3 research outputs found
Real-life benefits of intrajejunal levodopa infusion therapy in four patients with the parkinsonian variant of progressive supranuclear palsy:A 1-year follow-up data report
BACKGROUND: Progressive supranuclear palsy (PSP) is a progressive neurodegenerative condition presenting with different clinical endophenotypes. The parkinsonian variant of PSP (PSPâP) is characterised by early but fading responsiveness to highâdose levodopa therapy; however, highâdose oral therapy is often associated with intolerance due to dopaminergic side effects and so doses may have to be capped despite clinical benefits. Evidence from animal models and realâlife registries suggest far higher doses of levodopa can be tolerated if given in a continuous drug delivery (CDD) manner. We investigated tolerance and possible clinical benefits in patients with PSPâP still responsive to levodopa after initiating CDD in the form of intrajejunal levodopa infusion (IJLI) therapy as part of a compassionate usage program (CU). METHODS: This is an observational clinical data report from the IJLI implementation program undertaken in regional tertiary referral Parkinson's centres in India and at King's College Hospital London, Dubai as part of a CU. Four patients with PSPâP receiving IJLI as a part of a CU underwent evaluations of liver and renal function, motor and nonmotor function, quality of life, sleep dysfunction, fatigue, anxiety and depression, and cognitive impairment at baseline and 6 and 12 months postâIJLI initiation. RESULTS: In total, three out of four patients successfully completed 12 months of treatment (6 months in one patient). All four patients showed good tolerability to IJLI even at higher doses (1400 and 1960 mg at 6 and 12 months, respectively) when compared to oral levodopa (812.5 ± 103 levodopa equivalent daily dose [LEDD]) and presented with overall persistent improvements in motor and nonmotor scores and qualityâofâlife scores at 6 and 12 months postâIJLI. All patients showed improvement in estimated glomerular filtration rate (43.50 ml/min/1.73 m(2) to 67.5 ml/min/1.73 m(2) and 79.5 ml/min/1.73 m(2) at 6 and 12 months, respectively). CONCLUSIONS: IJLI led to persistent beneficial effects on motor and some nonmotor aspects in patients with PSPâP at up to 12 months after treatment with associated improvement in overall renal function