Objective: To report our experience with transitioning from apomorphine subcutaneous infusion (ASI) to levodopa-carbidopa intestinal gel (LCIG) in two patients with advanced idiopathic Parkinson’s disease (PD).
Background: Device-assisted infusion therapies have been studied and established for patients with advanced idiopathic PD (1). Each has its selection criteria and follow-up plan (2,3). However, switching from ASI to LCIG is not well reported in case of treatment failure or disease progression.
Method: We report two patients with advanced PD and the reason behind shifting from ASI to LCIG. The first was a 66-year-old lady, and the second was a 63-year-old gentleman; both were diagnosed with idiopathic PD for 7 and 10 years, respectively, and both had started on ASI 2 years ago.
Initially, they showed a satisfactory response to therapy, as shown by reduced off periods, peak dose dyskinesia, and overall disability. The need for oral dopaminergic supplements was at its minimum level.
However, they gradually developed declined clinical response, increased demand infusion rates, and an increased oral supplement that reached the pre-infusion doses. The reason behind this included skin complications, such as local infections and skin atrophy.
The need for the shift to another infusion therapy had been identified, and assessment of fitness for LCIG was done according to standard hospital protocol, and LCIG through PEG-J tub had been inserted, and infusion started.
Results: Extended follow-up revealed regaining good clinical response, in both motor and non-motor signs and symptoms, measured pre and post LCIG; in addition, all-oral therapies were discontinued. Infusion parameters were adjusted according to the patient’s clinical response.
Conclusion: Switching between the device-assisted infusion therapies in PD is possible in case of treatment failure and disease progression. More extensive controlled research studies are needed to set the protocol and selection criteria of shifting between different infusion therapies to maximize the possible added benefits.
References: 1.Prakash N, McFarthing K, Simuni T. Clinical Trial Highlights – Infusion Therapies. J Parkinsons Dis. 2020;10(1):5-17. doi:10.3233/JPD-199005
2.Dijk JM, Espay AJ, Katzenschlager R, de Bie RMA. The Choice Between Advanced Therapies for Parkinson’s Disease Patients: Why, What, and When? J Parkinsons Dis. 2020;10(s1):S65-S73. doi: 10.3233/JPD-202104. PMID: 32651333; PMCID: PMC7592668.
3.Manson AJ, Turner K, Lees AJ. Apomorphine monotherapy in the treatment of refractory motor complications of Parkinson’s disease: long-term follow-up study of 64 patients. Mov Disord. 2002 Nov;17(6):1235-41. doi: 10.1002/mds.10281. PMID: 12465062.
To cite this abstract in AMA style:
M. Abu Al-Melh, M. Farghal, N. Abdelall. Lateral shifting from apomorphine subcutaneous infusion (ASI) to levodopa-carbidopa intestinal gel (LCIG) in the treatment of advanced idiopathic Parkinson’s disease (PD): Case series [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/lateral-shifting-from-apomorphine-subcutaneous-infusion-asi-to-levodopa-carbidopa-intestinal-gel-lcig-in-the-treatment-of-advanced-idiopathic-parkinsons-disease-pd-case-series/. Accessed May 18, 2025.« Back to 2022 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/lateral-shifting-from-apomorphine-subcutaneous-infusion-asi-to-levodopa-carbidopa-intestinal-gel-lcig-in-the-treatment-of-advanced-idiopathic-parkinsons-disease-pd-case-series/