Objective: To evaluate the clinical benefit on motor complications of transitioning from levodopa-carbidopa intestinal gel (LCIG) to levodopa-carbidopa-entacapone intestinal gel (LECIG) in a cohort of patients with advanced Parkinson’s disease (PD) suffering from severe, refractory dyskinesias.

Background: Continuous levodopa infusion via LCIG is a standard of care for advanced PD; however, a subset of patients remains challenging to manage due to persistent fragile motor responses, specifically biphasic and peak-of-dose dyskinesias. LECIG incorporates entacapone, which increases the bioavailability of levodopa and extends its half-life, potentially leading to more stable plasma levels and allowing for a reduction in the total levodopa dose.

Method: We conducted a retrospective clinical analysis of 6 advanced PD patients who underwent a therapeutic switch from LCIG to LECIG due to severe dyskinetic patterns. Demographics: 5 women; mean age at diagnosis: 49 years (range 28–78); mean disease duration 17 years (range 8–31); mean age at switch: 66 years (range 47–86). Baseline Treatment: Mean duration on LCIG was 51 months (range 10–118), with a mean LCIG dose of 1402 mg (range 960–1964) and a mean LEDD of 1802 mg (range 1215–2383). Patients were assessed at baseline and six months using the MDS-UPDRS scale.

Results: At six months, the switch to LECIG resulted in a clinical improvement across the entire cohort. The mean MDS-UPDRS-IV score decreased from 14.2 (range 12–16) at baseline to 4.1 at six months. Remarkably, 4 patients achieved zero “OFF” time at six-months. Five patients exhibited both severe biphasic and peak-of-dose patterns; all showed marked, simultaneous improvement in both types of dyskinesia. Intensity and duration of disabling transitions were significantly reduced. The mean LEDD at six months was 1512 mg (range 613–2704). In 5 patients, there was a mean reduction of 450 mg (range 214–602), while one patient required a dose increase.

Conclusion: Our findings suggest that LECIG is an effective alternative for patients who fail to achieve adequate motor smoothing with LCIG. LECIG appears particularly adept at stabilizing the dopaminergic therapeutic window and effectively suppressing complex dyskinesias. This switch should be considered for advanced PD patients insufficiently controlled with LCIG.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effectiveness-of-switching-from-levodopa-carbidopa-intestinal-gel-to-levodopa-carbidopa-entacapone-intestinal-gel-in-patients-with-refractory-biphasic-and-peak-of-dose-dyskinesia/