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Levodopa/carbidopa intestinal gel

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https://www.readbyqxmd.com/read/28344656/levodopa-carbidopa-enteral-suspension-in-advanced-parkinson-s-disease-clinical-evidence-and-experience
#1
REVIEW
Johan Virhammar, Dag Nyholm
The duration of action of oral levodopa becomes shorter as Parkinson's disease (PD) progresses. Patients with advanced PD may develop potentially disabling motor fluctuations and abnormal involuntary movement (dyskinesia), which cannot be managed with optimized oral or transdermal PD medications. The progressively worsening symptoms can have a substantial impact on the patient quality of life (QoL). Levodopa-carbidopa intestinal gel (LCIG) is delivered continuously via a percutaneous endoscopic gastrostomy with a jejunal extension (PEG-J)...
March 2017: Therapeutic Advances in Neurological Disorders
https://www.readbyqxmd.com/read/28276779/development-of-new-levodopa-treatment-strategies-in-parkinson-s-disease-from-bedside-to-bench-to-bedside
#2
Sten-Magnus Aquilonius, Dag Nyholm
This review will illustrate the process of moving from an idea through preclinical research and Galenic developments into clinical investigations and finally to approval by regulatory agencies within the European Union. The two new treatment strategies described, levodopa/carbidopa intestinal gel and levodopa/carbidopa microtablets, for advanced Parkinson's disease, have been developed in collaborative research within departments at Uppsala University. With this historical approach, reference priority is given to reports considered to be of special importance for this more than two decades long process 'from bedside to bench to bedside'...
March 3, 2017: Upsala Journal of Medical Sciences
https://www.readbyqxmd.com/read/28238650/which-patients-discontinue-issues-on-levodopa-carbidopa-intestinal-gel-treatment-italian-multicentre-survey-of-905-patients-with-long-term-follow-up
#3
Mariachiara Sensi, Giovanni Cossu, Francesca Mancini, Manuela Pilleri, Maurizio Zibetti, Nicola Modugno, Rocco Quatrale, Filippo Tamma, Angelo Antonini
OBJECTIVES: To report the results of a national survey aimed at quantifying the current level of diffusion of Levodopa/carbidopa intestinal gel (LCIG) in Italy. METHODS: Sixty Parkinson's Disease (PD) specialists in Italy were invited to complete a survey covering issues on clinical and practical aspects of LCIG therapy. RESULTS: Clinical features of 905 patients were collected retrospectively. The majority of centres reported the use of a multidisciplinary team, biochemistry testing, neurophysiological and neuropsychological tests before and after treatment, in addition to caregivers' training and patient's follow as outpatients...
February 21, 2017: Parkinsonism & related Disorders
https://www.readbyqxmd.com/read/28229223/levodopa-carbidopa-intestinal-gel-lcig-infusion-as-mono-or-combination-therapy
#4
Carsten Buhmann, R Hilker, P Lingor, C Schrader, J Schwarz, M Wolz, H Reichmann
Levodopa/carbidopa intestinal gel (LCIG) infusion is an effective escalating therapy in patients with Parkinson disease (PD) suffering from motor fluctuations and dyskinesia. Levodopa/carbidopa given continuously as infusion provides an optimized application of the most effective and best tolerable antiparkinsonian drug. It has been proven to have a superior motor effect compared with oral levodopa and to improve also non-motor symptoms. However, invasiveness, discomfort resulting from carrying an external device, and side effects associated with the way of administration limit its application in PD patients...
February 22, 2017: Journal of Neural Transmission
https://www.readbyqxmd.com/read/28211816/levodopa-carbidopa-intestinal-gel-pharmacokinetics-lower-variability-than-oral-levodopa-carbidopa
#5
Ahmed A Othman, Matthew Rosebraugh, Krai Chatamra, Charles Locke, Sandeep Dutta
In a double-blind, double-dummy, double-titration Phase 3 trial in advanced Parkinson's disease (PD) patients, the efficacy and safety of Levodopa-carbidopa intestinal gel (LCIG) infusion were characterized relative to immediate-release oral levodopa-carbidopa (LC-oral) treatment. We present in this report the comparative pharmacokinetic profiles of LCIG and LC-oral from this pivotal study. The results presented in this report clearly demonstrate that LCIG results in lower variability and fluctuations in levodopa and carbidopa plasma concentrations compared to LC-oral...
