Motor and nonmotor symptoms in patients treated with 24-hour daily levodopa-carbidopa intestinal gel infusion: Analysis of the COmedication Study assessing Mono- and cOmbination therapy with levodopa-carbidopa inteStinal gel (COSMOS)

Introduction: Patients with advanced Parkinson's disease (APD) commonly experience motor and nonmotor symptoms (NMS) associated with functional limitations and decreased quality of life. We compared motor and nonmotor outcomes in patients with APD receiving 24-versus 16-h levodopa-carbidopa intestinal gel (LCIG).Methods: Data from COSMOS, a large, real-world, retrospective and cross-sectional, observational study on LCIG and comedication in APD were obtained from medical records and a single patient visit for patients receiving 24 -and 16-h LCIG infusion. Changes from baseline were evaluated for motor symptoms, NMS, and clinical char-acteristics. Safety was also assessed.Results: Data for 401 patients were included in this subanalysis. At the patient visit there were 35 patients on 24-h LCIG and 366 on 16-h LCIG. Off time and dyskinesia (duration and severity) were reduced in both groups. In both LCIG treatment groups, prevalence of most symptoms was reduced. There were significant differences in the change from baseline in severity and frequency of freezing of gait with 24-h LCIG versus 16-h LCIG (p = 0.011 and p = 0.038), severity of urinary symptoms (p = 0.006), and frequency of cognitive impairment (p = 0.014) with 24-h LCIG versus 16-h LCIG. Adverse events were similar for both treatment groups and considered tolerable.Conclusions: LCIG 24-h infusion may be a useful treatment option, when clinically justified, for select patients with APD.Clinical trial number: NCT03362879.

Automated summary

This study compared motor and nonmotor outcomes in APD patients receiving 24-hour versus 16-hour LCIG treatment. The results showed reductions in off time, dyskinesia, and prevalence of most symptoms in both treatment groups. Significant differences were found in freezing of gait, urinary symptoms, and cognitive impairment between the two groups.