Levodopa‐carbidopa intestinal gel: ‘dismantling the road blocks of a journey’

Abstract

Levodopa-carbidopa intestinal gel offers superior treatment to standard oral therapy in selective patients with advanced Parkinson disease. The costs involved in instituting and maintaining this treatment are high but largely mitigated with the quality of life years the treatment offers. Key to this is ensuring a high retention rate once the treatment is instituted. We outline factors and considerations from our experience and viewpoints at each stage of the process to address in this 'journey' patients undertake that can help maximise retention rates and benefits.

The Prephase Nursing in Levodopa Carbidopa Intestinal Gel Therapy

“…15,16 During the final phase of pre-LCIG evaluation, the nurse evaluates other no less important aspects, such as the number of years in which the patient was affected by PD, which often leads (because of the general clinical conditions) to treatment abandonment 15,16 ; tolerance or not to the weight of the infusion pump (often not suitable for the patient's state of wasting and malnutrition) 1 ; and initial phase of the LCIG treatment. 19 According to the scientific literature, the initial phase of nursing assessment, in combination with the multidisciplinary team, ensures the appropriate selection of candidates who have to face these therapeutic choices. 19…”

“…19 According to the scientific literature, the initial phase of nursing assessment, in combination with the multidisciplinary team, ensures the appropriate selection of candidates who have to face these therapeutic choices. 19…”

Cost-Effectiveness of Device-Aided Therapies in Parkinson’s Disease: A Structured Review

“…Finally, from both a patient's and health care professional's perspective, potential post-interventional adverse events might represent an additional barrier in choosing device-aided therapies (Table 3). Examples include the greater risk of falling and hallucinations in DBS, potentially leading to longer hospitalization, local nodules at infection site, haemolytic anaemia, fatigue, dizziness, orthostatic hypotension, and electrocardiographic changes in CSAI [65,66], and the development of polyneuropathy in IJLI treated patients [67]. Related to this, there is limited unbiased and comparable information for all three options, as no randomized controlled trials directly comparing the device-aided therapies have been conducted [59].…”

Therapeutic Strategies to Treat or Prevent Off Episodes in Adults with Parkinson’s Disease

“…Despite the substantial advantages in MF seen with this treatment, the use of LCIG may be limited by device and procedurerelated complications such as blocked tubes, tube dislocations, stoma complications, superficial infections, peritonitis, and pneumoperitoneum [190], [192]. These issues can result in a proportion of patients discontinuing treatment, though systemic and procedural modifications have been demonstrated to minimise these occurrences [193], [194], [195]. Polyneuropathy has been noted in a small proportion of patients using LCIG, therefore prior surveillance for vitamin B12 deficiency (including measurement of homocysteine and methyl malonic acid) and parenteral B12 replacement may be useful in this regard [196], [197].…”