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Marano M, Pizzicannella M, di Biase L, Rea R, Di Santo A, Martino M, Andrisani G, Pandolfi M, Di Matteo FM, Di Lazzaro V. Jejunal pulling syndrome: A peculiar LCIG complication. Parkinsonism Relat Disord 2018; 52:113-114. [PMID: 29588146 DOI: 10.1016/j.parkreldis.2018.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 02/26/2018] [Accepted: 03/16/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Massimo Marano
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy.
| | - Margherita Pizzicannella
- Endoscopy Unit, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Lazzaro di Biase
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Roberta Rea
- Endoscopy Unit, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Alessandro Di Santo
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Margareth Martino
- Endoscopy Unit, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Gianluca Andrisani
- Endoscopy Unit, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Monica Pandolfi
- Endoscopy Unit, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
| | | | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
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Fernandez HH, Boyd JT, Fung VSC, Lew MF, Rodriguez RL, Slevin JT, Standaert DG, Zadikoff C, Vanagunas AD, Chatamra K, Eaton S, Facheris MF, Hall C, Robieson WZ, Benesh J, Espay AJ. Long-term safety and efficacy of levodopa-carbidopa intestinal gel in advanced Parkinson's disease. Mov Disord 2018; 33:928-936. [DOI: 10.1002/mds.27338] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - James T. Boyd
- University of Vermont Larner College of Medicine, Burlington; Vermont USA
| | | | - Mark F. Lew
- Keck/University of Southern California School of Medicine; Los Angeles California USA
| | - Ramon L. Rodriguez
- University of Florida College of Medicine, Gainesville, Florida, USA, and Orlando Veterans Affairs Medical Center; Orlando Florida USA
| | - John T. Slevin
- University of Kentucky Medical Center; Lexington Kentucky USA
| | | | - Cindy Zadikoff
- Feinberg School of Medicine; Northwestern University; Chicago Illinois USA
| | | | | | | | | | | | | | | | - Alberto J. Espay
- University of Cincinnati Academic Health Center; Cincinnati Ohio USA
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53
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Antonini A, Moro E, Godeiro C, Reichmann H. Medical and surgical management of advanced Parkinson's disease. Mov Disord 2018; 33:900-908. [DOI: 10.1002/mds.27340] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 01/07/2018] [Accepted: 01/19/2018] [Indexed: 12/26/2022] Open
Affiliation(s)
- Angelo Antonini
- Department of Neuroscience; University of Padua; Padua Italy
| | - Elena Moro
- Division of Neurology, CHU of Grenoble; Grenoble Alpes University; Grenoble France
| | - Clecio Godeiro
- Division of Neurology, CHU of Grenoble; Grenoble Alpes University; Grenoble France
- Division of Neurology; Federal University of Rio Grande do Norte; Natal Brazil
| | - Heinz Reichmann
- Department of Neurology; Dresden University of Technology; Dresden Germany
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54
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Murata M, Mihara M, Hasegawa K, Jeon B, Tsai CH, Nishikawa N, Oeda T, Yokoyama M, Robieson WZ, Chatamra K, Facheris MF, Benesh J. Safety and efficacy of levodopa-carbidopa intestinal gel: results from an open-label extension study in Japanese, Korean and Taiwanese patients with advanced Parkinson's disease. Ther Adv Neurol Disord 2018; 11:1756286418759315. [PMID: 29511383 PMCID: PMC5833238 DOI: 10.1177/1756286418759315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/04/2017] [Indexed: 11/16/2022] Open
Abstract
Objectives: Levodopa-carbidopa intestinal gel (LCIG) was developed to reduce motor complications in Parkinson’s disease (PD) caused by pulsatile levodopa plasma concentrations following oral levodopa administration. Dyskinesia and ‘wearing off’ symptoms can vary between Asian and Caucasian patients with PD, thus highlighting the importance of assessing the effectiveness of LCIG in an Asian population. Efficacy and safety of LCIG were previously assessed in a 12-week open-label study; we report the efficacy and safety of at least 52 weeks of LCIG treatment in Japanese, Taiwanese, and Korean patients with advanced PD in the ongoing extension study. Methods: In this interim analysis of a phase III, open-label, multicenter extension study in Japan, South Korea, and Taiwan [ClinicalTrials.gov identifier: NCT02082249/JapiCTI-142482], the mean change from baseline to final visit in ‘off’ time, as reported in the PD symptom diary, was normalized to a 16-h waking day. Changes in Parkinson’s Disease Questionnaire-39 (PDQ-39) summary index and domains scores were also analyzed. Adverse events (AEs) were recorded. Results: Of the 28 patients enrolled (21 Japanese, 3 Taiwanese, 4 Korean), 27 completed at least 52 total weeks of treatment, and 25 patients were continuing in the study at data cutoff. The mean [standard deviation (SD)] ‘off’ time was significantly reduced by 4.6 (3.1) h/day (p < 0.001, n = 28). Patients experienced significant improvements in quality of life, as recorded by the mean change from baseline in PDQ-39 summary index (p < 0.001). All patients had at least one AE; three patients (11%) discontinued due to an AE. There were two deaths (sepsis and drowning), both of which the investigator considered unrelated to LCIG treatment. Conclusions: These data suggest that LCIG treatment is efficacious, safe, and well tolerated in Japanese, Taiwanese, and Korean patients with advanced PD, thus confirming the consistency of LCIG treatment in patients with advanced PD.
