Navaratnam Prakash, Arcona Steve, Friedman Howard S, Leoni Matthew, Sasane Rahul
DataMed Solutions, LLC, New York, NY, United States.
Cerevel Therapeutics, Cambridge, MA, United States.
Clin Park Relat Disord. 2022 Jan 28;6:100135. doi: 10.1016/j.prdoa.2022.100135. eCollection 2022.
Medication regimens for Parkinson's disease (PD) may change as the disease progresses, symptoms fluctuate, or medication-related adverse events occur. This study evaluated treatment trends by observation year for patients initially receiving monotherapy with levodopa and a peripheral dopa decarboxylase inhibitor (PDDI).
In this retrospective chart review, therapy changes were evaluated for patients across the US diagnosed with PD on or before 6/30/2014 who initially received levodopa-PDDI monotherapy. Index date was the first clinic visit. Post-index was any time between the first 31 days after index and study end (6/30/2019). Index Hoehn-Yahr (H-Y) score and medication changes were also analyzed by index low (<400 mg/day) or high (≥400 mg/day) levodopa doses in the levodopa-PDDI combinations.
In the levodopa-PDDI cohort (n = 95), there were 0.39 dose escalations, 0.16 dose reductions, 0.12 discontinuations, 0.19 therapy switches, and 0.24 add-ons per patient per year during the study. Most dose escalations or add-ons occurred within the first 6 months post-index. Of those who ever stopped levodopa-PDDI (n = 34), 31 (91%) restarted within the study period. Most (83%) patients who restarted levodopa-PDDI did so in the same year as stopping treatment. Index low dose users were associated with lower H-Y scores, were more inclined to escalate their dose, and were less inclined to reduce their dose in the first 2 years of treatment than index high dose users.
Prescribers and patients tend to experiment with levodopa-PDDI treatment. Although many patients appeared to stop levodopa-PDDI after an initial course of treatment, most subsequently restarted treatment.
帕金森病（PD）的药物治疗方案可能会随着疾病进展、症状波动或出现药物相关不良事件而改变。本研究评估了最初接受左旋多巴与外周多巴脱羧酶抑制剂（PDDI）单一疗法的患者按观察年份划分的治疗趋势。
在这项回顾性病历审查中，对2014年6月30日或之前被诊断为PD且最初接受左旋多巴 - PDDI单一疗法的美国患者的治疗变化进行了评估。索引日期为首次临床就诊日期。索引后时间为索引日期后的前31天至研究结束（2019年6月30日）之间的任何时间。还根据左旋多巴 - PDDI组合中索引时低剂量（<400mg/天）或高剂量（≥400mg/天）的左旋多巴剂量分析了索引Hoehn - Yahr（H - Y）评分和药物变化。
在左旋多巴 - PDDI队列（n = 95）中，研究期间每位患者每年有0.39次剂量增加、0.16次剂量减少、0.12次停药、0.19次治疗转换和0.24次加用药物。大多数剂量增加或加用药物发生在索引后前6个月内。在那些曾停用左旋多巴 - PDDI的患者中（n = 34），31例（91%）在研究期间重新开始用药。大多数重新开始使用左旋多巴 - PDDI的患者（83%）在停药同年重新开始治疗。索引时低剂量使用者与较低的H - Y评分相关，在治疗的前2年比索引时高剂量使用者更倾向于增加剂量，而不太倾向于减少剂量。
处方医生和患者倾向于尝试左旋多巴 - PDDI治疗。尽管许多患者在初始治疗疗程后似乎停用了左旋多巴 - PDDI，但大多数随后又重新开始治疗。
