. Polyneuropathy occurs as a complication in 10-15% of patients. We wanted to assess the frequency of polyneuropathy in Finnish advanced Parkinson's disease (PD) patients with continuous LCIG infusion, and the value of different clinical monitoring parameters during follow-up. MATERIALS AND METHODS Patient records of PD patients started on LCIG infusion at Helsinki University Hospital who received nerve conduction studies at baseline and 6 months after treatment initiation were reviewed for epidemiological information, mini mental state examination, baseline and 6 months' UPRDS-III, weight, body mass index, levodopa dose (LD), plasma homocysteine levels, folate, vitamin B6 and B12. RESULTS Out of 19 patients (n = 6 on B-vitamin substitution), two (10.5%) developed new-onset polyneuropathy after initiation of LCIG therapy (n = 0 with vitamin substitution). Neuropathy was associated with significant weight loss (BMI reduction > 1.5), but not with other monitoring parameters. Homocysteine rose significantly in patients not substituted with B-vitamin complex, but not in patients with B-vitamin substitution. Homocysteine changes correlated with LD changes in the absence of vitamin B substitution. After oral B-vitamin substitution, both patients' polyneuropathy remained electrophysiologically and clinically stable. CONCLUSIONS Rates of polyneuropathy in Finnish PD patients with LCIG treatment are comparable to previous studies. Patients' weight should be included in regular follow up monitoring and can be used for patient self-monitoring. Vitamin B substitution appears to reduce coupling between levodopa dose and homocysteine and may be useful to prevent polyneuropathy related to LCIG.
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Affiliation(s)
- K Amande M Pauls
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland.,BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Toppila
- Department of Clinical Neurophysiology, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Maija Koivu
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
| | - Johanna Eerola-Rautio
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
| | - Marianne Udd
- Department of Gastrointestinal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Eero Pekkonen
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
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12
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Scharfenort M, Timpka J, Sahlström T, Henriksen T, Nyholm D, Odin P. Close relationships in Parkinson´s disease patients with device-aided therapy. Brain Behav 2021; 11:e02102. [PMID: 33949144 PMCID: PMC8213651 DOI: 10.1002/brb3.2102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/31/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Deep brain stimulation, continuous subcutaneous apomorphine infusion, and levodopa-carbidopa intestinal gel infusion, together called device-aided therapies (DAT), are introduced when oral and transdermal pharmacotherapy are not enough for a satisfactory control of Parkinson's disease (PD) symptoms. Solid relationships are central to an individual's well-being, but the impact of close relationships in advanced PD remains underexplored. The aim of this study was to investigate the development of close relationships between PD patients and their partners following the initiation of DAT and to examine the relationship structures in these relationships. MATERIALS AND METHODS This was a retrospective quantitative multicenter pilot study wherein 41 couples, patients with advanced PD and their partners, retrospectively rated their relationship satisfaction before the start of DAT, after one year of DAT and at the time of the interview. The couples also answered the Experiences in Close Relationships-Questionnaire of Relational Structures (ECR-RS). RESULTS Partners more often report changes in relationship satisfaction than patients between baseline and both 1 year after start of DAT (p = .049) and last evaluation (p = .041). The ECR-RS data reported significantly higher avoidance score for partners (p = .005) and significantly higher anxiety score for patients (p = .024). CONCLUSIONS The close relationship wherein one part has PD and receives DAT has a high risk of being unequal. Prospective studies are needed for further clarification of the interplay between advanced PD, DAT, and close relationships, this in order to improve pre- and postinterventional support for PD patients receiving DAT, as well as their partners.
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Affiliation(s)
- Monica Scharfenort
- Division of Neurology, Lund University, Lund, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Jonathan Timpka
- Division of Neurology, Lund University, Lund, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden
| | | | - Tove Henriksen
- Department of Neurology, University Hospital of Bispebjerg, Copenhagen, Denmark
| | - Dag Nyholm
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Per Odin
- Division of Neurology, Lund University, Lund, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden
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13
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Abstract
Levodopa-carbidopa intestinal gel infusion (LCIG) is an established therapy for advanced Parkinson disease (PD), resulting in a significant improvement of quality of life. With increased LCIG adoption worldwide, potential complications due to abnormal vitamin absorption or metabolism have been reported in these patients. Neurologists are unfamiliar with vitamins physiology and pathophysiological mechanisms in case of their deficiency. Unfortunately, clinical and laboratory guidelines related to vitamin monitoring and supplementation in the context of treatment with LCIG are not available. We herein summarize the current knowledge on three vitamins that are reduced with LCIG therapy reporting on their physiology, laboratory testing, and clinical impact of their deficiency/excess. In addition, we proposed an opinion-based recommendation for clinicians treating LCIG patients. Patients and caregivers should be informed about the risk of vitamin deficiency. Vitamin B12, homocysteine, and methylmalonic acid (MMA) should be tested before starting LCIG, six months after and once/year thereafter. Vitamin B6 and folate testing is not universally available but it should be considered if homocysteine is elevated but MMA and/or total vitamin B12 are normal. Prophylaxis of vitamin deficiency should be started as soon as LCIG is implemented, possibly even before. Dietary recommendations are enough in most patients although a subgroup of patients is at higher risk and should receive Vitamin B12 regularly and cycles of B6. Finally, once diagnosed a vitamin deficiency should be readily treated and accompanied by clinical and laboratory monitoring. Resistant cases should receive non-oral routes of administration and possibly discontinue LCIG, even temporarily.
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Initial Experience of the Levodopa-Entacapone-Carbidopa Intestinal Gel in Clinical Practice. J Pers Med 2021; 11:jpm11040254. [PMID: 33807308 PMCID: PMC8067183 DOI: 10.3390/jpm11040254] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022] Open
Abstract
Patients in fluctuating stages of Parkinson’s disease (PD) require device-aided treatments. Continuous infusion of levodopa–carbidopa intestinal gel (LCIG) is a well-proven option in clinical practice. We now report the first clinical experience of levodopa–entacapone–carbidopa intestinal gel (LECIG) therapy. An observational study of the first patients to start LECIG in our clinic was performed. Twenty-four patients (11 females, 13 males) were included. The median age was 71.5 years, and the median duration since PD diagnosis was 15.5 years. The median treatment duration was 305 days. Median doses were: 6.0 mL as morning dose, 2.5 mL/h as infusion rate, and 1.0 mL as extra dose. Half of the patients were switched directly from LCIG. These patients express improvements in the size and weight of the pump. Furthermore, most of them considered the new pump to be improved regarding user-friendliness. Six patients discontinued LECIG, three due to diarrhea, one due to hallucinations and two deceased (one cardiac arrest and one COVID-19). LECIG has shown to be possible to use in patients with PD, efficacy and safety as expected. Patients are generally happy with the size and usability of the pump, but some technical improvements of the software are warranted, as well as larger, prospective studies.
