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

Udd, Marianne; Lyytinen, Jukka; Eerola‐Rautio, Johanna; Kenttämies, Anu; Lindström, Outi; Kylänpää, Leena; Pekkonen, Eero

doi:10.1002/brb3.737

Cited by 37 publications

(36 citation statements)

References 25 publications

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“…Nonetheless, currently there are few articles available that analyze the reasons that led to the discontinuation of treatment on large groups of patients. [7][8][9][10] The LCIG therapy became available in Romania in 2009. In 2016 a multicenter study was published analyzing data of the first 113 Romanian patients (9 university teaching hospital centers).…”

Section: Introductionmentioning

confidence: 99%

<p>Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients</p>

Constantin¹,

Szász²,

Orbán-Kis³

et al. 2020

NDT

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Background: Parkinson's disease (PD) is the second most common progressive neurodegenerative disease. In the advanced stages, the continuous delivery of levodopa (LD) as levodopa-carbidopa intestinal gel (LCIG) has demonstrated significant improvement of motor and nonmotor complications and improvement of the patients' quality of life (QoL). Despite the growing global experience with this treatment, anumber of unsolved practical issues remain, and currently, the data on the reasons that can lead to the discontinuation of LCIG are scarce. Objective: In the present study, we aimed to analyze the causes that led to the discontinuation of LCIG therapy. Methods: In this retrospective study, after 10 years of experience with LCIG as a therapeutic option in advanced PD, we analyzed the data of all dropout cases among the 204 patients that initiated LCIG therapy in two Romanian centers. Results: Of the 204 patients enrolled, 43 patients dropped out. Disease duration until LCIG infusion was significantly longer (11.67±4.98 vs 9.44±3.44) and the overall clinical picture more sever (both regarding motor symptoms and cognitive decline) in dropout patients (compared to patients who continued treatment). The dropout patients also presented significant differences regarding the incidence of polyneuropathy (32.5% vs 11.18%). The main cause of discontinuation was death. Conclusion: The causes of discontinuation from LCIG therapy in Romanian patients are similar to those from other centers; however, the rate of dropouts is somewhat lower. The clinician's experience in selecting and treating the patients in advanced stages of PD can increase therapeutic adherence. Also, the presence of a well-trained caregiver along with the availability of a proper aftercare system is mandatory for maintaining the long-term benefits of the therapy and the overall best outcome possible. Targeted prospective studies are needed to confirm whether a more severe stage of the disease and cognitive impairment at the time of initiation, respectively, the association of polyneuropathy can be considered as predictive factors for dropout.

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Section: Introductionmentioning

confidence: 99%

<p>Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients</p>

Constantin¹,

Szász²,

Orbán-Kis³

et al. 2020

NDT

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“…Abdominal pain is the most common AE related to device insertion, affecting approximately a third of patients [6-7]. AEs related to the tubing system, including tube dislodgement, knot formation, kinking, or obstruction are reported in 8-55% of patients [5,7,9]. Gastrostomy site AEs, including incision site infection, erythema, or excessive granulation tissue are also reported in varying degrees in 4-59% of patients, with only one previous case of BBS [5,7,9-10].…”

Section: Discussionmentioning

confidence: 99%

Delayed Diagnosis of Buried Bumper Syndrome When Only the Jejunostomy Extension is Used in a Percutaneous Endoscopic Gastrostomy-jejunostomy Levodopa-carbidopa Intestinal Gel Delivery System

Abu-Heija

Tama

Abu-Heija

et al. 2019

Cureus

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Direct intrajejunal levodopa-carbidopa intestinal gel (LCIG) administered through a percutaneous endoscopic gastrostomy (PEG) with a jejunal extension tube (PEG-J) is an FDA-approved modality for treatment of patients with advanced Parkinson’s disease (PD). Buried bumper syndrome (BBS) is a rare complication associated with PEG tubes inserted for drug administration or enteral feeding. The syndrome is diagnosed endoscopically revealing burial of the internal bumper in the gastric wall, causing numerous serious complications. When only the J extension of a PEG-J is used to deliver medications, and the G tube is not utilized, a delay in the diagnosis of BBS can occur. This is likely as the small caliber J extension tube remains patent and functional. We present the case of an elderly patient with advanced PD on LCIG therapy, who presented with a dislodged J-tube from a PEG-J system. Endoscopy revealed BBS that had likely developed prior to dislodgment of J-extension and despite a conservative approach, the internal bumper needed to be surgically extracted to prevent further complications.

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“…Complications such as dislocation of the intestinal tube, catheter migration and infection are common. 58 Both treatments need to be commenced in hospital under specialist supervision. Once these treatments fail to control symptoms, options are limited.…”

Section: Advanced Pdmentioning

confidence: 99%

Pharmacological management of Parkinson’s disease in older people

Mouchaileh

Hughes

2020

Pharmacy Practice and Res

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Parkinson's disease is a chronic neurodegenerative disorder that mainly affects older people. It is predominately recognised as a movement disorder; however, the non-motor symptoms are gaining increased recognition. Treating both motor and non-motor symptoms can be challenging. Co-morbidities, in particular dementia, polypharmacy and an increased susceptibility to adverse medication effects often necessitate a different approach to management compared to younger patients. In older people, the mainstay of treatment for motor symptoms is levodopa. However, long-term side-effects including motor fluctuations and dyskinesia can be severely disabling and may require the addition of adjunctive agents including dopamine agonists, catechol-o-methyltransferase inhibitors, monoamine oxidase-B inhibitors and amantadine. Medications can significantly improve symptoms; however, optimal management of motor and non-motor symptoms usually requires a multidisciplinary approach. In this article we present an evidence-based review of Parkinson's disease treatments and guidance to improve clinical management and outcomes in older people.

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

Cited by 37 publications

References 25 publications

<p>Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients</p>

<p>Levodopa-Carbidopa Intestinal Gel Infusion Therapy Discontinuation: A Ten-Year Retrospective Analysis of 204 Treated Patients</p>

Delayed Diagnosis of Buried Bumper Syndrome When Only the Jejunostomy Extension is Used in a Percutaneous Endoscopic Gastrostomy-jejunostomy Levodopa-carbidopa Intestinal Gel Delivery System

Pharmacological management of Parkinson’s disease in older people

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