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Levodopa/carbidopa intestinal gel (LCIG) infusion as mono- or combination therapy

  • Neurology and Preclinical Neurological Studies - Original Article
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Abstract

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. At present, there are no guidelines that delineate to which patients LCIG should be offered as monotherapy, in combination with oral and/or transdermal medication, or as additional therapy to deep brain stimulation (DBS). Based on clinical studies, we propose an expert consensus for neurologists addressing the question when LCIG therapy should be recommended and in which cases LCIG infusion is suggested in combination with other antiparkinsonian drugs and/or DBS. We describe how LCIG should be initiated and what we consider necessary for clinical follow-up. We suggest an algorithm facilitating decision-making with respect to the currently available invasive PD therapies, namely infusion with subcutaneous apomorphine, LCIG, and DBS.

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Author contributions

CB, RH, PL, CS, JS, MW and HR were responsible for drafting/revising the manuscript for content, including medical writing for content. Supervision or coordination was by CB and HR.

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Authors and Affiliations

  1. Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Carsten Buhmann

  2. Department of Neurology, Klinikum Vest, Dorstener Strasse 151, 45657, Recklinghausen, Germany

    R. Hilker

  3. Department of Neurology, University Medicine Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany

    P. Lingor

  4. Department of Neurology and Clinical Neurophysiology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany

    C. Schrader

  5. Geriatric Hospital Haag, Krankenhausstrasse 4, 83527, Haag, Germany

    J. Schwarz

  6. Department of Neurology, Elblandklinikum Meissen, Nassauweg 7, 01662, Meissen, Germany

    M. Wolz

  7. Department of Neurology, University Hospital Dresden, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany

    H. Reichmann

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  1. Carsten Buhmann
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  2. R. Hilker
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  3. P. Lingor
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  4. C. Schrader
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  5. J. Schwarz
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  6. M. Wolz
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  7. H. Reichmann
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Correspondence to Carsten Buhmann.

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Conflict of interest

C. Buhmann has been supported by funding from the Georg & Jürgen Rickertsen Stiftung Hamburg and received honoraria as speaker and/or scientific advisory board member from Desitin, GE Healthcare, TEVA, UCB, and Zambon as well as travel funding from Abbvie and Desitin. R. Hilker has received speaker honoraria from Medtronic, Orion, GlaxoSmithKline, TEVA, Cephalon, Solvay, Desitin, Ipsen, Merz, Archimedes Pharma, and Boehringer Ingelheim as well as travel funding from Medtronic, Allergan, and Cephalon. He has served on a scientific advisory board for Cephalon and has received research funding from the Deutsche Parkinson Vereinigung (dPV), Bundesministerium für Bildung und Forschung and Goethe University Frankfurt. P. Lingor was a study investigator, acted on advisory boards, received speaker honoraria and/or travel grants from Abbvie, Licher MT, Medtronic, BayerVital, UCB, and Zambon. H. Reichmann was acting on advisory Boards and gave lectures and received research grants from Abbott, Abbvie, Bayer Health Care, Bial, Boehringer/Ingelheim, Brittania, Cephalon, Desitin, GSK, Lundbeck, Medtronic, Merck-Serono, Novartis, Orion Pharma, Pfizer, TEVA, UCB, Valeant, and Zambon. C. Schrader is consultant to Abbvie and has received honoraria from Abbvie. J. Schwarz has received honoraria from Abbvie, Zambon, UCB, Licher, Desitin, Boston Scientific and Orion. M. Wolz has received honoraria from Abbvie, Zambon, UCB, Licher, Desitin, Boehringer/Ingelheim and Daiichi Sankyo.

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Buhmann, C., Hilker, R., Lingor, P. et al. Levodopa/carbidopa intestinal gel (LCIG) infusion as mono- or combination therapy. J Neural Transm 124, 1005–1013 (2017). https://doi.org/10.1007/s00702-017-1698-7

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