Objective: Investigation of efficacy and challenges of intravenous L-dopa therapy as an alternative treatment for PD patients and those with DLB who experience difficulty with oral medication administration.

Background: In Japan, the PD Treatment Guidelines 2018 address the management of patients requiring fasting due to surgery or deteriorating health conditions. While the guidelines recommend interdisciplinary collaboration and specific L-dopa intravenous dosing protocols (50-100mg per 100mg L-dopa/DCI tablet over 1-2 hours), evidence supporting fasting management in PD patients remains limited and extends to DLB patients. Furthermore, challenges persist in implementing appropriate alternative therapies and achieving effective interdisciplinary coordination, especially in facilities without specialized neurological care units.

Method: We retrospectively analyzed the clinical data of PD and DLB patients who received intravenous L-dopa replacement therapy between August 2020 and April 2024. The analysis included demographic characteristics, pre-admission treatment status, L-dopa equivalent daily dose (LEDD), intravenous L-dopa dosage, duration of replacement therapy, indications for replacement, status of oral medication resumption, and discharge outcomes.

Results: A total of 47 medication replacements were performed in 42 patients (31 PD patients [36 replacements] and 11 DLB patients [11 replacements], mean age 80.4±7.0 years). The cohort was divided into neurologist intervention (62%) and non-intervention groups (38%). Infection and surgery were the predominant indications for alternative therapy in both PD and DLB cases, with infection-triggered cases and DLB patients showing poorer outcomes. The intervention group tended to have shorter treatment interruptions (>2 days: 6.9% vs. 16.7%, p=0.361), lower use of low-dose IV L-dopa (3.4% vs. 61.1%, p<0.001), higher medication resumption rates (72.4% vs. 66.7%, p=0.751) and lower mortality rate (6.9% vs. 16.7%, p=0.357).

Conclusion: Intravenous L-dopa usage was often infection-related, extended in duration, and associated with unfavorable outcomes. Early intervention by a neurologist may improve patient outcomes by reducing long-term oral interruptions and inappropriate alternative therapies.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/intravenous-l-dopa-administration-in-pd-and-dlb-patients-with-oral-intake-difficulties-current-status-and-challenges/