Objective: To report our institution’s initial clinical experience with initiation and management of levodopa carbidopa intestinal gel (LCIG) formulation Duopa®.

Background: Carbidopa/levodopa intestinal gel (LCIG) (PEG-J) was approved in early 2015 by the United States Food and Drug Administration for Parkinson’s disease patients with disabling motor fluctuations.

Methods: We retrospectively reviewed the records of the first 7 patients (7 men: 0 women) we placed on LCIG. Patients were on average 70 +/-5 years old and had a duration of disease of 11 +/-3 years. Average duration of treatment of LCIG was 14 +/-8 weeks.

Results: Patients underwent PEG-J tube placement with general surgery as an outpatient procedure. Patients presented to clinic in the “on” state 3-7 days following J-tube placement. Patient’s initial LCIG hourly rate was calculated by taking their total daily dose of oral levodopa equivalents divided by 16 hours of therapy. Morning dose was set at 50% of the hourly rate, and patients were given the option of an extra dose of 25% of the hourly rate every 2 hours as needed. Patients were given an hourly dose range extending 10% above their calculated rate and instructed on how to adjust the rate at home. Most patients were discharged from clinic within 2 hours. All patients were able to successfully titrate their dose at home. Six patients required follow up over the phone. Average time to follow up in clinic was 55 days. Two patients required adjustment of their hourly infusion rate. Two patients required adjustment of their morning dose, and 2 patients required adjustment of their extra dose. Patients’ clinical global impression of the therapy was overall positive. Main complications have been from device hardware, specifically PEG-J tube malfunction in 2 patients. One patient had a jejunal anchor detachment requiring reinsertion. One patient had a G-J connector detachment.

Conclusions: Initiation of pump-delivered LCIG can be a rather straight forward procedure and provides an additional therapeutic option to control severe disabling motor fluctuations in more advanced Parkinson’s disease patients. Using the above algorithm, the initiation and ongoing management have been simpler and less time consuming than that described in the initial clinical trials.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/real-life-data-on-the-use-of-levodopa-carbidopa-intestinal-gel-in-parkinsons-disease/