Gremke Niklas, Griewing Sebastian, Printz Marcel, Kostev Karel, Wagner Uwe, Kalder Matthias
Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043 Marburg, Germany.
Department of Neurology, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043 Marburg, Germany.
J Clin Med. 2022 Nov 29;11(23):7077. doi: 10.3390/jcm11237077.
The occurrence of autonomic dysfunctions (e.g., urological dysfunctions) is a common phenomenon during the course of Parkinson's disease (PD) and resulting complications such as lower urinary tract infections (LUTI) are one of the leading causes of hospitalizations and mortality in patients with the condition. Therefore, the aim of this retrospective cohort study was to compare the most common levodopa-based treatment regimens (DOPA decarboxylase inhibitor (DCI) + carbidopa or benserazide) and to analyze the incidence of LUTI and antibiotic prescriptions in patients receiving the respective treatments.
This study was based on data from the Disease Analyzer database (IQVIA) and included adult patients (≥18 years) with an initial prescription of levodopa therapy including fixed-dose levodopa/DCI combinations in 1284 general practices in Germany between January 2010 and December 2020. Conditional Cox regression models were used to analyze the association between levodopa/DCI combinations and LUTI incidence and antibiotic prescriptions.
Compared to levodopa + carbidopa, levodopa + benserazide therapy was significantly and negatively associated with LUTI (HR: 0.82; 95% CI: 0.71-0.95). This association was stronger in women (HR: 0.77; 95% CI: 0.65-0.92) than in men (HR: 0.93, not significant).
Especially in women, receiving levodopa + benserazide prescriptions was associated with a lower LUTI incidence. It is important for clinicians to keep this in mind, since LUTI is a leading cause of hospitalizations, morbidity, and mortality in patients with PD.
自主神经功能障碍（如泌尿系统功能障碍）的发生是帕金森病（PD）病程中的常见现象，由此引发的并发症如下尿路感染（LUTI）是该疾病患者住院和死亡的主要原因之一。因此，这项回顾性队列研究的目的是比较最常见的基于左旋多巴的治疗方案（多巴脱羧酶抑制剂（DCI）+卡比多巴或苄丝肼），并分析接受相应治疗的患者中LUTI的发生率和抗生素处方情况。
本研究基于疾病分析器数据库（IQVIA）的数据，纳入了2010年1月至2020年12月期间在德国1284家普通诊所接受左旋多巴治疗初始处方（包括固定剂量左旋多巴/DCI组合）的成年患者（≥18岁）。使用条件Cox回归模型分析左旋多巴/DCI组合与LUTI发生率和抗生素处方之间的关联。
与左旋多巴+卡比多巴相比，左旋多巴+苄丝肼治疗与LUTI显著负相关（HR：0.82；95%CI：0.71-0.95）。这种关联在女性中（HR：0.77；95%CI：0.65-0.92）比在男性中（HR：0.93，无显著性）更强。
特别是在女性中，接受左旋多巴+苄丝肼处方与较低的LUTI发生率相关。临床医生牢记这一点很重要，因为LUTI是PD患者住院、发病和死亡的主要原因。
