A szelektív monoaminoxidáz-B-gátlók helye a Parkinson-kór kezelési stratégiájában a marosvásárhelyi ideggyógyászati klinikák gyakorlatában = The role of selective monoamine oxidase B inhibitors in the therapeutic strategy of Parkinson’s disease in the neurology clinics of Tirgu Mures County Emergency Clinical Hospital

Absztrakt: Bevezetés: A Parkinson-kór kezelési stratégiájában a szelektív monoaminoxidáz-B-gátlóknak a betegség minden stádiumában jól meghatározott helyük van. Enyhe esetekben, főleg fiatal betegeknél, a szubsztitúciós terápia késleltetésének egyik hatékony eszközeként számolhatunk velük; előrehaladott Parkinson-kórban, a motoros komplikációk ellátásában, a levodopaterápia kiegészítői. Célkitűzés: Annak felmérése, hogy a marosvásárhelyi ideggyógyászati klinikákon alkalmazott terápiás stratégiákban mekkora szerep jut a szelektív monoaminoxidáz-B-gátlóknak. Módszer: Retrospektív tanulmányunkban 2003. január 1. és 2016. december 31. között a klinikákon vizsgált összes Parkinson-kóros beteg adatait elemeztük. A 2194 beteg zárójelentésében rögzített terápiás ajánlások alapján tanulmányoztuk a monoaminoxidáz-B-gátlók alkalmazásának sajátosságait. A Parkinson-kór megállapítása óta eltelt idő szerint öt éve, illetve több mint öt éve tartó betegségcsoportokat alkottunk. Eredmények: A vizsgált időszakban az öt éve vagy ennél rövidebb ideje diagnosztizált csoportban 1183 betegből 243 esetben szerepelt a kezelési stratégiában monoaminoxidáz-B-gátló: 12 esetben monoterápia, 52 esetben dopaminagonistával, illetve 61 esetben levodopával kombinálva. A többi 118 betegnél levodopa és dopaminagonista kombinációjához társítva kerültek alkalmazásra a monoaminoxidáz-B-gátlók. A több mint öt éve ismert 582 esetből 195-nél egészítették ki a terápiás stratégiát monoaminoxidáz-B-gátlóval (10 esetben szelegilin, 185 esetben rasagilin). Nem volt felhasználható adat a betegség kezdetét illetően 429 esetben (ezek közül öt esetben szelegilint, illetve 93 esetben rasagilint alkalmaztak). Következtetés: A vizsgált periódusban a monoaminoxidáz-B-gátlók alkalmazásának aránya hasonló az irodalomban talált adatokhoz. A betegséggel foglalkozó szakorvosoknak nagyobb bátorsággal kellene alkalmazniuk a rendelkezésre álló és az ajánlásokban szereplő készítményeket, jobban kihasználni a különböző gyógyszertársítások előnyeit, különösen, ha ez nem terheli anyagilag a beteget. Orv Hetil. 2017; 158(51): 2023–2028. | Abstract: Introduction: Selective monoamine oxidase B inhibitors have an accurate place in therapeutical strategy of Parkinsons’s disease. In the early stages of the disease, especially in younger patients with milder symptoms, the introduction of levodopa substitution could be efficacious in delaying; in advanced stages they are mainly used to treat motor complications, as an adjunct to levodopa. Aim: The evaluation of therapeutical strategies used in the neurology clinics of Tirgu Mures County Emergency Clinical Hospital in order to define the role of monoamine oxidase B inhibitors. Method: This retrospective study includes all records of patients with Parkinson’s disease hospitalized between 1 January 2003 and 31 December 2016. From the 2194 reports we used data focusing on the therapeutic recommendations. Regarding disease duration, we divided the patients in two groups: less than or equal to 5 years and more than 5 years. Results: From the 1183 patients in first group, 243 received monoamine oxidase inhibitors: 12 as monotherapy, 52 together with dopamine agonists, in 61 cases combined with levodopa. In 118 cases monoamine oxidase inhibitors were combined with levodopa and dopamine agonists. From 582 cases whith Parkinson’s disease for more than 5 years, 195 received monoamine oxidase B inhibitors (selegiline: 10 cases, rasagiline: 185 cases). In 429 cases we did not find accurate data regarding disease duration (selegiline: 5 cases, rasagiline: 93 cases). Conclusion: The use of monoamine oxidase B inhibitors was similar to those found in literature. The treating physicians should utilise more confidently the available therapeutical combinations. Orv Hetil. 2017; 158(51): 2023–2028

