Objective: Examine non-motor symptoms in patients with advanced Parkinson’s disease (APD) in a real-world clinical setting following ≥12 months of treatment with levodopa-carbidopa intestinal gel (LCIG).

Background: As PD progresses, adequate non-motor symptom treatment often requires multiple adjunctive PD therapies, increasing pill burden and the potential for poor adherence. Continuous LCIG administration may provide a more simplified treatment option.

Method: COSMOS (COmedication Study assessing Mono- and cOmbination therapy with levodopa-carbidopa inteStinal gel; NCT03362879) is a multi-country, cross-sectional, retrospective, post-marketing observational study that enrolled APD patients treated with LCIG for ≥12 months. Patients were stratified into 3 groups: LCIG monotherapy, LCIG monotherapy with oral or transdermal PD medication at nighttime only (ie, LCIG daytime monotherapy), and LCIG plus add-on PD medications. Non-motor symptoms were assessed using a structured non-motor symptoms questionnaire (retrospectively and at patient visit) and the Non-motor Symptoms Scale (NMSS; at patient visit).

Results: Overall, 409 patients were included in this analysis (120 LCIG monotherapy at the 12-month visit, 94 LCIG daytime monotherapy with adjunctive nighttime oral/transdermal PD medication, 164 LCIG plus add-on PD medication, 31 missing). After mean LCIG treatment for 35.8 months, the mean (standard deviation) NMSS score was 57.6 (42.2). NMSS total and domain scores were similar between treatment groups [table1]. The proportion of patients experiencing anxiety, pain, depression, and constipation decreased from baseline to patient visit (P < .0001) [table2]. However, the proportion of patients experiencing cognitive impairment, apathy, fatigue, urinary symptoms, and orthostatic hypotension increased (P < .0001) [table2]. The proportion of patients who experienced individual non-motor symptoms followed similar patterns across treatment groups.

Conclusion: Following almost 3 years of LCIG therapy, fewer patients experienced anxiety, pain, depression, and constipation, but more patients experienced cognitive impairment, apathy, fatigue, urinary symptoms, and orthostatic hypotension, aligned with other studies and with disease progression. NMSS scores were similar for all treatment groups.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/non-motor-symptoms-after-treatment-with-levodopa-carbidopa-intestinal-gel-in-patients-with-advanced-parkinsons-disease-analysis-of-the-cosmos-observational-study/