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15
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Santos-García D, Catalán M, Puente V, Valldeoriola F, Regidor I, Mir P, Matías-Arbelo J, Parra J, Grandas F. Uso de la infusión intestinal continua de levodopa-carbidopa en pacientes con enfermedad de Parkinson avanzada en España. Subanálisis por comunidades autónomas. Neurologia 2021; 36:101-111. [DOI: 10.1016/j.nrl.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022] Open
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16
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Santos-García D, Catalán M, Puente V, Valldeoriola F, Regidor I, Mir P, Matías-Arbelo J, Parra J, Grandas F. Continuous intestinal infusion of levodopa–carbidopa in patients with advanced Parkinson's disease in Spain: Subanalysis by autonomous community. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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17
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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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Moes HR, Groenendal-Laurensse JWMJ, Drent M, Tissingh G, van Laar T. Predictors of Time to Discontinuation of Levodopa-Carbidopa Intestinal Gel Infusion: A Retrospective Cohort Study. JOURNAL OF PARKINSON'S DISEASE 2020; 10:935-944. [PMID: 32675420 PMCID: PMC7458507 DOI: 10.3233/jpd-201978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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.
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Affiliation(s)
- Harmen R Moes
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Martje Drent
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerrit Tissingh
- Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Blaise AS, Baille G, Carrière N, Devos D, Dujardin K, Grolez G, Kreisler A, Kyheng M, Moreau C, Mutez E, Seguy D, Defebvre L. Safety and effectiveness of levodopa-carbidopa intestinal gel for advanced Parkinson's disease: A large single-center study. Rev Neurol (Paris) 2020; 176:268-276. [DOI: 10.1016/j.neurol.2019.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/21/2019] [Accepted: 07/23/2019] [Indexed: 01/15/2023]
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20
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Compliance with levodopa-carbidopa intestinal gel in a selected population in central south Italy: Beyond sex, a possible gender effect. Parkinsonism Relat Disord 2020; 73:57-59. [DOI: 10.1016/j.parkreldis.2020.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 11/18/2022]
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21
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Boyd JT, Zadikoff C, Benesh JA, Zamudio J, Robieson WZ, Kukreja P, Yokoyama M, Siddiqui MS. A post hoc comparison of levodopa-carbidopa intestinal gel daytime monotherapy vs polytherapy safety and efficacy in patients with advanced Parkinson's disease: Results from 6 phase 3/3b open-label studies. Clin Park Relat Disord 2019; 2:25-34. [PMID: 34316616 PMCID: PMC8302193 DOI: 10.1016/j.prdoa.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/25/2019] [Accepted: 12/02/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction As Parkinson's disease (PD) progresses, the number/frequency of PD medications tend to increase, which is correlated with decreased patient compliance and suboptimal control of PD symptoms. We investigated efficacy and safety of levodopa-carbidopa intestinal gel (LCIG) daytime monotherapy (with or without nighttime oral levodopa-carbidopa) compared with polytherapy (LCIG with ≥1 adjunctive PD therapy) in advanced PD patients. Methods This post hoc descriptive study compared LCIG stable daytime monotherapy with LCIG stable polytherapy in all six phase 3/3b open-label studies from both US and international sites; because of study design variability, pooling data for comparison was not appropriate. Efficacy assessments included PD diary data (mean change from baseline in “Off” time and “On” time with or without troublesome dyskinesia), mean Unified PD Rating Scale scores (Parts II and III), and 39-item Parkinson's Disease Questionnaire (PDQ-39) summary index. Adverse events were also assessed. Results Overall, LCIG daytime monotherapy and polytherapy demonstrated similar efficacy/safety profiles in advanced PD patients, regardless of treatment duration or population. LCIG monotherapy vs. polytherapy groups experienced similar mean decreases in “Off” time (4.6 vs. 4.1 h/day) and similar increases in “On” time without troublesome dyskinesia (4.6 vs. 4.1 h/day). In most studies, PDQ-39 summary index scores were reduced from baseline by ≥5 points, regardless of patient population or study duration. Adverse events not related to the procedure/device were similar in both groups. Conclusion Our data suggest that, for appropriate patients, LCIG monotherapy can provide a more simplified treatment option with similar efficacy and safety. Advanced Parkinson's disease (PD) often requires a large number of medications Levodopa-carbidopa intestinal gel (LCIG) is administered continuously LCIG monotherapy vs. polytherapy was assessed in six phase 3/3b studies LCIG monotherapy and polytherapy had similar efficacy and safety profiles LCIG monotherapy may provide a more simplified treatment option for advanced PD
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Affiliation(s)
- James T. Boyd
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, 1 South Prospect Street, UHC – Arnold 2, Burlington, VT 05401, USA
- Corresponding author at: Department of Neurological Sciences, University of Vermont, Larner College of Medicine, 1 South Prospect Street, UHC – Arnold 2, Burlington, VT 05401, USA.
| | - Cindy Zadikoff
- AbbVie, Inc., 1 Waukegan Rd, North Chicago, IL 60064, USA
| | | | - Jorge Zamudio
- AbbVie, Inc., 1 Waukegan Rd, North Chicago, IL 60064, USA
| | | | - Pavnit Kukreja
- AbbVie, Inc., 1 Waukegan Rd, North Chicago, IL 60064, USA
| | | | - Mustafa S. Siddiqui
- Department of Neurology, Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC 27101, USA
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Hultqvist J, Sahlström T, Timpka J, Henriksen T, Nyholm D, Odin P, Eklund M. Everyday Occupations and Other Factors in Relation to Mental Well-Being among Persons with Advanced Parkinson's Disease. Occup Ther Health Care 2019; 34:1-18. [PMID: 31766928 DOI: 10.1080/07380577.2019.1692269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This cross-sectional study investigated performed activities and the level of satisfaction with everyday occupations among people (n = 67) with advanced Parkinson's disease (PD), and how these factors and experiences of social relationships were related to mental well-being. Managing one's hygiene and physical exercises were activities that the majority still performed, whereas few were engaged in work or other productive occupations. Perceived health problems and satisfaction with everyday occupations were important factors for mental well-being since satisfaction with everyday occupations may be an important focus for occupational therapists and other health professionals when supporting mental well-being among persons with advanced PD.
