Levodopa-carbidopa intestinal gel (LCIG) treatment in routine care of patients with advanced Parkinson's disease: An open-label prospective observational study of effectiveness, tolerability and healthcare costs.
Continuous infusion of levodopa-carbidopa intestinal gel (LCIG) can effectively manage motor and non-motor complications in advanced Parkinson's disease (PD). Healthcare costs, quality of life (QoL), effectiveness, and tolerability were assessed in routine care treatment with LCIG.



The seventy-seven patients enrolled in this prospective, open-label, 3-year study in routine medical care were LCIG-naïve (N = 37), or had previous LCIG treatment for <2 (N = 22), or ≥2 (N = 18) years. Healthcare costs were collected monthly. PD symptoms and QoL were assessed with the Unified Parkinson's Disease Rating Scale (UPDRS), 39-item Parkinson's Disease Questionnaire (PDQ-39), and EuroQoL 5-Dimension Visual Analog Scale (EQ-5D VAS); LCIG dose, safety, and tolerability were monitored.



Mean monthly costs per patient (€8226 ± 5952) were similar across cohorts, remained steady during 3-year follow-up, and increased with PD severity and QoL impairment. In LCIG-naïve patients, significant improvements compared to baseline were observed on the UPDRS total score and PDQ-39 summary index score through 18 months (n = 24; UPDRS, p = 0.033; PDQ-39, p = 0.049). Symptom control was maintained during 3-year follow-up in LCIG-experienced cohorts. Small changes in mean daily LCIG dose were observed. Adverse events were common and generally related to the device, procedure, levodopa, or laboratory evaluations.



Costs in LCIG-treated patients were stable over 3 years. LCIG treatment led to significant improvements in motor function and QoL over 18 months in LCIG-naïve patients and no worsening was observed in LCIG-experienced patients over 3 years despite natural PD progression over time. The long-term safety was consistent with the established LCIG profile.
Department of Neurology, Karolinska University Hospital, Stockholm, Sweden. Electronic address: sven.palhagen@karolinska.se.
Sven E
SE
Pålhagen
Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
Olof
O
Sydow
Department of Neuroscience, Neurology, Uppsala University, Sweden.
Anders
A
Johansson
Department of Neuroscience, Neurology, Uppsala University, Sweden.
Dag
D
Nyholm
Department of Clinical Neuroscience, Sahlgrenska University Hospital, Gothenburg, Sweden.
Bjorn
B
Holmberg
Department of Neurology, Skane University Hospital, Lund, Sweden.
Hakan
H
Widner
Department of Neurology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Nil
N
Dizdar
Department of Neurology, Neurocentre Norrlands University Hospital, Umeå, Sweden.
Jan
J
Linder
Department of Neurology, Molde Hospital HNR, Molde, Norway.
Tove
T
Hauge
Department of Geriatric Medicine and Rehabilitation, Sundsvall Hospital, Sundsvall, Sweden.
Rasmus
R
Jansson
AbbVie Inc., USA.
Lars
L
Bergmann
AbbVie AB, Sweden.
Susanna
S
Kjellander
AbbVie Inc., USA.
Thomas S
TS
Marshall
D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D002230:Carbidopa / Q000627:therapeutic use*; D015331:Cohort Studies; D004338:Drug Combinations; D005260:Female; D005782:Gels / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D007422:Intestines / Q000502:physiology*; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D064232:Visual Analog Scale
D000978:Antiparkinson Agents; D004338:Drug Combinations; D005782:Gels; C009265:carbidopa, levodopa drug combination; D007980:Levodopa; D002230:Carbidopa
Cost; Infusion; LCIG; Levodopa; Parkinson’s disease