Guo Yi-Jen, Liao Yi-Chu, Lin Ching-Heng, Chang Ming-Hong
Section of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
Section of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
PLoS One. 2014 Sep 15;9(9):e107465. doi: 10.1371/journal.pone.0107465. eCollection 2014.
Several treatment guidelines for Parkinson's disease (PD) had been proposed in recent decades. The aim of current study was to investigate the initial medication utilized in newly diagnosed PD subjects in Taiwan during an eleven-year period.
A total of 7,550 patients with newly diagnosed Parkinsonism were retrospectively enrolled from the National Health Insurance Research Database of Taiwan from 2000 to 2010. After excluding patients at risk of secondary or atypical Parkinsonism, those never receiving medication or having incomplete data, 1,645 subjects were included. The participants were then divided into four treating regimen groups, namely levodopa (LD) only group, dopamine agonist (DA) only group, LD+DA group, and No-LD, No-DA group. The demographic data and medication retention rate were compared across the four treatment groups.
LD only and No-LD, No-DA regimens were the main initial choice of PD treatment in Taiwan. LD containing drugs were more often prescribed to the elderly population than the other two treatment regimens, while No-LD, No-DA medication was the major initial choice for younger patients. DA only regimen occupied only 3-4% of the initial PD prescriptions and was given predominantly by neurologists. Over the eleven-year period, there is a trend for the middle-aged population to receive medication containing LD as initial treatment. The one year retention rate of anti-Parkinsonism medication was around 30-50% in our population. Age, polypharmacy, change of one-year daily levodopa equivalent dosage and newly onset of dementia, stroke and psychiatric diseases all affect drug compliance in PD patients.
This is the first long-term study to explore initial pharmacotherapies in an Asian PD population. We hope to provide evidence for adjusting government policies and public education of physicians and PD patients in the future.
近几十年来，已经提出了几种帕金森病（PD）的治疗指南。本研究的目的是调查台湾地区11年间新诊断帕金森病患者的初始用药情况。
从2000年至2010年台湾地区国民健康保险研究数据库中回顾性纳入了7550例新诊断为帕金森综合征的患者。在排除有继发性或非典型帕金森综合征风险的患者、从未接受过药物治疗或数据不完整的患者后，纳入了1645例受试者。然后将参与者分为四个治疗方案组，即仅左旋多巴（LD）组、仅多巴胺激动剂（DA）组、LD+DA组和无LD、无DA组。比较了四个治疗组的人口统计学数据和药物保留率。
仅LD和无LD、无DA方案是台湾地区PD治疗的主要初始选择。与其他两种治疗方案相比，含LD的药物更常用于老年人群，而无LD、无DA药物治疗是年轻患者的主要初始选择。仅DA方案仅占初始PD处方的3-4%，主要由神经科医生开具。在这11年期间，中年人群有接受含LD药物作为初始治疗的趋势。在我们的研究人群中，抗帕金森病药物的一年保留率约为30-50%。年龄、多种药物治疗、一年每日左旋多巴等效剂量的变化以及痴呆、中风和精神疾病的新发均影响PD患者的药物依从性。
这是第一项探索亚洲PD人群初始药物治疗的长期研究。我们希望为未来调整政府政策以及对医生和PD患者进行公众教育提供依据。
