Objective: To determine the clinical characteristics associated with early withdrawal of Levodopa-Carbidopa Intestinal Gel infusion (LCIG) in patients with advanced Parkinson´s Disease (APD)

Background: LCIG infusion has been demonstrated to be a safe and efficacious option for long-term patients with APD. Studies in patients treated with LCCIG have proved improvement in UPDRS score, reduction of Off time and increased ON time without disabling dyskinesias, and sustained improvements in non-motor symptoms, as well as quality of life. However, the clinical characteristics of patients with early withdrawal are poorly studied, and studies on the prediction of occurrence is scarce.

Method: This is a single-center retrospective cohort study of consecutive patients diagnosed with advanced PD, and treated with LCIG infusion at a Movement Disorders Unit over 13 years. A total of 23 patients were included. Demographic, clinical and treatment variables were registered. Most of the patients analyzed received treatment with LCIG for more than one year, and some of them presenting discontinuation during the first year.

Results: a total of 6(26%) patients discontinued the treatment with LCIG in the first year, 3 (13%) due to patient request, and 1 (4.3%) because of to side effects related to advanced therapy, progression to high disability, and demise, respectively. Socio-demographics and clinical characteristics of patients who continued LCIG further than 1 year and the group with early withdrawal of LCIG were similar. No differences were found in PD duration (17.2±5.4 vs 15.8±5.6 years, p=0.51), length (16.3±5.4 vs 14.0±5.2 years, p=0.42), and doses (1.3±0.4 vs 1.2±0.5 grams, p=0.97) of levodopa treatment previous LCIG started. However, the patients with early withdrawal LCIG began motor fluctuations younger (55.8±10.3 vs 67.3±7.8, p=0.03) than the group that continued with advanced therapy beyond 1 year.

Conclusion: LCIG infusion was demonstrated to be safe, with a low rate of side effects related to advanced therapy. The onset of fluctuations at a younger age was the only characteristic related to the group of patients with early discontinuation of LCIG.

References: 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; GLORIA study co-investigators. Levodopa-carbidopa intestinal gel in advanced Parkinson’s: Final results of the GLORIA registry. Parkinsonism Relat Disord. 2017 Dec;45:13-20. doi: 10.1016/j.parkreldis.2017.09.018. Epub 2017 Sep 22. PMID: 29037498.
Antonini A, Odin P, Pahwa R, Aldred J, Alobaidi A, Jalundhwala YJ, Kukreja P, Bergmann L, Inguva S, Bao Y, Chaudhuri KR. The Long-Term Impact of Levodopa/Carbidopa Intestinal Gel on ‘Off’-time in Patients with Advanced Parkinson’s Disease: A Systematic Review. Adv Ther. 2021 Jun;38(6):2854-2890. doi: 10.1007/s12325-021-01747-1. Epub 2021 May 20. PMID: 34018146; PMCID: PMC8189983.
Regidor I, Santos-García D, Catalán MIJ, Puente V, Valldeoriola F, Grandas F, Mir P, Parra JC, Arbelo JM. Impact of Disease Duration in Effectiveness of Treatment with Levodopa-Carbidopa Intestinal Gel and Factors Leading to Discontinuation. J Parkinsons Dis. 2019;9(1):173-182. doi: 10.3233/JPD-181324. PMID: 30562907.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-characteristics-associated-with-early-discontinuation-of-levodopa-carbidopa-intestinal-gel-infusion-in-patients-with-advanced-parkinson-disease/