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Levodopa and Carbidopa intestinal gel treatment: Italian multicentre survey of 905 patients with long-term follow-up

The results of a national survey aimed at quantifying the current level of diffusion of Levodopa and Carbidopa intestinal gel ( LCIG ) in Italy, were reported.

Sixty Parkinson's disease specialists in Italy were invited to complete a survey covering issues on clinical and practical aspects of LCIG therapy.

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.

Most centres ( 60% ) used internal guidelines for patient selection.

The overall rate of adverse events was 55.1%. Weight loss, chronic polyneuropathy and stoma infection were the most frequently reported.

40% of centres used replacement therapy with Vitamin B12 and Folic acid from the start of LCIG and continued this for the duration of treatment.

The rate of discontinuation was of 25.7% overall, with 9.5% of cases occurring in the first year.
The main causes of withdrawal were device-related complications, disease progression ( comorbidity, severe dementia ) and caregiver and/or patient dissatisfaction.

In conclusion, in Italy LCIG infusion is managed in a uniform manner at a clinical, practical and organizational level even though the selection criteria are not standardized through the country.
The high percentage of patients remaining on treatment in the short- and long-term follow-up confirms effectiveness of treatment, careful follow-up, and appropriate patient and caregivers training. ( Xagena )

Sensi M et al, Parkinsonism Relat Disord 2017; 38:90-92