Advanced Parkinson’s Disease Treatment Simplification and Long-Term Outcomes with Levodopa Carbidopa Intestinal Gel: COSMOS Romanian Subanalysis

The aim of the COmedication Study assessing Mono- and cOmbination therapy with levodopa-carbidopa inteStinal gel (COSMOS) was to assess the use of levodopa/carbidopa intestinal gel (LCIG) as monotherapy in patients with advanced Parkinson’s disease (APD) in routine clinical practice. COSMOS was an international observational study with one cross-sectional visit and retrospective data collection. In Romania, 95 adult patients with APD on LCIG treatment for at least 12 months were enrolled and stratified according to their LCIG therapy after 12 months: monotherapy (without any add-on PD medication), monotherapy with night PD medication and LCIG + add-on medication. Compared to the moment of LCIG initiation, the percentage of patients on monotherapy increased at three months after LCIG initiation and remained constant up to 12 months, when 30.5% of the patients were on LCIG monotherapy and 11.6% were on monotherapy with night medication. “Off” time and “On” time with dyskinesia decreased from LCIG initiation to patient visit in all groups. LCIG monotherapy with or without night medication may provide a simplified treatment option for selected APD patients, with long-term efficacy similar to that of LCIG plus add-on medication

Management Challenges of Severe, Complex Dyskinesia. Data from a Large Cohort of Patients Treated with Levodopa-Carbidopa Intestinal Gel for Advanced Parkinson’s Disease

Background: In the advanced stages of Parkinson’s disease (APD), complex forms of dyskinesia may severely impair the patient’s quality of life. Objective: In the present study, we aimed to analyze the evolution under LCIG therapy of the most important motor fluctuations and complex disabling dyskinesias, including diphasic dyskinesia. Methods: In this retrospective study, we analyzed the characteristics of patients with APD who had at least 30 min of diphasic dyskinesia (DID) in 3 consecutive days, were considered responders and were treated with LCIG in our clinic. Patients were evaluated before and after PEG and at 6, 12 and 18 months, when the changes in the therapy were recorded, and they completed a 7-point Global Patient Impression of Improvement (PGI-I) scale. Results: Forty patients fulfilled the inclusion criteria—out of which, 34 performed all visits. There was a substantial difference between the calculated and real LCIG (1232 ± 337 mg vs. 1823 ± 728 mg). The motor fluctuations and most dyskinesias improved significantly after starting LCIG, but an increasing number of patients needed longer daily administrations of LCIG (24 instead of 16 h). Conclusions: Patients with APD with complex dyskinesias must be tested in dedicated hospitals, and they need a special therapeutic approach. The properly adapted LCIG treatment regarding the dose and time of administration completed with well-selected add-on medication should offer improvement for patients who want to or can only choose this DAT vs. others

Starting with 24-h levodopa carbidopa intestinal gel at initiation in a large cohort of advanced Parkinson’s disease patients

Abstract Continuous intra-jejunal infusion of levodopa-carbidopa intestinal gel (LCIG) is a long-term proven and effective treatment in advanced Parkinson’s Disease (APD). Efficacy and safety of 16-h administration of LCIG has already been established. Additional benefits of 24-h LCIG administration have been reported in several case series and small clinical studies. The aim of this retrospective study was to compare the characteristics of patients who needed 24-h LCIG from the beginning of the DAT (device-aided treatment) with those who remained with the standard 16-h LCIG treatment and to identify particular motives if any. We initiated LCIG in 150 patients out of which in case of 62 patients (41,3%) due to unsatisfactory initial clinical benefits continuous 24-h LCIG was deemed necessary. Despite the subjective complaints and more severe clinical condition, at baseline evaluation we found statistically significant differences between 16-h LCIG cohort and 24-h LCIG cohort only in case of incidence of freezing (47% vs 65%, p = 0.03) and sudden off (32% vs 48%, p = 0.04). Wake hours/daytime LCIG does not always sufficiently improve the patient's quality of life in some patients due to persistent nighttime troublesome symptoms. Instead of labeling the patient as a non-responder, it is worth trying the 24-h LCIG dosage in a carefully selected group of patients, as there is currently no consensus on reliable criteria that serve the decision in these patients