Duodopa
Levodopa carbidopa intestinal gel (LCIG) can be delivered directly to the proximal jejunum via a percutaneous endoscopic gastrojejunostomy tube connected to a portable infusion pump (Figure 2). This pump therapy can be used to avoid erratic gastric emptying and to improve intestinal absorption. Several studies have observed that LCIG is an effective treatment for improving motor fluctuations and QoL scores when compared with conventional therapy. In a recent placebo-controlled parallel group study including 71 patients with advanced Parkinson's disease, 66 patients completed the trial. There were 35 patients randomly allocated to treatment with LCIG and oral placebo, and 31 were randomly allocated to treatment with immediate release oral levodopa carbidopa and placebo intestinal gel. At the end of 12 weeks of treatment with LCIG, the infusion showed a significant reduction in OFF time of -4.04 h/day compared with treatment with immediate release oral levodopa carbidopa and placebo intestinal gel (2.14 h/day, P < 0.0015). This improvement was also observed in ON time without troublesome dyskinesia (P < 0.0059), and in ON time without dyskinesia (P < 0.0142). Similar to the other studies, 95% of patients in the LCIG group had an adverse event, and 14% of them serious adverse events (SAE). Interestingly, 100% in the placebo group had adverse events, and 21% had an SAE. Most of the complications of the pump therapy were associated with the percutaneous gastrojejunostomy. Although available in 43 countries, this therapy is not currently available in the United States.
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Figure 2.
Levodopa carbidopa intestinal gel delivered system. Reproduced with permission from [63].