Carbidopa levodopa enteral suspension

Abstract

Introduction: The search for consistent, effective treatments in Parkinson’s disease (PD) is ongoing. The importance of continuous dopaminergic stimulation (CDS) is understood to underlie best medical therapy for PD by providing closer replication of physiological patterns of dopamine release in healthy brains.

Areas covered: An overview of interventions to improve motor fluctuations in PD is presented. Significant improvements in off-time are achieved by providing continuous therapy using targeted deep brain stimulation (DBS), subcutaneous apomorphine infusion and carbidopa/levodopa enteral suspension (Duopa). Duopa is a newly approved treatment in the US for advanced PD that delivers levodopa pumped to the intestinal tract through a percutaneous gastrostomy with jejunum tube extension (PEG-J tube). Trials with carbidopa/levodopa enteral suspension show improvement in motor fluctuations, reduction in plasma levodopa variation and improvement in overall “on” time compared with oral immediate release formulation of carbidopa/levodopa.

Expert opinion: The degree of improvement in number of off hours per day on carbidopa/levodopa enteral suspension infusion rivals that seen with DBS and apomorphine infusion and makes this new treatment a valuable option in advanced fluctuating PD patients, especially those who are neither candidates for DBS or who do not have access to apomorphine infusion therapy or who have failed either or both therapies.

Keywords:

• carbidopa-levodopa enteral suspension
• continuous dopaminergic stimulation
• decarboxylase inhibitor
• dopamine precursor
• Duodopa
• levodopa-carbidopa intestinal gel
• motor fluctuations
• non-motor symptoms
• Parkinson’s disease
• percutaneous gastrostomy
• pump
• quality of life
• therapy
• treatment

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Corrigendum

Declaration of interest

R A Hauser is a consultant for Auspex Pharmaceuticals, Cowan Therapeutics, Gerson Lehrman Group (GLG), Allergan, AbbVie, Eli Lilly and Company, Impax Laboratories, Lundbeck Pharmaceuticals, Michael J. Fox Foundation, Teva Pharmaceuticals and UCB BioSciences, Inc. He is on the advisory boards for Acorda Therapeutics, Acadia Pharmaceuticals, AstraZeneca, Lundbeck Pharmaceuticals, Neurocrine Biosciences, Pfizer, Inc. and Cynapsus Therapeutics. R Hauser is on the steering committee for Chelsea Therapeutics and on the speaker’s bureau for Biotie Therapies, Novartis, Teva Pharmaceuticals and UCB BioSciences, Inc. The authors have 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.