Predictors of Time to Discontinuation of Levodopa-Carbidopa Intestinal Gel Infusion: A Retrospective Cohort Study

Harmen R. Moes*, Jerney W. M. J. Groenendal-Laurensse, Martje Drent, Gerrit Tissingh, Teus van Laar

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: Continuous intra-duodenal infusion of levodopa-carbidopa intestinal gel (LCIG) is a well-established therapy for patients with advanced Parkinson's disease (PD) suffering from motor complications despite optimized treatment with oral dopaminomimetics. However, time to discontinuation of treatment with LCIG varies considerably between patients, ranging from a few months to more than ten years. To improve the selection of candidates for LCIG, knowledge of prognostic factors is of paramount importance.

Objective: To explore baseline predictors of time to discontinuation of LCIG.

Methods: In this two-center retrospective cohort study, we reviewed the medical files of 98 PD patients treated with LCIG between April 2006 and December 2015 (53% male; mean age: 66.2 years; mean disease duration: 12.3 years). Baseline patient characteristics were used as covariates in Cox regression models.

Results: During follow-up (mean observation time: 2.6 years; range: 0.1-9.3) eighteen patients discontinued treatment (18.4%), while seven patients died (7.1%). Median duration of treatment with LCIG, estimated with Kaplan-Meier analysis, was 7.8 years (95% CI: 6.7-9.0). Disease duration (in years) at baseline was a statistically significant predictor of time to discontinuation of LCIG (HR: 0.85; 95% CI: 0.75-0.96, p = 0.006). All other characteristics studied, e.g. age >70 years, did not show statistically significant associations with the total duration of treatment with LCIG.

Conclusion: Our findings show a low overall rate of discontinuation of LCIG infusion, with a median duration of treatment of 7.8 years. Shorter disease duration at baseline appeared to be a predictor of earlier discontinuation of LCIG.

Original languageEnglish
Pages (from-to)935-944
Number of pages10
JournalJournal of Parkinson's Disease
Volume10
Issue number3
DOIs
Publication statusPublished - 28-Jul-2020

Keywords

  • Parkinson disease
  • carbidopa
  • levodopa drug combination
  • duodopa
  • treatment adherence
  • drug-related side effects and adverse reactions
  • survival analysis
  • Kaplan-Meier estimate
  • regression analysis
  • observational study
  • retrospective study
  • ADVANCED PARKINSONS-DISEASE
  • CLINICAL ANTIPSYCHOTIC TRIALS
  • LONG-TERM
  • MOTOR COMPLICATIONS
  • NONMOTOR SYMPTOMS
  • SAFETY
  • ISSUES
  • FLUCTUATIONS
  • DIAGNOSIS
  • 12-MONTH

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