Objective: To analyze the influence of the overall levodopa exposure on the risk of polyneuropathy (PN) in levodopa-carbidopa intestinal gel (LCIG)-infusion treated patients with Parkinson’s disease (PD).

Background: Symptomatic PN may occur as a complication of LCIG infusion. However, PN is also related to long-term exposure to oral levodopa. It is still unclear how the overall exposure to levodopa contributes to the risk on PN in LCIG treated patients.

Methods: The charts of PD patients treated with LCIG infusion between 2006-2014 at the University Medical Center Groningen were retrospectively reviewed. Only patients with at least a baseline EMG at the start of LCIG and one follow-up EMG were included. The diagnosis of PN was based on the EMG criteria. The baseline risk on PN was correlated to the cumulative levodopa exposure and time of levodopa exposure. This risk was compared to the post-LCIG risk on PN and the post-LCIG increase of the cumulative levodopa dose.

Results: 24 advanced PD patients were included in this analysis (male: 50%; age: 64.3 ± 8.6 years; disease duration: 12.9 ± 5.8 years; duration of levodopa therapy before LCIG: 10.2 ± 6.4 years; cumulative dose of levodopa before LCIG: 3.4 ± 2.2 kg). At baseline, 15 PD patients (62.5%) were diagnosed with PN. PD patients with PN had a significantly longer duration of levodopa exposure as compared to the non-PN patients (12.7 ± 6.2 years vs. 6.2 ± 4.6 years; p = 0.01) and a higher cumulative levodopa dosage (4.2 ± 2.2 kg vs 2.1 ± 1.5 kg; p = 0.01). Duration of levodopa exposure (yrs.) was an independent predictor of PN at baseline (OR: 1.27; 95% CI: 1.03-1.60; p = 0.03).

A post-LCIG EMG was available in 5 out of 15 patients with PN and in 5 out of 9 patients without PN at the start of LCIG. After a mean follow-up of 3.7 ± 1.2 years, three patients developed a new axonal sensory PN.

The estimated incidence rate of PN prior to LCIG was 6.1 cases per 100 person years of oral levodopa (95% CI: 3.5-9.8). The estimated incidence rate of PN during LCIG was 16.4 cases per 100 person years of LCIG infusion (95% CI: 4.2-44.6). These rates did not differ significantly (p = 0.16).

Conclusions: The prevalence of pre-existing PN in patients treated with LCIG was high and significantly associated with the duration and cumulative dose of oral levodopa therapy. There was no evidence for a higher risk of PN during LCIG infusion as compared to use of oral levodopa.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/does-levodopa-carbidopa-intestinal-gel-in-parkinsons-disease-patients-increase-the-risk-on-polyneuropathy/