BACKGROUND: Levodopa-carbidopa intestinal gel (LCIG) treatment has shown variable effect on dyskinesia in Parkinson's disease (PD). OBJECTIVE: To identify PD patients who are likely to have troublesome dyskinesia under LCIG treatment and describe the pharmacokinetic-dynamic profile and dyskinesia phenomenology of those patients. METHODS: PD patients were assessed for clinical and therapeutic variables, before LCIG treatment (T0) and at last outpatient visit (T1). Sub-groups of patients with and without "troublesome dyskinesia" (UPDRS IV, item 33 ≥2), matched for disease and LCIG treatment duration, underwent a pharmacokinetic-dynamic assessment. RESULTS: We included 53 PD patients. After a mean of 51.7 ± 34.1 months of LCIG treatment, "off-time" was significantly reduced, whereas, dyskinesia duration/disability did not change. The multivariate regression model, adjusted for LCIG treatment duration, showed that being female increases the risk of presenting troublesome dyskinesia at T1 (odds ratio [OR] = 9.2; 95% confidence interval [CI] = 2.4-37.4) that was also significantly associated to longer off periods at T1 (OR= 4.4; 95% CI = 1.1-14.3). Female patients showed a higher risk for a higher dyskinesia score at T1 (sum of the items 32 and 33: P = 0.001). Patients with troublesome dyskinesia showed a tendency for a lower motor benefit and the appearance of more severe dyskinesia despite similar levodopa plasma concentration. CONCLUSION: Dyskinesia should be carefully monitored in patients undergoing LCIG, with particular caution for female patients. Whether combined clinical and pharmacodynamic assessments could be helpful to manage patients with troublesome dyskinesia under LCIG treatment needs further evaluation in a larger group of patients.
BACKGROUND: Levodopa-carbidopa intestinal gel (LCIG) treatment has shown variable effect on dyskinesia in Parkinson's disease (PD). OBJECTIVE: To identify PD patients who are likely to have troublesome dyskinesia under LCIG treatment and describe the pharmacokinetic-dynamic profile and dyskinesia phenomenology of those patients. METHODS: PD patients were assessed for clinical and therapeutic variables, before LCIG treatment (T0) and at last outpatient visit (T1). Sub-groups of patients with and without "troublesome dyskinesia" (UPDRS IV, item 33 ≥2), matched for disease and LCIG treatment duration, underwent a pharmacokinetic-dynamic assessment. RESULTS: We included 53 PD patients. After a mean of 51.7 ± 34.1 months of LCIG treatment, "off-time" was significantly reduced, whereas, dyskinesia duration/disability did not change. The multivariate regression model, adjusted for LCIG treatment duration, showed that being female increases the risk of presenting troublesome dyskinesia at T1 (odds ratio [OR] = 9.2; 95% confidence interval [CI] = 2.4-37.4) that was also significantly associated to longer off periods at T1 (OR= 4.4; 95% CI = 1.1-14.3). Female patients showed a higher risk for a higher dyskinesia score at T1 (sum of the items 32 and 33: P = 0.001). Patients with troublesome dyskinesia showed a tendency for a lower motor benefit and the appearance of more severe dyskinesia despite similar levodopa plasma concentration. CONCLUSION: Dyskinesia should be carefully monitored in patients undergoing LCIG, with particular caution for female patients. Whether combined clinical and pharmacodynamic assessments could be helpful to manage patients with troublesome dyskinesia under LCIG treatment needs further evaluation in a larger group of patients.
Authors: Ronald B Postuma; Daniela Berg; Matthew Stern; Werner Poewe; C Warren Olanow; Wolfgang Oertel; José Obeso; Kenneth Marek; Irene Litvan; Anthony E Lang; Glenda Halliday; Christopher G Goetz; Thomas Gasser; Bruno Dubois; Piu Chan; Bastiaan R Bloem; Charles H Adler; Günther Deuschl Journal: Mov Disord Date: 2015-10 Impact factor: 10.338
Authors: Hubert H Fernandez; James T Boyd; Victor S C Fung; Mark F Lew; Ramon L Rodriguez; John T Slevin; David G Standaert; Cindy Zadikoff; Arvydas D Vanagunas; Krai Chatamra; Susan Eaton; Maurizio F Facheris; Coleen Hall; Weining Z Robieson; Janet Benesh; Alberto J Espay Journal: Mov Disord Date: 2018-03-23 Impact factor: 10.338
Authors: Alberto J Espay; Francesca Morgante; Aristide Merola; Alfonso Fasano; Luca Marsili; Susan H Fox; Erwan Bezard; Barbara Picconi; Paolo Calabresi; Anthony E Lang Journal: Ann Neurol Date: 2018-11-30 Impact factor: 10.422
Authors: Wolfgang Oertel; Karla Eggert; Rajesh Pahwa; Caroline M Tanner; Robert A Hauser; Claudia Trenkwalder; Reinhard Ehret; Jean Philippe Azulay; Stuart Isaacson; Larissa Felt; Mary Jean Stempien Journal: Mov Disord Date: 2017-08-21 Impact factor: 10.338
Authors: Angelo Antonini; Victor S C Fung; James T Boyd; John T Slevin; Coleen Hall; Krai Chatamra; Susan Eaton; Janet A Benesh Journal: Mov Disord Date: 2016-01-28 Impact factor: 10.338