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Affiliation(s)
- Miho Murata
- National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira 187-8551, Tokyo, Japan
| | | | - Kazuko Hasegawa
- National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Beomseok Jeon
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Chon-Haw Tsai
- Department of Neurology, China Medical University Hospital Medical College, China Medical University, Taichung, Taiwan
| | | | - Tomoko Oeda
- National Hospital Organization Utano Hospital, Kyoto, Japan
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55
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Catalán MJ, Antonini A, Calopa M, Băjenaru O, de Fábregues O, Mínguez-Castellanos A, Odin P, García-Moreno JM, Pedersen SW, Pirtošek Z, Kulisevsky J. Can suitable candidates for levodopa/carbidopa intestinal gel therapy be identified using current evidence? eNeurologicalSci 2017; 8:44-53. [PMID: 29260038 PMCID: PMC5730910 DOI: 10.1016/j.ensci.2017.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 01/24/2023] Open
Abstract
Advanced Parkinson's disease (APD) is characterized by increased functional disability, caused by motor complications, the presence of axial symptoms, and emergent disease- and drug-related non-motor symptoms. One of the advanced therapies available is intrajejunal infusion of levodopa/carbidopa intestinal gel (LCIG); however, patient selection for this treatment is sometimes difficult, particularly because of overlapping indications with other alternatives. In recent years, strong evidence has supported the use of LCIG in treating motor fluctuations associated with APD, and several clinical studies provide emerging evidence for additional benefits of LCIG treatment in certain patients. This article provides an overview of the published literature on the benefits, limitations, and drawbacks of LCIG in relation to PD symptoms, the psychosocial impact of the disease, and the quality of life of patients, with the aim of determining candidates for whom treatment with LCIG would be beneficial. According to current evidence, patients with APD (defined as inability to achieve optimal control of the disease with conventional oral treatment), a relatively well-preserved cognitive-behavioral status, and good family/caregiver would count as suitable candidates for LCIG treatment. Contraindications in the opinion of the authors are severe dementia and active psychosis.
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Key Words
- APD, Advanced Parkinson's disease
- DBS, Deep brain stimulation
- Duodopa
- ICD, Impulse control disorders
- Intrajejunal infusion of levodopa/carbidopa intestinal gel
- LCIG, Levodopa-carbidopa intestinal gel
- Motor symptoms
- NMS, Non-motor symptoms
- NMSS, Non-motor symptoms scale
- Non-motor symptoms
- PD, Parkinson's disease
- PDSS, Parkinson's disease sleep scale
- PEG, Percutaneous endoscopic gastrostomy
- Parkinson's disease
- QoL, Quality of life
- Quality of life
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Affiliation(s)
- Maria José Catalán
- Parkinson and Movement Disorders Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences, IRCCS Hospital San Camillo, Venice, Italy
| | | | - Ovidiu Băjenaru
- University of Medicine and Pharmacy "Carol Davila" Bucharest - University Emergency Hospital, Department of Neurology, Bucharest, Romania
| | - Oriol de Fábregues
- Vall d'Hebron University Hospital, Neurology Service, Movement Disorders Unit, Autonomous University of Barcelona, Neurodegenerative Diseases Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Adolfo Mínguez-Castellanos
- Complejo Hospitalario Universitario de Granada, Instituto de Investigación Biosanitaria "ibs. Granada,", Granada, Spain
| | - Per Odin
- Skåne University Hospital, Lund University, Lund, Sweden.,Klinikum-Bremerhaven, Bremerhaven, Germany
| | | | | | | | - Jaime Kulisevsky
- Hospital Santa Creu i Sant Pau, Ciberned, Universitat Autònoma de Barcelona, Universitat Oberta de Catalunya, Barcelona, Spain
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56
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Antonini A, Poewe W, Chaudhuri KR, Jech R, Pickut B, Pirtošek Z, Szasz J, Valldeoriola F, Winkler C, Bergmann L, Yegin A, Onuk K, Barch D, Odin P, Amalia E, Arnold G, Bajenaru O, Bergmans B, Bjornara KA, Blackie J, Bode M, Bourgeois P, Bohlhalter S, Buraga I, Burkhard PR, Busson P, Calopa M, Clausen J, Danielsen EH, Defebvre L, Delvaux V, Dethy S, Dietrichs E, De Fabregues O, Gerhard R, Gusmaroli G, Hahn K, Hauptmann B, Henriksen T, Hernandez-Vara J, Jeanjean A, Kaiserova M, Kassubek J, Kimber T, Konitsiotis S, Krüger R, Kulisevsky J, Leenders J, Lundqvist C, Ory Magne F, Marano P, Milanov I, Modugno N, Misbahuddin A, Nevrly M, Panayiotis Z, Pedersen KF, Pedersen SW, Perju-Dumbrava L, Ponsen M, Popescu BO, Rijntjes M, Puente V, Redecker C, Schrader C, Sensi M, Simu M, Spanaki C, Storch A, Storstein A, Tomantschger V, van der Linden C, van Laar T, Viallet F, Witjas T, Wolz M, Zibetti M, Van Zandijcke M. Levodopa-carbidopa intestinal gel in advanced Parkinson's: Final results of the GLORIA registry. Parkinsonism Relat Disord 2017; 45:13-20. [DOI: 10.1016/j.parkreldis.2017.09.018] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/16/2017] [Accepted: 09/18/2017] [Indexed: 11/24/2022]
