Adverse effects of levodopa/carbidopa intrajejunal gel treatment: A single‐center long‐term follow‐up study
Open Access
- 28 July 2022
- journal article
- research article
- Published by Hindawi Limited in Acta Neurologica Scandinavica
- Vol. 146 (5), 537-544
- https://doi.org/10.1111/ane.13675
Abstract
Objectives Levodopa/carbidopa intrajejunal gel (LCIG) is an effective therapeutic strategy to overcome levodopa-induced motor complications in advanced Parkinson's disease (PD). However, it requires invasive percutaneous endoscopic gastrojejunostomy (PEG-J) and may be associated with serious adverse effects (AE). In this study, we aimed to evaluate long-term AEs related to LCIG treatment in a large homogenous cohort of advanced PD patients. Methods One hundred three consecutive PD patients were regularly monitored for LCIG-related, PEG-J-related, and device-related AEs up to 14 years. Incidence of AEs was studied in time applying a time-to-event analysis and Cox proportional hazard model with age, disease duration, gender, and recurrent AE as covariates. Health-related quality of life (HRQoL) was estimated at each visit and compared to HRQoL before the LCIG treatment. Results Among 296 AEs noted, 48.8% were LCIG-related, 32.4% PEG-J-related, and 19.6% device-related. While most of the studied AEs steadily accumulated throughout the follow-up period, 24.3% of the patients (95% CI 10.1%-36.3%) experienced PEG-J-related AE already within the first days after the PEG-J insertion. Cox model revealed that older patients had higher probability of psychosis, PEG-J- and device-related AEs (p < .05, p < .05, and p = .02) and suggested increased recurrence risk in those with early PEG-J and device-related AEs. Despite relatively high incidence of AEs, HRQoL significantly increased in the follow-up period (p < .0001). Conclusion AEs related to LCIG treatment are common. Therefore, careful patient selection and monitoring throughout the treatment is recommended, especially in those with early side effects. Nevertheless, LCIG significantly improves HRQoL in advanced PD patients on a long term.Keywords
Funding Information
- Javna Agencija za Raziskovalno Dejavnost RS (J7‐2600, P1‐0389)
This publication has 29 references indexed in Scilit:
- Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson's disease: Consensus from an international survey and discussion programParkinsonism & Related Disorders, 2015
- Initiation and dose optimization for levodopa-carbidopa intestinal gel: Insights from phase 3 clinical trialsParkinsonism & Related Disorders, 2015
- Four pioneers of L‐dopa treatment: Arvid Carlsson, Oleh Hornykiewicz, George Cotzias, and Melvin YahrMovement Disorders, 2014
- Continuous intrajejunal infusion of levodopa-carbidopa intestinal gel for patients with advanced Parkinson's disease: a randomised, controlled, double-blind, double-dummy studyThe Lancet Neurology, 2013
- Disease duration and the integrity of the nigrostriatal system in Parkinson’s diseaseBrain, 2013
- Knotting of Percutaneous Endoscopic Jejunostomy Feeding Tubes in Two Patients with Parkinson’s Disease and Continuous Duodopa® treatmentZeitschrift für Gastroenterologie, 2012
- Striatal plasticity in Parkinson's disease and L-DOPA induced dyskinesiaParkinsonism & Related Disorders, 2012
- Oral and Infusion Levodopa-Based Strategies for Managing Motor Complications in Patients with Parkinsonʼs DiseaseCNS Drugs, 2010
- Dyskinesias and motor fluctuations in Parkinson's diseaseBrain, 2000
- Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases.Journal of Neurology, Neurosurgery & Psychiatry, 1992