Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.
Parkinsonism Relat Disord. 2021 Feb;83:132-139. doi: 10.1016/j.parkreldis.2020.10.042. Epub 2020 Nov 2.
In advanced Parkinson's disease (PD), therapeutic interventions include device-aided therapies such as continuous subcutaneous apomorphine infusion (CSAI), levodopa-carbidopa intestinal gel (LCIG) infusion, and deep brain stimulation (DBS). We reappraised the evidence guiding the decision of appropriate device-aided therapies in advanced PD, and systematically reviewed the literature (including ongoing clinical trials) comparing CSAI, LCIG, DBS in terms of efficacy and cost-effectiveness, with particular consideration to possible conflicts of interests. Of 14,980 documents screened, sixteen were included (4 and 13 studies examining efficacy and cost-effectiveness, respectively). LCIG and DBS showed higher efficacy compared to best medical therapy (BMT). DBS was more expensive than BMT and LCIG. Lifetime costs of CSAI were lower of those of DBS, and DBS lifetime costs were lower than those of LCIG. The majority of studies (11 out of 16) showed direct or indirect sponsorship from pharmaceutical or device companies. Only one ongoing clinical trial comparing LCIG with DBS was found. Device-aided therapies address unmet needs in advanced PD. LCIG and DBS are superior to BMT in head-to-head studies; however, initial and lifetime costs should be considered when choosing those therapies. Guidelines to assist clinicians and patients to choose device-aided therapies, free from conflict of interests, are required.
在晚期帕金森病（PD）中，治疗干预包括器械辅助治疗，如持续皮下阿朴吗啡输注（CSAI）、左旋多巴-卡比多巴肠凝胶（LCIG）输注和深部脑刺激（DBS）。我们重新评估了指导晚期 PD 中适当器械辅助治疗决策的证据，并系统地回顾了文献（包括正在进行的临床试验），比较了 CSAI、LCIG 和 DBS 在疗效和成本效益方面的情况，特别考虑了可能存在的利益冲突。在筛选出的 14980 份文件中，有 16 份被纳入（4 项和 13 项研究分别考察了疗效和成本效益）。LCIG 和 DBS 与最佳药物治疗（BMT）相比显示出更高的疗效。DBS 比 BMT 和 LCIG 更昂贵。CSAI 的终身成本低于 DBS，而 DBS 的终身成本低于 LCIG。大多数研究（16 项中的 11 项）显示出来自制药或器械公司的直接或间接赞助。仅发现一项正在进行的比较 LCIG 和 DBS 的临床试验。器械辅助治疗满足了晚期 PD 的未满足需求。LCIG 和 DBS 在头对头研究中优于 BMT；然而，在选择这些治疗方法时，应考虑初始和终身成本。需要制定指导方针，以协助临床医生和患者选择不受利益冲突影响的器械辅助治疗。
