Objective: To provide suggested guidance on how to select appropriate candidates for therapy with carbidopa/levodopa enteral suspension (CLES) based on published literature.

Background: The introduction of new therapies can be somewhat confusing, delaying availability of treatment for patients. CLES is a recently approved therapy for the treatment of Advanced PD using a pump to continuously infuse carbidopa/levodopa. The rationale is to provide sustained dopaminergic stimulation while bypassing any potential GI interactions. Currently, there are no guidelines on how to select the appropriate patient for this therapy, which might cause some confusion among treating physicians. We present a suggested guideline for patient selection based on European experience and published data.

Methods: We reviewed the published data and manuscripts and discussed the experience of healthcare professionals exposed to the therapy. Ideal patient characteristics were discussed and contraindications for therapy was discussed.

Results: The appropriate candidate for CLES must have Idiopathic PD, prove to be levodopa responsive ([at least 30% improvement in UPDRS III), have more than 3 hours of "off time" refractory to optimization of all other oral therapies, not have a contraindication for PEG-J placement (sepsis, abdominal malignancy, coagulation disorders, intestinal obstruction), must be willing to carry the equipment for 16 hours per day and must not suffer from cognitive impairment (MMSE equal or more than 24). Patients must be able to perform the medication cassette changes and maintain proper hygiene of the abdominal wall stoma and communicate any issues to medical team in a timely fashion. The availability of a caregiver is not strictly necessary but highly encouraged.

Conclusions: In the carefully chosen patient, CLES can provide significant benefit decreasing "off time" and increasing "on time w/o troublesome dyskinesias" with a reasonable safety profile. It is critical that patients understand the potential adverse events, technology and the proper care associated with it. Good cognitive status is recommended perform drug cassette changes. More experience with the product will provide better understanding, but while this is available, the above recommendations might prove to be useful to establish therapy. An evaluation and guide to treatment protocol is provided.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/suggested-criteria-for-patient-selection-for-therapy-with-carbidopalevodopa-enteral-suspension-cles/