Klocke Philipp, Loeffler Moritz A, Cebi Idil, Grund Karl-Ernst, Daniels Christine, Volkmann Jens, Koschel Jiri, Jost Wolfgang H, Logmin Kazimierz, Wojtecki Lars, Werner Christoph R, Weiss Daniel
Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
Centre for General Surgery, Department for Surgical Endoscopy, University Medical Centre Tübingen, Tübingen, Germany.
Mov Disord Clin Pract. 2025 May;12(5):614-625. doi: 10.1002/mdc3.14352. Epub 2025 Feb 4.
Real-world clinical evidence is missing to understand the resorption characteristics of levodopa through duodenal and jejunal parts of the small intestine.
To characterize how different application sites of intestinal levodopa gel would impact on levodopa dosing and clinical outcomes.
This multicentre retrospective analysis investigated Parkinson's disease patients (n = 111) and their change in levodopa equivalent dosage when switching from oral treatment to intestinal continuous infusion therapy while stratifying for differences in percutaneous gastrojejunostomy (PEG-J) tube localizations. We analyzed data from patients treated with both levodopa-carbidopa (LCIG) and levodopa-carbidopa-entacapone (LECIG) intestinal gel.
In dichotomic analysis, duodenal and jejunal tube positions showed similar levodopa equivalent dosages changes from baseline (P = 0.143). This was similar when subdividing patients for LCIG and LECIG treatment. In duodenal PEG-J positions, 44.4% of patients showed persistent motor fluctuations compared to 21.9% in jejunal placements (P = 0.026). In duodenal positions, fluctuations most often persisted when the PEG-J tube was placed proximally into the duodenum. In jejunal localizations, several patients displayed a satisfactory outcome from the primary intervention but experienced dislocation of the PEG-J tube to a duodenal position. This was associated with re-emergence of motor fluctuations in a majority of them.
Our real-world data suggest that LCIG and LECIG are absorbed similarly in both duodenal and jejunal portions of the small intestine. However, clinical data suggest, that jejunal positioning is critical to the stabilization of dopaminergic motor fluctuations.
缺乏真实世界的临床证据来了解左旋多巴在小肠十二指肠和空肠部分的吸收特性。
描述肠道左旋多巴凝胶不同的应用部位如何影响左旋多巴的剂量和临床结局。
这项多中心回顾性分析调查了帕金森病患者（n = 111），以及他们从口服治疗转换为肠道持续输注治疗时左旋多巴等效剂量的变化，同时对经皮胃空肠造口术（PEG-J）管定位的差异进行分层。我们分析了接受左旋多巴-卡比多巴（LCIG）和左旋多巴-卡比多巴-恩他卡朋（LECIG）肠道凝胶治疗的患者的数据。
在二分法分析中，十二指肠和空肠管位置的左旋多巴等效剂量与基线相比变化相似（P = 0.143）。将患者分为LCIG和LECIG治疗时情况类似。在十二指肠PEG-J位置，44.4%的患者出现持续性运动波动，而空肠位置为21.9%（P = 0.026）。在十二指肠位置，当PEG-J管近端置于十二指肠时，波动最常持续存在。在空肠定位中，一些患者在初次干预后有满意的结果，但PEG-J管移位至十二指肠位置。这与他们中的大多数人运动波动再次出现有关。
我们的真实世界数据表明，LCIG和LECIG在小肠的十二指肠和空肠部分吸收相似。然而，临床数据表明，空肠定位对多巴胺能运动波动的稳定至关重要。
