Li Wenting, Zhang Hua, Zhang Yuan, Wang Ke, Hui Jiaojiao, Yi Zhanmiao
Department of Pharmacy, Peking University Third Hospital, Beijing, China.
Department of Pharmacy, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.
CNS Neurosci Ther. 2024 Apr;30(4):e14531. doi: 10.1111/cns.14531. Epub 2023 Nov 20.
This study aimed to systematically compare the effectiveness, safety, and costs of different anti-Parkinson drugs (APDs).
This is a multi-center study that retrospectively analyzed the data of 8420 outpatients with PD from 2014 to 2019 across 30 tertiary hospitals in China. The effectiveness was evaluated by changes in total dosages of APDs, normalized by levodopa equivalent dose (LED) and presented as ΔLEDs; levodopa equivalent dose cost (LEDc) represented the daily cost of APDs; and newly added diagnostics were represented as APDs-related adverse events.
A total of 384 patients with eligible medical records for three consecutive years were enrolled. Patients treated with carbidopa/levodopa or levodopa/benserazide had significantly lower mean ΔLEDs than other groups (p < 0.01), followed by pramipexole and selegiline. The piribedil group had the highest ΔLEDs, with mean differences of 112.56-355.04 mg compared to other groups (p < 0.01). Meanwhile, LEDc in the levodopa/benserazide, carbidopa/levodopa, and piribedil groups were significantly lower than those in pramipexole or selegiline groups ($0.088-0.135/day for levodopa/benserazide; $0.070-0.126/day for carbidopa/levodopa; $0.112-0.138/day for piribedil; $0.290-0.332/day for pramipexole; $0.229-0.544/day for selegiline; p < 0.01). Patients with piribedil had more adverse events, with an incidence rate of 35.7%, followed by levodopa/benserazide (25.6%), selegiline (23.5%), carbidopa/levodopa (23.3%), and pramipexole (16.4%). Pramipexole showed a lower incidence rate of adverse events than piribedil, including neuropsychiatric symptoms (p = 0.006), headache/dizziness (p = 0.016), and gastrointestinal symptoms (p = 0.031).
Carbidopa/levodopa or levodopa/benserazide might exhibit better clinical improvement with less medical cost, while piribedil presented less clinical improvement but a higher risk of headache/dizziness, gastrointestinal, and neuropsychiatric symptoms.
本研究旨在系统比较不同抗帕金森病药物（APD）的有效性、安全性和成本。
这是一项多中心研究，回顾性分析了2014年至2019年中国30家三级医院8420例帕金森病门诊患者的数据。有效性通过APD总剂量的变化进行评估，以左旋多巴等效剂量（LED）进行标准化，并表示为ΔLEDs；左旋多巴等效剂量成本（LEDc）代表APD的每日成本；新增诊断以APD相关不良事件表示。
共纳入384例连续三年有合格病历的患者。接受卡比多巴/左旋多巴或左旋多巴/苄丝肼治疗的患者平均ΔLEDs显著低于其他组（p<0.01），其次是普拉克索和司来吉兰。吡贝地尔组的ΔLEDs最高，与其他组相比平均差异为112.56 - 355.04mg（p<0.01）。同时，左旋多巴/苄丝肼、卡比多巴/左旋多巴和吡贝地尔组的LEDc显著低于普拉克索或司来吉兰组（左旋多巴/苄丝肼为0.088 - 0.135美元/天；卡比多巴/左旋多巴为0.070 - 0.126美元/天；吡贝地尔为0.112 - 0.138美元/天；普拉克索为0.290 - 0.332美元/天；司来吉兰为0.229 - 0.544美元/天；p<0.01）。吡贝地尔治疗的患者不良事件更多，发生率为35.7%，其次是左旋多巴/苄丝肼（25.6%）、司来吉兰（23.5%）、卡比多巴/左旋多巴（23.3%）和普拉克索（16.4%）。普拉克索的不良事件发生率低于吡贝地尔，包括神经精神症状（p = 0.006）、头痛/头晕（p = 0.016）和胃肠道症状（p = 0.031）。
卡比多巴/左旋多巴或左旋多巴/苄丝肼可能在临床改善方面表现更好且医疗成本更低，而吡贝地尔的临床改善较少，但头痛/头晕、胃肠道和神经精神症状的风险较高。
