Multicenter Retrospective Study of LCIG Therapy in Japan: Efficacy, Factors Associated with Discontinuation, and...

Introduction Levodopa-carbidopa intestinal gel (LCIG) reduces the "off" time and improves the quality of life in people with Parkinson's disease (PwPD). However, real-world data from Asian populations, particularly Japan, are limited. Methods We retrospectively collected clinical data from PwPD who received LCIG across nine institutions in Kyushu, Japan. Patients who were assessed for key clinical parameters, including MDS-UPDRS Part III scores, Hoehn and Yahr (HY) stage, the daily "off" time, dyskinesia, and hallucinations, before LCIG initiation and at the latest available follow-up assessment at each participating institution were included in the study. The motor outcomes, daily "off" time, and neuropsychiatric complications were evaluated at baseline and at the latest available follow-up assessment. Statistical analyses were performed using the appropriate parametric and nonparametric tests. Results Thirty-seven PwPD were included based on the study criteria. LCIG therapy significantly reduced the MDS-UPDRS Part III scores (p=0.003) and HY stage during "off" states (p<0.001), as well as daily "off" time (p<0.001). No significant changes were observed during the "on" state. Compared with patients who continued LCIG, those who discontinued had significantly higher HY stages in the "on" state both before and after LCIG, and hallucinations were also significantly more frequent after LCIG initiation. Although no statistically significant differences were detected, PwPD who experienced tube-related complications were characterized by higher ages at disease onset and LCIG initiation and a greater HY stage during the "on" state following LCIG initiation. Conclusion This study provides region-specific real-world insights into LCIG therapy. Together with lessons from five instructive cases, these findings may help optimize LCIG management in clinical settings.