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Levodopa–Carbidopa Intestinal Gel in Patients with Parkinson’s Disease: A Systematic Review

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A Letter to the Editor to this article was published on 19 August 2016

Abstract

Background

Levodopa–carbidopa intestinal gel (LCIG) is available in several countries for the treatment of advanced levodopa-responsive Parkinson’s disease (PD) with severe motor fluctuations and dyskinesia when other treatments have not given satisfactory results.

Objective

Our objective was to summarize the present evidence base for LCIG therapy through a systematic review of the literature.

Methods

Studies were identified from the PubMed and EMBASE databases up to 12 March 2016 using the following search terms: Parkinson disease, duodopa, levodopa/carbidopa intestinal gel, levodopa–carbidopa intestinal gel, LCIG, l-dopa infusion, levodopa infusion, duodenal l-dopa infusion, and duodenal levodopa infusion. Data extraction focused on whether LCIG therapy improves motor and non-motor outcomes as well as quality of life in PD patients compared with conventional therapy, apomorphine infusion, or deep brain stimulation. Randomized controlled trials (RCTs) and observational studies, with or without a control group, that included more than ten patients were included. The search was limited to peer-reviewed articles published in full in the English language and involving humans.

Results

Infusion of LCIG reduced “off” time, increased “on” time without increasing troublesome dyskinesias, and improved quality of life in three RCTs (one double-blind). Open-label follow-ups confirm these findings. The data evaluating long-term efficacy and safety are still limited.

Conclusions

The quality of evidence that LCIG is effective in reducing fluctuating motor symptoms and improving quality of life is moderate. Quality of evidence for reduction of non-motor symptoms is very low. Safety issues mainly relate to the intestinal infusion system. LCIG might be a useful treatment option in PD patients with severe motor fluctuations.

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Authors and Affiliations

  1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden

    Karin Wirdefeldt

  2. Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden

    Karin Wirdefeldt

  3. Department of Neurology, Skåne University Hospital, Lund, Sweden

    Per Odin

  4. Klinikum-Bremerhaven, Bremerhaven, Germany

    Per Odin

  5. Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden

    Dag Nyholm

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  1. Karin Wirdefeldt
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Corresponding author

Correspondence to Dag Nyholm.

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Funding

No funding was received for the preparation of this manuscript.

Conflict of interest

Karin Wirdefeldt has no conflicts of interest. Per Odin has received payment for lectures and expert consultations from AbbVie, Britannia, NordicInfu Care, UCB, and Zambon. Dag Nyholm receives royalties from Liber AB; has served as a consultant to Sensidose AB and OrbiMed Advisors LLC; has received honoraria from H. Lundbeck AB, Movement Disorders Society, NordicInfu Care, and The National Board of Health and Welfare; has received lecture fees from AbbVie and NordicInfu Care; has received research support from AbbVie, Ipsen, Selanders Foundation, Swedish Knowledge Foundation, Swedish Parkinson’s Disease Foundation, Swedish Research Council, and VINNOVA Sweden’s innovation agency; is a co-founder and stock owner in Jemardator AB; receives remuneration from the website netdoktor.se for participation in an expert panel; and has received institutional support from Uppsala University Hospital.

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Wirdefeldt, K., Odin, P. & Nyholm, D. Levodopa–Carbidopa Intestinal Gel in Patients with Parkinson’s Disease: A Systematic Review. CNS Drugs 30, 381–404 (2016). https://doi.org/10.1007/s40263-016-0336-5

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