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57
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Olanow CW, Stocchi F. Levodopa: A new look at an old friend. Mov Disord 2017; 33:859-866. [DOI: 10.1002/mds.27216] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- C. Warren Olanow
- Department of Neurology; Mount Sinai School of Medicine; New York New York USA
| | - Fabrizio Stocchi
- Department of Neurology; Institute for Research and Medical Care IRCCS San Raffaele; Rome Italy
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58
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Dietrichs E, Odin P. Algorithms for the treatment of motor problems in Parkinson's disease. Acta Neurol Scand 2017; 136:378-385. [PMID: 28133726 PMCID: PMC5655734 DOI: 10.1111/ane.12733] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 12/17/2022]
Abstract
Several different strategies are effective for medical treatment of motor problems in Parkinson's disease (PD). Many guidelines and evidence-based reviews are available, but there is no documentation or consensus in favor of just one treatment strategy. This review presents two algorithms that may be helpful when deciding how to treat a PD patient at various stages of the disease. The first algorithm suggests one way to treat PD from the first onset of motor symptoms. It is largely based on treatment recommendations from the Scandinavian countries and Germany. The other algorithm is meant as assistance for choosing among the different device-aided treatments for advanced PD. There is not sufficient comparative data to recommend one particular line of treatment, neither in early PD nor in advanced disease with motor complications. Individualized treatment is needed for each patient. The current algorithms only represent an alternative for aiding treatment decisions.
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Affiliation(s)
- E. Dietrichs
- Department of NeurologyOslo University Hospital and University of OsloOsloNorway
| | - P. Odin
- Department of NeurologySkåne University HospitalUniversity of LundLundSweden
- Department of NeurologyKlinikum‐BremerhavenBremerhavenGermany
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59
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Mackinnon RE. The complications of jejunostomy tubes for patients receiving Duodopa: New challenges for neuroscience nurses. AUSTRALASIAN JOURNAL OF NEUROSCIENCE 2017. [DOI: 10.21307/ajon-2017-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Standaert DG, Rodriguez RL, Slevin JT, Lobatz M, Eaton S, Chatamra K, Facheris MF, Hall C, Sail K, Jalundhwala YJ, Benesh J. Effect of Levodopa-carbidopa Intestinal Gel on Non-motor Symptoms in Patients with Advanced Parkinson's Disease. Mov Disord Clin Pract 2017; 4:829-837. [PMID: 29242809 PMCID: PMC5724683 DOI: 10.1002/mdc3.12526] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/23/2017] [Accepted: 06/27/2017] [Indexed: 11/18/2022] Open
Abstract
Background Levodopa‐carbidopa intestinal gel (LCIG; carbidopa‐levodopa enteral suspension in the United States), delivered via percutaneous gastrojejunostomy (PEG‐J) and titrated in the inpatient setting, is an established treatment option for advanced Parkinson's disease (PD) patients with motor fluctuations. However, long‐term prospective data on the efficacy of LCIG on non‐motor symptoms and the safety of outpatient titration are limited. Methods In this 60‐week, open‐label phase 3b study, LCIG titration was initiated in an outpatient setting following PEG‐J placement in PD patients. The efficacy of LCIG on motor and non‐motor symptoms, quality of life, and safety was assessed. Results Thirty‐nine patients were enrolled in the study and 28 patients completed the treatment. A majority of patients (54%) completed outpatient titration within the first week of LCIG infusion. LCIG led to significant reductions from baseline in Non‐Motor Symptom Scale (NMSS) total score (least squares mean ± SE = −17.6 ± 3.6, P < 0.001) and 6 of the NMSS domain scores (sleep/fatigue, attention/memory, gastrointestinal tract, urinary, sexual function, miscellaneous) at week 12. These reductions were maintained at week 60 with the exception of the urinary domain. “Off” time (−4.9 ± 0.5 hours/day, P < 0.001) and “On” time without troublesome dyskinesia (−4.3 ± 0.6 hours/day, P < 0.001) were improved at week 60. Adverse events (AEs) were reported in 37 (95%) patients. Conclusions LCIG treatment led to reductions in non‐motor symptom burden and motor fluctuations in advanced PD patients. The safety profile was consistent with previous studies that used inpatient titration and outpatient titration did not appear to pose additional risk.
