Levodopa/carbidopa intestinal gel infusion in advanced Parkinson's disease: a 7‐year experience

Zibetti, Maurizio; Merola, Aristide; Artusi, Carlo Alberto; Rizzi, Laura; Angrisano, Serena; Reggio, D.; Angelis, CG De; Rizzone, Mario Giorgio; Lopiano, Leonardo

doi:10.1111/ene.12309

Cited by 90 publications

(92 citation statements)

References 26 publications

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“…In terms of safety, our profile was consistent with that reported in previous studies [27,21,12,13] and similar to the safety profile of oral treatment, as referred by other authors [21,28,29]. Our main problems were related to the infusion device and in most of the cases they were of mild intensity.…”

Section: Discussionsupporting

confidence: 91%

“…However our results showed also that LCIG may cause the occurrence of very severe hyperkinetic movements and an increase time with not troublesome dyskinesias in some patients. Those results are in disagreement with other studies that have reported a global improvement of dyskinesias [13,19,12,7]. Most of them however did not focus on specific effect of LCIG on dyskinesias.…”

Section: Discussioncontrasting

confidence: 84%

See 1 more Smart Citation

Long-term response to continuous duodenal infusion of levodopa/carbidopa gel in patients with advanced Parkinson disease: The Barcelona registry

Buongiorno

Antonelli

Cámara

et al. 2015

Parkinsonism & Related Disorders

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 84%

Long-term response to continuous duodenal infusion of levodopa/carbidopa gel in patients with advanced Parkinson disease: The Barcelona registry

Buongiorno

Antonelli

Cámara

et al. 2015

Parkinsonism & Related Disorders

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“…Significant improvements it QoL measures were observed at follow ups of 2 years and 25.8 ± 19.5 months in studies in Spain and Italy [Antonini et al 2008;Cáceres-Redondo et al 2014;Zibetti et al 2014].…”

Section: Long-term Efficacymentioning

confidence: 90%

“…Significant improvements in the total UPDRS IV (motor complications) score were observed in most studies where this was reported [Antonini et al 2008;Honig et al 2009;Palhagen et al 2012;Pickut et al 2014;Zibetti et al 2014;Martinez-Martin et al 2015;Slevin et al 2015].…”

Section: Motor Symptomsmentioning

confidence: 92%

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

Virhammar

Nyholm

2016

Ther Adv Neurol Disord

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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.

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“…The addition of a COMT inhibitor has been described to economize LCIG and may be useful if the patients' daily dosage slightly exceeds the amount of one cartridge to avoid the need for additional cartridge change (Nyholm et al 2012). Remarkably, most patients do not require an increase in the originally determined LCIG dosage and may remain on the same dosage for many years (Fasano et al 2011;Zibetti et al 2013). In many cases, even a slight reduction of the dosage is possible, which usually is not observed in PD patients treated with pulsatile oral levodopa.…”

Section: Introductionmentioning

confidence: 99%

Advanced stages of PD: interventional therapies and related patient-centered care

et al. 2015

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During the last decades, symptomatic treatment of motor symptoms of Parkinson's disease (PD) improved continuously and is reflected by long-range independency of the patient during the disease course. However, advanced stages of PD still represent an important challenge to patients, caregivers and treating physicians. In patients with advanced PD, interventional therapy strategies are increasingly applied. These device-related treatment strategies using pump-based continuous dopaminergic stimulation (CDS) or deep brain stimulation (DBS) opened new treatment options especially if motor complications predominate. Well-designed clinical studies on these interventional therapeutic approaches provided class 1 evidence for the efficacy of DBS and CDS in advanced PD and opened new perspectives for their use in earlier disease stages also. Therefore, careful selection of patients amenable to the (semi)invasive therapy options becomes more and more important and requires an interdisciplinary setting that accounts for (i) optimal patient information and awareness, (ii) selection of best individual treatment modality, (iii) training of relatives and caregivers, (iv) management of complications, and (v) follow-up care. Here, we address these topics by summarizing current state-of-the-art in patient selection, providing specificities of treatment options and troubleshooting, and defining steps towards an optimized patient-centered care. Interventional therapies pioneer in the area of individualized treatment approaches for PD, and may be complemented in the future by biomarker-based improved stratification and by closed-loop systems for adaptive therapeutic strategies. In the present review, we summarize the proceedings of an Expert Workshop on Parkinson's disease held on November 22, 2014 in Frankfurt, Germany.

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Levodopa/carbidopa intestinal gel infusion in advanced Parkinson's disease: a 7‐year experience

Abstract: LCIG infusion is effective for the long-term treatment of advanced PD patients and exerts a positive and clinically significant effect on motor complications with a relatively low dropout rate.

Cited by 90 publications

References 26 publications

Long-term response to continuous duodenal infusion of levodopa/carbidopa gel in patients with advanced Parkinson disease: The Barcelona registry

Long-term response to continuous duodenal infusion of levodopa/carbidopa gel in patients with advanced Parkinson disease: The Barcelona registry

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

Advanced stages of PD: interventional therapies and related patient-centered care

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