Objective: To evaluate the efficacy of Levodopa-Entacapone-Carbidopa Intestinal Gel (LECIG) in the treatment of patients with advanced Parkinson’s Disease (APD).

Background: The continuous enteral infusion of Levodopa-entacapone-carbidopa intestinal gel infusion is the latest device-aided therapy (DAT) available for APD in our country. LECIG requires the same surgical procedure as Levodopa-Carbidopa Intestinal Gel (LCIG) to insert a percutaneous endoscopic gastro-jejunostomy (PEG-J) system. The presence of the entacapone in the LECIG formulation increases the bioavailability of levodopa compared with LCIG, allowing a reduced levodopa dose (by an average of 20–30%) to be given to achieve the same therapeutic plasma levodopa levels.

Method: We performed a retrospective analysis of 29 consecutive APD patients, naive to enteral levodopa infusion, treated with LECIG in our department between December 2021 and December 2023. Daily duration of OFF time and dyskinesias were assessed before and after initiation of LECIG treatment.

Results: Patients initiated onto LECIG treatment had a mean (±SD) age of 65.1±9.0 years and a mean disease duration of 10.4±4.7 years. They presented with a mean daily OFF time of 4.8±0.8 hours and 26/29 also presented with 2.7±1.2 hours dyskinesias/day. At baseline, the mean daily dose of levodopa was 822 ± 259 mg divided into 5.3 ± 0.5 doses. Most patients (72%) were also being treated with dopamine agonists, namely pramipexole (3 patients; mean dose 2.4±0.6 mg), ropinirole (7 patients; mean dose 12 ± 6.5mg) or rotigotine patch (12 patients; mean dose 8.2 ± 2.0 mg). Therapeutic regimens also included rasagiline (18 patients, 62%) and entacapone (23 patients, 79%). After starting LECIG treatment, the mean daily OFF time duration was significantly reduced to 1.4 ± 0.5 hours (p<0.001). Dyskinesia duration was also significantly reduced to 1.4 ± 0.6 hours (p˂0.001) in 18/26 patients who had dyskinesias at baseline, while 8/26 became free of dyskinesias.

Conclusion: LECIG represents an effective DAT option for managing motor complications in APD. Further targeted studies are necessary to define the profile of APD patients who would benefit most from this new therapeutic solution, gather additional data on long-term safety and efficacy, and analyze the reduction of add-on medication over time.

« Back to 2024 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/levodopa-entacapone-carbidopa-intestinal-gel-in-the-treatment-of-advanced-parkinsons-disease-a-two-year-experience/