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. 2022 Sep;12(9):e2547.
doi: 10.1002/brb3.2547. Epub 2022 Aug 9.

Real-life benefits of intrajejunal levodopa infusion therapy in four patients with the parkinsonian variant of progressive supranuclear palsy: A 1-year follow-up data report

Vinod Metta  1   2 , K Ray Chaudhuri  1   2 , Valentina Leta  1   2 , Kandadai Rukmini Mridula  3 , Chaitanya Koduri  4 , Sai Deepak  4 , Rakesh Kalpala  4 , Nageswar Reddy  4 , Guy Chung-Faye  5 , Rupam Borgohain  3
Affiliations

Real-life benefits of intrajejunal levodopa infusion therapy in four patients with the parkinsonian variant of progressive supranuclear palsy: A 1-year follow-up data report

Vinod Metta et al. Brain Behav. 2022 Sep.

Abstract

Background: Progressive supranuclear palsy (PSP) is a progressive neurodegenerative condition presenting with different clinical endophenotypes. The parkinsonian variant of PSP (PSP-P) is characterised by early but fading responsiveness to high-dose levodopa therapy; however, high-dose oral therapy is often associated with intolerance due to dopaminergic side effects and so doses may have to be capped despite clinical benefits. Evidence from animal models and real-life registries suggest far higher doses of levodopa can be tolerated if given in a continuous drug delivery (CDD) manner. We investigated tolerance and possible clinical benefits in patients with PSP-P still responsive to levodopa after initiating CDD in the form of intrajejunal levodopa infusion (IJLI) therapy as part of a compassionate usage program (CU).

Methods: This is an observational clinical data report from the IJLI implementation program undertaken in regional tertiary referral Parkinson's centres in India and at King's College Hospital London, Dubai as part of a CU. Four patients with PSP-P receiving IJLI as a part of a CU underwent evaluations of liver and renal function, motor and nonmotor function, quality of life, sleep dysfunction, fatigue, anxiety and depression, and cognitive impairment at baseline and 6 and 12 months post-IJLI initiation.

Results: In total, three out of four patients successfully completed 12 months of treatment (6 months in one patient). All four patients showed good tolerability to IJLI even at higher doses (1400 and 1960 mg at 6 and 12 months, respectively) when compared to oral levodopa (812.5 ± 103 levodopa equivalent daily dose [LEDD]) and presented with overall persistent improvements in motor and nonmotor scores and quality-of-life scores at 6 and 12 months post-IJLI. All patients showed improvement in estimated glomerular filtration rate (43.50 ml/min/1.73 m2 to 67.5 ml/min/1.73 m2 and 79.5 ml/min/1.73 m2 at 6 and 12 months, respectively).

Conclusions: IJLI led to persistent beneficial effects on motor and some nonmotor aspects in patients with PSP-P at up to 12 months after treatment with associated improvement in overall renal function.