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Affiliation(s)
- Jenny Hultqvist
- Department of Health Sciences, Mental Health, Activity and Participation (MAP), Lund University, Lund, Sweden
| | - Thomas Sahlström
- Department of Clinical Sciences Lund, Neurology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jonathan Timpka
- Department of Clinical Sciences Lund, Neurology, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Tove Henriksen
- Movement Disorder Clinic, University Hospital of Bispebjerg, Copenhagen, Denmark
| | - Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Per Odin
- Department of Clinical Sciences Lund, Neurology, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden.,Department of Neurology, Central Hospital, Bremerhaven, Germany
| | - Mona Eklund
- Department of Health Sciences, Mental Health, Activity and Participation (MAP), Lund University, Lund, Sweden
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Artusi CA, Balestrino R, Imbalzano G, Bortolani S, Montanaro E, Tuttobene S, Fabbri M, Zibetti M, Lopiano L. Beyond 10 years of levodopa intestinal infusion experience: Analysis of mortality and its predictors. Parkinsonism Relat Disord 2019; 76:98-103. [PMID: 31610986 DOI: 10.1016/j.parkreldis.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/15/2019] [Accepted: 10/05/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Although levodopa/carbidopa intestinal infusion (LCIG) proved a sustained efficacy on Parkinson's disease (PD) motor fluctuations, there is a lack of studies on mortality of LCIG patients. In this study, we aimed at analyzing mortality and its predictors in a cohort of 105 PD patients treated with LCIG for over 10 years. METHODS The death rate, death causes, mortality predictors, and serious adverse events (SAEs) were analyzed. A Cox regression model was used to estimate the influence of several demographic and clinical factors on mortality, and a binary logistic regression to evaluate the association between SAEs number and mortality. Kaplan-Meier and Log-rank test was used for a survival comparison between patients with an early drop-out (within 3 years since LCIG start) and patients continuing LCIG. RESULTS Ninety-eight advanced PD patients treated with LCIG were included. During follow-up, 34.7% of patients died at a mean age of 74.7 years, with a mean survival time of 4.6 years since LCIG start and 18 years since PD onset. The only predictor of mortality identified was the Mini Mental State Examination score at LCIG start (p:0.034). A total of 222 SAEs occurred in 87.9% of LCIG patients. The number of SAEs did not correlate with the mortality of LCIG patients (p:0.370). No survival difference exists between early drop-out patients and those continuing LCIG (p:0.341). CONCLUSION Our findings do not indicate an association between SAEs or LCIG treatment duration and mortality and highlight the importance of cognitive alterations as a mortality predictor of LCIG patients.
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Affiliation(s)
- Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy.
| | - Roberta Balestrino
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Sara Bortolani
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Elisa Montanaro
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Sara Tuttobene
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Margherita Fabbri
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy
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25
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Motor and non-motor outcomes in patients with advanced Parkinson's disease treated with levodopa/carbidopa intestinal gel: final results of the GREENFIELD observational study. J Neurol 2019; 266:2164-2176. [PMID: 31134377 PMCID: PMC6687881 DOI: 10.1007/s00415-019-09337-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/03/2022]
Abstract
Introduction The GREENFIELD observational study assessed the effect of levodopa/carbidopa intestinal gel (LCIG) on motor and non-motor symptoms, and the related impact on patient quality of life and caregiver burden up to 8 years. Methods Final results of a large Italian cohort of patients who started LCIG in routine care between 2007 and 2014 are presented. Comparison between baseline (before LCIG) and follow-up visits on yearly basis (visit 2/3) is reported. Primary endpoint was Unified Parkinson’s Disease Rating Scale (UPDRS-IV) Item 39; secondary endpoints were UPDRS I and II, dyskinesia items, PD Quality of Life Questionnaire-39, Parkinson’s Disease Sleep Scale-2, Gait and Falls Questionnaire, Questionnaire on Impulsive Disorders, and Relative Stress Scale. Results Overall, 145 patients from 14 centers were assessed with a mean time since LCIG start of 2.8 ± 1.7 years at visit 2. The mean UPDRS-IV item 39 score showed significant reductions compared to baseline (mean score 2.0 ± 0.81) at visit 2 (mean score 0.9 ± 0.69; − 55%; p < 0.001) and at visit 3 (mean score 1.0 ± 0.75; − 50%; p < 0.001). At visit 3, significant reductions were observed for dyskinesia duration score (− 28%; p < 0.001), dyskinesia disability (− 40%; p < 0.001), and painful dyskinesia (− 50%; p < 0.001). Overall, 40 (27.6%) patients experienced 49 serious adverse events which were considered related to PEG/J procedure or to device in 16.3% of the cases. Conclusions The results of this study support the long-term efficacy of LCIG on PD symptoms as well as on activities of daily living. The adverse events were consistent with the established LCIG safety profile. Electronic supplementary material The online version of this article (10.1007/s00415-019-09337-6) contains supplementary material, which is available to authorized users.
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26
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Kalabina S, Belsey J, Pivonka D, Mohamed B, Thomas C, Paterson B. Cost-utility analysis of levodopa carbidopa intestinal gel (Duodopa) in the treatment of advanced Parkinson's disease in patients in Scotland and Wales. J Med Econ 2019; 22:215-225. [PMID: 30484353 DOI: 10.1080/13696998.2018.1553179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS To carry out a cost-utility analysis comparing the cost-effectiveness of levodopa carbidopa intestinal gel (LCIG) with standard of care (SOC) in patients with advanced Parkinson's Disease (aPD) unsuitable for apomorphine or deep brain stimulation (DBS). LCIG is the only treatment option in this small, but clinically important, population. METHODS A Markov model with 25 disease states based on disease stage and off-time status plus death. Patients enter the model with aPD spending >50% of their waking day in the off-state. Patients progress through the model in 6-monthly cycles for 20 years to approximate lifetime treatment and capture long-term costs and effects of therapy. Inputs are based on LCIG clinical trials for clinical outcomes and health state utilities, the literature for health state transitions and use UK-based input data wherever possible (drug costs, disease/adverse event management costs, discontinuation rates, mortality rates). LIMITATIONS Data collection can be challenging in this small, elderly population with advanced disease, therefore some model inputs were estimated, rather than collected directly. It was assumed that a reduction in off-time was the only benefit after the first year of treatment with LCIG; this is a conservative approach, since there may be additional clinical benefits. RESULTS There is a considerable incremental gain in quality adjusted life years (QALYs) for patients treated with LCIG of 1.26 QALY with an associated incremental cost-effectiveness ratio (ICER) of £52,110. If the impact on caregivers is included, the ICER reduces to £47,266. CONCLUSIONS In cases where there is an orphan population, with no alternative treatment options, HTA assessments have a broader decision-making framework and the ICER is interpreted in this context. In the setting of a very small population, with considerable unmet need, LCIG represents value for money, as reflected by funding approval across the UK.
