Takeda Atsushi, Baba Toru, Watanabe Jun, Nakayama Masahiko, Hozawa Hiroyuki, Ishido Miwako
Department of Neurology, National Hospital Organization Sendai Nishitaga Hospital, 2-11-11 Kagitorihoncho, Taihaku-ku, Sendai 982-8555, Japan.
Department of Cognitive & Motor Aging, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aobaku, Sendai 980-8575, Japan.
Parkinsons Dis. 2023 Sep 27;2023:9404207. doi: 10.1155/2023/9404207. eCollection 2023.
Prescription doses of levodopa in patients with advanced Parkinson's disease (PD) are generally lower in Japan than in the United States or Europe, although Japanese guidelines for the management of PD recommend increasing the dosage as the disease progresses. However, data regarding levodopa prescription practices in patients with advanced PD in the clinical setting are limited. This retrospective observational study analyzed patterns of drug use for patients with advanced PD in Japan using claims data from hospitalized patients in the Medical Data Vision Co. database. Eligible patients had at least two PD-associated claims in two different quarters between April 1, 2008, and November 30, 2018, and a 10-item activities of daily living score <60 upon hospital discharge (as a proxy for advanced PD). The primary endpoint was the prescribed dosage of levodopa at the index hospitalization. Dosages of other PD drugs (medications with an on-label indication for PD) and non-PD drugs were also assessed. Overall, 4029 patients met the inclusion criteria (mean age, 76.9 years; 83.3% aged ≥70 years). At the index date, 74.0% were receiving levodopa. Patients received a median of one PD drug in addition to levodopa, and 27.4% and 20.2% received one or two concomitant PD drugs, respectively. Patients received a median of two non-PD drugs. The median levodopa dosage and total levodopa equivalent dosage (LED) at the index hospitalization were 418.2 and 634.8 mg/day (adjusted for body weight, 9.0 and 13.7 mg/kg/day), respectively. The median levodopa and total LED dosage in each 6-month increment during the 5 years before and after the index date ranged between 263.9 and 330.2 mg/day (5.0 and 6.5 mg/kg/day) and 402.0 and 504.9 mg/day (8.3 and 10.1 mg/kg/day), respectively. This study suggests that many Japanese patients with advanced PD could receive more intensive treatment with higher doses of levodopa.
在日本，晚期帕金森病（PD）患者左旋多巴的处方剂量通常低于美国或欧洲，尽管日本帕金森病管理指南建议随着疾病进展增加剂量。然而，关于临床环境中晚期PD患者左旋多巴处方实践的数据有限。这项回顾性观察研究利用Medical Data Vision公司数据库中住院患者的理赔数据，分析了日本晚期PD患者的用药模式。符合条件的患者在2008年4月1日至2018年11月30日期间的两个不同季度中至少有两项与PD相关的理赔记录，且出院时日常生活活动能力10项评分<60分（作为晚期PD的替代指标）。主要终点是索引住院时左旋多巴的处方剂量。还评估了其他PD药物（有PD标签适应症的药物）和非PD药物的剂量。总体而言，4029名患者符合纳入标准（平均年龄76.9岁；83.3%年龄≥70岁）。在索引日期，74.0%的患者正在接受左旋多巴治疗。除左旋多巴外，患者接受的PD药物中位数为一种，27.4%和20.2%的患者分别接受一种或两种伴随的PD药物。患者接受的非PD药物中位数为两种。索引住院时左旋多巴的中位数剂量和总左旋多巴等效剂量（LED）分别为418.2和634.8毫克/天（根据体重调整后为9.0和13.7毫克/千克/天）。索引日期前后5年中，每6个月增量的左旋多巴和总LED剂量中位数分别在263.9至330.2毫克/天（5.0至6.5毫克/千克/天）和402.0至504.9毫克/天（8.3至10.1毫克/千克/天）之间。这项研究表明，许多日本晚期PD患者可以接受更高剂量左旋多巴的强化治疗。
