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The combination of levodopa and carbidopa is the mainstream treatment for Parkinson's disease (PD)
.
Generally speaking, catechol-O-methyltransferase (COM-T) inhibitors, monoamine oxidase-B (MAO-B) inhibitors and dopamine agonists are used together with levodopa to reduce exercise fluctuations
Even with the best oral treatment, the management of dyskinesias is often challenging
Against the background of severe neurodegeneration, unstable absorption, unpredictable changes in gastric emptying and short levodopa half-life, multiple oral doses of levodopa can lead to instability of plasma levodopa levels.
Therefore, the basal The level of dopamine in the ganglia is also unstable
.
.
Therefore, the dyskinesia of PD may come from drug treatment, especially levodopa treatment
.
Treatment options for movement disorders include oral amantadine, continuous subcutaneous apomorphine infusion, and deep brain stimulation (DBS)
Levodopa-Carbidopa Intestinal Gel (LCIG) is continuously delivered to the upper intestine through percutaneous endoscopic gastrostomy and J tube extension (PEG-J) using an external pump
.
Compared with standard oral levodopa therapy, LCIG provides more stable plasma levels of levodopa, thereby reducing the possibility of motor complications and dyskinesias
However, these studies use the patient’s PD diary and/or the exercise part (Part 4) of the Unified Rating Scale for Parkinson’s Disease (UPDRS) to assess dyskinesias, the sensitivity of these two methods to changes and the ability to quantify dyskinesia symptoms All are very limited
.
Unified Dyskinesia Rating Scale (UDysRS) was developed to assess the patient "on" dyskinesias and "off" muscle tension historic disability barriers, an objective evaluation of the severity and distribution of motion disorders, movement disorders and provide some measure Metric attributes of each aspect
.
There are currently no randomized clinical trials to compare the effectiveness of LCIG for dyskinesias with optimized treatment (OMT) using UdysRS
tension
In this way, Eric Freire-Alvarez of the University General Hospital of Elche, Spain, and others conducted a 12-week randomized study in patients with advanced Parkinson’s disease to evaluate LCIG and OMT in dyskinesias through UdysRS and Parkinson’s disease diary.
Effectiveness in terms of symptoms
.
In addition, they also compared the differences between LCIG and OMT in exercise fluctuations, health-related outcomes, safety and tolerability
.
.
In this phase 3b, open-label, multicenter, 12-week intervention study (NCT02799381), 63 patients with advanced PD who did not receive LCIG treatment (UDysRS≥30) were randomly assigned to LCIG (N = 30) or OMT ( N = 33) Treatment
.
The effect of dyskinesia was assessed using UdysRS from baseline to week 12
After 12 weeks, compared with the OMT group (n = 26; -2.
33 ± 2.
56), the LCIG group (n = 24; -17.
37 ± 2.
79) had significantly less dyskinesia measured by UdysRS (-15.
05 ± 3.
20; 95% CI,- 21.
47 to -8.
63; P <0.
0001)
.
In the 12th week, compared with OMT, LCIG had no troublesome dyskinesias in the "remaining" time (P = 0.
0001), QoL (P <0.
0001), global change impression (P <0.
0001), activities of daily living (P = 0.
0006) and the third part of the Unified Parkinson’s Disease Score (UPDRS) (P = 0.
0762)
.
Twenty-seven (44.
3%) patients reported adverse events during treatment (LCIG, 18[64.
3%]; OMT, 9[27.
3%])
.
Serious adverse events occurred in 2 patients (7.
Compared with OMT, LCIG significantly reduces the occurrence of dyskinesias
.
LCIG has shown efficacy in the treatment of troublesome dyskinesias in patients with advanced PD, and has shown benefits in both motor and non-motor symptoms and QoL
.
Compared with OMT, LCIG significantly reduces the occurrence of dyskinesias
.
Original source:
Freire-Alvarez E, Kurča E, Lopez Manzanares L, et al.
Levodopa-Carbidopa Intestinal Gel Reduces Dyskinesia in Parkinson's Disease in a Randomized Trial.
Mov Disord.
Published online July 8, 2021:mds.
28703.
doi:10.
1002 /mds.
28703
Levodopa‐Carbidopa Intestinal Gel Reduces Dyskinesia in Parkinson's Disease in a Randomized Trial.
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