Initial Experience of the Levodopa–Entacapone–Carbidopa Intestinal Gel in Clinical Practice

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.

The Impact of CB1 Receptor on Inflammation in Skeletal Muscle Cells

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“…If positive, these studies will support an earlier positioning of opicapone within the PD algorithm -in early wearing-off and in so called 'stable' disease, but there is also a pharmacological rationale to use COMT inhibitors in combination with levodopa and carbidopa/benserazide in a dual inhibitor preparation that is universally employed. Development of new dual inhibitor products may occur with the life-cycle management of modern COMT inhibitors (in the same way that Stalevo [125], and more recently the levodopa/entacapone/carbidopa intestinal gel infusion for advanced patients [126], developed from entacapone) and remains very much in the unknown future.…”

Optimizing Treatment of Parkinson’s Disease

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“…The results from intestinal levodopa infusion trials demonstrate that stable plasma concentrations as well as personalized drug levels are the determining factors for efficacy and tolerability. The article by Öthman et al is the first report on the clinical use of the most recently marketed infusion therapy for PD in Europe: the levodopa/entacapone/carbidopa intestinal gel [6]. Some of the patients switched from previous levodopa/cabidopa infusion and perceived the smaller pump size as an important improvement.…”