Which patients discontinue? Issues on Levodopa/carbidopa intestinal gel treatment: Italian multicentre survey of 905 patients with long-term follow-up

Parkinsonism Relat Disord. 2017 May;38:90-92. doi: 10.1016/j.parkreldis.2017.02.020. Epub 2017 Feb 21.

Abstract

Objectives: To report the results of a national survey aimed at quantifying the current level of diffusion of Levodopa/carbidopa intestinal gel (LCIG) in Italy.

Methods: Sixty Parkinson's Disease (PD) specialists in Italy were invited to complete a survey covering issues on clinical and practical aspects of LCIG therapy.

Results: Clinical features of 905 patients were collected retrospectively. The majority of centres reported the use of a multidisciplinary team, biochemistry testing, neurophysiological and neuropsychological tests before and after treatment, in addition to caregivers' training and patient's follow as outpatients. Most centres (60%) used internal guidelines for patient selection. The overall rate of adverse events was 55.1%. Weight loss, chronic polyneuropathy and stoma infection were the most frequently reported. 40% of centres used replacement therapy with Vitamin B12 and Folic acid from the start of LCIG and continued this for the duration of treatment. The rate of discontinuation was of 25.7% overall, with 9.5% of cases occurring in the first year. The main causes of withdrawal were device-related complications, disease progression (comorbidity, severe dementia) and caregiver and/or patient dissatisfaction.

Conclusions: In Italy LCIG infusion is managed in a uniform manner at a clinical, practical and organizational level even though the selection criteria are not standardized through the country. The high percentage of patients remaining on treatment in the short- and long-term follow-up confirms effectiveness of treatment, careful follow-up, and appropriate patient and caregivers training.

Keywords: Levodopa-carbidopa intestinal gel infusion; Neuropathy; Parkinson's disease; Withdrawal.

Publication types

  • Multicenter Study

MeSH terms

  • Antiparkinson Agents / administration & dosage*
  • Carbidopa / administration & dosage*
  • Disease Progression
  • Drug Combinations
  • Female
  • Gels / therapeutic use*
  • Health Surveys
  • Humans
  • Intestines / physiology*
  • Italy
  • Levodopa / administration & dosage*
  • Longitudinal Studies
  • Male
  • Parkinson Disease / drug therapy*
  • Retrospective Studies
  • Substance Withdrawal Syndrome / etiology

Substances

  • Antiparkinson Agents
  • Drug Combinations
  • Gels
  • carbidopa, levodopa drug combination
  • Levodopa
  • Carbidopa