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Affiliation(s)
| | | | | | - Biju Mohamed
- c Cardiff and Vale University Health Board , Cardiff , UK
| | - Chris Thomas
- c Cardiff and Vale University Health Board , Cardiff , UK
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Regidor I, Santos-García D, Catalán MJ, Puente V, Valldeoriola F, Grandas F, Mir P, Parra JC, Arbelo JM. Impact of Disease Duration in Effectiveness of Treatment with Levodopa-Carbidopa Intestinal Gel and Factors Leading to Discontinuation. JOURNAL OF PARKINSONS DISEASE 2019; 9:173-182. [DOI: 10.3233/jpd-181324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Ignacio Regidor
- Functional Neurosurgery Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Diego Santos-García
- Department of Internal Medicine, Neurology Section, Hospital Arquitecto Marcide, Complejo Hospitalario Universitario de Ferrol (CHUF), A Coruña, Spain
| | - Mar;ıa José Catalán
- Department of Neurology, Movement Disorders Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Vıctor Puente
- Department of Neurology, Movement Disorders Unit, Parc de salut Mar, Institut Hospital del Mar d’investigacions Mèdicas, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Francisco Grandas
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pablo Mir
- Department of Neurology, Movement Disorders Unit, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | | | - José Matías Arbelo
- Department of Neurology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Dafsari HS, Martinez-Martin P, Rizos A, Trost M, Dos Santos Ghilardi MG, Reddy P, Sauerbier A, Petry-Schmelzer JN, Kramberger M, Borgemeester RWK, Barbe MT, Ashkan K, Silverdale M, Evans J, Odin P, Fonoff ET, Fink GR, Henriksen T, Ebersbach G, Pirtošek Z, Visser-Vandewalle V, Antonini A, Timmermann L, Ray Chaudhuri K. EuroInf 2: Subthalamic stimulation, apomorphine, and levodopa infusion in Parkinson's disease. Mov Disord 2019; 34:353-365. [PMID: 30719763 DOI: 10.1002/mds.27626] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/18/2018] [Accepted: 01/04/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Real-life observational report of clinical efficacy of bilateral subthalamic stimulation (STN-DBS), apomorphine (APO), and intrajejunal levodopa infusion (IJLI) on quality of life, motor, and nonmotor symptoms (NMS) in Parkinson's disease (PD). METHODS In this prospective, multicenter, international, real-life cohort observation study of 173 PD patients undergoing STN-DBS (n = 101), IJLI (n = 33), or APO (n = 39) were followed-up using PDQuestionnaire-8, NMSScale (NMSS), Unified PD Rating Scale (UPDRS)-III, UPDRS-IV, and levodopa equivalent daily dose (LEDD) before and 6 months after intervention. Outcome changes were analyzed with Wilcoxon signed-rank or paired t test when parametric tests were applicable. Multiple comparisons were corrected (multiple treatments/scales). Effect strengths were quantified with relative changes, effect size, and number needed to treat. Analyses were computed before and after propensity score matching, balancing demographic and clinical characteristics. RESULTS In all groups, PDQuestionnaire-8, UPDRS-IV, and NMSS total scores improved significantly at follow-up. Levodopa equivalent daily dose was significantly reduced after STN-DBS. Explorative NMSS domain analyses resulted in distinct profiles: STN-DBS improved urinary/sexual functions, mood/cognition, sleep/fatigue, and the miscellaneous domain. IJLI improved the 3 latter domains and gastrointestinal symptoms. APO improved mood/cognition, perceptual problems/hallucinations, attention/memory, and the miscellaneous domain. Overall, STN-DBS and IJLI seemed favorable for NMSS total score, and APO favorable for neuropsychological/neuropsychiatric NMS and PDQuestionnaire-8 outcome. CONCLUSIONS This is the first comparison of quality of life, nonmotor. and motor outcomes in PD patients undergoing STN-DBS, IJLI, and APO in a real-life cohort. Distinct effect profiles were identified for each treatment option. Our results highlight the importance of holistic nonmotor and motor symptoms assessments to personalize treatment choices. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Haidar S Dafsari
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Alexandra Rizos
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Maja Trost
- Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | | | - Prashanth Reddy
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Anna Sauerbier
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Milica Kramberger
- Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Robbert W K Borgemeester
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michael T Barbe
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Keyoumars Ashkan
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom
| | - Per Odin
- Department of Neurology, Klinikum-Bremerhaven, Bremerhaven, Germany.,Department of Neurology, Skane University Hospital, Lund, Sweden
| | - Erich Talamoni Fonoff
- Department of Neurology, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.,Laboratory of Neuromodulation, Institute of Teaching and Research, Hospital Sirio-Libanês, São Paulo, Brazil
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Tove Henriksen
- Movement Disorder Clinic, University Hospital of Bispebjerg, Copenhagen, Denmark
| | - Georg Ebersbach
- Movement Disorder Clinic, Kliniken Beelitz, Beelitz-Heilstätten, Germany
| | - Zvezdan Pirtošek
- Department of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Veerle Visser-Vandewalle
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Angelo Antonini
- Department for Parkinson's disease, IRCCS Hospital San Camillo, Venice, Italy.,Department of Neuroscience, University of Padua, Padua, Italy
| | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - K Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Maximizing benefits of the levodopa/carbidopa intestinal gel: Systematic considerations, challenging convention and individualizing approaches. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.baga.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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30
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Fernandez HH, Boyd JT, Fung VSC, Lew MF, Rodriguez RL, Slevin JT, Standaert DG, Zadikoff C, Vanagunas AD, Chatamra K, Eaton S, Facheris MF, Hall C, Robieson WZ, Benesh J, Espay AJ. Long-term safety and efficacy of levodopa-carbidopa intestinal gel in advanced Parkinson's disease. Mov Disord 2018; 33:928-936. [DOI: 10.1002/mds.27338] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - James T. Boyd
- University of Vermont Larner College of Medicine, Burlington; Vermont USA
| | | | - Mark F. Lew
- Keck/University of Southern California School of Medicine; Los Angeles California USA
| | - Ramon L. Rodriguez
- University of Florida College of Medicine, Gainesville, Florida, USA, and Orlando Veterans Affairs Medical Center; Orlando Florida USA
| | - John T. Slevin
- University of Kentucky Medical Center; Lexington Kentucky USA
| | | | - Cindy Zadikoff
- Feinberg School of Medicine; Northwestern University; Chicago Illinois USA
| | | | | | | | | | | | | | | | - Alberto J. Espay
- University of Cincinnati Academic Health Center; Cincinnati Ohio USA
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Duodenal Levodopa Infusion for Long-Term Deep Brain Stimulation-Refractory Symptoms in Advanced Parkinson Disease. Clin Neuropharmacol 2018; 40:103-107. [PMID: 28452905 DOI: 10.1097/wnf.0000000000000216] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study assesses the effect of levodopa/carbidopa intestinal infusion gel (LCIIG) as an additional treatment in patients with advanced idiopathic Parkinson disease (PD) previously treated with deep brain stimulation (DBS). METHODS Prospective study of advanced PD patients, satisfactorily treated with bilateral DBS of the subthalamic nucleus, who had developed refractory symptoms and LCIIG was added. Controls were advanced PD patients treated with LCIIG. Measurements included the Unified Parkinson Disease Rating Scale (UPDRS)-III and the UPDRS axial compound. RESULTS There were 19 patients in the DBS-LCIIG therapy group and 21 in the control group. The DBS-LCIIG patients were younger and had disease duration longer than controls. The median time from DBS to gastrostomy was 7.8 years (range, 2-12 years). In both study groups, the mean scores of the UPDRS-III and UPDRS axial subscales improved significantly after LCIIG treatment (DBS-LCIIG group: UPDRS-III, 62.0 [15.7] vs 30.9 [12.1]; UPDRS axial, 24.7 [4.9] vs 10.2 [2.7]; P < 0.0005 for all comparisons). There were no differences in adverse events between the groups. In the follow-up of the DBS-LCIIG group. 5 patients discontinued DBS-LCIIG therapy and returned to DBS, 5 discontinued DBS and were maintained with LCIIG, and the remaining 9 continued with DBS-LCIIG therapy. Mean time until discontinuation in the double DBS-LCIIG group was 891 days. The main risk factors for discontinuation were age at the beginning of LCIIG and severity of the UPDRS axial subscale. CONCLUSIONS Levodopa/carbidopa intestinal infusion gel therapy may be a valuable option in selected patients with advanced PD who develop refractory symptoms after long-term subthalamic nucleus-DBS.