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Affiliation(s)
| | | | - John T Slevin
- University of Kentucky Medical Center Lexington KY USA
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Krüger R, Lingor P, Doskas T, Henselmans JML, Danielsen EH, de Fabregues O, Stefani A, Sensken SC, Parra JC, Onuk K, Yegin A, Antonini A. An Observational Study of the Effect of Levodopa-Carbidopa Intestinal Gel on Activities of Daily Living and Quality of Life in Advanced Parkinson's Disease Patients. Adv Ther 2017. [PMID: 28631218 PMCID: PMC5504221 DOI: 10.1007/s12325-017-0571-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction Continuous delivery of levodopa–carbidopa intestinal gel (LCIG) by percutaneous endoscopic gastrojejunostomy (PEG-J) in advanced Parkinson’s disease (PD) patients reduces variability in plasma levels, providing better control of motor fluctuations (“on” and “off” states). The MONOTREAT study assessed the effect of LCIG on activities of daily living, motor and non-motor symptoms, and quality of life in advanced PD patients. Methods This prospective, observational study included patients with advanced, levodopa-responsive PD with either 2–4 h of “off” time or 2 h of dyskinesia daily. Patients received LCIG via PEG-J for 16 h continuously. Effectiveness was assessed using Unified PD Rating Scale parts II and III, the Non-Motor Symptom Scale, and the PD Questionnaire-8. Results The mean (SD) treatment duration was 275 (157) days. Patients experienced significant improvement from baseline in activities of daily living at final visit (p < 0.05) as well as at months 3 and 6 (p < 0.0001). Patients also experienced significant improvements from baseline in quality of life and non-motor symptoms at all time points (p < 0.001 for all). Specifically, patients manifested significant improvements in mean change from baseline at every study visit in five of nine non-motor symptom score domains: sleep/fatigue, mood/cognition, gastrointestinal tract, urinary, and miscellaneous. One-third of patients (32.8%) experienced an adverse event; 21.9% experienced a serious adverse event; 11.1% discontinued because of an adverse event. Conclusion This study demonstrated significant and clinically relevant improvements in measures of activities of daily living, quality of life, and a specific subset of non-motor symptoms after treatment with LCIG. Funding AbbVie Inc. Electronic supplementary material The online version of this article (doi:10.1007/s12325-017-0571-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rejko Krüger
- Luxembourg Center for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
- Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg.
- Center for Neurology, University of Tübingen, Tübingen, Germany.
