Objective: Objective: To evaluate the usage of dopamine agonists (DA) as part of the last conventional dopaminergic treatment in a large cohort of consecutive patients with advanced Parkinson’s Disease (APD), treated with Levodopa Carbidopa Intestinal Gel (LCIG).
Background: Background: DA can be used in every stage of PD, even in APD (as an add-on therapy with time-limited efficacy). Continuous intra-jejunal infusion of LCIG is a long-term proven and effective treatment in APD with severe motor fluctuations, with or without dyskinesias.
Method: Methods: We performed a retrospective review of all APD patients treated with LCIG between June 2011 and June 2021 at the 2nd Department of Neurology in Târgu Mureş. We analyzed the usage of dopaminergic agents, based on the last treatment recommendations and referral letters.
Results: Results: Treatment with LCIG was initiated in 150 patients with APD (81 men, 69 women) with an average age of 63.97±8.2 years (mean±SD) and an average disease duration of 10.95±4.4 years. The mean treatment duration with Levodopa was 10.59±4.4 years with an average daily dose of 854.16±258.15 mg, divided into 5.18±0.97 doses. Most patients (123, 82%) also had treatment with dopamine agonists, namely Pramipexole in 42 cases (average dose 2.3±0.6 mg), Ropinirole in 33 patients (average dose 13.45±4.93 mg) or Rotigotine patch in 51 cases (average dose 8.16±2.92 mg). In three cases the combination of two dopamine agonists was used (Rotigotine as an add-on option). In the evaluated period, apomorphine was not available. All patients had off periods with an average duration of 4.73±1.08 hours daily and 95 patients also had dyskinesias (2.96±0.84 hours/day).
Conclusion: Conclusions: In our department, just before initiating LCIG treatment, the frequency of levodopa usage was adequate while the average daily dose was at the lower end found in the literature, whereas the combination with dopamine agonists was more common/higher. We consider that the decision-making process and the therapeutic strategy are more difficult and limited if there is no access to all adjuvant dopaminergic drugs or DATs.
To cite this abstract in AMA style:J. Szasz, V. Constantin, K. Orban-Kis, L. Bancu, S. Bataga, R. Neagoe, J. Szederjesi, B. Grigorescu, M. Ciorba, I. Mihaly, K. Kelemen, S. Szatmari. Dopamine agonist utilization prior to the initiation of device aided therapy: data from 150 patients with advanced Parkinson’s disease treated with Levodopa Carbidopa Intestinal Gel [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/dopamine-agonist-utilization-prior-to-the-initiation-of-device-aided-therapy-data-from-150-patients-with-advanced-parkinsons-disease-treated-with-levodopa-carbidopa-intestinal-gel/. Accessed September 23, 2023.
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