Objective: To evaluate the clinical outcomes and tolerability of switching from levodopa/carbidopa intestinal gel (LCIG) to levodopa/carbidopa/entacapone intestinal gel (LECIG) in patients with advanced Parkinson’s disease (PD).

Background: LCIG is an established device-aided therapy for advanced PD with motor fluctuations. LECIG combines levodopa, carbidopa, and entacapone in a single intestinal gel, allowing levodopa dose reduction and improved pharmacokinetic stability.

Method: We conducted a retrospective observational study including patients with advanced PD treated with LCIG who were switched to LECIG in routine clinical practice. We collected baseline data and follow-up assessment at 6 months, 1 month for the most recently switched patients.

Results: We included 13 patients (9 women). Median age was 79 years (IQR 75-81) with a disease duration of 20 years (15-21) and 13 years (11-16) of motor fluctuations. Median UPDRS-III (ON) was 35 (22-46). The main reason for switching was persistent motor fluctuations (n=7) or uncontrolled dyskinesias (n=5). Six patients had previously received oral entacapone. One patient had discontinued LCIG due to polyneuropathy before initiating LECIG.

Nine patients completed 6-month follow-up. According to CGI-I, 2 were very much improved, 4 much improved, 2 minimally improved and 1 unchanged. One patient discontinues LECIG during the first month due to diarrhea despite marked clinical improvement. Among the 3 most recently switched patients, 1 reported very much improvement and 2 much improvement at one month.

At 6 months, daily OFF time decreased from 4 hours (3-6) to 1 hour (0-2), and dyskinesia time from 3 hours (1.5-5) to 1 hour (0.75-2.25). Daily levodopa dose decreased from 1764 mg/day (1174-1964) to 1480 mg/day (776-1624), while LEDD changed from 1971.4 mg/day (1431-2384) to 2081.3 mg/day (1075-2361). One patient developed mild hallucinations that improved after dose adjustment and one patient experienced jejunal tube displacement.

PDQ8 recorded in the first 5 patients improved from 14 (6-17) to 8 (3-8), and NMSS from 96 (19-133) to 35 (13-26) at 6 months.

Conclusion: Switching from LCIG to LECIG was feasible, safe and associated with clinical improvement in most patients, together with a reduction in daily levodopa dose. These findings support LECIG as a practical alternative in advanced PD patients with motor fluctuations insufficiently controlled with LCIG.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/switch-from-lcig-to-lecig-in-advanced-parkinsons-disease-real-world-outcomes-from-a-single-centre/