A novel treatment option for intrajejunal levodopa administration

ABSTRACT

Introduction

In Parkinson’s disease, oral medication often fails to achieve sufficient therapeutic success in an advanced stage. At this point, non-oral, device-aided therapies such as the apomorphine pump, the intrajejunal levodopa pump, and deep brain stimulation are discussed.

Areas covered

The purpose of this manuscript is to highlight a modern form of the well-known intestinal levodopa pump that allows for the continuation of the oral triple combination of levodopa, carbidopa and entacapone, a combination already used by many patients. This new form of pump has been available in both Austria and Germany since 2021, with entacapone being added to the combination to ‘save’ levodopa. The pump and cartridge are significantly smaller and lighter than the LCIG pump which should benefit therapeutic adherence.

Expert opinion

Intrajejunal administration of levodopa is a useful treatment option for advanced Parkinson’s disease. The higher acceptance of the smaller pump and the improved user-friendliness have already been reported in an observational study from Sweden. Clinical experience in Germany confirms this too and in addition to motor symptoms, even non-motor ones are influenced positively, and in this respect sleep and pain can be especially emphasized.

KEYWORDS:

• Advanced parkinson’s disease
• device-aided therapies
• levodopa
• LECIG
• intrajejunal pump

Article highlights

• Intrajejunal administration of levodopa is a useful treatment option for advanced Parkinson’s disease.

• The drug Lecigon is a combination of levodopa, entacapone and carbidopa as intestinal gel (LECIG) and was approved in Germany for the ‘treatment of advanced Parkinson’s disease with severe motor fluctuations and hyperkinesia or dyskinesia when available oral combinations of Parkinson’s drugs have not led to satisfactory treatment outcomes’ in December 2020.

• A randomized, open-label, 2-day crossover study showed that with a reduced dose of levodopa comparably effective steady-state plasma levels of levodopa can be achieved

• The majority of patients with previous LCIG therapy see an improvement in terms of user-friendliness and changing the cartridge.

• All patients see a significant improvement in terms of pump size

Declaration of interest

WH Jost is working or has worked as a consultant and speaker for AbbVie, Bial, Desitin, Stadapharm, UCB Pharma and Zambon. He has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose/

Additional information

Funding

This manuscript has not been funded.