Harrison-Jones Glynn, Marston Xiaocong Li, Morgante Francesca, Chaudhuri K Ray, Castilla-Fernández Guillermo, Di Foggia Valentina
Bial Pharma UK Ltd, Windsor, UK.
OPEN Health, Evidence & Access, Marlow, UK.
Eur J Neurol. 2023 Oct;30(10):3132-3141. doi: 10.1111/ene.15990. Epub 2023 Aug 19.
Motor fluctuations are a significant driver of healthcare resource utilization (HCRU) in people with Parkinson's disease (pwPD). A common management strategy is to include catechol-O-methyltransferase (COMT) inhibition with either opicapone or entacapone in the levodopa regimen. However, to date, there has been a lack of head-to-head data comparing the two COMT inhibitors in real-world settings. The aim of this study was to evaluate changes in HCRU and effect on sleep medications when opicapone was initiated as first COMT inhibitor versus entacapone.
In this retrospective cohort study, we assessed HCRU outcomes in pwPD naïve to COMT inhibition via UK electronic healthcare records (Clinical Practice Research Datalink and Hospital Episodes Statistics databases, June 2016 to December 2019). HCRU outcomes were assessed before (baseline) and after COMT inhibitor prescription at 0-6 months, 7-12 months and 13-18 months. Opicapone-treated pwPD were algorithm-matched (1:4) to entacapone-treated pwPD.
By 6 months, treatment with opicapone resulted in 18.5% fewer neurology outpatient visits compared to entacapone treatment; this effect was maintained until the last follow-up (18 months). In the opicapone group, the mean levodopa equivalent daily dose decreased over the first year and then stabilized, whereas the entacapone-treated group showed an initial decrease in the first 6 months followed by a dose increase between 7 and 18 months. Neither COMT inhibitor had a significant impact on sleep medication use.
This head-to-head study is the first to demonstrate, using 'real-world' data, that initiating COMT inhibition with opicapone is likely to decrease the need for post-treatment HCRU versus initiation of COMT inhibition with entacapone.
运动波动是帕金森病患者医疗资源利用（HCRU）的一个重要驱动因素。一种常见的管理策略是在左旋多巴治疗方案中加入儿茶酚-O-甲基转移酶（COMT）抑制剂奥匹卡朋或恩他卡朋。然而，迄今为止，在实际临床环境中，缺乏比较这两种COMT抑制剂的直接对比数据。本研究的目的是评估当奥匹卡朋作为首个COMT抑制剂与恩他卡朋相比，启动治疗后HCRU的变化以及对睡眠药物的影响。
在这项回顾性队列研究中，我们通过英国电子医疗记录（临床实践研究数据链和医院事件统计数据库，2016年6月至2019年12月）评估了未接受过COMT抑制治疗的帕金森病患者的HCRU结局。在开始使用COMT抑制剂之前（基线）以及治疗后0 - 6个月、7 - 12个月和13 - 18个月评估HCRU结局。接受奥匹卡朋治疗的帕金森病患者与接受恩他卡朋治疗的患者进行算法匹配（1:4）。
到6个月时，与恩他卡朋治疗相比，奥匹卡朋治疗使神经科门诊就诊次数减少了18.5%；这种效果一直维持到最后一次随访（18个月）。在奥匹卡朋组，左旋多巴等效日剂量在第一年下降，然后稳定下来，而恩他卡朋治疗组在最初6个月剂量下降，随后在7至18个月剂量增加。两种COMT抑制剂对睡眠药物的使用均无显著影响。
这项直接对比研究首次使用“真实世界”数据表明，与使用恩他卡朋启动COMT抑制治疗相比，使用奥匹卡朋启动COMT抑制治疗可能会减少治疗后对HCRU的需求。
