Frazer Monica, Arcona Steve, Le Lisa, Sasane Rahul
QualityMetric, USA.
Cerevel Therapeutics, USA.
Clin Park Relat Disord. 2022 Dec 17;8:100173. doi: 10.1016/j.prdoa.2022.100173. eCollection 2023.
To characterize patients with Parkinson's disease (PD) who initiated dopamine agonist (DA) monotherapy, describe medication utilization and provider types, and estimate medication adherence and discontinuation rates.
Retrospective study identified patients with PD in the Optum Research Database and included those with ≥1 claim for DA or levodopa between 09/01/2012 and 12/31/2018, ≥2 PD diagnoses, commercial or Medicare Advantage Part D (MAPD) insurance, ≥40 years old, and continuous medical and pharmacy coverage ≥12 months before and after index date. A subset of patients receiving DA monotherapy was selected for this analysis. Variables were analyzed descriptively. Adherence was measured with medication possession ratio (MPR) and proportion of days covered (PDC); defined as ≥0.80.
Patients (N = 642) had mean (SD) age of 70.2 (9.9) years, 70.6 % had MAPD coverage, and 61.7 % were male. Neurologists prescribed 64.6 % of DA monotherapy, and 56.9 % of patients had ≥2 PD diagnoses before or on the index date. Index therapy was discontinued by 44.1 % of patients, and 55.9 % persisted for 12 months without change. Mean (SD) time to discontinuation was 102 (79) days. Mean (SD) MPR for patients (n = 562) with ≥2 fills was 0.84 (0.2); 70.3 % were MPR adherent. Mean (SD) PDC for all 642 patients was 0.66 (0.3); 50.5 % were PDC adherent.
Adherence and continuation of therapy were suboptimal, which could translate into poor patient outcomes. Future studies could provide insights on the impact of low adherence and persistence with DA monotherapy.
对开始多巴胺激动剂（DA）单药治疗的帕金森病（PD）患者进行特征描述，描述药物使用情况和医疗服务提供者类型，并评估药物依从性和停药率。
回顾性研究在Optum研究数据库中识别出PD患者，纳入2012年9月1日至2018年12月31日期间有≥1次DA或左旋多巴索赔记录、≥2次PD诊断、商业保险或医疗保险优势计划D部分（MAPD）保险、年龄≥40岁且在索引日期前后连续12个月以上有医疗和药房保险的患者。选择接受DA单药治疗的患者子集进行该分析。对变量进行描述性分析。采用药物持有率（MPR）和覆盖天数比例（PDC）衡量依从性；定义为≥0.80。
患者（N = 642）的平均（标准差）年龄为70.2（9.9）岁，70.6%有MAPD保险，61.7%为男性。神经科医生开出了64.6%的DA单药治疗处方，56.9%的患者在索引日期之前或当日有≥2次PD诊断。44.1%的患者停止了索引治疗，55.9%的患者持续12个月无变化。平均（标准差）停药时间为102（79）天。有≥2次配药的患者（n = 562）的平均（标准差）MPR为0.84（0.2）；70.3%的患者MPR依从。所有642例患者的平均（标准差）PDC为0.66（0.3）；50.5%的患者PDC依从。
治疗的依从性和持续性不理想，这可能导致患者预后不良。未来的研究可以提供关于DA单药治疗依从性低和持续性的影响的见解。
