Abstract

Background:

Continuous intra-duodenal infusion of levodopa-carbidopa intestinal gel (LCIG) is a well-established therapy for patients with advanced Parkinson’s disease (PD) suffering from motor complications despite optimized treatment with oral dopaminomimetics. However, time to discontinuation of treatment with LCIG varies considerably between patients, ranging from a few months to more than ten years. To improve the selection of candidates for LCIG, knowledge of prognostic factors is of paramount importance.

Objective:

To explore baseline predictors of time to discontinuation of LCIG.

Methods:

In this two-center retrospective cohort study, we reviewed the medical files of 98 PD patients treated with LCIG between April 2006 and December 2015 (53% male; mean age: 66.2 years; mean disease duration: 12.3 years). Baseline patient characteristics were used as covariates in Cox regression models.

Results:

During follow-up (mean observation time: 2.6 years; range: 0.1–9.3) eighteen patients discontinued treatment (18.4%), while seven patients died (7.1%). Median duration of treatment with LCIG, estimated with Kaplan-Meier analysis, was 7.8 years (95% CI: 6.7–9.0). Disease duration (in years) at baseline was a statistically significant predictor of time to discontinuation of LCIG (HR: 0.85; 95% CI: 0.75–0.96, p = 0.006). All other characteristics studied, e.g. age >70 years, did not show statistically significant associations with the total duration of treatment with LCIG.

Conclusion:

Our findings show a low overall rate of discontinuation of LCIG infusion, with a median duration of treatment of 7.8 years. Shorter disease duration at baseline appeared to be a predictor of earlier discontinuation of LCIG.

中文翻译：

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停止左旋多巴-卡比多巴肠凝胶输注时间的预测因素：一项回顾性队列研究。

摘要

背景：

左旋多巴-卡比多巴肠凝胶 (LCIG) 的十二指肠内连续输注是一种行之有效的治疗方法，用于治疗患有运动并发症的晚期帕金森病 (PD) 患者，尽管口服多巴胺模拟物进行了优化治疗。然而，停止 LCIG 治疗的时间因患者而异，从几个月到超过十年不等。为了改善 LCIG 候选人的选择，预后因素的知识至关重要。

目标：

探索终止 LCIG 时间的基线预测因素。

方法：

在这项两中心回顾性队列研究中，我们回顾了 2006 年 4 月至 2015 年 12 月期间接受 LCIG 治疗的 98 名 PD 患者的医疗档案（男性占 53%；平均年龄：66.2 岁；平均病程：12.3 年）。基线患者特征用作 Cox 回归模型中的协变量。

结果：

随访期间（平均观察时间：2.6 年；范围：0.1-9.3）18 名患者停止治疗（18.4%），7 名患者死亡（7.1%）。用 Kaplan-Meier 分析估计的 LCIG 治疗的中位持续时间为 7.8 年（95% CI：6.7-9.0）。基线时的疾病持续时间（年）是 LCIG 停用时间的统计学显着预测因子（HR：0.85；95% CI：0.75–0.96，p  = 0.006）。所研究的所有其他特征，例如年龄 >70 岁，与 LCIG 治疗的总持续时间没有统计学上的显着关联。

结论：

我们的研究结果显示 LCIG 输注的总体中断率较低，中位治疗持续时间为 7.8 年。基线时较短的病程似乎是 LCIG 较早停药的预测因素。