Objectives
To perform a systematic review of the beneficial and harmful effects of LCIG for continuous intestinal infusion administered as per Health Canada–approved dose for the treatment of advanced levodopa-responsive PD in patients who do not have satisfactory control of severe, debilitating motor fluctuations and hyper-/dyskinesia despite optimized treatment with available combinations of PD medicinal products, and for whom the benefits of this treatment may outweigh the risks associated with the insertion and long-term use of the PEG-J tube required for administration.
Methods
All manufacturer-provided trials considered pivotal by Health Canada were included in the systematic review, as well as those meeting the selection criteria presented in .
Inclusion Criteria for the Systematic Review.
Any studies included in the previous CDR review (2009) were not included in the body of new evidence summarized in the current review.
The literature search was performed by an information specialist using a peer-reviewed search strategy.
Published literature was identified by searching the following bibliographic databases: MEDLINE (1946–) with in-process records and daily updates via Ovid; Embase (1974–) via Ovid; and PubMed. The search strategy consisted of both controlled vocabulary, such as the National Library of Medicine’s MeSH (Medical Subject Headings), and keywords. The main search concepts were Duodopa (carbidopa and levodopa).
No filters were applied to limit the retrieval by study type. Where possible, retrieval was limited to the human population. Retrieval was not limited by publication year or by language. Conference abstracts were excluded from the search results. See Appendix 2 for the detailed search strategies.
The initial search was completed on February 12, 2018. Regular alerts were established to update the search until the CDEC meeting on July 12, 2018. Regular search updates were performed on databases that do not provide alert services.
Grey literature (literature that is not commercially published) was identified by searching relevant websites from the following sections of the CADTH Grey Matters checklist (https://www.cadth.ca/grey-matters): Health Technology Assessment Agencies, Health Economics, Clinical Practice Guidelines, Drug and Device Regulatory Approvals, Advisories and Warnings, Drug Class Reviews, Databases (free). Google and other Internet search engines were used to search for additional Web-based materials. These searches were supplemented by reviewing the bibliographies of key papers and through contacts with appropriate experts. In addition, the manufacturer of the drug was contacted for information regarding unpublished studies.
Two CDR clinical reviewers independently selected studies for inclusion in the review based on titles and abstracts, according to the predetermined protocol. Full-text articles of all citations considered potentially relevant by at least one reviewer were acquired. Reviewers independently made the final selection of studies to be included in the review, and differences were resolved through discussion. Included studies are presented in Table 5; excluded studies (with reasons) are presented in Appendix 3.
