Clinical Outcomes and Predictors of Response to Levodopa-Entacapone-Carbidopa Intestinal Gel in Advanced Parkinson's Disease: A Retrospective Cohort Study over a 4-Year Period.

Background/

Objectives

Advanced Parkinson's disease is characterized by severe motor fluctuations and disabling dyskinesias that often become refractory to conventional oral dopaminergic therapies.

Methods

This study aimed to evaluate the clinical efficacy of levodopa-entacapone-carbidopa intestinal gel (LECIG) in 50 patients initiated during a four-year period at a tertiary movement disorders center. Motor outcomes were analyzed using Wilcoxon signed-rank and McNemar's tests, while multivariable logistic regression was employed to identify predictors of improvement.

Results

LECIG initiation significantly reduced mean daily OFF time from 4.63 ± 0.75 to 1.62 ± 1.97 h (p < 0.0001) and total dyskinesia duration by 65% (p < 0.0001). Furthermore, the prevalence of early morning akinesia decreased from 80% to 26%, and delayed ON phenomena were completely eliminated (p < 0.0001). Subgroup analyses indicated that patients with troublesome dyskinesia (≥1 h/day) achieved significantly greater reductions in involuntary movements compared to those with lower baseline dyskinesia levels (p = 0.013).

Conclusions

These findings suggest that LECIG provides a meaningful and sustained stabilization of motor complications, highlighting its role as a valuable device-aided therapy in managing advanced Parkinson's disease.