Levodopa-carbidopa intestinal gel in patients with advanced PD

Despite natural progression of the disease, over half of patients with advanced Parkinson’s disease (PD) experienced improvement or no change in symptoms after at least 12 months of treatment with levodopa-carbidopa intestinal gel (LCIG). The authors concluded that LCIG may help control symptoms that impact healthcare resource use.

LCIG is a long-term treatment option for advanced PD patients with symptoms not controlled by oral medication. It is delivered continuously via a percutaneous endoscopic gastroscopy with a jejunal extension tube (PEG-J), with the option to provide symptom control as monotherapy when possible. The post-marketing observational COSMOS study (NCT03362879) was the first to evaluate LCIG as monotherapy or in combination with oral medication in routine clinical practice. A subanalysis of COSMOS was presented by Dr József Szász (University of Târgu Mures, Romania), assessing changes in individual PD symptoms following LCIG treatment [1]. A total of 409 participants were evaluated at a single study visit conducted at least 12 months after LCIG initiation. They had had continuous LCIG treatment for ≥80 days in the past 12 months.

Most patients reported improvement or no change in individual motor symptoms following LCIG initiation (see Figure). This was also true for balance problems, but more patients experienced worsening of this symptom than of other symptoms. In general, patients not experiencing worsening of symptoms were younger, had shorter disease duration, greater improvements in “Off” time following LCIG treatment, and greater improvements in dyskinesia severity following LCIG treatment. Non-motor symptoms were also assessed. More patients reported improvement than worsening in anxiety, pain, depression, fatigue, and constipation; more patients reported worsening than improvement in cognitive impairment, apathy, urinary symptoms, and orthostatic hypotension. Adverse events were similar to those reported in other LCIG studies.

Figure: Percentage of patients reporting individual motor symptoms after LCIG treatment [1]

1. Fasano A, et al. Parkinson’s disease Symptoms Before and After Levodopa-Carbidopa Intestinal Gel: a Subanalysis From the COSMOS Study. OPR-150, EAN 2021 Virtual Congress, 19–22 June.

 

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Posted on 18 August 202117 May 2024