Session Information
Date: Thursday, June 23, 2016
Session Title: Pharmacology
Session Time: 12:00pm-1:30pm
Objective: To evaluate long-term efficacy, levodopa dose changes and complications in patients with advanced Parkinson’s disease (PD) treated.
Background: Administrated via percutaneous gastric gastrostomy to jejunum (PEG-J) by means of a permanent catheter connected to an external pump. The levodopa is delivered continuously in small quanta preventing large plasma level fluctuations and thus suppressing disabling motor complications related to oral treatment in advanced stages of PD.
Methods: We retrospectively analyzed records from 63 PD patients (33 males; aged 67±(SD)8 years) treated in the Movement Disorders Center in Prague with Duodopa® from June 2008 to November 2015. Objective Global Clinical Impression (GCI, ranging from +3 very much improved to -3 very much worsened), levodopa dose, body weight, side effects frequency and mortality were analyzed.
Results: Out of all the patients, 12 patients were unsatisfied with Duodopa and had already discontinued treatment during the titration period. The rest of 51 responders underwent (PEG-J) procedure and were treated for next 3 years with the treatment efficacy GCI median of 2(=much improved) (IQR 1-3). Adverse effects occurred in 71% of patients manifested most often by inflammation around stoma. Treatment was stopped in 55% patients (24% due to mortality; 23% lack of efficacy; 8% intolerable side effects). The levodopa dose increased from 1146±(SD)503 mg (N=49) to 1604±(SD)428mg (N=24) at the end of the first year and finally decreased to 1434mg±(SD)609 mg (N=12) (p<0.0001) at the end of the third year of the treatment. In addition, there was interaction between change of levodopa dose, change in body weight and treatment duration (p=0.023).
Conclusions: We confirm the long-term benefit in the treatment of late motor complications in advanced PD manifested by an improvement in 86 % patients accompanied by a relatively high frequency of side effects. Surprisingly, the levodopa dose increase in the first year of treatment nearly by 40% was most likely due to underdosing of patients during previous oral therapy rather than because of lower efficacy. Decrease of levodopa at the end of the observation period was probably related to decrease of body weight.
To cite this abstract in AMA style:
P. Havránková, J. Klempír, M. Fialová, A. Rezková, J. Petrtýl, V. Capek, E. Ruzicka, J. Roth, R. Jech. Levodopa/carbidopa intestinal gel treatment in advanced Parkinson’s disease: A long-term observational study [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/levodopacarbidopa-intestinal-gel-treatment-in-advanced-parkinsons-disease-a-long-term-observational-study/. Accessed May 21, 2025.« Back to 2016 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/levodopacarbidopa-intestinal-gel-treatment-in-advanced-parkinsons-disease-a-long-term-observational-study/