Beyond 10 years of levodopa intestinal infusion experience: Analysis of mortality and its predictors. (July 2020)

• Record Type: Journal Article
• Authors: Artusi, Carlo Alberto; Balestrino, Roberta; Imbalzano, Gabriele; Bortolani, Sara; Montanaro, Elisa; Tuttobene, Sara; Fabbri, Margherita; Zibetti, Maurizio; Lopiano, Leonardo
• Is Part Of: Parkinsonism & related disorders. Volume 76(2020)
• Page Start: 98
• Page End: 103
• Publication Date: 2020-07
• Subjects: Parkinson's disease -- Mortality -- Adverse events -- Advanced therapy -- Levodopa/carbidopa intestinal infusion; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2019.10.004
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Introduction: Although levodopa/carbidopa intestinal infusion (LCIG) proved a sustained efficacy on Parkinson's disease (PD) motor fluctuations, there is a lack of studies on mortality of LCIG patients. In this study, we aimed at analyzing mortality and its predictors in a cohort of 105 PD patients treated with LCIG for over 10 years. Methods: The death rate, death causes, mortality predictors, and serious adverse events (SAEs) were analyzed. A Cox regression model was used to estimate the influence of several demographic and clinical factors on mortality, and a binary logistic regression to evaluate the association between SAEs number and mortality. Kaplan-Meier and Log-rank test was used for a survival comparison between patients with an early drop-out (within 3 years since LCIG start) and patients continuing LCIG. Results: Ninety-eight advanced PD patients treated with LCIG were included. During follow-up, 34.7% of patients died at a mean age of 74.7 years, with a mean survival time of 4.6 years since LCIG start and 18 years since PD onset. The only predictor of mortality identified was the Mini Mental State Examination score at LCIG start (p:0.034). A total of 222 SAEs occurred in 87.9% of LCIG patients. The number of SAEs did not correlate with the mortality of LCIG patients (p:0.370). No survival difference exists between early drop-out patients and those continuing LCIG (p:0.341). Conclusion: Our findings do not indicate an association between SAEs or LCIG treatment duration and mortality and highlight the importance of cognitive alterations as a mortality predictor of LCIG patients. Highlights: During a mean follow-up of 5.3 years, 34.7% of PD patients treated with LCIG died. Mean PD duration at death was 18 years and age at death 74.7 years. Mini Mental State Examination score predicts mortality in LCIG patients. During 455 patient-years, 222 serious adverse events occurred in 87.9% of patients. We found no survival difference between early drop-out and patients continuing LCIG.