Objective: To evaluate the real-world response of patients who are converted from IR CD-LD and SR CD-LD to ER CD-LD in an academic practice.

Background: ER CD-LD was released in the USA in March 2015 with the hope that it would decrease the number of levodopa doses per day and result in less motor fluctuations than IR CD-LD. ER CD-LD trials studied subjects with more straightforward PD. However, as many patients in clinical practice may not have qualified for the FDA trials, the utility of the drug in clinical practice, risk factors for intolerance, and barriers to obtaining the drug needs to be monitored.

Methods: We conducted a chart review of all patients prescribed ER CD-LD in the Rush University movement disorders clinic in 2015. Demographics and clinical features of those prescribed the drug were gathered. Patients who tolerated it versus those that did not were compared.

Results: 85 patients were prescribed ER CD-LD. The mean age was 68(8.8), 56% male, median disease duration 11(8) years, and 89% with diagnosis of PD. 69 patients actually started the drug. 10 never started, and in 6 the prescription status was unclear. At the end of 2015, 41(59%) were still taking the drug, 25(36%) had stopped. Among the 25 who stopped, median time on the drug was 1.03 months (0.03-8). Those who stopped ER CD-LD were not different from those who continued it in terms of age, sex, race, length of diagnosis, H&Y stage, motor symptom severity, diagnosis, presence of dyskinesia, number of non-motor symptoms, and specific non-motor symptoms (p>0.05) with the exception of dementia. Dementia was more common in the group that tolerated the drug (p=0.02). Reasons for not getting the drug included insurance coverage and cost. The most common reasons for discontinuing the drug included inefficacy, cost, and increased dyskinesia.

Conclusions: In our practice, ER CD-LD was effective and tolerated by the majority of patients who received the drug, although cost was a barrier to many. Dementia diagnosis increased the likelihood that the drug would be tolerated, but other clinical and demographic features did not predict a poor outcome after conversion. Longer-term follow-up will be needed; however, for now our results indicate that patients should be considered for this formulation independent of their comorbidities.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/conversion-of-patients-from-immediate-release-carbidopa-levodopa-ir-cd-ld-and-sustained-release-carbidopa-levodopa-sr-cd-ld-to-extended-release-carbidopa-levodopa-er-cd-ld-in-clinical-practice/