Objective: We sought to analyze the mortality and the causes of death of 105 patients with Parkinson disease (PD) treated with levodopa-carbidopa intestinal gel (LCIG) infusion for over 10 years.

Background: LCIG infusion demonstrated a sustained efficacy on PD symptoms and motor fluctuations, but concerns have risen over time about the complications experienced by patients during LCIG therapy. However, analyses of the mortality of LCIG cohorts are lacking.

Method: We retrospectively analyzed data of 105 consecutive PD patients treated with LCIG in time-frame 2005-2018. We analyzed the death rate, the mean survival time and the causes of death. To verify the influence of LCIG on the mortality rate we also analyzed data of a group of 91 advanced PD patients treated with standard dopaminergic therapy (SDT group). Finally, we collected all the serious adverse events (SAEs) in LCIG patients and correlated the types and number of SAEs with mortality.

Results: According to data availability, we enrolled 98 LCIG and 86 SDT patients. The mean age at LCIG start was 67.9±7.3 years, and disease duration 13.0±4.3 years. The mean follow-up time since LCIG infusion start was 5.3±2.7 years. During follow-up, 34.7% of LCIG patients died. The mean survival time since LCIG start was 4.6±2.6 years. The causes of death were inhalation pneumonia in 17.1% of patients, cardio-cerebrovascular disease in 11.8%, deterioration of general condition in 32.3%, sepsis in 5.9%, gastro-intestinal disorders in 5.9%, traumatic injuries in 8.8%, metabolic alteration in 2.9%, and unknown in 14.7%. Only one cause of death, pertaining to the gastro-intestinal disorders, was considered likely related to the LCIG infusion therapy: the patient died for intestinal occlusion three months after LCIG start. The Cox regression model on the entire cohort of 184 advanced PD patients (LCIG + SDT) showed a not-significant association between mortality and LCIG infusion therapy (HR: 0.748, 95% CI 0.287-1.948; p: 0.552), and a significant association between mortality and Mini Mental State Examination score (HR: 0.900, 95% CI 0.825-0.983; p: 0.019). We observed 222 SAEs occurring in 87.9% of patients. The number of SAEs did not correlate with the mortality of LCIG patients (Odds ratio: 0.904; p: 0.370).

Conclusion: Our findings did not support the hypothesis of an influence of LCIG therapy on mortality.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/long-term-levodopa-carbidopa-intestinal-infusion-in-parkinsons-disease-survival-and-mortality/