Evidence map›Paper›PMID 31278691›Full record

ReviewAdvances in therapy2019

Current Practices for Outpatient Initiation of Levodopa-Carbidopa Intestinal Gel for Management of Advanced Parkinson's Disease in the United States.

Fahd Amjad, Danish Bhatti, Thomas L Davis, Odinachi Oguh, Rajesh Pahwa, Pavnit Kukreja, Jorge Zamudio, Leonard Verhagen Metman

Open access · hybridAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Advances in therapy, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 2 pooled it
3.0field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 37 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Article
  5. Article
  6. Levodopa treatment: impacts and mechanisms throughout Parkinson's disease progression.Journal of neural transmission (Vienna, Austria : 1996) · 2025
    Review
  7. Observational
  8. Article
  9. Article
  10. Article
  11. Review
  12. Article
  13. Observational
  14. Review
  15. Review
  16. Review
  17. Review
  18. Article
  19. Article
  20. Medical Management and Prevention of Motor Complications in Parkinson's Disease.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2020
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 7 institutions in 1 country.

Fahd AmjadDepartment of Neurology, Georgetown University Hospital Pasquerilla Healthcare Center, 7th Floor, 3800 Reservoir Road NW, Washington, DC, 20007, USA. Fahdvr@hotmail.com.
Danish BhattiDepartment of Neurological Sciences, University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE, 68198, USA.
Thomas L DavisDepartment of Neurology, Vanderbilt University Medical Center, 1301 Medical Center Drive #3930, Nashville, TN, 37212, USA.
Odinachi OguhDepartment of Neurology, University of Florida College of Medicine-Jacksonville, 9th Floor, Tower I, 580 West 8th Street, Jacksonville, FL, 32209, USA.
Rajesh PahwaDepartment of Neurology, University of Kansas Medical Center, 3599 Rainbow Blvd, Kansas City, KS, 66103, USA.
Pavnit KukrejaAbbVie, Inc, 1 North Waukegan Road, North Chicago, IL, 60064, USA.
Jorge ZamudioAbbVie, Inc, 1 North Waukegan Road, North Chicago, IL, 60064, USA.
Leonard Verhagen MetmanDepartment of Neurological Sciences, Rush University, 1725 W Harrison Street, Suite 755, Chicago, IL, 60612, USA.
AbbVie (United States) · USFlorida College · USGeorgetown University · USRush University · USUniversity of Kansas Medical Center · USUniversity of Nebraska Medical Center · USVanderbilt University Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

In 2015, the US Food and Drug Administration approved levodopa-carbidopa intestinal gel (LCIG; also known as carbidopa-levodopa enteral suspension in the US) for the treatment of motor fluctuations in patients with advanced Parkinson's disease. LCIG provides a continuous infusion of levodopa and carbidopa by means of a portable pump and percutaneous endoscopic gastrojejunostomy tube. The delivery system has a two-fold pharmacokinetic advantage over orally administered carbidopa/levodopa. First, levodopa is delivered in a continuous rather than intermittent, pulsatile fashion. Second, delivery to levodopa's site of absorption in the jejunum bypasses the stomach, thereby avoiding issues with erratic gastric emptying. In blinded prospective clinical trials and observational studies, LCIG has been shown to significantly decrease "off" time, increase "on" time without troublesome dyskinesia, and reduce dyskinesia. Consistent with procedures in previous studies, LCIG initiation and titration in the pivotal US clinical trial were performed in the inpatient setting and followed a standardized protocol. In clinical practice, however, initiation and titration of LCIG have a great degree of flexibility and, in the US, almost always take place in the outpatient setting. Nonetheless, there remains a significant amount of clinician uncertainty regarding titration in outpatient clinical practice. This review aims to shed light on and provide guidance as to the current methods of titration in the outpatient setting, as informed by the medical literature and the authors' experiences.

fundingAbbVie, Inc. Plain language summary available for this article.

Indexed as

AgedAntiparkinson AgentsCarbidopaDrug CombinationsFemaleGelsHumansInfusions, ParenteralLevodopaMaleMiddle AgedObservational Studies as TopicParkinson DiseasePrecision MedicineProspective StudiesUnited StatesAntiparkinson AgentsCarbidopacarbidopa, levodopa drug combinationDrug CombinationsGelsLevodopaCarbidopa/levodopa enteral suspensionContinuous dopaminergic stimulationDevice-aided therapyDuodopaDuopaLCIGNeurology

Identifiers

PMID31278691
PMCPMC6822848
OpenAlexW2955508371

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.