February 16, 2017: Journal of Parkinson's Disease
https://www.readbyqxmd.com/read/28195385/practical-approaches-to-commencing-device-assisted-therapies-for-parkinson-s-disease-in-australia
#6
REVIEW
D R Williams, A H Evans, V S C Fung, M Hayes, R Iansek, T Kimber, J D O'Sullivan, C M Sue
BACKGROUND: In Australia 1% of individuals aged over 50 years have Parkinson's disease (PD). AIMS: Guidance for commencing device-assisted therapies (DATs) for PD in Australia was developed based on a review of European recommendations and their relevance to the local clinical setting. METHODS: An online survey and teleconference discussions were held by a group of eight local movement disorder experts to develop consensus. RESULTS: Referral to a movement disorder specialist and consideration of DAT is appropriate when motor fluctuations cause disability or reduced quality of life, response to treatment is inconsistent or motor fluctuations and dyskinesias require frequent treatment adjustment without apparent benefit and levodopa is required four or more times daily...
February 14, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28185758/levodopa-carbidopa-intestinal-gel-can-improve-both-motor-and-non-motor-experiences-of-daily-living-in-parkinson-s-disease-an-open-label-study
#7
Annamária Juhász, Zsuzsanna Aschermann, Péter Ács, József Janszky, Márton Kovács, Attila Makkos, Márk Harmat, Dalma Tényi, Kázmér Karádi, Sámuel Komoly, Annamária Takáts, Adrián Tóth, Helga Nagy, Péter Klivényi, György Dibó, Lívia Dézsi, Dénes Zádori, Ádám Annus, László Vécsei, Lajos Varannai, Norbert Kovács
BACKGROUND: Levodopa/carbidopa intestinal gel therapy (LCIG) can efficiently improve several motor and non-motor symptoms of advanced Parkinson's disease (PD). The recently developed Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale (MDS-UPDRS) improved the original UPDRS making it a more robust tool to evaluate therapeutic changes. However, previous studies have not used the MDS-UPDRS and the Unified Dyskinesia Rating Scale (UDysRS) to assess the efficacy of LCIG...
February 3, 2017: Parkinsonism & related Disorders
https://www.readbyqxmd.com/read/28115853/the-role-and-structure-of-the-multidisciplinary-team-in-the-management-of-advanced-parkinson-s-disease-with-a-focus-on-the-use-of-levodopa-carbidopa-intestinal-gel
#8
REVIEW
Stephen W Pedersen, Martin Suedmeyer, Louis W C Liu, Dirk Domagk, Alison Forbes, Lars Bergmann, Koray Onuk, Ashley Yegin, Teus van Laar
A multidisciplinary team (MDT) approach is increasingly recommended in Parkinson's disease (PD) treatment guidelines, but no standard of care exists for such an approach, and the guidelines do not provide clarification on how it should be implemented. This paper reviews evidence of MDT interventions in people with PD and provides expert clinical perspectives for an MDT approach, with a focus on advanced PD and levodopa-carbidopa intestinal gel (carbidopa-levodopa enteral suspension in the USA). The key recommendations are to enable the best possible treatment of people with PD locally by facilitating a close structured collaboration of different health care professionals working in a fixed network structure; to refer people with PD to established MDT centers in a timely manner; to establish regular meetings for the MDT enabling interdisciplinary exchange and learning; to optimize individual treatment and carefully evaluate available treatment options; to ensure treatment decisions are agreed jointly between people with PD, their caregivers, family, and health care professional; and to include specialists outside of neurology from adjuvant medical departments as necessary when implementing advanced therapies...
2017: Journal of Multidisciplinary Healthcare
https://www.readbyqxmd.com/read/28063683/diphasic-dyskinesias-during-levodopa-carbidopa-intestinal-gel-lcig-infusion-in-parkinson-s-disease
#9
Mario Meloni, Paolo Solla, Marcello Mario Mascia, Francesco Marrosu, Antonino Cannas
OBJECTIVES: Levodopa-carbidopa intestinal gel infusion (LCIG) is indicated in patients with advanced levodopa-responsive Parkinson's disease (PD) for the treatment of motor fluctuations and dyskinesias. Here we describe 4 PD patients who developed disabling diphasic dyskinesias after LCIG initiation. METHODS: The clinical data of 33 PD patients consecutively treated with LCIG therapy were obtained through direct clinical observation and detailed review of medical records...
