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

October 1, 2020

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.

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.

In an interview with Neurologylive, 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.