1
|
Szász JA, Dulamea AO, Constantin VA, Mureşanu DF, Dumbravă LP, Tiu C, Jianu DC, Simu M, Ene A, Axelerad A, Falup-Pecurariu C, Lungu M, Danci AG, Sabau M, Strilciuc Ş, Popescu BO. Levodopa-Carbidopa-Entacapone Intestinal Gel in Advanced Parkinson Disease: A Multicenter Real-Life Experience. Am J Ther 2024; 31:e209-e218. [PMID: 38460175 DOI: 10.1097/mjt.0000000000001707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
BACKGROUND For Parkinson disease (PD) patients who have been diagnosed with advanced disease that can no longer be effectively controlled with optimized oral or transdermal medications, a range of device-aided therapies (DAT) are available, comprising either deep brain stimulation or infusion therapies providing continuous dopaminergic stimulation. Levodopa-entacapone-carbidopa intestinal gel (LECIG) infusion is the latest DAT for advanced PD (APD) that was approved in Romania in 2021. STUDY QUESTION What is the experience to date in real-world clinical practice in Romania regarding the efficacy and tolerability of LECIG in APD? STUDY DESIGN A retrospective evaluation of 74 APD patients treated with LECIG at 12 specialized APD centers in Romania. MEASURES AND OUTCOMES Demographic data and various clinical parameters were recorded, including Mini Mental State Evaluation score or Montreal Cognitive Assessment Test score. Levodopa-equivalent daily dose and the administered doses of levodopa and other PD medications were evaluated at baseline and after starting LECIG treatment. The efficacy of LECIG in reducing daily hours of off time, motor fluctuations, and dyskinesias were assessed. Any percutaneous endoscopic gastrojejunostomy system or device complications after starting LECIG treatment were noted. RESULTS At baseline, patients were taking oral levodopa for a mean of 5.3 times per day, with a high proportion also taking concomitant add-on therapies (dopamine agonists, 86%, monoamine oxidase type-B inhibitors, 53%; catechol-O-methyltransferase inhibitors, 64%). LECIG treatment significantly reduced daily off time versus baseline from 5.7 h/d to 1.7 hours per day ( P < 0.01). Duration and severity of dyskinesias was also significantly reduced versus baseline, and improvements were observed in Hoehn and Yahr Scale scores. LECIG treatment also allowed a significant reduction in the use of concomitant oral medications. CONCLUSIONS These findings suggest that LECIG treatment is an effective DAT option in APD that can simplify the treatment regimen.
Collapse
Affiliation(s)
- József Attila Szász
- Department of Neurology, "George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Târgu Mureş, Romania
- Neurology Department, Emergency Clinical County Hospital, Targu Mures, Romania
| | - Adriana Octaviana Dulamea
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Neurology, Fundeni Clinical Institute, Bucharest, Romania
| | | | - Dafin Fior Mureşanu
- Department of Neuroscience, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Neurology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Lăcrămioara Perju Dumbravă
- Department of Neuroscience, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Neurology Department, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Cristina Tiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Neurology Department, Bucharest University Emergency Hospital, Bucharest, Romania
| | - Dragoş Cătălin Jianu
- Department of Neurology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania
- Neurology Department, "Pius Brânzeu" Emergency Clinical County Hospital, Timişoara, Romania
| | - Mihaela Simu
- Department of Neurology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania
- Neurology Department, "Pius Brânzeu" Emergency Clinical County Hospital, Timişoara, Romania
| | - Amalia Ene
- Neurology Department, Bucharest University Emergency Hospital, Bucharest, Romania
| | - Any Axelerad
- Department of Neurology, "Ovidius" University, Faculty of Medicine, Constanţa, Romania
- Neurology Department, Sfântul Andrei Emergency Clinical County Hospital, Constanţa, Romania
| | - Cristian Falup-Pecurariu
- Faculty of Medicine, Transilvania University, Braşov, Romania
- Neurology Department, Emergency Clinical County Hospital, Braşov, Romania
| | - Mihaela Lungu
- Neurology Department, Emergency Clinical Hospital Galati, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galati, Romania
| | - Adina Gabriela Danci
- Neurology Department, Cluj-Napoca Military Emergency Hospital, Cluj-Napoca, Romania
| | - Monica Sabau
- Department of Psycho-Neuroscience and Medical Recovery, University of Medicine and Pharmacy Oradea, Emergency Clinical Hospital Bihor, Romania; and
| | - Ştefan Strilciuc
- Department of Neuroscience, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bogdan Ovidiu Popescu
- Department of Clinical Neurosciences, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| |
Collapse
|
2
|