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Systematic evaluation of levodopa-carbidopa intestinal gel patient-responder characteristics. NPJ PARKINSONS DISEASE 2018; 4:4. [PMID: 29387783 PMCID: PMC5784118 DOI: 10.1038/s41531-017-0040-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 12/12/2017] [Accepted: 12/21/2017] [Indexed: 01/17/2023]
Abstract
Levodopa-carbidopa intestinal gel (LCIG, carbidopa-levodopa enteral suspension in the United States) is a treatment option for advanced Parkinson’s disease (PD) patients with motor fluctuations. The objective of this investigation was to identify the baseline characteristics predictive of treatment response, measured by improvement in motor symptom severity, in advanced PD patients treated with LCIG during a 54-week, open-label phase 3 study. Patients with ≥1 h improvement from baseline in “Off” time were categorized as “Responders”; whereas those with <1 h improvement, any worsening, or no post-baseline assessment were “Non-Responders”. A subgroup of Responders with ≥3 h improvement in “Off” time was also examined; this subgroup was identified as “Robust Responders”. Baseline demographics and disease characteristics were analyzed and their predictive relationship to change from baseline in normalized “Off” time was assessed. Out of the 324 patients included in the analysis, 272 (84.0%) were categorized as Responders and 52 (16.0%) were Non-Responders. A majority of patients (65.7%) had ≥3 h improvement in “Off” time. In general, baseline characteristics were similar between Non-responders, Responders, and the subgroup of Robust Responders. A conditional tree-structured regression analysis identified baseline “Off” time as the only factor that had significant effect on Responder and Robust Responder status. The safety profile of LCIG was similar between patient groups. Overall, this analysis showed that 84% of LCIG-treated advanced PD patients had ≥1 h improvement in “Off” time and the number-needed-to-treat to observe one patient responder was 1.19 patients. Notably, Responders and Robust Responders to LCIG were observed across the range of baseline demographics and clinical characteristics examined. Continuous intestinal administration of Parkinson’s disease drugs in a gel formulation significantly improves motor symptoms in most patients. To identify patient characteristics that predict a favorable response to levodopa-carbidopa intestinal gel (LCIG), David Standaert at the University of Alabama at Birmingham, US, and colleagues examined the effects of LCIG over 54 weeks on 324 patients with advanced Parkinson’s disease. Eighty four percent of patients showed a positive response to LCIG, but the authors were not able to predict responsiveness to treatment (or the risk of them experiencing an adverse effect) based on the patients’ demographics or disease characteristics. Among the responsive patients, they found that those experiencing longer periods of movement difficulties (“Off” time) at baseline, were the ones that benefited the most from LCIG.
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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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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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Dietrichs E, Odin P. Algorithms for the treatment of motor problems in Parkinson's disease. Acta Neurol Scand 2017; 136:378-385. [PMID: 28133726 PMCID: PMC5655734 DOI: 10.1111/ane.12733] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 12/17/2022]
Abstract
Several different strategies are effective for medical treatment of motor problems in Parkinson's disease (PD). Many guidelines and evidence-based reviews are available, but there is no documentation or consensus in favor of just one treatment strategy. This review presents two algorithms that may be helpful when deciding how to treat a PD patient at various stages of the disease. The first algorithm suggests one way to treat PD from the first onset of motor symptoms. It is largely based on treatment recommendations from the Scandinavian countries and Germany. The other algorithm is meant as assistance for choosing among the different device-aided treatments for advanced PD. There is not sufficient comparative data to recommend one particular line of treatment, neither in early PD nor in advanced disease with motor complications. Individualized treatment is needed for each patient. The current algorithms only represent an alternative for aiding treatment decisions.
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Affiliation(s)
- E. Dietrichs
- Department of NeurologyOslo University Hospital and University of OsloOsloNorway
| | - P. Odin
- Department of NeurologySkåne University HospitalUniversity of LundLundSweden
- Department of NeurologyKlinikum‐BremerhavenBremerhavenGermany
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Skoromets AA, Odinak MM, Yakupov EZ, Litvinenko IV, Zalyalova ZA, Timofeeva AA, Kirtaev SY, Bogdanov RR, Agafina AS, Chatamra K, Robieson W, Benesh J, Latypova GR, Ershova MV, Illarioshkin SN. [Levodopa-carbidopa intestinal gel in the treatment of patients with Parkinson disease: results of a 12-month open study]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:22-31. [PMID: 28374689 DOI: 10.17116/jnevro20171172122-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To evaluate the long-term safety and efficacy of intrajejunal levodopa-carbidopa intestinal gel (LCIG) infusion in the treatment of patients with severe stages of Parkinson disease (PD) who did not respond adequately to treatment with oral drugs. MATERIAL AND METHODS A large-scale international prospective open-label 54-week study of LCIG in patients with PD with severe motor fluctuations was carried out. A total of 48 patients were enrolled in Russia, 46 patients (95.8%) had PEG-J inserted, and 43 of them completed the study. The safety, including adverse events (AEs), infusion system and pump failures analysis, number of patients completely terminated the study, and efficacy (duration of "off" periods, "on" periods with or without troublesome dyskinesias, UPDRS scores, Clinical Global Impression, Quality of Life (PDQ-39, EQ-5D и EQ-VAS) dynamics, an analysis of patient's diaries) were assessed throughout the whole study. RESULTS The majority of AEs were mild or moderate with most AEs connected with infusion system application (28.3% patients) including procedure pain. Serious AEs were registered in 8 patients (16.7%). 3 patients (6.3%) discontinued their participation in the study due to AEs. Mean duration of "off" periods by the end of the study decreased by 5.35±2.59 hours (p<0.001), duration of "on" periods without troublesome dyskinesia increased by 5.74±3.91 hours (p<0.001), reduction of "on" periods duration with troublesome dyskinesia became statistically significant by week 36 (p=0.020). The statistically significant improvement of UPDRS (generally and in respect to sub-scales), Clinical Global Impression, and Quality of Life scores was observed throughout the study. Levodopa dose remained stable throughout the 54 treatment weeks. Forty-three patients (93.5%) received LCIG monotherapy throughout the whole study. CONCLUSION LCIG intrajejunal infusion during 54 weeks showed the favorable safety profile, high tolerability, and efficacy in PD motor symptoms correction.
