Levodopa-carbidopa intestinal gel (LCIG) treatment in routine care of patients with advanced Parkinson’s disease: An open-label prospective observational study of effectiveness, tolerability and healthcare costs

Pålhagen, Sven; Sydow, Olof; Johansson, Anders; Nyholm, Dag; Holmberg, Björn; Widner, Håkan; Dizdar, Nil; Lindér, Jan; Hauge, Tove; Jansson, R; Bergmann, Lars; Kjellander, Susanna; Marshall, Thomas

doi:10.1016/j.parkreldis.2016.06.002

Cited by 45 publications

(57 citation statements)

References 21 publications

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“…Complications with the PEG‐J tube (Devos, ; Fernandez et al., ; Nyholm et al., ) are similar to complications related to PEG for feeding purposes (Schapiro & Edmundowicz, ; Udd et al., ). The risk of peritonitis has varied between zero and 4% (Devos, ; Epstein et al., ; Lang et al., ; Palhagen et al., ), and other serious complications like colonic perforations, gastropleural fistula (Klostermann et al., ) and liver injury (Pickut et al., ), have also been described. In our material, we did not have any peritonitis, nor any need for emergency abdominal surgery due to LCIG complications.…”

Section: Discussionmentioning

confidence: 99%

Problems related to levodopa‐carbidopa intestinal gel treatment in advanced Parkinson's disease

et al. 2017

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BackgroundContinuous levodopa‐carbidopa intestinal gel (LCIG) diminishes daily “off” time and dyskinesia in patients with advanced Parkinson′s disease (PD). Complications are common with percutaneous endoscopic gastrostomy with a jejunal extension tube (PEG‐J).Aim of the StudyTo report the clinical outcome of LCIG in patients with advanced PD in the years 2006–2014 at Helsinki University Hospital.Patients and MethodsLevodopa‐carbidopa intestinal gel treatment started following PEG‐J placement in patients with advanced PD after successful in‐hospital LCIG trial with a nasojejunal tube. Demographics, PEG‐J procedures, discontinuation of LCIG, complications and mortality were retrospectively analyzed.Results [mean (SD)]Sixty patients with advanced PD [age 68(7) years; duration of PD: 11(4) years] had LCIG treatment for 26(23) months. The majority of patients with advanced PD were satisfied with the LCIG treatment. For 51 patients (85%), the pump was on for 16 hr a day, and for nine patients (15%) it was on for 24 hr a day. After 6 months, the levodopa‐equivalent daily dose (LEDD) had increased by 30% compared to pre‐LCIG LEDD. Sixty patients underwent a total of 156 PEG‐J procedures, and 48 patients (80%) had a total of 143 complications. Forty‐six patients (77%) had 119 PEG‐J or peristomal complications, and 22 patients (37%) had a total of 25 other complications. The most common complications were accidental removal of the J‐tube in 23 patients (38%) and ≥5% weight loss in 18 patients (30%). Fifteen patients discontinued the LCIG after 21 (21) months. At the end of the follow‐up period of 33(27) months, 38 patients were still on LCIG and nine (15%) had died.ConclusionMost patients were satisfied with LCIG treatment. A few patients lost weight whereas the majority had complications with PEG‐J. When LCIG treatment is carried out, neurological and endoscopic units must be prepared for multiple endoscopic procedures.

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Section: Discussionmentioning

confidence: 99%

Problems related to levodopa‐carbidopa intestinal gel treatment in advanced Parkinson's disease

et al. 2017

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“…Management of PD requires recognition of both motor and non‐motor disturbances as well as an understanding of the relationship between these symptoms and how they can be ameliorated by medications . Treatment of NMSs can be challenging as these symptoms are often underestimated or unrecognized by clinicians and remain untreated .…”

