Intestinal Gel LECIG in the Treatment of Advanced Parkinson's Disease in Real Practice
A recently published study presents the first experiences with an intestinal gel containing a triple combination of antiparkinsonian drugs and dosed via an infusion pump through percutaneous endoscopic gastrostomy extended into the jejunum in the treatment of advanced Parkinson's disease.
Continuous Administration of Antiparkinsonian Drugs
As Parkinson's disease (PD) progresses, therapy needs to be adjusted to achieve satisfactory symptom control. Significant motor fluctuations, which cannot be managed by an optimized regimen of oral and transdermal pharmacotherapy, are often a major challenge. At this stage, it is advisable to consider continuous dopaminergic stimulation, for example, by continuous administration of antiparkinsonian drugs in the form of an intestinal gel delivered directly into the jejunum by a pump.
Most recently, a triple combination of levodopa, carbidopa, and entacapone (LECIG) can be administered in this way. In comparison to the older LCIG preparation, which contained only the combination of levodopa and carbidopa, both the formulation and the infusion pump have been innovated, making the pump smaller and lighter.
Real-World Practice Results
LECIG was approved in Sweden in 2018 and received health insurance reimbursement in 2019. In 2022, results from the use of this treatment in 24 patients with advanced PD in real-world practice were published.
The group included 11 women and 13 men, with a median age of 71.5 years at the start of LECIG therapy. The median duration of PD from diagnosis was 15.5 years, and the median duration of LECIG treatment was 305 days. Half of the patients were switched from the older LCIG preparation.
Most patients in the study reported an improvement in their ability to perform daily activities and an increase in quality of life after starting LECIG treatment. 70% of patients who were not previously on LCIG (n = 10) described symptom relief. Of the patients switched from LCIG, 45% reported no change, which is consistent with the expected achievement of comparable plasma concentrations of levodopa. The study participants also expressed satisfaction with the ease of use of the system and appreciated its smaller size compared to LCIG.
Further Data Collection from Real Clinical Practice
Currently, 100 patients treated with LECIG in Sweden are being monitored in the PARKreg registry (National Parkinson's Disease Patient Registry). Additionally, the post-registration observational study ELEGANCE (NCT05043103) for patients treated with LECIG in routine clinical practice has been launched. Sixteen European countries are expected to participate, and the study will collect data on the efficacy and safety of the therapy, quality of life of the patients, and the economic aspects of the treatment.
Conclusion
The results of clinical trials and initial practical experiences with the LECIG intestinal gel show similar clinical efficacy to LCIG, achieved with lower doses of levodopa thanks to entacapone. In addition to comparable efficacy, the first data from clinical practice also indicate that patients are satisfied with the product and the smaller infusion pump.
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Source: Nyholm D., Jost W. H. Levodopa-entacapone-carbidopa intestinal gel infusion in advanced Parkinson's disease: real-world experience and practical guidance. Ther Adv Neurol Disord 2022 Jun 26; 15: 17562864221108018, doi: 10.1177/17562864221108018.
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