| | - Paul Lingor
- University Medical Center Göttingen, Göttingen, Germany
| | | | | | - Erik H Danielsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Oriol de Fabregues
- Department of Neurology, Vall d'Hebron University Hospital, Neurodegenerative Diseases Group, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Alessandro Stefani
- Parkinson Center, Department System Medicine, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | | | - Koray Onuk
- AbbVie Inc, 1 Waukegan Road, North Chicago, IL, USA
| | - Ashley Yegin
- AbbVie Inc, 1 Waukegan Road, North Chicago, IL, USA
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, IRCCS Hospital San Camillo, Venice, Italy
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Udd M, Lyytinen J, Eerola‐Rautio J, Kenttämies A, Lindström O, Kylänpää L, Pekkonen E. Problems related to levodopa-carbidopa intestinal gel treatment in advanced Parkinson's disease. Brain Behav 2017; 7:e00737. [PMID: 28729942 PMCID: PMC5516610 DOI: 10.1002/brb3.737] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 04/14/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Continuous levodopa-carbidopa intestinal gel (LCIG) diminishes daily "off" time and dyskinesia in patients with advanced Parkinson's disease (PD). Complications are common with percutaneous endoscopic gastrostomy with a jejunal extension tube (PEG-J). AIM OF THE STUDY To report the clinical outcome of LCIG in patients with advanced PD in the years 2006-2014 at Helsinki University Hospital. PATIENTS AND METHODS Levodopa-carbidopa intestinal gel treatment started following PEG-J placement in patients with advanced PD after successful in-hospital LCIG trial with a nasojejunal tube. Demographics, PEG-J procedures, discontinuation of LCIG, complications and mortality were retrospectively analyzed. RESULTS MEAN SD Sixty patients with advanced PD [age 68(7) years; duration of PD: 11(4) years] had LCIG treatment for 26(23) months. The majority of patients with advanced PD were satisfied with the LCIG treatment. For 51 patients (85%), the pump was on for 16 hr a day, and for nine patients (15%) it was on for 24 hr a day. After 6 months, the levodopa-equivalent daily dose (LEDD) had increased by 30% compared to pre-LCIG LEDD. Sixty patients underwent a total of 156 PEG-J procedures, and 48 patients (80%) had a total of 143 complications. Forty-six patients (77%) had 119 PEG-J or peristomal complications, and 22 patients (37%) had a total of 25 other complications. The most common complications were accidental removal of the J-tube in 23 patients (38%) and ≥5% weight loss in 18 patients (30%). Fifteen patients discontinued the LCIG after 21 (21) months. At the end of the follow-up period of 33(27) months, 38 patients were still on LCIG and nine (15%) had died. CONCLUSION Most patients were satisfied with LCIG treatment. A few patients lost weight whereas the majority had complications with PEG-J. When LCIG treatment is carried out, neurological and endoscopic units must be prepared for multiple endoscopic procedures.
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Affiliation(s)
- Marianne Udd
- Department of SurgeryUnit of Therapeutic EndoscopyHelsinki UniversityHelsinkiFinland
| | - Jukka Lyytinen
- Clinical Neurosciences, NeurologyHelsinki UniversityHelsinkiFinland
- Department of NeurologyHelsinki University Hospital and Helsinki UniversityHelsinkiFinland
| | - Johanna Eerola‐Rautio
- Clinical Neurosciences, NeurologyHelsinki UniversityHelsinkiFinland
- Department of NeurologyHelsinki University Hospital and Helsinki UniversityHelsinkiFinland
| | - Anu Kenttämies
- HUS Medical Imaging CenterHelsinki UniversityHelsinkiFinland
| | - Outi Lindström
- Department of SurgeryUnit of Therapeutic EndoscopyHelsinki UniversityHelsinkiFinland
| | - Leena Kylänpää
- Department of SurgeryUnit of Therapeutic EndoscopyHelsinki UniversityHelsinkiFinland
| | - Eero Pekkonen
- Clinical Neurosciences, NeurologyHelsinki UniversityHelsinkiFinland
- Department of NeurologyHelsinki University Hospital and Helsinki UniversityHelsinkiFinland
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63
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Abstract
This review will illustrate the process of moving from an idea through preclinical research and Galenic developments into clinical investigations and finally to approval by regulatory agencies within the European Union. The two new treatment strategies described, levodopa/carbidopa intestinal gel and levodopa/carbidopa microtablets, for advanced Parkinson's disease, have been developed in collaborative research within departments at Uppsala University. With this historical approach, reference priority is given to reports considered to be of special importance for this more than two decades long process 'from bedside to bench to bedside'.
