Cargando…

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 (PSP‐P) is characterised by early but fading responsiveness to high‐dose levodopa therapy; however, high‐dose oral therapy...

Descripción completa

Detalles Bibliográficos
Autores principales: Metta, Vinod, Chaudhuri, K. Ray, Leta, Valentina, Mridula, Kandadai Rukmini, Koduri, Chaitanya, Deepak, Sai, Kalpala, Rakesh, Reddy, Nageswar, Chung‐Faye, Guy, Borgohain, Rupam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9480946/
https://www.ncbi.nlm.nih.gov/pubmed/35943202
http://dx.doi.org/10.1002/brb3.2547
_version_ 1784791153956093952
author Metta, Vinod
Chaudhuri, K. Ray
Leta, Valentina
Mridula, Kandadai Rukmini
Koduri, Chaitanya
Deepak, Sai
Kalpala, Rakesh
Reddy, Nageswar
Chung‐Faye, Guy
Borgohain, Rupam
author_facet Metta, Vinod
Chaudhuri, K. Ray
Leta, Valentina
Mridula, Kandadai Rukmini
Koduri, Chaitanya
Deepak, Sai
Kalpala, Rakesh
Reddy, Nageswar
Chung‐Faye, Guy
Borgohain, Rupam
author_sort Metta, Vinod
collection PubMed
description BACKGROUND: Progressive supranuclear palsy (PSP) is a progressive neurodegenerative condition presenting with different clinical endophenotypes. The parkinsonian variant of PSP (PSP‐P) is characterised by early but fading responsiveness to high‐dose levodopa therapy; however, high‐dose 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 real‐life 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 PSP‐P 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 PSP‐P 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 post‐IJLI 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 quality‐of‐life scores at 6 and 12 months post‐IJLI. 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 PSP‐P at up to 12 months after treatment with associated improvement in overall renal function.
format Online
Article
Text
id pubmed-9480946
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-94809462022-09-28 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 Metta, Vinod Chaudhuri, K. Ray Leta, Valentina Mridula, Kandadai Rukmini Koduri, Chaitanya Deepak, Sai Kalpala, Rakesh Reddy, Nageswar Chung‐Faye, Guy Borgohain, Rupam Brain Behav Original Articles BACKGROUND: Progressive supranuclear palsy (PSP) is a progressive neurodegenerative condition presenting with different clinical endophenotypes. The parkinsonian variant of PSP (PSP‐P) is characterised by early but fading responsiveness to high‐dose levodopa therapy; however, high‐dose 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 real‐life 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 PSP‐P 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 PSP‐P 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 post‐IJLI 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 quality‐of‐life scores at 6 and 12 months post‐IJLI. 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 PSP‐P at up to 12 months after treatment with associated improvement in overall renal function. John Wiley and Sons Inc. 2022-08-09 /pmc/articles/PMC9480946/ /pubmed/35943202 http://dx.doi.org/10.1002/brb3.2547 Text en © 2022 The Authors. Brain and Behavior published by Wiley Periodicals LLC. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Metta, Vinod
Chaudhuri, K. Ray
Leta, Valentina
Mridula, Kandadai Rukmini
Koduri, Chaitanya
Deepak, Sai
Kalpala, Rakesh
Reddy, Nageswar
Chung‐Faye, Guy
Borgohain, Rupam
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9480946/
https://www.ncbi.nlm.nih.gov/pubmed/35943202
http://dx.doi.org/10.1002/brb3.2547
work_keys_str_mv AT mettavinod reallifebenefitsofintrajejunallevodopainfusiontherapyinfourpatientswiththeparkinsonianvariantofprogressivesupranuclearpalsya1yearfollowupdatareport
AT chaudhurikray reallifebenefitsofintrajejunallevodopainfusiontherapyinfourpatientswiththeparkinsonianvariantofprogressivesupranuclearpalsya1yearfollowupdatareport
AT letavalentina reallifebenefitsofintrajejunallevodopainfusiontherapyinfourpatientswiththeparkinsonianvariantofprogressivesupranuclearpalsya1yearfollowupdatareport
AT mridulakandadairukmini reallifebenefitsofintrajejunallevodopainfusiontherapyinfourpatientswiththeparkinsonianvariantofprogressivesupranuclearpalsya1yearfollowupdatareport
AT kodurichaitanya reallifebenefitsofintrajejunallevodopainfusiontherapyinfourpatientswiththeparkinsonianvariantofprogressivesupranuclearpalsya1yearfollowupdatareport
AT deepaksai reallifebenefitsofintrajejunallevodopainfusiontherapyinfourpatientswiththeparkinsonianvariantofprogressivesupranuclearpalsya1yearfollowupdatareport
AT kalpalarakesh reallifebenefitsofintrajejunallevodopainfusiontherapyinfourpatientswiththeparkinsonianvariantofprogressivesupranuclearpalsya1yearfollowupdatareport
AT reddynageswar reallifebenefitsofintrajejunallevodopainfusiontherapyinfourpatientswiththeparkinsonianvariantofprogressivesupranuclearpalsya1yearfollowupdatareport
AT chungfayeguy reallifebenefitsofintrajejunallevodopainfusiontherapyinfourpatientswiththeparkinsonianvariantofprogressivesupranuclearpalsya1yearfollowupdatareport
AT borgohainrupam reallifebenefitsofintrajejunallevodopainfusiontherapyinfourpatientswiththeparkinsonianvariantofprogressivesupranuclearpalsya1yearfollowupdatareport