Szatmári S, Szász JA, Orbán-Kis K, Bataga S, Ciorba M, Nagy E, Neagoe R, Mihály I, Szász PZ, Kelemen K, Frigy A, Csipor-Fodor A, Constantin VA. Starting with 24-h levodopa carbidopa intestinal gel at initiation in a large cohort of advanced Parkinson's disease patients. Sci Rep 2024; 14:3676. [PMID: 38355970 PMCID: PMC10867013 DOI: 10.1038/s41598-024-54299-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/11/2024] [Indexed: 02/16/2024] Open
Abstract
Continuous intra-jejunal infusion of levodopa-carbidopa intestinal gel (LCIG) is a long-term proven and effective treatment in advanced Parkinson's Disease (APD). Efficacy and safety of 16-h administration of LCIG has already been established. Additional benefits of 24-h LCIG administration have been reported in several case series and small clinical studies. The aim of this retrospective study was to compare the characteristics of patients who needed 24-h LCIG from the beginning of the DAT (device-aided treatment) with those who remained with the standard 16-h LCIG treatment and to identify particular motives if any. We initiated LCIG in 150 patients out of which in case of 62 patients (41,3%) due to unsatisfactory initial clinical benefits continuous 24-h LCIG was deemed necessary. Despite the subjective complaints and more severe clinical condition, at baseline evaluation we found statistically significant differences between 16-h LCIG cohort and 24-h LCIG cohort only in case of incidence of freezing (47% vs 65%, p = 0.03) and sudden off (32% vs 48%, p = 0.04). Wake hours/daytime LCIG does not always sufficiently improve the patient's quality of life in some patients due to persistent nighttime troublesome symptoms. Instead of labeling the patient as a non-responder, it is worth trying the 24-h LCIG dosage in a carefully selected group of patients, as there is currently no consensus on reliable criteria that serve the decision in these patients.
Collapse
Affiliation(s)
- Szabolcs Szatmári
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
| | - József Attila Szász
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
| | - Károly Orbán-Kis
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania.
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania.
| | - Simona Bataga
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
- Department of Gastroenterology, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania
| | - Marius Ciorba
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
- Department of Gastroenterology, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania
| | - Előd Nagy
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
- Laboratory of Medical Analysis, Clinical County Hospital Mures, Târgu Mures, Romania
| | - Radu Neagoe
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
- 2nd Clinic of Surgery, Târgu Mures County Emergency Clinical Hospital, Târgu Mures, Romania
| | - István Mihály
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
- Department of Neurology, Emergency County Hospital, Miercurea-Ciuc, Romania
| | - Péter Zsombor Szász
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
| | - Krisztina Kelemen
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
| | - Attila Frigy
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures, George Emil Palade, Gh. Marinescu Street No 38, 540142, Târgu Mures, Romania
- Department of Internal Medicine IV, Clinical County Hospital Mures, Târgu Mures, Romania
| | - Andrea Csipor-Fodor
- 2nd Clinic of Neurology, Târgu Mures County Emergency Clinical Hospital, Târgu Mureș, Romania
| | | |
Collapse
|
3
|
Levodopa-Carbidopa Intestinal Gel in Advanced Parkinson’s Disease: Observations and Dilemmas after 10 Years of Real-Life Experience. Pharmaceutics 2022; 14:pharmaceutics14061115. [PMID: 35745688 PMCID: PMC9231164 DOI: 10.3390/pharmaceutics14061115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 12/04/2022] Open
Abstract
Advanced Parkinson’s disease (APD) cannot be treated efficiently using the classical medications however, in recent decades invasive therapeutical methods were implemented and confirmed as effective. One of these methods makes it possible to continue the levodopa (LD) supplementation as a gel administered directly into the upper intestine. However, there are a number of unanswered questions regarding this method. Therefore, we retrospectively analyzed a 10-year period of selected patients that were treated with levodopa/carbidopa intestinal gel (LCIG). We included all APD patients with motor fluctuations and dyskinesia at presentation. LCIG treatment was started in 150 patients: on average these patients received LD for 10.6 ± 4.4 years with a frequency of 5.2 ± 1.0/day until the introduction of LCIG. The estimated and the real LCIG dose differed significantly (mean: 1309 ± 321 mg vs. 1877 ± 769 mg). The mean duration of LCIG administration was 19.8 ± 3.6 h, but in a number of 62 patients we had to administer it for 24 h, to maximize the therapeutic benefit. A carefully and individually adjusted LCIG treatment improves the quality of life of APD patients, but questions remain unresolved even after treating a large number of patients. It is important to share the ideas and observations based on the real-life experience related to the optimal timing, the appropriate dose and duration of administration of the LCIG.