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Affiliation(s)
- A A Skoromets
- Pavlov First St.-Petersburg State Medical University, St.-Petersburg
| | - M M Odinak
- Kirov Military Medical Academy, St.-Petersburg
| | - E Z Yakupov
- Research Medical Complex "Your Health", Kazan
| | | | | | - A A Timofeeva
- Pavlov First St.-Petersburg State Medical University, St.-Petersburg
| | | | | | - A S Agafina
- Vladimirsky Moscow Regional Clinical and Research Institute, Moscow
| | - K Chatamra
- St.-Petersburg City Hospital N 40, St.-Petersburg
| | - W Robieson
- St.-Petersburg City Hospital N 40, St.-Petersburg
| | - J Benesh
- St.-Petersburg City Hospital N 40, St.-Petersburg
| | - G R Latypova
- AbbVie, Repablic Clinical Diagnostic Center Extrapyramidal Pathologies and Botulinotherapiya, Kazan
| | - M V Ershova
- Research Center of Neurology, Moscow, Russia
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Hallmarks of Treatment Aspects: Parkinson's Disease Throughout Centuries Including l -Dopa. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017. [DOI: 10.1016/bs.irn.2017.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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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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Pålhagen SE, Sydow O, Johansson A, Nyholm D, Holmberg B, Widner H, Dizdar N, Linder J, Hauge T, Jansson R, Bergmann L, Kjellander S, Marshall TS. Levodopa-carbidopa intestinal gel (LCIG) treatment in routine care of patients with advanced Parkinson’s disease: An open-label prospective observational study of effectiveness, tolerability and healthcare costs. Parkinsonism Relat Disord 2016; 29:17-23. [DOI: 10.1016/j.parkreldis.2016.06.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/11/2016] [Accepted: 06/02/2016] [Indexed: 12/27/2022]
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Abstract
BACKGROUND Levodopa-carbidopa intestinal gel (LCIG) is available in several countries for the treatment of advanced levodopa-responsive Parkinson's disease (PD) with severe motor fluctuations and dyskinesia when other treatments have not given satisfactory results. OBJECTIVE Our objective was to summarize the present evidence base for LCIG therapy through a systematic review of the literature. METHODS Studies were identified from the PubMed and EMBASE databases up to 12 March 2016 using the following search terms: Parkinson disease, duodopa, levodopa/carbidopa intestinal gel, levodopa-carbidopa intestinal gel, LCIG, l-dopa infusion, levodopa infusion, duodenal l-dopa infusion, and duodenal levodopa infusion. Data extraction focused on whether LCIG therapy improves motor and non-motor outcomes as well as quality of life in PD patients compared with conventional therapy, apomorphine infusion, or deep brain stimulation. Randomized controlled trials (RCTs) and observational studies, with or without a control group, that included more than ten patients were included. The search was limited to peer-reviewed articles published in full in the English language and involving humans. RESULTS Infusion of LCIG reduced "off" time, increased "on" time without increasing troublesome dyskinesias, and improved quality of life in three RCTs (one double-blind). Open-label follow-ups confirm these findings. The data evaluating long-term efficacy and safety are still limited. CONCLUSIONS The quality of evidence that LCIG is effective in reducing fluctuating motor symptoms and improving quality of life is moderate. Quality of evidence for reduction of non-motor symptoms is very low. Safety issues mainly relate to the intestinal infusion system. LCIG might be a useful treatment option in PD patients with severe motor fluctuations.
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Santos García D, Martínez Castrillo JC, Puente Périz V, Seoane Urgorri A, Fernández Díez S, Benita León V, Udaeta Baldivieso B, Campolongo Perillo A, Mariscal Pérez N. Clinical management of patients with advanced Parkinson's disease treated with continuous intestinal infusion of levodopa/carbidopa. Neurodegener Dis Manag 2016; 6:187-202. [PMID: 27075968 DOI: 10.2217/nmt-2016-0011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Patients with Parkinson's disease often have a good initial response to dopaminergic therapy but later usually develop motor fluctuations and dyskinesia. In these patients, continuous infusion of levodopa-carbidopa intestinal gel (LCIG) allows for maintaining adequate dopamine levels and for improving motor and nonmotor symptoms, as well as quality of life and autonomy. Adequate candidate selection and follow-up are crucial for treatment success. Management should be multidisciplinary, and patient and caregiver education is a priority. This expert consensus document has been developed by a team of neurologists, gastroenterologists and nurses who have a vast experience in LCIG therapy, with an intention to provide knowledge and tools to facilitate patient management throughout all phases of LCIG treatment process.
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Affiliation(s)
- Diego Santos García
- Section of Neurology, Hospital Arquitecto Marcide, Ferrol University Hospital Complex (CHUF), Ferrol, Spain
| | | | | | - Agustín Seoane Urgorri
- Section of Gastrointestinal Endoscopy, Department of Gastroenterology, Hospital del Mar, Barcelona, Spain
| | | | | | - Beatriz Udaeta Baldivieso
- Unit of Movement Disorders & Parkinson's Disease, Gran Canaria University Hospital, Las Palmas de Gran Canaria, Spain
| | - Antonia Campolongo Perillo
- Department of Neurology, Movement Disorders Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
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Epstein M, Johnson DA, Hawes R, Schmulewitz N, Vanagunas AD, Gossen ER, Robieson WZ, Eaton S, Dubow J, Chatamra K, Benesh J. Long-Term PEG-J Tube Safety in Patients With Advanced Parkinson's Disease. Clin Transl Gastroenterol 2016; 7:e159. [PMID: 27030949 PMCID: PMC4822096 DOI: 10.1038/ctg.2016.19] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/23/2016] [Accepted: 02/25/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES: The objectives of this study were to present procedure- and device-associated adverse events (AEs) identified with long-term drug delivery via percutaneous endoscopic gastrojejunostomy (PEG-J). Levodopa-carbidopa intestinal gel (LCIG, also known in US as carbidopa-levodopa enteral suspension, CLES) is continuously infused directly to the proximal small intestine via PEG-J in patients with advanced Parkinson's disease (PD) to overcome slow and erratic gastric emptying and treat motor fluctuations that are not adequately controlled by oral or other pharmacological therapy. METHODS: An independent adjudication committee of three experienced (>25 years each) gastroenterologists reviewed gastrointestinal procedure- and device-associated AEs reported for PD patients (total n=395) enrolled in phase 3 LCIG studies. The rate, clinical significance, and causality of the procedure/device events were determined. RESULTS: The patient median exposure to PEG-J at the data cutoff was 480 days. Procedure- and device-associated serious AEs (SAEs) occurred in 67 (17%) patients. A total of 42% of SAEs occurred during the first 4 weeks following PEG-J placement. SAEs of major clinical significance with the highest procedural incidence were peritonitis (1.5%), pneumonia (1.5%), and abdominal pain (1.3%). The most common non-serious procedure- and device-associated AEs were abdominal pain (31%), post-operative wound infection (20%), and procedural pain (23%). In all, 17 (4.3%) patients discontinued treatment owing to an AE. CONCLUSIONS: In conclusion, incidences of PEG-J AEs with the LCIG delivery system and PEG-J longevity were compared favorably with ranges described in the PEG/PEG-J literature. A low discontinuation rate in this study suggests acceptable procedural outcomes and AE rates in PD patients treated with this PEG-J drug delivery system.
