Levodopa-Carbidopa Intestinal Gel for Parkinson's Disease over 11 years: One Center's "Real-World" Experience.

Pub Date : 2024-05-01 Epub Date: 2023-07-18 DOI:10.1017/cjn.2023.251
Chetan Vekhande, Moath Hamed, Genise Tremain, Jennifer Mah, Aakash Shetty, Adriana Lazarescu, Oksana Suchowersky
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Abstract

Background: Levodopa-carbidopa intestinal gel (LCIG) therapy has been shown to be a safe and effective treatment for advanced Parkinson's disease (PD). Limited data are available regarding long-term benefits and complications in Canada. Objective of the study was to review long-term experience and clinical outcomes in PD patients with LCIG therapy over 11 years in a multidisciplinary University clinic setting.

Methods: Chart review was done on PD patients with LCIG from 2011 to 2022. Data collected: dosing, UPDRS-III motor scores, OFF times, hours with dyskinesias, MoCA, complications, discontinuation reasons, and nursing time requirements.

Results: Thirty-three patients received LCIG therapy with a mean follow-up of 3.25±2.09 years. UPDRS-III scores showed reduction of 15% from baseline (mean 35.9) up to 4 years (mean 30.4). Daily OFF time improved from baseline (mean 7.1 ± 3.13 hours) up to 5 years (mean 3.3 ± 2.31 hours; -53.5%; p < 0.048), and dyskinesias remained stable. Nursing time averaged 22 hours per patient per year after PEG-J insertion and titration. Most common complications were PEG-J tube dislodgement and stoma site infection (0-3zero to three events/patient/year). Serious side effects were seen in four (12%) patients resulting in hospitalization and/or death. Nine patients (27.2%) discontinued the treatment due to lack of improved efficacy over oral therapy or development of dementia and 10 (30%) died of causes unrelated to LCIG infusion.

Conclusion: Patients on LCIG showed improved motor function over 5-year follow-up. Serious complications were uncommon. Dedicated nursing time is required by LCIG-trained nurses in a multidisciplinary setting for optimum management.

Levodopa Carbidopa肠道凝胶治疗帕金森病11年:One Center的“真实世界”经验。
背景:左旋卡比多巴肠道凝胶(LCIG)治疗晚期帕金森病(PD)已被证明是一种安全有效的治疗方法。关于加拿大的长期益处和并发症的数据有限。本研究的目的是回顾在多学科大学临床环境中接受LCIG治疗的PD患者11年来的长期经验和临床结果。方法:对2011年至2022年患有LCIG的PD患者进行图表回顾。收集的数据:给药、UPDRS-III运动评分、关闭时间、运动障碍小时数、MoCA、并发症、停药原因和护理时间要求。结果:33例患者接受了LCIG治疗,平均随访3.25±2.09年。UPDRS-III评分显示,从基线(平均35.9)到4年(平均30.4),下降了15%。每日休息时间从基线(均值7.1±3.13小时)到5年(均值3.3±2.31小时;-53.5%;p<0.048)有所改善,运动障碍保持稳定。PEG-J插入和滴定后,每位患者每年的护理时间平均为22小时。最常见的并发症是PEG-J管移位和造口部位感染(0-30至3次事件/患者/年)。四名(12%)患者出现严重副作用,导致住院和/或死亡。9名患者(27.2%)因口服治疗效果不佳或出现痴呆而停止治疗,10名患者(30%)死于与LCIG输注无关的原因。结论:在5年的随访中,LCIG患者的运动功能有所改善。严重并发症并不常见。LCIG培训的护士需要在多学科环境中投入专门的护理时间,以实现最佳管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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