Section: Introductionmentioning

confidence: 99%

“…Parkinson's disease (PD) is characterized by a combination of motor and non-motor symptoms (NMSs) underpinned by relevant neuropathological changes [1][2][3][4][5][6][7] which contribute significantly to morbidity, loss of autonomy, institutionalization and increases in healthcare costs [8,9]. The Non-Motor Symptom Scale (NMSS) and the NMS questionnaire are validated tools [10,11] to assess a broad range of NMSs and have been used in many recent PD studies [12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Burden of non‐motor symptoms in Parkinson's disease patients predicts improvement in quality of life during treatment with levodopa‐carbidopa intestinal gel

Antonini

Robieson

Sánchez-Soliño

et al. 2018

Euro J of Neurology

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Background and purpose GLORIA , a registry conducted with 375 advanced Parkinson's disease patients treated with levodopa‐carbidopa intestinal gel ( LCIG ) for 24 months in routine clinical care, demonstrated significant reductions from baseline in ‘off’ time and ‘on’ time with dyskinesia and improvements in the Non‐Motor Symptom Scale ( NMSS ) total and individual domain scores, and in Parkinson's Disease Questionnaire 8 item ( PDQ ‐8) total score. Methods Associations between baseline NMSS burden ( NMSB ), the multi‐domain NMSS total score and the PDQ ‐8 total score were investigated for 233 patients. Baseline NMSB was assigned to five numerical categories defined by the NMSS total cutoff scores (0–20, 21–40, 41–60, 61–80 and >80). Pearson and Spearman correlations were calculated at month 24. Results The response of LCIG was assessed using validated criteria after 24 months. The proportion of patients decreasing ≥ 30 NMSS score points was 47% in the most affected NMSB category ( NMSS total score > 80). A positive association was noted between baseline NMSB and NMSS total score (0.57, P < 0.0001), as well as between NMSS total score and PDQ ‐8 total score (0.46, P < 0.0001). Associations between improvements of the NMSS domain sleep/fatigue and PDQ ‐8 total score (0.32, P = 0.0001) as well as between the NMSS domain mood/cognition and PDQ ‐8 total score (0.37, P < 0.0001) were also shown. Conclusions This analysis demonstrated positive associations between NMSS baseline burden and improvements of non‐motor symptoms. Improvements of non‐motor symptoms were associated with improved quality of life in advanced parkinsonian patients during a 2‐year treatment with LCIG and reflect the long‐term non‐motor efficacy of this treatment.

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“…A recent study of over 900 patients with PD and motor fluctuations initiated on LCIG indicated that the majority (~75%) of patients were able to continue long‐term LCIG to achieve improved motor function without troublesome dyskinesias even in the advanced stages of their disease . However, initiating and maintaining this form of treatment is a considerable undertaking, with the caveat that improvements in mobility may also occasionally render the patient at greater risk of falling or developing hallucinations . The costs of LCIG are substantial, but are mitigated by improvements in quality of life years (QALY) .…”

mentioning

confidence: 99%

“…2 However, initiating and maintaining this form of treatment is a considerable undertaking, with the caveat that improvements in mobility may also occasionally render the patient at greater risk of falling or developing hallucinations. [3][4][5] The costs of LCIG are substantial, but are mitigated by improvements in quality of life years (QALY). 5 However, achieving maximal QALY relies on the durability of treatment benefit.…”

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confidence: 99%

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

Vijiaratnam

Sue

2018

Internal Medicine Journal

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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.

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Levodopa-carbidopa intestinal gel (LCIG) treatment in routine care of patients with advanced Parkinson’s disease: An open-label prospective observational study of effectiveness, tolerability and healthcare costs

Cited by 45 publications

References 21 publications

Problems related to levodopa‐carbidopa intestinal gel treatment in advanced Parkinson's disease

Problems related to levodopa‐carbidopa intestinal gel treatment in advanced Parkinson's disease

Burden of non‐motor symptoms in Parkinson's disease patients predicts improvement in quality of life during treatment with levodopa‐carbidopa intestinal gel

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

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