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Affiliation(s)
| | - Dag Nyholm
- CONTACT Dag Nyholm Department of Neuroscience, Neurology, Uppsala University, Uppsala University Hospital, SE-75185 Uppsala, Sweden
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64
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Sensi M, Cossu G, Mancini F, Pilleri M, Zibetti M, Modugno N, Quatrale R, Tamma F, Antonini A, Aguggia M, Amboni M, Arca R, Bartolomei L, Bonetto N, Calandra-Buonaura G, Bove F, Calandrella D, Canesi M, Cannas A, Capecci M, Caputo E, Ceravolo MG, Ceravolo R, Cerrone G, Coletti Moja M, Comi C, Cortelli P, D'Antonio P, Dematteis F, Di Lazzaro V, Eleopra R, Fabbrini G, Fichera M, Grassi E, Guido M, Gusmaroli G, Latorre A, Malaguti MC, Marano M, Marano P, Marconi R, Mazzucchi S, Meco G, Minafra B, Morgante F, Pacchetti C, Pierantozzi M, Pontieri FE, Riboldazzi G, Ricchi V, Ricchieri G, Rinaldo S, Rispoli V, Rossi S, Rubino A, Russo A, Saddi MV, Stefani A, Simoni S, Solla P, Tambasco N, Tamburin S, Tessitore A, Torre E, Ulivelli M, Vita MG, Volonté MA. Which patients discontinue? Issues on Levodopa/carbidopa intestinal gel treatment: Italian multicentre survey of 905 patients with long-term follow-up. Parkinsonism Relat Disord 2017; 38:90-92. [DOI: 10.1016/j.parkreldis.2017.02.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/11/2017] [Accepted: 02/18/2017] [Indexed: 10/20/2022]
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65
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Titova N, Ray Chaudhuri K. Intrajejunal levodopa infusion therapy for Parkinson's disease: practical and pragmatic tips for successful maintenance of therapy. Expert Rev Neurother 2017; 17:529-537. [PMID: 28406336 DOI: 10.1080/14737175.2017.1317595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Intrajejunal levodopa infusion (IJLI) therapy is one of the most influential therapies in moderate to late stage Parkinson's disease with documented effects on motor and nonmotor symptoms and quality of life. The process of initiation and maintenance of therapy however, remains a challenge particularly in the long term. Areas covered: The authors reviewed 'evidence base' for pathways and advice given to patients pre and post IJLI initiation. The authors found lack of patient, carer and clinician led 'real life' advisory documents which need to be given to patients on IJLI. Expert commentary: Experience from centers engaged in IJLI therapy as well as feedback from carers and patients on IJLI suggest wide variability of practical advice given to patients. This is important as such tips could avoid termination of treatment or serious adverse events in some cases. In this review the authors provide a collection of pragmatic and practical tips for patients initiated on IJLI, both related to the short and long term and which we believe is a key unmet need. The paper is illustrated with two case reports.
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Affiliation(s)
- Nataliya Titova
- a Department of Neurology, Neurosurgery and Medical Genetics, Federal State Budgetary Educational Institution of Higher Education , 'N.I. Pirogov Russian National Research Medical University' of the Ministry of Healthcare of the Russian Federation , Moscow , Russia
| | - K Ray Chaudhuri
- b Movement Disorders, National Parkinson Foundation International Centre of Excellence , Kings College and Kings College Hospital , London , UK.,c The Maurice Wohl Clinical Neuroscience Institute , King's College London , London , UK
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Timpka J, Nitu B, Datieva V, Odin P, Antonini A. Device-Aided Treatment Strategies in Advanced Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:453-474. [DOI: 10.1016/bs.irn.2017.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Mundt-Petersen U, Odin P. Infusional Therapies, Continuous Dopaminergic Stimulation, and Nonmotor Symptoms. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1019-1044. [DOI: 10.1016/bs.irn.2017.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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van Laar T, Borgemeester R. The need for non-oral therapy in Parkinson's disease; a potential role for apomorphine. Parkinsonism Relat Disord 2016; 33 Suppl 1:S22-S27. [PMID: 27998652 DOI: 10.1016/j.parkreldis.2016.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
Abstract
In the course of Parkinson's disease (PD), oral medication may lose its effectiveness due to several reasons, like dysphagia, impaired absorption from the gastro-intestinal tract and delayed emptying of the stomach. If these problems occur, a non-oral therapy should be considered. Examples of non-oral therapies are transdermal patches, (e.g. rotigotine) which may overcome motor and nonmotor nighttime problems, and may serve as well to treat daytime response-fluctuations, if oral therapies fail to do so. Other options are injections with apomorphine to treat early morning dystonia and random off-periods during daytime, as well as continuously infused subcutaneous apomorphine for random fluctuations in PD patients. Low-dose apomorphine infusions also may be useful in the peri-operative phase, when PD patients may not be able to swallow oral medication. Finally, levodopa-carbidopa intestinal gel (LCIG) infusions or DBS have shown to be effective non-oral options to treat PD patients adequately, if they are not properly controlled by oral options.
