Abstract
Patients in fluctuating stages of Parkinson’s disease (PD) require device-aided treatments. Continuous infusion of levodopa–carbidopa intestinal gel (LCIG) is a well-proven option in clinical practice. We now report the first clinical experience of levodopa–entacapone–carbidopa intestinal gel (LECIG) therapy. An observational study of the first patients to start LECIG in our clinic was performed. Twenty-four patients (11 females, 13 males) were included. The median age was 71.5 years, and the median duration since PD diagnosis was 15.5 years. The median treatment duration was 305 days. Median doses were: 6.0 mL as morning dose, 2.5 mL/h as infusion rate, and 1.0 mL as extra dose. Half of the patients were switched directly from LCIG. These patients express improvements in the size and weight of the pump. Furthermore, most of them considered the new pump to be improved regarding user-friendliness. Six patients discontinued LECIG, three due to diarrhea, one due to hallucinations and two deceased (one cardiac arrest and one COVID-19). LECIG has shown to be possible to use in patients with PD, efficacy and safety as expected. Patients are generally happy with the size and usability of the pump, but some technical improvements of the software are warranted, as well as larger, prospective studies.
Highlights
Continuous infusion of levodopa–carbidopa intestinal gel (LCIG) is approved in many countries for the treatment of motor fluctuations in Parkinson’s disease (PD) [1].The infusion via an intestinal tube immediately provides levodopa at the absorption site, rendering stable levodopa concentrations in plasma and thereby continuous drug delivery to the brain [2]
We report our initial experience, based on the clinical use of levodopa–entacapone–carbidopa intestinal gel (LECIG) and patient-reported outcome
100% of patients exposed to LECIG wereof levodopaindosage in LCIG and LECIG, when the duration of infusion therapy was not included this report
Summary
Continuous infusion of levodopa–carbidopa intestinal gel (LCIG) is approved in many countries for the treatment of motor fluctuations in Parkinson’s disease (PD) [1].The infusion via an intestinal tube immediately provides levodopa at the absorption site, rendering stable levodopa concentrations in plasma and thereby continuous drug delivery to the brain [2]. LCIG efficiently reduces motor fluctuations and dyskinesias [3], and some non-motor fluctuations [4]. It thereby increases the quality of life in patients with fluctuating responses to oral dopaminergic drugs [5] and has the potential to serve the patients for many years, like the other device-aided therapies, subcutaneous apomorphine infusion and deep brain stimulation (DBS) [6]. Many patients complain about the size and weight of the pump, which has not been changed since the method was introduced in Sweden in the 1990s, two different models of the pump have been used [7,8]
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