Objective: Objectives of this study were to evaluate changes in medication, adverse events and early discontinuations of levodopa-entacapone-carbidopa-intestinal-gel (LECIG) treatment in advanced Parkinson’s disease (PD).

Background: LECIG is a novel device assisted treatment option for advanced PD that has been available in Finland since 2020.[1] Compared to levodopa-carbidopa-intestinal-gel (LCIG), LECIG contains catechol-O-methyltransferase (COMT) inhibitor entacapone, which increases the bioavailability of levodopa. As in LCIG treatment, a constant infusion of LECIG is delivered with portable infusion pump directly to the proximal jejunum.[2] There is paucity of scientific studies considering the LECIG treatment in clinical practice.

Method: Data of 30 consecutive advanced PD patients evaluated for LECIG treatment between August 2020 and December 2022 in Helsinki University Hospital were analyzed. Six patients switched from LCIG to LECIG, and 21 patients initiated the treatment de novo after screening. 19 patients reached the six-month follow-up as shown in [figure1]. We evaluated retrospectively from the patient records changes in medication, discontinuations, and adverse events during the LECIG treatment.

Results: Epidemiological data of the patients are shown in [table1]. During the follow-up mean levodopa equivalent daily dose (LEDD) rose significantly between baseline before LECIG and six months with treatment (1230 vs. 1570, p=0.001) as shown in [figure2]. Seven (26%) patients discontinued the treatment during follow-up. There were no cases of polyneuropathy; peritonitis or other major infections. There were 11 tube replacements during the follow-up; seven due to displacement and three due to blockage of the inner tube. One patient died during the follow-up; the cause of death was not related to LECIG treatment. There was one case of rhabdomyolysis due to severe dyskinesia during the LECIG treatment.

Conclusion: Early discontinuation rate in LECIG appears higher than expected from experiences with LCIG treatment.[3, 4] LEDD seems to increase during the early phase of LECIG treatment possibly related to better tolerance of levodopa due to constant infusion. Rhabdomyolysis has rarely been reported with LCIG and its incidence in LECIG treatment needs further investigation.[5]

References: 1. Senek, M., E.I. Nielsen, and D. Nyholm, Levodopa-entacapone-carbidopa intestinal gel in Parkinson’s disease: A randomized crossover study. Mov Disord, 2017. 32(2): p. 283-286.
2. Nyholm, D. and W.H. Jost, Levodopa-entacapone-carbidopa intestinal gel infusion in advanced Parkinson’s disease: real-world experience and practical guidance. Ther Adv Neurol Disord, 2022. 15: p. 17562864221108018.
3. Viljaharju, V., et al., Single-Center Study of 103 Consecutive Parkinson’s Disease Patients with Levodopa-Carbidopa Intestinal Gel. Mov Disord Clin Pract, 2022. 9(1): p. 60-68.
4. Sensi, M., et al., Which patients discontinue? Issues on Levodopa/carbidopa intestinal gel treatment: Italian multicentre survey of 905 patients with long-term follow-up. Parkinsonism Relat Disord, 2017. 38: p. 90-92.
5. Sarchioto, M., et al., Dyskinesia-Hyperpyrexia Syndrome in Parkinson’s Disease: A Heat Shock-Related Emergency? Mov Disord Clin Pract, 2018. 5(5): p. 534-537.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/levodopa-entacapone-carbidopa-infusion-treatment-in-parkinsons-disease-a-six-month-follow-up-study/