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Affiliation(s)
- Teus van Laar
- Parkinson Expertise Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Robbert Borgemeester
- Parkinson Expertise Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Abstract
PURPOSE OF REVIEW We aim to review the most interesting recent advances on the clinical aspects of continuous dopaminergic stimulation in Parkinson's disease. RECENT FINDINGS Several large, open-label studies have presented data that are in line with the randomized controlled trial on L-dopa-carbidopa intestinal gel infusion, which shows that a continuous drug delivery can improve motor fluctuations and dyskinesia in patients with advanced Parkinson's disease. Furthermore, new extended-release formulations of L-dopa aim to stabilize plasma concentrations and thus reduce the degree of motor complications - despite a reduced number of daily doses. Transdermal rotigotine has been shown to be effective for specific subgroups of patients, although the general effect on nonmotor symptoms is still unclear. New products for L-dopa infusion are also at different stages of development, but the routes of administration are widely different: intrajejunal, subcutaneous, and oral. SUMMARY The understanding of the mechanisms behind the complications of long-term L-dopa treatment is still not complete, but therapies aiming for continuous dopaminergic stimulation are already widely used in clinical practice and the evidence strength is improving. However, there is still an urgent need for both less invasive and less costly options in order to increase access to these therapies.
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Virhammar J, Nyholm D. Levodopa-carbidopa enteral suspension in advanced Parkinson's disease: clinical evidence and experience. Ther Adv Neurol Disord 2016; 10:171-187. [PMID: 28344656 DOI: 10.1177/1756285616681280] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The duration of action of oral levodopa becomes shorter as Parkinson's disease (PD) progresses. Patients with advanced PD may develop potentially disabling motor fluctuations and abnormal involuntary movement (dyskinesia), which cannot be managed with optimized oral or transdermal PD medications. The progressively worsening symptoms can have a substantial impact on the patient quality of life (QoL). Levodopa-carbidopa intestinal gel (LCIG) is delivered continuously via a percutaneous endoscopic gastrostomy with a jejunal extension (PEG-J). LCIG is licensed for the treatment of levodopa-responsive advanced PD in individuals experiencing severe motor fluctuations and dyskinesia when available combinations of antiparkinsonian medications have not given satisfactory results. Initial evidence for the efficacy and tolerability of LCIG came from a number of small-scale studies, but recently, three prospective studies have provided higher quality evidence. A 12-week double-blind comparison of LCIG with standard levodopa therapy, a 52-week open-label study extension of the double-blind study, and a 54-week open-label safety study, demonstrated significant improvements in 'off' time and 'on' time without troublesome dyskinesia, and QoL measures that were maintained in the longer term. There are also observations that LCIG may be effective treatment for nonmotor symptoms (NMS) although the evidence is limited. There is a need for further research on the efficacy of LCIG in reducing NMS, dyskinesia and improving QoL. This review surveys the clinical evidence for the effectiveness and tolerability of LCIG in the management of advanced PD and highlights some practical considerations to help optimize treatment.
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Affiliation(s)
- Johan Virhammar
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Dag Nyholm
- Department of Neuroscience, Neurology, Uppsala University Hospital, 751 85 Uppsala, Sweden
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Non-oral dopaminergic therapies for Parkinson's disease: current treatments and the future. NPJ PARKINSONS DISEASE 2016; 2:16023. [PMID: 28725704 PMCID: PMC5516582 DOI: 10.1038/npjparkd.2016.23] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/07/2016] [Accepted: 08/25/2016] [Indexed: 12/30/2022]
Abstract
Dysfunction of the gastrointestinal tract has now been recognized to affect all stages of Parkinson’s disease (PD). The consequences lead to problems with absorption of oral medication, erratic treatment response, as well as silent aspiration, which is one of the key risk factors in developing pneumonia. The issue is further complicated by other gut abnormalities, such as small intestinal bacterial overgrowth (SIBO) and an altered gut microbiota, which occur in PD with variable frequency. Clinically, these gastrointestinal abnormalities might be associated with symptoms such as nausea, early-morning “off”, and frequent motor and non-motor fluctuations. Therefore, non-oral therapies that avoid the gastrointestinal system seem a rational option to overcome the problems of oral therapies in PD. Hence, several non-oral strategies have now been actively investigated and developed. The transdermal rotigotine patch, infusion therapies with apomorphine, intrajejunal levodopa, and the apomorphine pen strategy are currently in clinical use with a few others in development. In this review, we discuss and summarize the most recent developments in this field with a focus on non-oral dopaminergic strategies (excluding surgical interventions such as deep brain stimulation) in development or to be licensed for management of PD.