Keywords: Parkinsonian variant of progressive supranuclear palsy; intrajejunal levodopa-carbidopa infusion; motor and nonmotor symptoms; quality of life.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Scale based assessments, results for Patient 1 performed at an optimally on condition. IJLI, intrajejunal levodopa infusion therapy; eGFR, estimated glomerular filtration rate; HADS, Hospital Anxiety and Depression Scale; MMSE, Mini Mental State Examination; NMSS, Nonmotor Symptoms Scale; PDQ, Parkinson's Disease Questionnaire; PDSS, Parkinson's Disease Sleep Scale; PFS, Parkinson's Fatigue Scale; UPDRS, Unified Parkinson's Disease Rating Scale
FIGURE 2
FIGURE 2
Scale based assessments,results for Patient 2 performed at an optimally on condition. eGFR, estimated glomerular filtration rate; HADS, Hospital Anxiety and Depression Scale; IJLI, intrajejunal levodopa infusion therapy; LED, levodopa equivalent dose; MMSE, Mini Mental State Examination; PDQ, Parkinson's Disease Questionnaire; UPDRS, Unified Parkinson's Disease Rating Scale
FIGURE 3
FIGURE 3
Scale based assessments for Patient 3 performed at an optimally on condition. eGFR, estimated glomerular filtration rate; HADS, Hospital Anxiety and Depression Scale; IJLI, intrajejunal levodopa infusion therapy; MMSE, Mini Mental State Examination; NMSS, Nonmotor Symptoms Scale; PDQ, Parkinson's Disease Questionnaire; PDSS, Parkinson's Disease Sleep Scale; PFS, Parkinson's Fatigue Scale; UPDRS, Unified Parkinson's Disease Rating Scale
FIGURE 4
FIGURE 4
Scale based assessments for Patient 4 performed at an optimally on condition. eGFR, estimated glomerular filtration rate; HADS, Hospital Anxiety and Depression Scale; IJLI, intrajejunal levodopa infusion therapy; LED, levodopa equivalent dose; MMSE, Mini Mental State Examination; NMSS, Nonmotor Symptoms Scale; PDQ, Parkinson's Disease Questionnaire; PDSS, Parkinson's Disease Sleep Scale; PFS, Parkinson's Fatigue Scale; UPDRS, Unified Parkinson's Disease Rating Scale.
FIGURE 5
FIGURE 5
Effects of IJLI on individual NMSS domains. GIT, gastrointestinal symptoms; IJLI, intrajejunal levodopa infusion therapy; NMSS, Nonmotor Symptoms Scale
FIGURE 6
FIGURE 6
Effects of IJLI on individual UPDRS‐2 domains. IJLI, intrajejunal levodopa infusion therapy; UPDRS, Unified Parkinson's Disease Rating Scale (GOB = Getting out of Bed) W&B = Walking & Balance)
FIGURE 7
FIGURE 7
Effects of IJLI on individual UPDRS‐3 domains. IJLI, intrajejunal levodopa infusion therapy; UPDRS, Unified Parkinson's Disease Rating Scale
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References

    1. Antonini, A. , Poewe, W. , Chaudhuri, K. R. , Jech, R. , Pickut, B. , Pirtošek, Z. , Szasz, J. , Valldeoriola, F. , Winkler, C. , Bergmann, L. , Yegin, A. , Onuk, K. , Barch, D. , Odin, P. , & GLORIA Study Co‐investigators (2017). Levodopa‐carbidopa intestinal gel in advanced Parkinson's: Final results of the GLORIA registry. Parkinsonism & Related Disorders, 45, 13–20. 10.1016/j.parkreldis.2017.09.018 - DOI - PubMed
    1. Höglinger, G. U. , Respondek, G. , Stamelou, M. , Kurz, C. , Josephs, K. A. , Lang, A. E. , Mollenhauer, B. , Müller, U. , Nilsson, C. , Whitwell, J. L. , Arzberger, T. , Englund, E. , Gelpi, E. , Giese, A. , Irwin, D. J. , Meissner, W. G. , Pantelyat, A. , Rajput, A. , van Swieten, J. C. , … Litvan, I. , Movement Disorder Society‐endorsed PSP Study Group (2017). Clinical diagnosis of progressive supranuclear palsy: The movement disorder society criteria. Movement Disorders, 32, 853–864. 10.1002/mds.26987 - DOI - PMC - PubMed
    1. Jenner, P. (2015). Treatment of the later stages of Parkinson's disease ‐ pharmacological approaches now and in the future. Transl Neurodegener, 4, 3. 10.1186/2047-9158-4-3 - DOI - PMC - PubMed
    1. Metta, V. , Batzu, L. , Leta, V. , Trivedi, D. , Powdleska, A. , Mridula, K. R. , Kukle, P. , Goyal, V. , Borgohain, R. , Chung‐Faye, G. , & Chaudhuri, K. R. (2021). Parkinson's disease: Personalized pathway of care for device‐aided therapies (DAT) and the role of continuous objective monitoring (COM) using wearable sensors. Journal of Personalized Medicine, 11, 680. 10.3390/jpm11070680 - DOI - PMC - PubMed
    1. Rowe, J. B. , Holland, N. , & Rittman, T. (2021). Progressive supranuclear palsy: Diagnosis and management. Practical Neurology, 21, 376–383. 10.1136/practneurol-2020-002794 - DOI - PMC - PubMed