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Affiliation(s)
| | - David A Johnson
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Robert Hawes
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Nathan Schmulewitz
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Arvydas D Vanagunas
- Department of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Susan Eaton
- Department of Pharmaceutical Development, AbbVie Inc., North Chicago, Illinois, USA
| | - Jordan Dubow
- Department of Pharmaceutical Development, AbbVie Inc., North Chicago, Illinois, USA
| | - Krai Chatamra
- Department of Pharmaceutical Development, AbbVie Inc., North Chicago, Illinois, USA
| | - Janet Benesh
- Department of Pharmaceutical Development, AbbVie Inc., North Chicago, Illinois, USA
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Timpka J, Henriksen T, Odin P. Non-oral Continuous Drug Delivery Techniques in Parkinson's Disease: For Whom, When, and How? Mov Disord Clin Pract 2016; 3:221-229. [PMID: 30363573 DOI: 10.1002/mdc3.12303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/28/2015] [Accepted: 11/08/2015] [Indexed: 11/06/2022] Open
Abstract
Continuous dopaminergic stimulation (CDS) has become one of the main concepts in present Parkinson's disease (PD) research. This is based on the assumption that CDS, or rather near CDS, is the normal striatal setting in a healthy individual. In PD, the degeneration of dopaminergic neurons leads to a reduced capacity to buffer dopamine, which could increase the vulnerability to a pulsatile administration of drugs. The term continuous drug delivery (CDD) describes the process of delivering drugs continuously with the aim of achieving CDS. There are three principal techniques for non-oral CDD: continuous subcutaneous apomorphine infusion CSAi), levodopa-carbidopa intestinal gel infusion (LCIGi), and transdermal rotigotine therapy. CDD has repeatedly been shown effective in the day-to-day treatment of PD patients. Although this review does not replace local guidelines regarding the use of the included non-oral CDD-based therapies, we have compiled the current base of evidence or consensus view with the intention of facilitating both the selection and the use in a clinical setting. The indications for CSAi and LCIGi are very similar and are centered around motor complications in advanced PD, whereas rotigotine has been proven effective both as a monotherapy in early PD and as an add-on to levodopa in advanced PD. Deep-brain stimulation is a relevant option for many of the patients with advanced PD, and we therefore also discuss its use in relation to the CDD-based techniques. Blinded and controlled trials have shown that non-oral CDD is an effective approach for the treatment of PD.
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Affiliation(s)
- Jonathan Timpka
- Department of Clinical Sciences Neurology Lund University Lund Sweden
| | - Tove Henriksen
- Department of Neurology University Hospital of Bispebjerg Copenhagen Denmark
| | - Per Odin
- Department of Clinical Sciences Neurology Lund University Lund Sweden.,Department of Neurology Central Hospital Bremerhaven Germany
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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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Lang AE, Rodriguez RL, Boyd JT, Chouinard S, Zadikoff C, Espay AJ, Slevin JT, Fernandez HH, Lew MF, Stein DA, Odin P, Fung VS, Klostermann F, Fasano A, Draganov PV, Schmulewitz N, Robieson WZ, Eaton S, Chatamra K, Benesh JA, Dubow J. Integrated safety of levodopa-carbidopa intestinal gel from prospective clinical trials. Mov Disord 2015; 31:538-46. [PMID: 26695437 PMCID: PMC5064722 DOI: 10.1002/mds.26485] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 10/23/2015] [Accepted: 10/28/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Continuous administration of levodopa-carbidopa intestinal gel (carbidopa-levodopa enteral suspension) through a percutaneous endoscopic gastrojejunostomy is a treatment option for advanced Parkinson disease (PD) patients with motor fluctuations resistant to standard oral medications. Safety data from 4 prospective studies were integrated to assess the safety of this therapy. METHODS Safety data from 4 studies were summarized using 2 overlapping data sets, permitting the separation of procedure/device-associated (n = 395) from non-procedure/device adverse events (n = 412). RESULTS At the data cutoff, median exposure to levodopa-carbidopa intestinal gel was 911 days (range, 1-1980 days) with 963 total patient-years of exposure. Procedure/device adverse events occurred in 300 patients (76%), and serious adverse events occurred in 68 (17%); most frequently reported procedure/device adverse events and serious adverse events were complications of device insertion (41% and 8%, respectively) and abdominal pain (36% and 4%, respectively). Non-procedure/device adverse events occurred in 92% (379), with most frequently reported being insomnia (23%) and falls (23%); 42% (171) had non-procedure/device serious adverse events, with most frequently reported being pneumonia (5%) and PD symptoms (2%). Adverse events led to discontinuation in 17% (72), most frequently because of complication of device insertion (2.4%). There were 34 treatment-emergent deaths (8.3%) in the overlapping data sets, 2 of which (0.5%) were considered "possibly related" to the treatment system. CONCLUSION In the largest collection of levodopa-carbidopa intestinal gel safety data from prospective clinical studies, procedure/device events were frequently reported and occasionally life threatening. Most non-procedure/device events were typical for levodopa treatment and an elderly population. These factors combined with high treatment efficacy led to a relatively low discontinuation rate in advanced PD patients.
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Affiliation(s)
- Anthony E. Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | | | - James T. Boyd
- University of Vermont College of MedicineBurlingtonVermontUSA
| | | | - Cindy Zadikoff
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Alberto J. Espay
- University of Cincinnati Academic Health CenterCincinnatiOhioUSA
| | - John T. Slevin
- University of Kentucky Medical CenterLexingtonKentuckyUSA
| | | | - Mark F. Lew
- Keck/University of Southern California School of MedicineLos AngelesCaliforniaUSA
| | | | - Per Odin
- Klinikim‐BremerhavenGermany and Skane University HospitalLundSweden
| | | | | | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
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Băjenaru O, Ene A, Popescu BO, Szász JA, Sabău M, Mureşan DF, Perju-Dumbrava L, Popescu CD, Constantinescu A, Buraga I, Simu M. The effect of levodopa-carbidopa intestinal gel infusion long-term therapy on motor complications in advanced Parkinson's disease: a multicenter Romanian experience. J Neural Transm (Vienna) 2015; 123:407-14. [PMID: 26699635 PMCID: PMC4805768 DOI: 10.1007/s00702-015-1496-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/02/2015] [Indexed: 11/23/2022]
Abstract
Chronic treatment with oral levodopa is associated with an increased frequency of motor complications in the late stages of Parkinson’s disease (PD). Continuous administration of levodopa–carbidopa intestinal gel (LCIG—Duodopa®, Abbott Laboratories), which has been available in Romania since 2009, represents an option for treating patients with advanced PD. Our primary objective was to report changes in motor complications after initiation of LCIG therapy. The secondary objectives were as follows: to determine the impact of LCIG therapy on the daily levodopa dose variation before/and after LCIG, to collect patient self-assessments of quality of life (QoL), and to study the overall tolerability and safety of LCIG administration. A retrospective analysis (2009–2013) of LCIG therapy and the experience in nine neurology centers in Romania was performed. The impact of LCIG therapy was evaluated by analyzing changes in motor fluctuations, dyskinesia and the patients’ QoL after initiating therapy. The safety of LCIG therapy was estimated by noting agent-related adverse events (AEs) and medical device-related AEs. In the 113 patients included, we observed a significant improvement in PD symptoms after initiation of LCIG therapy. The “on” period increased, with a mean value of 6.14 h, and the dyskinesia period was reduced, with a mean value of 29.4 %. The quantified non-motor symptoms subsided. The patients exhibited significant improvements in QoL scores. There were few AEs and few cases of LCIG therapy discontinuation. LCIG is an important and available therapeutic option for managing patients with advanced PD.
