Rajesh Pahwa, MD

The challenges and problems patients with Parkinson disease face in later stages, we cannot help with levodopa.

Parkinson disease (PD) is characterized by a multitude of individualized issues including cognitive impairments, motor fluctuations, increased number of comorbidities, and more. Carbidopa-levodopa remains 1 of the few FDA-approved treatments to help with patients’ OFF time but does not fully mitigate a lot of the remaining issues.

As PD continues to progress into its later stages, the problems patients face can sometimes be untreatable, especially with levodopa-carbidopa. Rajesh Pahwa, MD, noted his belief that the patient community is unaware of these limitations of the treatment. Pahwa, who is director of the Parkinson’s Foundation Center for Excellence at the University of Kansas Medical Center, sees the potential of levodopa-carbidopa intestinal gel as an option that will be not only be incorporated more commonly in future trials, but across clinical care as a whole.

 to detail the limitations of the available options in treating patients with PD and the future outlook for those who are more willing to undergo treatment with carbidopa-levodopa intestinal gel.

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The director of the Parkinson’s Foundation Center for Excellence at the University of Kansas Medical Center provided insight on the lapses in levodopa-carbidopa treatment and what potential changes could come in the future.

Rajesh Pahwa, MD: Understanding Levodopa-Carbidopa Treatment Impact

On the other side, people are fine undergoing deep brain stimulation, where they’re doing brain surgery. That part I’ve never quite figured out. A person is more willing to do brain surgery than abdominal surgery?

Post-hoc analysis from a randomized, controlled study demonstrated that patients with Parkinson disease (PD) treated with levodopa-carbidopa intestinal gel (LCIG) experienced a 

faster time to ON without troublesome dyskinesia

 (ON-woTD) compared to levodopa-carbidopa oral capsules (LCIR). Additionally, there were some hour-by-hour benefits shown, with 65.5% of LGIC patients achieving ON-woTD 1.5 hours after turning the pump on compared to 61.7% of LCIR patients after 2.5 hours.

Despite all the results of the study highlighting the benefit of LGIC, Rajesh Pahwa, MD, still feels as though it is underused in clinical care. Pahwa, the Laverne and Joyce Rider Professor of Neurology; chief of the Parkinson’s and Movement Disorder Division; and director of the Parkinson's Foundation Center for Excellence at University of Kansas Medical Center, cited a lack of awareness, incorrect public perception, and insurance technicalities all as factors contributing to the underutilization.

, Pahwa further detailed the reasons for the lack of LCIG utilization and why the myths associated with its use play a big part in patients potentially opting against the treatment.

The director of the Parkinson’s Foundation Center for Excellence at the University of Kansas Medical Center shared the reasons why LCIG is underused in clinical care.

Rajesh Pahwa, MD: Underutilization of Levodopa-Carbidopa Intestinal Gel

"If a medicine is not going into your blood or your brain, but rather is just sitting in your stomach, then it is as good as you not taking it.”

, September 12–16, 2020, by Rajesh Pahwa, MD, revealed that patients with Parkinson disease (PD) who were treated with levodopa-carbidopa intestinal gel (LCIG) experienced a faster time to ON without troublesome dyskinesia (ON-woTD) compared with immediate-release levodopa-carbidopa oral capsules (LCIR). Within 30 minutes of waking up, 11.3% of patients on LCIG had ON-woTD compared to 20% of those on LCIR.

Pahwa, the Laverne and Joyce Rider Professor of Neurology; chief of the Parkinson’s and Movement Disorder Division; and director of the Parkinson's Foundation Center for Excellence at University of Kansas Medical Center, feels as though the advantages clear enough to where LCIG should be more normalized into clinical care. The major difference between the 2 options is that LCIG is administered through a port, whereas LCIR is taken orally.

, Pahwa explained the concepts behind how LCIG is administered, and why its mechanism of action allows for faster ON-woTD in patients with PD.

The director of the Parkinson’s Foundation Center for Excellence at University of Kansas Medical Center detailed the pros and cons of levodopa-carbidopa intestinal gel. 

Rajesh Pahwa, MD

Articles

Rajesh Pahwa, MD: Understanding Levodopa-Carbidopa Treatment Impact

Rajesh Pahwa, MD: Underutilization of Levodopa-Carbidopa Intestinal Gel

Rajesh Pahwa, MD: Advantages of Levodopa-Carbidopa Intestinal Gel