Objective: To evaluate the efficacy of Levodopa-Entacapone-Carbidopa Intestinal Gel (LECIG) in achieving adequate control of motor complications in patients with advanced Parkinson’s Disease (APD).

Background: Levodopa-entacapone-carbidopa intestinal gel infusion is the latest device-aided therapy (DAT) available for APD and was approved in Romania in 2021. LECIG requires the same surgical procedure as Levodopa-Carbidopa Intestinal Gel (LCIG) to insert a percutaneous endoscopic gastro-jejunostomy (PEG-J) system. According to available data, the presence of the entacapone in the LECIG formulation increases the bioavailability of levodopa compared with LCIG, allowing a reduced levodopa dose (by an average of 20–30%) to be given to achieve the same therapeutic plasma levodopa levels.

Method: We performed a retrospective analysis of 16 consecutive APD patients treated with LECIG in our department. Daily duration of OFF time and dyskinesias were assessed before (baseline) and after commencing LECIG treatment with a mean (±SD) follow-up of 7.1±4.9 months.

Results: Patients initiated onto LECIG treatment had a mean (±SD) age of 66.2±7.5 years and a mean disease duration of 10.6±4.9 years. They presented with a mean daily OFF time of 4.8±1.0 hours and 11/16 also presented with 3.2±1.3 hours dyskinesias/day. At baseline, the mean daily dose of levodopa was 901.6±308.3 mg divided into 5.4±0.6 doses (with 5-7 daily doses). Most patients (81.2%) were also being treated with dopamine agonists, namely pramipexole (3 patients, 18.6%; mean dose 2.4±0.6 mg), ropinirole (5 patients, 31.3%; mean dose 9.6±4.56 mg) or rotigotine patch (5 patients, 31.3%; mean dose 8.0±2.4 mg). Therapeutic regimens also included rasagiline (13 patients, 81.2%) and entacapone (12 patients, 75%; mean dose 1,083±103 mg). After starting LECIG treatment, the mean daily OFF time duration was significantly reduced to 1.4 ± 0.54 hours (p˂0.01). Dyskinesia duration was also significantly reduced to 1.11±0.6 hour (p˂0.01) in 9/11 patients who had dyskinesias at baseline, while 2/11 became free of dyskinesias.

Conclusion: LECIG represents an effective DAT option for the management of motor complications in APD. Further targeted studies are necessary to define the profile of APD patients who would benefit most from this therapeutic solution.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/levodopa-entacapone-carbidopa-intestinal-gel-in-advanced-parkinsons-disease-a-single-center-experience/