Intestinal Gel Infusion Therapy in Advanced Parkinson’s Disease: Practical Insights and Real-World Experience

As Parkinson’s disease (PD) progresses to advanced stages, treatment optimization becomes imperative for managing refractory motor fluctuations and non-motor symptoms. Conventional oral and transdermal therapies demonstrate limited efficacy in >70% of patients after 5-7 years of treatment. Device-aided therapies (DATs) providing continuous dopaminergic stimulation represent an established approach, reducing OFF-time by 4-6 hours/day in clinical trials. The novel levodopa-entacapone-carbidopa intestinal gel (LECIG) formulation, approved in 202X, uniquely combines continuous duodenal levodopa delivery with peripheral COMT inhibition, enhancing bioavailability while reducing dose requirements.

This article has two primary aims: firstly to review LECIG’s pharmacokinetic profile and synthesize clinical evidence from real-world experience, including patient-reported outcomes from early adopters (e.g., Swedish cohorts); and secondly to offer practical guidance for clinicians initiating LECIG, covering transitions from oral therapies or other DATs (e.g., LCIG), stepwise dosing titration, and adverse event management. Notably, LECIG demonstrates motor improvements comparable to standard levodopa–carbidopa intestinal gel (LCIG) but achieves therapeutic plasma concentrations at lower doses due to entacapone’s enhancement of levodopa bioavailability. These features position LECIG as a valuable option for personalized advanced PD care.