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Klostermann F, Bojarski C, Marzinzik F, Maier A, Schindlbeck KA, Ehlen F. Necessity of long-term alertness in levodopa-carbidopa intestinal gel infusion for PD patients. Mov Disord 2016; 32:300-301. [PMID: 27859611 DOI: 10.1002/mds.26853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/05/2016] [Accepted: 10/02/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Fabian Klostermann
- Charité-University Medicine Berlin, Department of Neurology, CBF, Germany
| | - Christian Bojarski
- Charité-University Medicine Berlin, Department of Gastroenterology, Infectiology and Rheumatology, CBF, Germany
| | - Frank Marzinzik
- Charité-University Medicine Berlin, Department of Neurology, CBF, Germany
| | - André Maier
- Charité-University Medicine Berlin, Department of Neurology, CBF, Germany
| | | | - Felicitas Ehlen
- Charité-University Medicine Berlin, Department of Neurology, CBF, Germany
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Murata M, Mihara M, Hasegawa K, Jeon B, Tsai CH, Nishikawa N, Oeda T, Yokoyama M, Robieson WZ, Ryman D, Eaton S, Chatamra K, Benesh J. Efficacy and safety of levodopa-carbidopa intestinal gel from a study in Japanese, Taiwanese, and Korean advanced Parkinson's disease patients. NPJ PARKINSONS DISEASE 2016; 2:16020. [PMID: 28725701 PMCID: PMC5516619 DOI: 10.1038/npjparkd.2016.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/01/2016] [Accepted: 08/23/2016] [Indexed: 01/12/2023]
Abstract
In a previous multinational, randomized, double-blind, double-dummy study, levodopa–carbidopa intestinal gel (LCIG) was tolerable and significantly improved ‘off’ time in advanced Parkinson’s disease (PD) patients. However, efficacy and safety in the Asian population has not yet been demonstrated. In this open-label study, efficacy and safety of LCIG were assessed in Japanese, Korean, and Taiwanese advanced PD patients with motor complications not adequately controlled by available PD medication. The patients were treated with LCIG monotherapy for 12 weeks. The primary end point was the mean change from baseline to week 12 in ‘off’ time, as reported in the PD Symptom Diary, normalized to a 16 h waking day and analyzed by a mixed-model repeated-measures analysis. Adverse events (AEs) were recorded. Thirty-one patients were enrolled (23 Japanese, 4 Taiwanese, 4 Korean) and 28 (90%) completed the study. For those who completed the study, the mean (s.d.) total daily levodopa dose from LCIG was 1,206.3 (493.6) mg/day at final visit (n=28); last observation carried forward (n=30) was 1,227.6 (482.8) mg/day. There was a significant mean change (s.d.) of −4.6 (3.0) hours of ‘off’ time from baseline (mean (s.d.)=7.4 (2.3)) to week 12 (n=29), P<0.001. All the patients had an AE, with the most frequently reported being incision site pain (42%); 1 (3.2%) discontinued treatment because of an AE and later died because of sepsis, which the investigator considered unrelated to LCIG treatment. These results suggest that LCIG is efficacious and tolerable in Japanese, Taiwanese, and Korean advanced PD patients.
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Affiliation(s)
- Miho Murata
- National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | - Kazuko Hasegawa
- National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | | | - Chon-Haw Tsai
- Department of Neurology, China Medical University Hospital and Medical College, China Medical University, Taichung, Taiwan
| | | | - Tomoko Oeda
- National Hospital Organization Utano Hospital, Kyoto, Japan
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Abstract
BACKGROUND Levodopa-carbidopa intestinal gel (LCIG) is available in several countries for the treatment of advanced levodopa-responsive Parkinson's disease (PD) with severe motor fluctuations and dyskinesia when other treatments have not given satisfactory results. OBJECTIVE Our objective was to summarize the present evidence base for LCIG therapy through a systematic review of the literature. METHODS Studies were identified from the PubMed and EMBASE databases up to 12 March 2016 using the following search terms: Parkinson disease, duodopa, levodopa/carbidopa intestinal gel, levodopa-carbidopa intestinal gel, LCIG, l-dopa infusion, levodopa infusion, duodenal l-dopa infusion, and duodenal levodopa infusion. Data extraction focused on whether LCIG therapy improves motor and non-motor outcomes as well as quality of life in PD patients compared with conventional therapy, apomorphine infusion, or deep brain stimulation. Randomized controlled trials (RCTs) and observational studies, with or without a control group, that included more than ten patients were included. The search was limited to peer-reviewed articles published in full in the English language and involving humans. RESULTS Infusion of LCIG reduced "off" time, increased "on" time without increasing troublesome dyskinesias, and improved quality of life in three RCTs (one double-blind). Open-label follow-ups confirm these findings. The data evaluating long-term efficacy and safety are still limited. CONCLUSIONS The quality of evidence that LCIG is effective in reducing fluctuating motor symptoms and improving quality of life is moderate. Quality of evidence for reduction of non-motor symptoms is very low. Safety issues mainly relate to the intestinal infusion system. LCIG might be a useful treatment option in PD patients with severe motor fluctuations.
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Greig SL. Carbidopa/levodopa enteral suspension in advanced Parkinson’s disease: a guide to its use. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0297-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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