Neo Shermyn, Wong Sheng Yong Aidan, Ng Hwee Lan, Li Wei, Tay Kay Yaw, Au Wing Lok, Tan Louis Chew Seng
Department of Neurology, National Neuroscience Institute, Singapore.
Department of Research, National Neuroscience Institute, Singapore.
Parkinsons Dis. 2020 Mar 30;2020:6293124. doi: 10.1155/2020/6293124. eCollection 2020.
The aim of this study is to compare Parkinson's disease (PD) treatment practices by movement disorder (MD) specialists across a decade, and to determine the factors that influence drug choice for the motor symptoms of PD in newly diagnosed drug-naïve patients.
This prospective temporal analysis included patients seen at the National Neuroscience Institute in Singapore and diagnosed with PD by MD specialists in the years 2007 and 2017. Primary outcomes were use of specific PD drugs and changes in drug-prescribing patterns. Descriptive analyses and multivariable logistic regression models determined the extent to which patient characteristics were associated with type of PD treatment.
Of 230 patients with PD (mean (SD) age, 66.7 (10.3) years), 131 (57.0%) were male. From 2007 to 2017, the use of ergot dopamine agonists and anticholinergics decreased from 19.3% to 2.0% ( < 0.001) and from 12.0% to 2.7% ( = 0.004), respectively. The use of monoamine oxidase B inhibitors (MAOBI) increased from 13.3% to 25.2% ( = 0.033). The use of levodopa (LD)-sparing strategies decreased nonsignificantly from 33.7% to 24.5% ( = 0.133). Overall, 196 (85.2%) patients were initiated on symptomatic monotherapy, with LD being the most commonly prescribed. MAOBI was the most common drug used in combination therapy. Age ≤70 (adjusted OR, 11.9; 95% CI, 4.5-31.5) and Hoehn and Yahr (HY) stage <2 (adjusted OR, 3.4; 95% CI, 1.5-7.7) were independent factors for LD-sparing strategies. Non-LD prescriptions (13 of 92; 14.1%) were more likely to be discontinued compared to LD ones (6 of 149; 4.0%) ( = 0.005).
Drug-prescribing patterns in PD have changed significantly through the last decade, influenced by emerging evidence and reports of adverse drug effects. Choosing drugs based on the patient's age and disease severity remain sound guiding principles across the years. It is important that international and national guidelines for pharmacotherapy in PD be updated consistently throughout different socioeconomic settings to optimize care.
本研究旨在比较运动障碍（MD）专家在十年间对帕金森病（PD）的治疗方法，并确定影响新诊断的未接受过药物治疗患者PD运动症状药物选择的因素。
这项前瞻性时间分析纳入了在新加坡国立神经科学研究所就诊并于2007年和2017年被MD专家诊断为PD的患者。主要结局是特定PD药物的使用情况和药物处方模式的变化。描述性分析和多变量逻辑回归模型确定了患者特征与PD治疗类型的关联程度。
在230例PD患者中（平均（标准差）年龄为66.7（10.3）岁），131例（57.0%）为男性。从2007年到2017年，麦角多巴胺激动剂和抗胆碱能药物的使用分别从19.3%降至2.0%（<0.001）和从12.0%降至2.7%（=0.004）。单胺氧化酶B抑制剂（MAOBI）的使用从13.3%增至25.2%（=0.033）。左旋多巴（LD）节省策略的使用从33.7%降至24.5%，无显著下降（=0.133）。总体而言，196例（85.2%）患者开始接受症状性单药治疗，LD是最常用的药物。MAOBI是联合治疗中最常用的药物。年龄≤70岁（调整后比值比，11.9；95%置信区间，4.5 - 31.5）和霍恩与雅尔（HY）分期<2期（调整后比值比，3.4；95%置信区间，1.5 - 7.7）是LD节省策略的独立因素。与LD处方（149例中的6例；4.0%）相比，非LD处方（92例中的13例；14.1%）更有可能被停用（=0.005）。
在过去十年中，PD的药物处方模式发生了显著变化，这受到新出现的证据和药物不良反应报告的影响。根据患者年龄和疾病严重程度选择药物多年来仍然是合理的指导原则。重要的是，在不同的社会经济环境中持续更新国际和国家的PD药物治疗指南，以优化治疗。
