Adverse effects of levodopa/carbidopa intrajejunal gel treatment : a single-center long-term follow-up study

Rus, Tomaž (author), Premzl, Maša (author), Zupančič-Križnar, Nina (author), Gregorič Kramberger, Milica (author), Rajnar, Robert (author), Ocepek, Lidija (author), Pirtošek, Zvezdan (author), Trošt, Maja (author)

Objectives: Levodopa/carbidopa intrajejunal gel (LCIG) is an effective therapeutic strategy to overcome levodopa-induced motor complications in advanced Parkinson's disease (PD). However, it requires invasive percutaneous endoscopic gastrojejunostomy (PEG-J) and may be associated with serious adverse effects (AE). In this study, we aimed to evaluate long-term AEs related to LCIG treatment in a large homogenous cohort of advanced PD patients. Methods: One hundred three consecutive PD patients were regularly monitored for LCIG-related, PEG-J-related, and device-related AEs up to 14 years. Incidence of AEs was studied in time applying a time-to-event analysis and Cox proportional hazard model with age, disease duration, gender, and recurrent AE as covariates. Health-related quality of life (HRQoL) was estimated at each visit and compared to HRQoL before the LCIG treatment. Results: Among 296 AEs noted, 48.8% were LCIG-related, 32.4% PEG-J-related, and 19.6% device-related. While most of the studied AEs steadily accumulated throughout the follow-up period, 24.3% of the patients (95% CI 10.1%–36.3%) experienced PEG-J-related AE already within the first days after the PEG-J insertion. Cox model revealed that older patients had higher probability of psychosis, PEG-J- and device-related AEs (p < .05, p < .05, and p = .02) and suggested increased recurrence risk in those with early PEG-J and device-related AEs. Despite relatively high incidence of AEs, HRQoL significantly increased in the follow-up period (p < .0001). Conclusion: AEs related to LCIG treatment are common. Therefore, careful patient selection and monitoring throughout the treatment is recommended, especially in those with early side effects. Nevertheless, LCIG significantly improves HRQoL in advanced PD patients on a long term.

• Language: English
• Keywords: advanced Parkinson's disease, levodopa-carbidopa intestinal gel, percutaneous endoscopic gastrojejunostomy, adverse effects, health-related quality of life
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2022
• Number of pages: Str. 537-544
• Numbering: Vol. 146, iss. 5
• PID: 20.500.12556/RUL-143424
• UDC: 616.8
• ISSN on article: 0001-6314
• DOI: 10.1111/ane.13675
• COBISS.SI-ID: 117250307
• Publication date in RUL: 20.12.2022

Record is a part of a journal

• Title: Acta neurologica Scandinavica
• Shortened title: Acta neurol. Scand.
• Publisher: Wiley
• ISSN: 0001-6314
• COBISS.SI-ID: 3710474

Licences

• License: CC BY-NC 4.0, Creative Commons Attribution-NonCommercial 4.0 International
• Link: http://creativecommons.org/licenses/by-nc/4.0/
• Description: A creative commons license that bans commercial use, but the users don’t have to license their derivative works on the same terms.

Secondary language

• Language: Slovenian
• Keywords: nevrologija, napredovala Parkinsonova bolezen, levdopa-karbidopa gel, perkutana endoskopska gastrojujenostoma, kvaliteta življenja, stranski učinki