Impact of Infusion Therapies on Quality of Life in Advanced Parkinson’s Disease

Abstract

A high burden of motor and non-motor parkinsonian symptoms is known to have a significant negative impact on the quality of life (QoL) of people with Parkinson’s disease (PD). Effective control of these symptoms with therapies that enable patients to maintain a good QoL is therefore a key treatment goal in PD management. When symptom control can no longer be accomplished with oral or transdermal PD treatment regimens, device-aided therapies (DAT), namely levodopa and apomorphine infusion therapies, and deep brain stimulation, are valuable options to consider. DAT options may also help reduce pill burden and thereby improve compliance with treatment. Since PD therapy relies on symptomatic management, the efficacy and tolerability of any intervention is undoubtedly important, however the impact of different therapies on patient-related outcome measures, in particular health-related QoL, is also a critical consideration for those living with a chronic and disabling condition. This review discusses clinical evidence and ongoing research regarding the QoL benefits of levodopa and apomorphine infusion therapies from studies that have used validated QoL outcome measures. The data suggest that timing of these interventions is important to achieve optimal treatment effects, and that early initiation onto infusion therapies at the point when motor fluctuations emerge, and before patient QoL and functioning have significantly declined, may provide the best long-term outcomes. Healthcare professionals caring for people with PD should therefore discuss all available DAT options with them at an early stage in the course of their disease so they can make informed and timely choices that best suit them, their families and care network.

Starting with 24-h levodopa carbidopa intestinal gel at initiation in a large cohort of advanced Parkinson’s disease patients

“…When the motor complications can no longer be improved to an acceptable level, it is necessary to evaluate the patients in order to introduce device-aided therapies (enteral infusions of levodopa, subcutaneous infusion of apomorphine or deep brain stimulation) 27 , 28 . The levodopa/carbidopa intestinal gel is a treatment developed for patients with APD.…”

Levodopa–Entacapone–Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease: A Single Center Real-World Experience

“…With an extremely heterogeneous and constantly changing clinical picture, the therapeutic strategy must be continuously adapted under conditions of strict personalization. This is also true for the use of different DAT options (enteral infusions of levodopa, subcutaneous infusion of apomorphine, or deep brain stimulation (DBS), which are expected to improve motor and non-motor complications and thus health-related QoL [ 30 , 31 , 32 ]. Non-oral LD delivery bypasses issues with gastrointestinal transport and absorption that may compromise oral treatment and has been developed along two main rationales: to provide stable plasma concentrations via continuous drug delivery and to provide a rapid onset of clinically beneficial effect suitable for use as an on-demand (“rescue”) medication.…”