Can suitable candidates for levodopa/carbidopa intestinal gel therapy be identified using current evidence?

Research output: Contribution to journalReview article

Abstract

Advanced Parkinson's disease (APD) is characterized by increased functional disability, caused by motor complications, the presence of axial symptoms, and emergent disease- and drug-related non-motor symptoms. One of the advanced therapies available is intrajejunal infusion of levodopa/carbidopa intestinal gel (LCIG); however, patient selection for this treatment is sometimes difficult, particularly because of overlapping indications with other alternatives. In recent years, strong evidence has supported the use of LCIG in treating motor fluctuations associated with APD, and several clinical studies provide emerging evidence for additional benefits of LCIG treatment in certain patients. This article provides an overview of the published literature on the benefits, limitations, and drawbacks of LCIG in relation to PD symptoms, the psychosocial impact of the disease, and the quality of life of patients, with the aim of determining candidates for whom treatment with LCIG would be beneficial. According to current evidence, patients with APD (defined as inability to achieve optimal control of the disease with conventional oral treatment), a relatively well-preserved cognitive-behavioral status, and good family/caregiver would count as suitable candidates for LCIG treatment. Contraindications in the opinion of the authors are severe dementia and active psychosis.

Details

Authors
  • Maria José Catalán
  • Angelo Antonini
  • Matilde Calopa
  • Ovidiu Băjenaru
  • Oriol de Fábregues
  • Adolfo Mínguez-Castellanos
  • Per Odin
  • José Manuel García-Moreno
  • Stephen W. Pedersen
  • Zvezdan Pirtošek
  • Jaime Kulisevsky
Organisations
External organisations
  • Hospital Clinico San Carlos de Madrid
  • Bellvitge University Hospital-IDIBELL
  • Carol Davila University of Medicine and Pharmacy
  • Vall d'Hebron University Hospital
  • University of Granada
  • Central Hospital Bremerhaven
  • Skåne University Hospital
  • University of Copenhagen
  • University Medical Centre Ljubljana
  • Autonomous University of Barcelona
  • San Camillo Hospital
  • University Hospital Virgen Macarena
  • Copenhagen University Hospital
  • Hospital de Sant Pau
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Neurosciences
  • Neurology

Keywords

  • Duodopa, Intrajejunal infusion of levodopa/carbidopa intestinal gel, Motor symptoms, Non-motor symptoms, Parkinson's disease, Quality of life
Original languageEnglish
Pages (from-to)44-53
Number of pages10
JournaleNeurologicalSci
Volume8
Publication statusPublished - 2017 Sep 1
Publication categoryResearch
Peer-reviewedYes