Wang Libo, Li Jia, Chen Jiajun
Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China.
Front Neurol. 2018 Jul 30;9:620. doi: 10.3389/fneur.2018.00620. eCollection 2018.
Levodopa has been widely used and regarded as the most effective therapy for Parkinson's disease (PD), but long-term treatment with oral levodopa may result in motor fluctuations and involuntary movements (dyskinesias). There is evidence to suggest that Continuous infusion of levodopa-carbidopa intestinal gel (LCIG) can effectively manage motor and non-motor complications in PD, but clinical studies investigating this have yielded inconsistent results. This systematic review and meta-analysis was performed to examine the efficacy and safety of LCIG for patients with PD. A systematic search was conducted to retrieve published data in the EMBASE, PubMed, and the Cochrane Library up to March 2018. Both efficiency and safety of LCIG were analyzed using pooled standardized mean differences (SMDs) or odds ratio (ORs) with 95% confidence interval (CIs). Eight trials with 384 PD patients were included in the present study. Compared with the control group, LCIG significantly decreased off-time (SMD, -1.19; 95% CI, -2.25 to -0.12; = 0.003) and increased on-time without troublesome dyskinesia (SMD, 0.55; 95% CI, 0.20 to 0.90; = 0.002). However, no significant difference of LCIG was found in on-time with troublesome dyskinesia. There were no significant differences in UPDRS, Hoehn & Yahr and PDQ-39 scores. Besides, no significant differences in the drop-out and adverse effects. Continuous delivery of LCIG may offer a promising option for PD patients. More randomized double-blind controlled studies with large sample sizes were needed to further confirm the efficacy and safety of LCIG for PD patients.
左旋多巴已被广泛应用，并被视为治疗帕金森病（PD）最有效的疗法，但口服左旋多巴的长期治疗可能会导致运动波动和不自主运动（异动症）。有证据表明，持续输注左旋多巴-卡比多巴肠凝胶（LCIG）可有效控制PD的运动和非运动并发症，但对此进行的临床研究结果并不一致。进行这项系统评价和荟萃分析以检验LCIG对PD患者的疗效和安全性。进行了系统检索，以获取截至2018年3月在EMBASE、PubMed和Cochrane图书馆发表的数据。使用合并的标准化均数差（SMD）或比值比（OR）及95%置信区间（CI）分析LCIG的有效性和安全性。本研究纳入了8项试验共384例PD患者。与对照组相比，LCIG显著减少了关期（SMD，-1.19；95%CI，-2.25至-0.12；P = 0.003），并增加了无麻烦异动症的开期（SMD，0.55；95%CI，0.20至0.90；P = 0.002）。然而，在有麻烦异动症的开期方面，未发现LCIG有显著差异。在统一帕金森病评定量表（UPDRS）、霍恩和雅尔分级（Hoehn & Yahr）及帕金森病问卷-39项（PDQ-39）评分方面无显著差异。此外，在退出率和不良反应方面也无显著差异。持续输注LCIG可能为PD患者提供一个有前景的选择。需要更多大样本的随机双盲对照研究来进一步证实LCIG对PD患者的疗效和安全性。
