Levodopa-carbidopa enteral suspension in advanced Parkinson’s disease: clinical evidence and experience

Abstract

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.

24-Hour Levodopa-Carbidopa Intestinal Gel: Clinical Experience and Practical Recommendations

“…Levodopa-carbidopa intestinal gel (LCIG; designated in the USA as carbidopa-levodopa enteral suspension) is an approved treatment for advanced PD that continuously delivers levodopa through infusion into the proximal jejunum via a percutaneous endoscopic gastrostomy tube with a jejunal extension (PEG-J) connected to a portable infusion pump. Efficacy of up to 16-hours continuous administration of LCIG in reducing motor fluctuations has been established in multiple prospective studies [6][7][8][9][10][11][12][13][14][15][16][17][18], and reviewed extensively [2,[19][20][21]. Although the pathogenesis of NMS remains partially unclear, 16-hour (16-h) continuous administration of LCIG has been associated with improvements in NMS, sleep quality, and quality-of-life measures (Table 1) [6,7,11,13,17,22,23].…”

Multicenter study of levodopa carbidopa intestinal gel in Parkinson's disease: the Turkish experince

“…Although there are numerous studies showing that LCIG is effective in treating PD [9][10][11][12], there is only one randomized, controlled, double-blind, double-dummy study to prove its efficacy [13]. Different types of scales (Unified PD Rating Scale: UPDRS, Parkinson Patient Quality of Life: PDQ, Nonmotor Symptoms Scale: NMSS, etc.)…”

Phytobezoar and duodenal ulcer as complication of Duodopa therapy in a patient affected by Parkinson’s disease

“…Even if the efficacy of LCIG in advanced PD is unquestionable today, the rate of related adverse events is high (up to 94% in some studies) 15. Fortunately, complications are often minor and do not lead to permanent discontinuation of treatment.…”

“…In a review published in 2017, Virhammar and Nyholm reported an incidence of serious adverse event of 11% in the maintenance period. Cases of dislocation of the jejunal tube are reported in the literature and affect about 2.3% of patients treated 15. Decubitus duodenal ulcer is a rare complication of dislocation of jejunal tube.…”