Objective: To evaluate whether Helicobactor pylori (H.pylori) infection affects the pharmacokinetics of L-DOPA in patients with Parkinson’s disease (PD).

Background: H. pylori infects gastric mucosa and causes chronic gastritis. Decreased gastric acid secretion caused by chronic gastritis and the production of ammonia by H. pylori result in the decreased acidity in the stomach. On the other hand, L-DOPA is known to be easily dissolved under acidic conditions, resulting in rapid absorption of L-DOPA. Therefore, H. pylori infection may change the absorption efficiency, and eventually, affect pharmacokinetics.

Method: We extracted 102 PD patients who had measured the blood concentration of L-DOPA over time after oral 100mg L-DOPA administration under fasting conditions. These patients were classified as anti-H. pylori antibody (Ab)-positive or Ab-negative according to the serum anti-H. pylori Ab titer, and divided into two groups. L-DOPA concentrations were measured with 100/25mg levodopa/benserazide in 62 patients and with 100/10mg levodopa/carbidopa in 40 patients. The maximum blood concentration (Cmax), time to reach maximum blood concentration (Tmax), and area under the blood concentration curve (AUC) were compared between the groups.

Results: Among 102 PD patients, 28 (27.5%) were H. pylori Ab-positive, and 74 were Ab-negative. The mean age of PD onset in the Ab-positive and Ab-negative groups was 62.2 vs. 61.0 years, and the mean age at blood concentration measurement was 69.4 vs. 67.0 years. Among patients who had measured L-dopa blood concentration with levodopa/benserazide (N=40), the mean Cmax (nmol/mL) and Tmax (min) up to 2 hours after oral administration in Ab-positive group were significantly lower compared with those of Ab-negative group [(8.5±3.2vs 11.9±5.4 (p=0.04) and 69±48 vs 41±31 (p=0.03), respectively]. The AUC (min・nmol/mL) up to four hours after oral administration evaluated from 39 patients was 880±234 vs 911±272 (p=0.73) in Ab-positive group (N=12) vs. Ab-negative group (N=27), with no difference. Among the patients who administered levodopa/carbidopa, there was no difference in Cmax, Tmax, or AUC between Ab-positive and Ab-negative groups.

Conclusion: In PD patients receiving levodopa/benserazide, Cmax is lower and Tmax prolongs compared with H. pylori Ab-positive groups. H. pylori infection should be considered in PD patients showing poor response to levodopa/benserazide.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-h-pylori-infection-on-l-dopa-pharmacokinetics-in-patients-with-parkinsons-disease/