Collapse
|
4
|
Szász JA, Constantin VA, Orbán-Kis K, Bancu LA, Ciorba M, Mihály I, Nagy EE, Szász RM, Kelemen K, Simu MA, Szatmári S. Management Challenges of Severe, Complex Dyskinesia. Data from a Large Cohort of Patients Treated with Levodopa-Carbidopa Intestinal Gel for Advanced Parkinson's Disease. Brain Sci 2021; 11:826. [PMID: 34206596 PMCID: PMC8301838 DOI: 10.3390/brainsci11070826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/12/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In the advanced stages of Parkinson's disease (APD), complex forms of dyskinesia may severely impair the patient's quality of life. OBJECTIVE In the present study, we aimed to analyze the evolution under LCIG therapy of the most important motor fluctuations and complex disabling dyskinesias, including diphasic dyskinesia. METHODS In this retrospective study, we analyzed the characteristics of patients with APD who had at least 30 min of diphasic dyskinesia (DID) in 3 consecutive days, were considered responders and were treated with LCIG in our clinic. Patients were evaluated before and after PEG and at 6, 12 and 18 months, when the changes in the therapy were recorded, and they completed a 7-point Global Patient Impression of Improvement (PGI-I) scale. RESULTS Forty patients fulfilled the inclusion criteria-out of which, 34 performed all visits. There was a substantial difference between the calculated and real LCIG (1232 ± 337 mg vs. 1823 ± 728 mg). The motor fluctuations and most dyskinesias improved significantly after starting LCIG, but an increasing number of patients needed longer daily administrations of LCIG (24 instead of 16 h). CONCLUSIONS Patients with APD with complex dyskinesias must be tested in dedicated hospitals, and they need a special therapeutic approach. The properly adapted LCIG treatment regarding the dose and time of administration completed with well-selected add-on medication should offer improvement for patients who want to or can only choose this DAT vs. others.
Collapse
Affiliation(s)
- József Attila Szász
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| | - Viorelia Adelina Constantin
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- Doctoral School, ”Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timișoara, Romania
| | - Károly Orbán-Kis
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| | - Ligia Ariana Bancu
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
- 1st Clinic of Internal Medicine, Târgu Mures County Emergency Clinical Hospital, 540142 Târgu Mureș, Romania
| | - Marius Ciorba
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
- Department of Gastroenterology, Târgu Mures County Emergency Clinical Hospital, 540142 Târgu Mureș, Romania
| | - István Mihály
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| | - Előd Ernő Nagy
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
- Laboratory of Medical Analysis, Clinical County Hospital Mures, 540142 Târgu Mureș, Romania
| | - Róbert Máté Szász
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| | - Krisztina Kelemen
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| | - Mihaela Adriana Simu
- Department of Neurology II, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timișoara, Romania;
- ”Pius Branzeu” Emergency Clinical County Hospital, 300723 Timișoara, Romania
| | - Szabolcs Szatmári
- 2nd Clinic of Neurology, Târgu Mureș County Emergency Clinical Hospital, 540136 Târgu Mureș, Romania; (J.A.S.); (V.A.C.); (I.M.); (K.K.); (S.S.)
- “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (L.A.B.); (M.C.); (E.E.N.); (R.M.S.)
| |
Collapse
|