Category: Parkinson's Disease: Non-Motor Symptoms
Objective: To evaluate the impact of levodopa-carbidopa intestinal gel (LCIG) on dyskinesia, sleep, and other non-motor symptoms over 24 months after initiation.
Background: Complications of levodopa therapy such as dyskinesia and non-motor Parkinson’s disease (PD) symptoms impair patient functioning and well-being, presenting challenges for the management of advanced PD (APD). [1-2] Previous analyses of LCIG studies showed improvements persisting up to 2 years in “off” time, activities of daily living, and quality of life for APD patients treated with LCIG. [3]
Method: Published trials and observational studies examining the efficacy of LCIG were identified from EMBASE and MEDLINE up to September 7, 2020. Outcomes evaluated were Dyskinesia (UDysRS, UPDRS-IV items 32 and 32-24), non-motor symptoms (NMSS), mood/behavior (UPDRS-I), and sleep (PDSS-2, ESS). The pooled mean change from baseline (CFB) with 95% confidence interval (CI) was estimated for each 3-month interval up to 24 months by a random-effects model. Heterogeneity was evaluated using I2 and Q-statistic.
Results: A total of 22 studies evaluating 1085 patients with advanced PD were included. All outcomes of interest showed statistically significant improvement within 3 months of starting LCIG. Dyskinesia outcomes showed improvement at nearly all timepoints up to 24 months after starting LCIG [Table 1]. Reported sleep scale outcomes also showed significant improvement throughout the first 2 years, which were also clinically meaningful for PDSS-2. CFB in UPDRS-I score was significantly improved at month 3, but few studies reported at remaining timepoints. Statistically significant and clinically meaningful improvements in NMSS score were identified at month 3 with mean [95% CI] CFB of -29.77 [-53.29, -6.24] points [Figure 1]. The significant reduction of non-motor symptoms burden was maintained through month 24 with mean [95% CI] CFB of -16.21 [-20.64, -11.79] points.
Conclusion: APD patients receiving LCIG have shown significant improvements in the burden of dyskinesia and non-motor symptoms including sleep with consistent findings up to 2 years after initiation.
References: 1. Chaudhuri KR, Schapira AH. Non-motor symptoms of Parkinson’s disease: dopaminergic pathophysiology and treatment. Lancet Neurol. 2009;8(5):464-474. doi:10.1016/S1474-4422(09)70068-7 2. Valentina Leta, Peter Jenner, K. Ray Chaudhuri & Angelo Antonini (2019) Can therapeutic strategies prevent and manage dyskinesia in Parkinson’s disease? An update, Expert Opinion on Drug Safety, 18:12, 1203-1218, DOI: 10.1080/14740338.2019.1681966 3. David Standaert, et al. Impact of carbidopa-levodopa enteral suspension on quality of life and activities of daily living in patients with advanced Parkinson’s Disease: Results from a pooled meta-analysis. Neurology. Apr 2019, 92 (15 Supplement) P3.8-033;
To cite this abstract in AMA style:
K. Chaudhuri, A. Antonini, R. Pahwa, P. Odin, N. Titova, S. Thakkar, S. Snedecor, S. Hegde, A. Alobaidi, Y. Jalundhwala, J. Parra, C. Zadikoff, L. Bergmann, D. Standaert. Effects of Levodopa-Carbidopa Intestinal Gel on Dyskinesia and Non-Motor Symptoms including Sleep: Results from a Meta-Analysis with 24-month follow-up [abstract]. Mov Disord. 2021; 36 (suppl 1). https://www.mdsabstracts.org/abstract/effects-of-levodopa-carbidopa-intestinal-gel-on-dyskinesia-and-non-motor-symptoms-including-sleep-results-from-a-meta-analysis-with-24-month-follow-up/. Accessed June 16, 2025.« Back to MDS Virtual Congress 2021
MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-levodopa-carbidopa-intestinal-gel-on-dyskinesia-and-non-motor-symptoms-including-sleep-results-from-a-meta-analysis-with-24-month-follow-up/