Safety and effectiveness of levodopa-carbidopa intestinal gel for advanced Parkinson's disease: A large single-center study.
Adult
Aged
Aged, 80 and over
Antiparkinson Agents
/ administration & dosage
Carbidopa
/ administration & dosage
Catheters, Indwelling
/ adverse effects
Drug Combinations
Drug-Related Side Effects and Adverse Reactions
/ epidemiology
Endoscopy, Gastrointestinal
/ adverse effects
Female
France
/ epidemiology
Gastrostomy
/ adverse effects
Gels
Humans
Infusion Pumps
/ adverse effects
Intestinal Absorption
Levodopa
/ administration & dosage
Male
Mental Status and Dementia Tests
Middle Aged
Parkinson Disease
/ drug therapy
Retrospective Studies
Severity of Illness Index
Treatment Outcome
Adverse event
Gastrostomy
Levodopa-carbidopa intestinal gel
Parkinson's disease
Journal
Revue neurologique
ISSN: 0035-3787
Titre abrégé: Rev Neurol (Paris)
Pays: France
ID NLM: 2984779R
Informations de publication
Date de publication:
May 2020
May 2020
Historique:
received:
13
05
2019
revised:
21
07
2019
accepted:
23
07
2019
pubmed:
2
11
2019
medline:
5
1
2021
entrez:
1
11
2019
Statut:
ppublish
Résumé
Treatment with levodopa-carbidopa intestinal gel (LCIG) can effectively relieve motor and non-motor symptoms in advanced Parkinson's disease (PD). However, adverse events (AEs) are frequent. To describe AEs associated with LCIG treatment and the main reasons for treatment discontinuation. We also looked for factors that were potentially predictive of serious AEs and assessed the effectiveness of and satisfaction with LCIG. We retrospectively analyzed data on AEs in patients treated with LCIG at a French university medical center. For patients still receiving treatment at last follow-up, effectiveness was assessed according to the Clinical Global Impression (CGI) scale and the Movement Disorders Society - Unified Parkinson's Disease Rating Scale motor score. Of the 63 patients treated with LCIG for a mean (range) of 19 months (8-47), 57 (90%) experienced at least one AE (340 AEs in total). Most of the AEs (in 69.8% of the patients) were related to percutaneous endoscopic gastrostomy with a jejunal tube (PEG-J) or affected the gastrointestinal tract (granuloma, leakage, or a local infection). Device-related AEs (such as PEG-J removal and device occlusion) were frequent (in 63.5% of patients). Forty-three patients (68%) required at least one additional endoscopic procedure. Dopatherapy-related AEs occurred in 30 patients (48%). Most of the AEs occurred long after treatment initiations, and only a small proportion led to discontinuation. On the CGI scale, 53 patients (84.4%) considered that their condition had improved during LCIG treatment. Despite the high frequency of AEs, patients with advanced PD gain clinical benefit from treatment with LCIG. This treatment requires a competent, multidisciplinary team on site.
Sections du résumé
BACKGROUND
BACKGROUND
Treatment with levodopa-carbidopa intestinal gel (LCIG) can effectively relieve motor and non-motor symptoms in advanced Parkinson's disease (PD). However, adverse events (AEs) are frequent.
OBJECTIVE
OBJECTIVE
To describe AEs associated with LCIG treatment and the main reasons for treatment discontinuation. We also looked for factors that were potentially predictive of serious AEs and assessed the effectiveness of and satisfaction with LCIG.
METHOD
METHODS
We retrospectively analyzed data on AEs in patients treated with LCIG at a French university medical center. For patients still receiving treatment at last follow-up, effectiveness was assessed according to the Clinical Global Impression (CGI) scale and the Movement Disorders Society - Unified Parkinson's Disease Rating Scale motor score.
RESULTS
RESULTS
Of the 63 patients treated with LCIG for a mean (range) of 19 months (8-47), 57 (90%) experienced at least one AE (340 AEs in total). Most of the AEs (in 69.8% of the patients) were related to percutaneous endoscopic gastrostomy with a jejunal tube (PEG-J) or affected the gastrointestinal tract (granuloma, leakage, or a local infection). Device-related AEs (such as PEG-J removal and device occlusion) were frequent (in 63.5% of patients). Forty-three patients (68%) required at least one additional endoscopic procedure. Dopatherapy-related AEs occurred in 30 patients (48%). Most of the AEs occurred long after treatment initiations, and only a small proportion led to discontinuation. On the CGI scale, 53 patients (84.4%) considered that their condition had improved during LCIG treatment.
CONCLUSION
CONCLUSIONS
Despite the high frequency of AEs, patients with advanced PD gain clinical benefit from treatment with LCIG. This treatment requires a competent, multidisciplinary team on site.
Identifiants
pubmed: 31668287
pii: S0035-3787(19)30655-1
doi: 10.1016/j.neurol.2019.07.024
pii:
doi:
Substances chimiques
Antiparkinson Agents
0
Drug Combinations
0
Gels
0
carbidopa, levodopa drug combination
0
Levodopa
46627O600J
Carbidopa
MNX7R8C5VO
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
268-276Informations de copyright
Copyright © 2019 Elsevier Masson SAS. All rights reserved.