First Experiences with the Combination of Levodopa/Entacapone/Carbidopa in Intestinal Gel from the Perspective of Patients with Parkinson's Disease
The work presented at the 8th Congress of the European Academy of Neurology (EAN) in Vienna in June 2022 summarizes the first experiences with the use of intestinal gel combining the active ingredients levodopa/entacapone/carbidopa in patients with Parkinson’s disease (PD) in clinical practice in Austria.
Introduction
As Parkinson's disease progresses, it is necessary to adjust therapy to alleviate the symptoms of the disease as much as possible. In advanced stages of PD, treatment can be administered via pump systems directly into the small intestine. In Austria, an intestinal gel with a combination of levodopa/entacapone/carbidopa (LECIG) administered via a pump system was approved for this indication in 2021.
Survey
LECIG was used in the monitored cohort of 18 PD patients for 1–10 months. Fourteen patients (9 were using a pump system for the first time, 5 transitioned from another pump system) were cognitively able to participate in the research and answer questions. The questionnaire covered the following areas: patient satisfaction with the pump system and its effect on compensating PD symptoms, satisfaction with care provided by the application specialist and physician, various issues with the pump system, and reasons for starting LECIG. The assessment used a scale from 1 to 5, where 1 = very dissatisfied, 5 = very satisfied.
Results
A total of 14 patients completed the questionnaire (4 on their own, 5 with a caregiver, and 5 by the caregiver), consisting of 7 men and 7 women with an average age of 76.9 years (range 70–84 years). The average duration of the disease was 15.2 years (range 3–25 years), with Hoehn and Yahr stages 3–4.
Overall satisfaction with symptom compensation during LECIG treatment was high – average 4.29. The average rating of therapeutic effect was 4.29, physician rating 4.79, application specialist rating 4.50, flow rate change rating 3.21, regular pump usage 4.29, device wearability 3.14, and in the case of pump weight and size, it was 3.71.
None of the patients discontinued treatment during the observation period, 8 reported issues with the pump system. The main reasons for converting treatment to LECIG were motor fluctuations (7), non-motor fluctuations (2), the burden associated with oral therapy (9), and a smaller pump (4). Patients and caregivers appreciated the possibility of contacting the physician by phone and the written emergency plan along with home or hospital system operation instructions provided by the application specialist.
Conclusion
This real-world experience with the levodopa/entacapone/carbidopa pump system in Parkinson’s disease treatment showed that the treating physician and application specialist significantly influence patient satisfaction. The survey also highlighted suggestions for improving the pump system, particularly its wearability and flow rate changes.
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Source: Tomantschger V., Tautscher-Basnett A., Hohenwarter C. Initial experience with levodopa-entacapone-carbidopa intestinal gel infusion (LECIG) in clinical practice in Austria. Poster A-22-03268. 8th Annual Congress of the European Academy of Neurology, Vienna, 2022 Jun 25–28.
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