Objective: To evaluate 6-month changes in motor and non-motor outcomes in patients with advanced Parkinson’s disease treated with levodopa/carbidopa intestinal gel (LCIG) or levodopa/entacapone/carbidopa intestinal gel (LECIG), using an optimized medical therapy (OMT) group as comparator. Quality of life was assessed as a secondary outcome.

Background: Advanced Parkinson’s disease is characterized by motor fluctuations and dyskinesias that limit the benefit of oral therapy. Intestinal levodopa infusion provides continuous dopaminergic stimulation and is used in patients with insufficient symptom control on conventional treatment.

Method: This prospective single-center interventional study included 42 patients with advanced Parkinson’s disease: LCIG (n=15), LECIG (n=17), and OMT (n=10). Patients in the infusion groups were assessed at baseline and after 6 months of treatment; the OMT group was evaluated at the same interval. Assessments included MDS-UPDRS, MDS-NMS, UDysRS, PDQ-8, and MoCA. Data were analyzed using non-parametric methods. Baseline demographic and clinical characteristics were comparable across groups, , although baseline non-motor symptom burden was higher in the LCIG group.

Results: After 6 months, both intestinal gel therapies were associated with significant improvement in motor complications (MDS-UPDRS part IV: LCIG p=0.009; LECIG p=0.002) and dyskinesia severity (UDysRS: LCIG p=0.021; LECIG p=0.037). Quality of life improved in both infusion groups (PDQ-8: LCIG p=0.036; LECIG p=0.028), whereas no significant changes were observed in the OMT group. In the non-motor domain, LCIG was associated with improvement in global MDS-NMS score (p=0.032), particularly depression (p=0.040) and orthostatic hypotension (p=0.036). LECIG was associated with improvement in selected MDS-NMS domains, including orthostatic hypotension (p=0.014), pain (p=0.020), and sleep disturbance (p=0.047), without a significant change in global MDS-NMS score.

Conclusion: In this prospective real-world cohort, both LCIG and LECIG were associated with reduced motor complications and dyskinesia burden, together with improved quality of life over 6 months. Non-motor effects appeared to be domain-specific, with broader improvement in global non-motor burden in the LCIG group and selected domain-level changes in the LECIG group. 

This work was supported by grant APVV-24-0369.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/intestinal-levodopa-infusion-therapies-in-advanced-parkinsons-disease-a-6-month-prospective-cohort-study/