Beyond 10 years of levodopa intestinal infusion experience: Analysis of mortality and its predictors

Artusi, Carlo Alberto; Balestrino, Roberta; Imbalzano, Gabriele; Bortolani, Sara; Montanaro, Elisa; Tuttobene, Sara; Fabbri, Margherita; Zibetti, Maurizio; Lopiano, Leonardo

doi:10.1016/j.parkreldis.2019.10.004

Cited by 11 publications

(15 citation statements)

References 34 publications

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“…In particular, they found that an MMSE cut-off of 26 is significantly associated with mortality; patients scoring <26 have a 2.8 fold higher risk of death. 38 In contrast to their results (MMSE score 26.3 ± 3.3), in our dropout group, the mean MMSE was 24.88±2.37 (also significantly lower when compared to patients with ongoing treatment -27.07±2.02).…”

Section: Deterioration Of General Condition 8 24%contrasting

confidence: 95%

“…The death causes are very similar to those found in previous publications. 38 In a recently published retrospective, longitudinal observational study, Artusi et al, investigating the potential predictors of mortality among numerous clinical and demographic features, observed that a lower MMSE score before starting LCIG negatively influenced survival. In particular, they found that an MMSE cut-off of 26 is significantly associated with mortality; patients scoring <26 have a 2.8 fold higher risk of death.…”

Section: Deterioration Of General Condition 8 24%mentioning

confidence: 99%

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<p>Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients</p>

Constantin¹,

Szász²,

Orbán-Kis³

et al. 2020

NDT

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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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Section: Deterioration Of General Condition 8 24%contrasting

confidence: 95%

Section: Deterioration Of General Condition 8 24%mentioning

confidence: 99%

<p>Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients</p>

Constantin¹,

Szász²,

Orbán-Kis³

et al. 2020

NDT

View full text Add to dashboard Cite

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“…However, there are relatively few studies considering long‐term features of the LCIG treatment 12–17 . Studies have found an average duration of 7 to 8 years of LCIG infusion 13,14 and a high number of adverse events 18,19 . Some authors have reported a group of patients who discontinue the treatment early on 13,20,21 .…”

mentioning

confidence: 99%

“…number of adverse events. 18,19 Some authors have reported a group of patients who discontinue the treatment early on. 13,20,21 Others have found somewhat conflicting risk-factors for discontinuation such as longer 14 or shorter 13 duration of PD before initiation of the infusion and female gender.…”

mentioning

confidence: 99%

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

Viljaharju

Mertsalmi

Pauls

et al. 2021

Movement Disord Clin Pract

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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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“…21 Complications related to the device, lower than expected efficacy, and death tended to be the most consistently noted events leading to discontinuation throughout relevant studies. 20,[64][65][66]68,70 Complications of LCIG Complications of LCIG are generally divided into device-or procedure-related issues and those arising from levodopa/carbidopa administration. Device-related complications were commonly noted in the literature reviewed and especially included dislocation, migration, occlusion, and kinking of tubing, deterioration of connectors, and accidental removal.…”

Section: Discontinuationmentioning

confidence: 99%

Intrajejunal Infusion of Levodopa/Carbidopa for Advanced Parkinson's Disease: A Systematic Review

et al. 2021

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A BS TRACT: Advanced Parkinson's disease is inconsistently defined, and evidence is lacking in relation to device-aided therapies. To update existing reviews of intrajejunal infusion of levodopa/carbidopa (LCIG), we performed a literature search for relevant articles (to November 3, 2020) using PubMed supplemented by hand searching. Retrieved articles were categorized by relevance to identified research questions, including motor complications and symptoms; nonmotor symptoms; functioning, quality of life, and caregiver burden; optimal timing of treatment initiation and administration duration; discontinuation; and complications. Most eligible studies (n = 56) were open-label, observational studies including relatively small patient numbers. LCIG consistently reduces OFF time and increased ON time without troublesome dyskinesia with varying effects regarding ON time with troublesome dyskinesia and the possibility of diphasic dyskinesia. More recent evidence provides some increased support for the benefits of LCIG in relation to nonmotor symptoms, quality of life, activities of daily living, and reduced caregiver burden. Patient age does not appear to significantly impact the effectiveness of LCIG. Discontinuation rates with LCIG (~17%-26%) commonly relate to device-related issues, although the ability to easily discontinue LCIG may represent a potential benefit. LCIG may be a favorable option for patients with advanced Parkinson's disease who show predominant nonmotor symptoms and vulnerability to complications of other advanced therapy modalities. Larger, well-controlled studies, including precise investigation of cost effectiveness, would further assist treatment selection.

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Beyond 10 years of levodopa intestinal infusion experience: Analysis of mortality and its predictors

Cited by 11 publications

References 34 publications

<p>Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients</p>

<p>Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients</p>

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

Intrajejunal Infusion of Levodopa/Carbidopa for Advanced Parkinson's Disease: A Systematic Review

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