Soileau Michael J, Pagan Fernando, Fasano Alfonso, Rodriguez-Cruz Ramon, Wang Lin, Kandukuri Prasanna L, Yan Connie H, Alobaidi Ali, Bao Yanjun, Kukreja Pavnit, Oh Mok, Siddiqui Mustafa S
Texas Movement Disorder Specialists, 204 S. Interstate 35, Suite 103, Georgetown, TX, 78628, USA.
Department of Neurology, Georgetown University Hospital, Washington DC, USA.
Neurol Ther. 2022 Jun;11(2):851-861. doi: 10.1007/s40120-022-00351-x. Epub 2022 Apr 20.
In advanced Parkinson's disease (PD), a high pill burden is associated with poor compliance, reduced control of symptoms, and decreased quality of life. We assessed the impact of carbidopa-levodopa enteral suspension (CLES) and deep brain stimulation (DBS) on PD-related pill burden.
A retrospective cohort analysis was conducted in the IBM MarketScan and Medicare Supplemental databases. Patients with advanced PD, taking only PD medications, and initiating CLES or DBS between 9 January 2015 and 31 July 2019 were identified. CLES patients were matched to DBS patients in a 1:3 ratio based on a propensity score to balance patient characteristics. Pill burden was measured as a 30-day average number of PD-related pills per day and was captured monthly. Pill-free status was evaluated as the percentage of patients receiving CLES or DBS monotherapy. Descriptive statistics were used to compare pill counts and assess the proportion of patients on monotherapy at 6 and 12 months after initiating CLES or DBS.
The cohorts included 34 CLES patients matched to 97 DBS patients. A significant reduction in PD-related pill burden was observed at 6 months after initiation of CLES or DBS (∆CLES: -5.62, p < 0.0001; ∆DBS: -1.48, p = 0.0022). PD-related pill burden reduction in CLES patients was significantly greater than in matched DBS patients at 6 months (∆: -4.14, p < 0.0001), which was sustained at 12 months after initiation. At 12 months, nearly three times more CLES patients were pill free than DBS patients (29.41% and 10.31%, respectively, p = 0.0123).
Device-aided therapies such as CLES and DBS are effective in significantly reducing PD-related pill burden. Patients treated with CLES were more likely to achieve pill-free status than patients receiving DBS.
在晚期帕金森病（PD）中，高药片负担与依从性差、症状控制不佳及生活质量下降相关。我们评估了卡比多巴-左旋多巴肠内悬浮液（CLES）和脑深部电刺激（DBS）对帕金森病相关药片负担的影响。
在IBM MarketScan和医疗保险补充数据库中进行了一项回顾性队列分析。确定了2015年1月9日至2019年7月31日期间仅服用帕金森病药物并开始使用CLES或DBS的晚期帕金森病患者。根据倾向得分以1:3的比例将CLES患者与DBS患者进行匹配，以平衡患者特征。药片负担以每天帕金森病相关药片的30天平均数来衡量，并每月记录。无药状态评估为接受CLES或DBS单一疗法的患者百分比。使用描述性统计来比较药片数量，并评估开始使用CLES或DBS后6个月和12个月时单一疗法患者的比例。
队列包括34名CLES患者和97名匹配的DBS患者。在开始使用CLES或DBS后6个月，观察到帕金森病相关药片负担显著降低（CLES组变化量：-5.62，p < 0.0001；DBS组变化量：-1.48，p = 0.0022）。CLES患者在6个月时帕金森病相关药片负担的降低显著大于匹配的DBS患者（差值：-4.14，p < 0.0001），在开始治疗12个月时仍持续。在12个月时，CLES患者无药的比例几乎是DBS患者的三倍（分别为29.41%和10.31%，p = 0.0123）。
CLES和DBS等设备辅助疗法在显著降低帕金森病相关药片负担方面是有效的。与接受DBS治疗的患者相比，接受CLES治疗的患者更有可能达到无药状态。
