Women, Underweight Patients More Likely to Have Dyskinesia on LCIG, Study Finds

Women and underweight individuals with Parkinson’s disease are more likely to experience troublesome episodes of dyskinesia when receiving levodopa/carbidopa intestinal gel, a formulation of levodopa and carbidopa infused into the intestines, a study has found.

According to researchers, this sub-group of patients should be carefully monitored when starting the therapy, and have individual dose adjustments according to their treatment response, whenever needed.

The study, “Levodopa/carbidopa intestinal gel long-term outcome in Parkinson’s disease: focus on dyskinesia,” was published in the journal Movement Disorders.

Levodopa-based therapies currently are the main forms of treatment used to alleviate Parkinson’s motor symptoms. However, when used for long periods of time, these treatments can cause several side effects, including levodopa-induced dyskinesia (LID), a condition in which patients start having involuntary muscle movements.

Levodopa/carbidopa intestinal gel (LCIG), developed by AbbVie and currently available in the U.S. and Europe under the brand name Duodopa, is a long-term therapy for patients at advanced stages of Parkinson’s. In this form of treatment, levodopa and carbidopa are continuously infused into the patients’ upper intestine, via a soft plastic tube surgically inserted through the skin and with the help of a portable pump.

Although LCIG was found to be effective at reducing motor symptom fluctuations caused by the long-term use of levodopa-based therapies, its effects on dyskinesia in patients at advanced stages of Parkinson’s are more variable.

“So far, no study has specifically investigated the pre-treatment prognostic factors for a poor outcome in terms of dyskinesia management under chronic LCIG treatment,” researchers wrote.

To identify which factors could increase the chances patients with Parkinson’s have of developing troublesome dyskinesia while receiving LCIG, a team of Italian researchers reviewed the medical records of 53 patients who had been receiving LCIG for at least six months.

All 53 patients in the study — 20 women and 33 men, with an average age of 55 years at disease onset — were evaluated one week before starting treatment with LCIG and at their last outpatient visit.

Clinical data gathered at both time-points included patients’ body weight, and scores on the Unified Parkinson’s disease rating scale (UPDRS) and the Hoehn and Yahr scale, two measures of disease progression and severity.Patients were considered to have troublesome dyskinesia if they had a score greater than 2 (moderately disabling) on item 33 (“Disability: How disabling are the dyskinesias?”) of the UPDRS.

After being exposed to LCIG for an average of 51.7 months (approximately four years), patients had a marked reduction in the duration of off episodes — periods of time when motor symptoms return because levodopa-based therapies cease to be effective. However the duration and severity of dyskinesia episodes remained unchanged.

Before starting treatment with LCIG, 19 (35%) patients had episodes of troublesome dyskinesia. At the last outpatient visit, seven patients were still having dyskinesia and 10 others started experiencing these episodes while receiving LCIG, yielding a total of 17 (32%) cases of troublesome dyskinesia.

Statistical analyses found that female patients and, to a lesser extent, underweight individuals, were more likely to have episodes of troublesome dyskinesia after receiving LCIG. These episodes of dyskinesia after LCIG also were associated with longer periods of off time following treatment.

“Being female and, to a lesser extent, having a lower BW [body weight] may be associated with a less favorable outcome in terms of LID management under chronic LCIG treatment,” the researchers wrote.

“This sub-group of PD [Parkinson’s disease] patients should be carefully monitored once started on this device-aided therapy. Individualized adjustment of dose parameters, based on dyskinesia response to morning dose/extra bolus may be particularly helpful,” they added.