March 2008
Antonini
A, Mancini F, Canesi M, Zangaglia R, Isaias IU, Manfredi L, Pacchetti C,
Zibetti M, Natuzzi F, Lopiano L, Nappi G, Pezzoli G
Objectives: In patients with advanced Parkinson
disease, levodopa/carbidopa formulated as a gel suspension (Duodopa)
permits continuous delivery into the small intestine using a portable
pump, resulting in less variability in levodopa concentrations and fewer
motor fluctuations and dyskinesias than with oral levodopa
administration. This is a retrospective analysis of the long-term
clinical experience with this agent.
Methods: All but 1 of the patients who had received
enteral levodopa infusion treatment between January 1, 1991, and June
30, 2002, consented to a review of their hospital charts.
Results: Of the 65 patients with initial testing of
the treatment, 86% opted for continued treatment via percutaneous
endoscopic gastrostomy or gastrojejunostomy. Total exposure to levodopa
infusion was 216 patient-years (mean, 3.7 years). Maximum treatment
duration was 10.7 years. Fifty-two patients were treated for 1 year or
longer. The adverse effect profile of levodopa/carbidopa infusion was
similar to that observed with oral administration of levodopa. Seven
deaths occurred, all considered unrelated to the treatment. Intestinal
tube problems, including dislocation of the intestinal tube to the
stomach, were the most common technical problem, occurring in 69% of the
patients during the first year. The optimal daily dose of levodopa
decreased by an average of 5% during follow-up.
Conclusions: The safety of enteral infusion of
levodopa/carbidopa formulated as a gel suspension was found acceptable.
For most patients, the technical challenges posed by the enteral
infusion system were offset by the improvement in motor fluctuations and
dyskinesias offered by this technique.
