Objective: The objectives of this study were to find predictive factors for early dropout from levodopa-carbidopa intestinal gel (LCIG) infusion in advanced Parkinson’s disease (PD) and to explore the changes in anti-Parkinson medication and levodopa equivalent daily dosage (LEDD) during the long-term LCIG treatment in real-life clinical practice.

Background: LCIG-infusion effectively reduces off-time and dyskinesia and increases on-time in advanced PD. However, many patients discontinue the treatment early on. There is limited information considering changes in anti-Parkinson medication and LEDD during the long-term LCIG-infusion.

Method: LCIG-infusion was administered to 103 patients between July 2006 and May 2020 at the Helsinki University Hospital, accumulating 350 years of follow-up data. We retrospectively evaluated the LCIG-therapy adherence and changes in medication from the patient records. We defined discontinuation of LCIG-infusion during the first year of treatment as an early dropout. A subgroup analysis of 67 patients who had received at least 2 years of treatment was done to evaluate the changes in LEDD.

Results: There were 15 early dropouts in our study. Based on bivariate logistic regression analysis living alone predicted early dropout (OR 3.88; 95% Cl 1.034 – 14.66; p=0.045) when controlled for age, duration of disease, H&Y and gender. The finding was even more robust, when patients who died during the first year of treatment (n=4) were excluded from the analysis (OR 5.412; 95% 1.20 – 24.42; p=0.028). The mean LEDD rose from baseline before LCIG-infusion to discharge from hospital with LCIG-infusion (1198 vs. 1553, p=0.001). It increased further from discharge with LCIG to 6 months control visit (1554 vs. 1621, p=0.016), stabilizing thereafter. Patients commonly switched from polypharmacy to LCIG-only or to LCIG + oral levodopa during long-term treatment as shown in Figure 1.

Conclusion: Mean LEDD rises sharply during first six months of LCIG-infusion, stabilizing thereafter. The anti-Parkinson medication simplifies with time as patients switch from polypharmacy to LCIG + oral levodopa and to LCIG-monotherapy. Living alone appears to be a predictive factor for early treatment dropout.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/predictive-factors-of-lcig-infusion-therapy-adherence-a-single-center-study-of-103-consecutive-lcig-patients/