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. 2020 Jul 28:16:1835-1844.
doi: 10.2147/NDT.S256988. eCollection 2020.

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

Viorelia Adelina Constantin #  1   2 , József Attila Szász #  1   3 , Károly Orbán-Kis  1   4 , Elena Cecilia Rosca  5   6 , Maria Popovici  7 , Amalia Cornea  5   6 , Ligia Ariana Bancu  8   9 , Marius Ciorba  8   10 , István Mihály  1   4 , Előd Nagy  11   12 , Szabolcs Szatmári  1   3 , Mihaela Simu  5   6
Affiliations

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

Viorelia Adelina Constantin et al. Neuropsychiatr Dis Treat. .

Abstract

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.

Keywords: advanced Parkinson’s disease; levodopa-carbidopa intestinal gel; polyneuropathy; therapy discontinuation.

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Conflict of interest statement

Viorelia Adelina Constantin reports personal fees from Abbvie, Bayer, UCB Pharma, and Worwag Pharma, outside the submitted work. József Attila Szász reports personal fees from Abbvie, Boehringer Ingelheim, Lundbeck, Novartis, Pfizer, Teva, and UCB, outside the submitted work. Maria Popovici reports speaking honoraria/travel grants from Abbvie, Bayer, Merck, and UCB. Non-financial support from Abbvie, and Merck, outside the submitted work. Amalia Cornea reports personal fees, non-financial support from Abbvie SRL, outside the submitted work. Ligia Ariana Bancu reports speaking honoraria from Abbvie, Alfasigma, Sanofi. Marius Ciorba reports non-financial support and speaking honoraria Abbvie, Alfasigma, Krka, Naturpharma, SunWave, Terapia SA, during the conduct of the study. Mihaela Simu reports personal fees from Abbvie, AOP ORP, Boehringer Ingelheim, Krka, Merck, Sanofi, Servier Pharma, Teva, UCB Pharma, outside the submitted work. Non-financial support from Abbvie, Merck, Sanofi, and Teva, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Cause of death in LCIG dropout patients (n=33).
See this image and copyright information in PMC

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