December 31, 2016: Parkinsonism & related Disorders
https://www.readbyqxmd.com/read/27998652/the-need-for-non-oral-therapy-in-parkinson-s-disease-a-potential-role-for-apomorphine
#10
Teus van Laar, Robbert Borgemeester
In the course of Parkinson's disease (PD), oral medication may lose its effectiveness due to several reasons, like dysphagia, impaired absorption from the gastro-intestinal tract and delayed emptying of the stomach. If these problems occur, a non-oral therapy should be considered. Examples of non-oral therapies are transdermal patches, (e.g. rotigotine) which may overcome motor and nonmotor nighttime problems, and may serve as well to treat daytime response-fluctuations, if oral therapies fail to do so. Other options are injections with apomorphine to treat early morning dystonia and random off-periods during daytime, as well as continuously infused subcutaneous apomorphine for random fluctuations in PD patients...
December 2016: Parkinsonism & related Disorders
https://www.readbyqxmd.com/read/27987231/levodopa-entacapone-carbidopa-intestinal-gel-in-parkinson-s-disease-a-randomized-crossover-study
#11
Marina Senek, Elisabet I Nielsen, Dag Nyholm
BACKGROUND: The addition of oral entacapone to levodopa-carbidopa intestinal gel treatment leads to less conversion of levodopa to 3-O-methyldopa, thereby increasing levodopa plasma concentration. The objective of this study was to compare systemic levodopa exposure of the newly developed levodopa-entacapone-carbidopa intestinal gel after a 20% dose reduction with levodopa exposure after the usual levodopa-carbidopa intestinal gel dose in a randomized crossover trial in advanced Parkinson's disease patients...
February 2017: Movement Disorders: Official Journal of the Movement Disorder Society
https://www.readbyqxmd.com/read/27859651/sustained-striatal-dopamine-levels-following-intestinal-levodopa-infusions-in-parkinson-s-disease-patients
#12
Marios Politis, Anna Sauerbier, Clare Loane, Nicola Pavese, Anne Martin, Benjamin Corcoran, David J Brooks, K Ray-Chaudhuri, Paola Piccini
BACKGROUND: The objective of this study was to investigate in vivo the ability of levodopa/carbidopa intestinal gel infusions to produce sustained striatal dopamine levels and to improve clinical outcomes in Parkinson's disease patients. METHODS: Six advanced Parkinson's disease patients had serial [(11) C]raclopride PET to assess levodopa/carbidopa intestinal gel infusion-induced rises in striatal dopamine as reflected by a fall in dopamine-D2/3 receptor availability...
February 2017: Movement Disorders: Official Journal of the Movement Disorder Society
https://www.readbyqxmd.com/read/27743318/novel-levodopa-formulations-for-parkinson-s-disease
#13
REVIEW
Maria Eliza Freitas, Marta Ruiz-Lopez, Susan H Fox
Levodopa remains the most effective treatment for Parkinson's disease and is considered the gold standard therapy. However, disease progression and changes in the gastrointestinal tract result in a declining window of treatment response in a majority of patients. Efforts have been made recently to improve levodopa bioavailability either by developing more effective oral formulations or by innovating routes of administration (intestinal infusion, transcutaneous or inhaled levodopa). IPX066 is a novel levodopa-carbidopa (LD/CD) oral formulation combining immediate-release (IR) and extended-release (ER) LD/CD recently approved in the USA and the EU...
November 2016: CNS Drugs
https://www.readbyqxmd.com/read/27614656/weight-loss-and-decubitus-duodenal-ulcer-in-parkinson-s-disease-treated-with-levodopa-carbidopa-intestinal-gel-infusion
#14
Tommaso Martino, Donato Melchionda, Paolo Tonti, Vincenzo De Francesco, Alessandra Lalla, Luigi Maria Specchio, Carlo Avolio
Apparently, unexplained weight loss is a common symptom experienced by patients affected by Parkinson's disease, especially in those treated by levodopa-carbidopa infusion gel (LCIG) with a poor control of dyskinesias. Weight loss is considered part of gastrointestinal dysfunction seen in patients affected by Parkinson's disease, along with gastroparesis and reduced bowel peristalsis. In patients treated with LCIG, weight loss needs to be accurately evaluated, because of possible underlying life-threatening adverse events, like duodenum decubitus ulcer...
December 2016: Journal of Neural Transmission
https://www.readbyqxmd.com/read/27575745/corrigendum-to-global-long-term-study-on-motor-and-non-motor-symptoms-and-safety-of-levodopa-carbidopa-intestinal-gel-in-routine-care-of-advanced-parkinson-s-disease-patients-12-month-interim-outcomes-parkinsonism-relat-disord-21-3-2015-231-235
#15
Angelo Antonini, Ashley Yegin, Cornelia Preda, Lars Bergmann, Werner Poewe
No abstract text is available yet for this article.
