Levodopa/carbidopa intestinal gel infusion long-term therapy in advanced Parkinson's disease

Background: Infusion of levodopa/carbidopa intestinal gel (Duodopa (R); Abbott) was introduced in Sweden in 1991 as an experimental treatment in advanced Parkinsons disease and obtained EU approval in 2004. There is compelling evidence for short-term use of this treatment; however, long-term data are scarce. Methods: A retrospective review of medical records was performed. The primary objective was to assess the duration of treatment for all Swedish patients starting long-term levodopa/carbidopa gel therapy between January 1991 and June 2008. Secondary aims were to study demographics, treatment with anti-Parkinsons disease drugs and other concomitant medications, and reasons for discontinuation of levodopa/carbidopa gel. Results: Of 150 identified patients, 135 were included in the study. On average, patients were 49 years at diagnosis of Parkinsons disease and 63 years when infusion therapy was initiated. The median treatment time on infusion was 3.4 years (range, 016 years). The restricted mean treatment time was nearly 8 years; 81 patients were still on treatment at the end of the study. Levodopa was used as monotherapy in a majority of patients. Dosage of the drug was stable over time. Thirty-one patients discontinued infusion prior to the cutoff date and 23 patients died. Device-related problems were the most common reason for discontinuation. Patients were more likely to discontinue infusion therapy before 2000. The year of infusion initiation was significantly earlier in the dropout group compared with a matched group of continuing patients. Conclusions: Levodopa/carbidopa intestinal gel infusion is a long-term treatment alternative in patients with advanced Parkinsons disease.