A175 LINACLOTIDE AND PRUCALOPRIDE FOR MANAGEMENT OF CONSTIPATION IN PATIENTS WITH PARKINSONISM.

Abstract

Background: Constipation is a common condition in patients with neurodegenerative parkinsonism, including Parkinson's disease (PD), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP). Chronic constipation negatively impacts quality of life and decrease the absorption of antiparkinsonian drugs. Linaclotide (guanylate cyclase C agonist) and prucalopride (selective 5-HT4 receptor agonist) are emerging effective drugs for the management of chronic idiopathic constipation (CIC). To date, neither of these drugs has been tested in controlled trials in parkinsonism patients and their efficacy is unknown in this population. Aims: We aimed to identify patients who received linaclotide or prucalopride in our clinic database and to review the change in bowel movement frequency and the patient perception of drug effect. Methods: We searched our patient database for patients diagnosed with neurodegenerative parkinsonism and constipation who had received linaclotide or prucalopride. Constipation was defined by Rome III criteria. Demographics, treatment characteristics, BM frequency, side effects were captured from medical records. Objective improvement was defined as post-treatment BM frequency of 3 or more per week. Subjective improvement was assessed by clinical or telephone interview and defined as agreement or strong agreement in a 5-point Likert scale. Continuous variables were expressed as median[range] or mean±SD (Wilcoxon signed-rank or Fisher's exact test). Results: Among the 31 patients identified, 13 patients received linaclotide, 11 received prucalopride, and 7 individuals initially received prucalopride, which was switched to linaclotide. The number of BM per week significantly increased after treatment with either linaclotide (1[1-3] vs. 3.5[2-7]; p<0.05) or prucalopride (1[1-2] vs. 5[1-7]; p<0.05). In patients who did not respond to prucalopride, 71.4% reported improvement after switching to linaclotide. Conclusions: Both drugs improved the BM frequency in our patients with neurodegenerative parkinsonism who had failed initial constipation management. Interestingly, a higher proportion of patients reported subjective satisfaction in controlling their constipation symptoms with the use of linaclotide as compared with prucalopride. Our preliminary results suggested potential benefits of these medications, thus should encourage further well-designed controlled trials to advance the standard of care of constipation in patients with parkinsonism.