October 2016: Parkinsonism & related Disorders
https://www.readbyqxmd.com/read/27514937/levodopa-carbidopa-intestinal-gel-therapy-for-advanced-parkinson-disease-an-early-toxic-effect-for-small-nerve-fibers
#16
Grazia Devigili, Sara Rinaldo, Christian Lettieri, Roberto Eleopra
INTRODUCTION: Peripheral neuropathy related to levodopa/carbidopa intestinal gel (LCIG) therapy for advanced Parkinson disease (PD) is under investigation and is debated in the literature. The purpose of the study was to detect whether small nerve fibers are damaged during LCIG infusion. METHODS: Five advanced PD patients were enrolled prior to starting LCIG infusion. Six PD patients on oral levodopa (LD) treatment and 6 PD patients naïve to LD were also enrolled...
August 12, 2016: Muscle & Nerve
https://www.readbyqxmd.com/read/27495198/treating-the-motor-symptoms-of-parkinson-disease
#17
John C Morgan, Susan H Fox
PURPOSE OF REVIEW: After a patient is diagnosed with Parkinson disease (PD), there are many therapeutic options available. This article provides examples of prototypical patients encountered in clinical practice and illustrates the various pharmacologic and nonpharmacologic treatment options for the motor symptoms of PD. RECENT FINDINGS: Levodopa became available in the late 1960s and remains the gold standard for the treatment of PD even today. Since that time, amantadine, monoamine oxidase type B inhibitors, dopamine agonists, and catechol-O-methyltransferase inhibitors have emerged as monotherapy, add-on therapies, or both, in the armamentarium against PD...
August 2016: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/27472888/choosing-an-advanced-therapy-in%C3%A2-parkinson-s-disease-is%C3%A2-it%C3%A2-an%C3%A2-evidence-based-decision-in%C3%A2-current%C3%A2-practice
#18
Frouke A P Nijhuis, Jolien van Heek, Bastiaan R Bloem, Bart Post, Marjan J Faber
BACKGROUND: In advanced Parkinson's disease (PD), neurologists and patients face a complex decision for an advanced therapy. When choosing a treatment, the best available evidence should be combined with the professional's expertise and the patient's preferences. OBJECTIVE: The objective of this study was to explore current decision-making in advanced PD. METHODS: We conducted focus group discussions and individual interviews with patients (N = 20) who had received deep brain stimulation, Levodopa-Carbidopa intestinal gel, or subcutaneous apomorphine infusion, and with their caregivers (N = 16)...
July 25, 2016: Journal of Parkinson's Disease
https://www.readbyqxmd.com/read/27440190/long-term-effectiveness-of-levodopa-carbidopa-intestinal-gel-in-177-spanish-patients-with-advanced-parkinson-s-disease
#19
Francesc Valldeoriola, Francisco Grandas, Diego Santos-García, Ignacio Regidor, María José Catalán, José Matías Arbelo, Víctor Puente, Pablo Mir, Juan Carlos Parra
AIM: To assess long-term effectiveness and tolerability of levodopa-carbidopa intestinal gel (LCIG) in Spanish patients with advanced Parkinson's disease. PATIENTS & METHODS: This was an observational, multicenter, cross-sectional, retrospective study. RESULTS: Data of 177 patients were analyzed. LCIG treatment led to a reduction in the percentage of daily 'off' time (16.2 vs 47.6% before LCIG), an increase in the percentage of daily 'on' time without disabling dyskinesia (55...
August 2016: Neurodegenerative Disease Management
https://www.readbyqxmd.com/read/27421834/motor-outcomes-in-patients-with-advanced-parkinson-s-disease-treated-with-levodopa-carbidopa-intestinal-gel-in-italy-an-interim-analysis-from-the-greenfield-observational-study
#20
Leonardo Lopiano, Nicola Modugno, Pietro Marano, Mariachiara Sensi, Giuseppe Meco, Antonino Cannas, Graziano Gusmaroli, Filippo Tamma, Francesca Mancini, Rocco Quatrale, Anna Maria Costanzo, Giuliana Gualberti, Gabriella Melzi, Umberto di Luzio Paparatti, Angelo Antonini
Several levodopa/carbidopa intestinal gel (LCIG) studies showed a significant reduction of OFF time and a significant increase of ON time, as well as a reduction of dyskinesia, and improvement of non-motor symptoms and quality of life. However, few studies have been conducted in a large population for more than 3 years. Interim outcomes from GREENFIELD observational study on a large Italian cohort of advanced PD patients who started LCIG in routine care between 2007 and 2014, still on treatment at the enrollment, are presented...
November 2016: Neurological Sciences
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