Objective: Describe and compare demographic and clinical characteristics, motor, and non-motor symptoms for patients with advanced Parkinson’s disease (APD) by daily duration (<24 hours or 24 hours) of continuous levodopa-carbidopa intestinal gel (LCIG) infusion.

Background: Effective symptom management with oral medication can be difficult in APD. LCIG delivers a continuous intestinal infusion of levodopa-carbidopa, which may offer a simplified treatment option. Based on a justified medical reason (ie, to relieve nighttime or early morning symptoms), select patients may benefit from LCIG treatment for 24h.

Method: COmedication Study assessing Mono- and cOmbination therapy with levodopa-carbidopa inteStinal gel (COSMOS; NCT03362879) is a retrospective, observational, cross-sectional, multi-country, post-marketing study. Patients with APD taking LCIG ≥12 months in routine clinical practice were stratified to 2 groups by duration of daily LCIG use (<24h, or 24h). Symptoms were measured at a single study visit. Baseline characteristics were gathered retrospectively.

Results: At study visit, 366 patients were using daily LCIG <24h (mean 1314.0 mg levodopa; 328.5 mg carbidopa), while 35 were using LCIG 24h (mean 2372.0 mg levodopa; 593.0 mg carbidopa). At patient visit, the 24h group had slightly longer history of LCIG use, longer daily “Off” time, and higher rates of morning akinesia [table1]. For patients who had ever used LCIG 24h (n=41), reasons included nocturnal/morning akinesia (53.7%), sleep problems (36.6%), and biphasic dyskinesia (12.2%). In this group, most patients (n=25) were treated with different doses throughout the day, 24 patients used 2 doses, and 1 patient used 3. Mean difference between lowest and highest doses was 50.3%. Mean “Off” time was reduced following LCIG treatment by 3.9h (P < .0001) in the <24h group, and by 5.4h (P < .0001) in the 24h group. “On” time with dyskinesia was reduced by 1.9h (P < .0001) in the <24h group, and by 1.6h (P = .015) in the 24h group. Changes in individual motor [table2] and non-motor symptoms [table3] following LCIG therapy are indicated. Retrospectively collected safety events were in line with the known LCIG profile.

Conclusion: In this study, the main reason for 24h LCIG use was to address nocturnal/morning akinesia. LCIG 24h infusion improved motor fluctuations and can be considered for select patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/motor-and-non-motor-symptoms-in-patients-treated-with-24-hour-daily-levodopa-carbidopa-intestinal-gel-infusion-analysis-of-the-cosmos-observational-study/