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Affiliation(s)
- O Băjenaru
- Department of Neurology, University of Medicine and Pharmacy "Carol Davila" Bucharest, University Emergency Hospital Bucharest, 169 Splaiul Independentei, Sector 5, Bucharest, Romania
| | - A Ene
- Department of Neurology, University of Medicine and Pharmacy "Carol Davila" Bucharest, University Emergency Hospital Bucharest, 169 Splaiul Independentei, Sector 5, Bucharest, Romania
| | - B O Popescu
- Department of Neurology, University of Medicine and Pharmacy "Carol Davila" Bucharest, Colentina Hospital, 19-21 Stefan cel Mare Street, Sector 2, 020125, Bucharest, Romania
| | - J A Szász
- Department of Neurology, University of Medicine and Pharmacy Targu Mures, 38 Gh Marinescu Street, 540139, Targu Mures, Mures, Romania
| | - M Sabău
- Department of Neurology, Emergency Clinical Hospital Oradea, 65 Gh Doja Street, 410169, Oradea, Bihor, Romania
| | - D F Mureşan
- Department of Neurology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Cluj County Hospital, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - L Perju-Dumbrava
- Department of Neurology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Cluj County Hospital, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - C D Popescu
- Neurology Rehabilitation Department, University of Medicine and Pharmacy "Gr. T. Popa" Iasi, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661, Iasi, Romania
| | - A Constantinescu
- Neurology Rehabilitation Department, University of Medicine and Pharmacy "Gr. T. Popa" Iasi, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661, Iasi, Romania
| | - I Buraga
- Department of Neurology, University of Medicine and Pharmacy "Carol Davila" Bucharest, Colentina Hospital, 19-21 Stefan cel Mare Street, Sector 2, 020125, Bucharest, Romania
| | - M Simu
- Department of Neurology, University of Medicine and Pharmacy "Victor Babes," Timisoara County Hospital, 10 Iosif Bulbuca Street, 300736, Timisoara, Timis, Romania.
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Bohlega S, Abou Al-Shaar H, Alkhairallah T, Al-Ajlan F, Hasan N, Alkahtani K. Levodopa-Carbidopa Intestinal Gel Infusion Therapy in Advanced Parkinson's Disease: Single Middle Eastern Center Experience. Eur Neurol 2015; 74:227-36. [DOI: 10.1159/000442151] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/02/2015] [Indexed: 11/19/2022]
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Abstract
INTRODUCTION The search for consistent, effective treatments in Parkinson's disease (PD) is ongoing. The importance of continuous dopaminergic stimulation (CDS) is understood to underlie best medical therapy for PD by providing closer replication of physiological patterns of dopamine release in healthy brains. AREAS COVERED An overview of interventions to improve motor fluctuations in PD is presented. Significant improvements in off-time are achieved by providing continuous therapy using targeted deep brain stimulation (DBS), subcutaneous apomorphine infusion and carbidopa/levodopa enteral suspension (Duopa). Duopa is a newly approved treatment in the US for advanced PD that delivers levodopa pumped to the intestinal tract through a percutaneous gastrostomy with jejunum tube extension (PEG-J tube). Trials with carbidopa/levodopa enteral suspension show improvement in motor fluctuations, reduction in plasma levodopa variation and improvement in overall "on" time compared with oral immediate release formulation of carbidopa/levodopa. EXPERT OPINION The degree of improvement in number of off hours per day on carbidopa/levodopa enteral suspension infusion rivals that seen with DBS and apomorphine infusion and makes this new treatment a valuable option in advanced fluctuating PD patients, especially those who are neither candidates for DBS or who do not have access to apomorphine infusion therapy or who have failed either or both therapies.
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Affiliation(s)
- Lauren C Seeberger
- a Department of Neurology , University of Colorado , Denver , CO 80045 , USA
| | - Robert A Hauser
- b Department of Neurology , Molecular Pharmacology and Physiology, University of South Florida , Tampa , FL 33613 , USA
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Merola A, Romagnolo A, Zibetti M, Bernardini A, Cocito D, Lopiano L. Peripheral neuropathy associated with levodopa–carbidopa intestinal infusion: a long‐term prospective assessment. Eur J Neurol 2015; 23:501-9. [DOI: 10.1111/ene.12846] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 08/04/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A. Merola
- Department of Neuroscience University of Turin Torino Italy
| | - A. Romagnolo
- Department of Neuroscience University of Turin Torino Italy
| | - M. Zibetti
- Department of Neuroscience University of Turin Torino Italy
| | - A. Bernardini
- Department of Neuroscience University of Turin Torino Italy
| | - D. Cocito
- Department of Neuroscience University of Turin Torino Italy
| | - L. Lopiano
- Department of Neuroscience University of Turin Torino Italy
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Ojo OO, Fernandez HH. Levodopa/carbidopa intestinal gel: an effective formulation for the management of advanced Parkinson's disease. FUTURE NEUROLOGY 2015. [DOI: 10.2217/fnl.15.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY With disease progression, almost all Parkinson's disease (PD) patients eventually experience motor fluctuations, often posing a significant challenge for patients and caregivers. Majority of these patients end up with complex medication regimens resulting in increased incidence of adverse effects and a poorer quality of life. Treatment options for advanced PD remain limited; thus, providing the optimal treatment for this growing subpopulation of patients continues to be the focus of many drug development efforts. While deep brain stimulation is considered the most significant therapeutic advancement for advanced PD, it remains an expensive and invasive procedure, with its own risks and complications, which limits global applicability to a wider PD population. Levodopa/carbidopa intestinal gel is one option that may offer a therapeutic benefit as significant as that of deep brain stimulation, and to a broader spectrum of PD patients. This article reviews the pharmacological properties, efficacy, safety and tolerability of levodopa/carbidopa intestinal gel in PD.
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Affiliation(s)
- Oluwadamilola O Ojo
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Neurology Unit, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Hubert H Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
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