Objective: To evaluate the characteristics of the last conventional dopaminergic treatments in a large cohort of patients with advanced Parkinson’s Disease (APD) treated with Levodopa Carbidopa Intestinal Gel (LCIG).

Background: Continuous intra-jejunal infusion of LCIG is a long-term proved and effective device-aided treatment (DAT) in APD associated with severe motor fluctuations with or without dyskinesias.

Method: We performed a retrospective review of all patients treated with LCIG (the only available DAT) between 1st June 2011 and 31st December 2019 at the 2nd Department of Neurology Târgu Mureş. We analyzed the particularities of dopaminergic agents’ usage based on the last treatment recommendations and referral letters.

Results: Treatment with LCIG was initiated in 127 patients with APD (68 men, 59 women) with an average age of 64.3±8.2 years (mean±SD) and an average disease duration of 11.1±4.5 years. The average treatment duration with Levodopa was 10.8±4.5 years with an average daily dose of 821.5±246.6 mg divided into 5.1±1.0 doses. Most patients (102, 80.3%) had treatment also with dopamine agonists, namely Pramipexole in 38 cases (average dose 2.3±0.6 mg), Ropinirole in 25 patients (average dose 14.1±5.3 mg) or Rotigotine patch in 42 cases (average dose 7.9±2.8 mg). In three cases the combination of two dopamine agonists was used. The therapeutic strategy also included Rasagiline in 87 cases (68.5%), Amantadine in 37 (29.1%) cases and Entacapone in 79 (62.2%) patients. Other add-on options (Opicapone, Tolcapone, Safinamide) were not available in our country. All patients had off periods with an average duration of 4.72±1.12 hours daily and 85 patients also had dyskinesias (2.92±0.77 hours/day).

Conclusion: In our Department, just before the initiation of LCIG treatment, although the frequency of levodopa dosing was adequate the average daily dose was at the lower end found in the literature, whereas the combination with adjuvant therapy was more common. In our experience, if there is no access to all adjuvant drugs or DAT, the clinical decision-making process and therapeutic strategy may be limited.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/limitations-of-conventional-dopaminergic-medication-in-advanced-parkinsons-disease-results-from-127-patients-treated-with-levodopa-carbidopa-intestinal-gel/