Comparison of Efficacy and Safety of Device-Based Interventions Versus Pharmacological Therapy in the Management of Patients With Advanced Parkinson's Disease: A Literature Review.

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms that profoundly impact patients' quality of life. While pharmacological therapies such as levodopa remain the mainstay of treatment, their long-term use is often limited by motor complications. Device-based interventions, including deep brain stimulation (DBS) and continuous dopaminergic infusions, have emerged as alternatives, promising sustained symptomatic control and reduced medication-related side effects. This systematic review and meta-analysis evaluate the comparative efficacy, safety, and cost-effectiveness of device-based interventions versus pharmacological therapies in the management of advanced PD. A comprehensive search was conducted across multiple databases to identify randomized controlled trials, observational studies, and systematic reviews. Primary outcomes included motor function improvement, quality of life, and adverse events. Meta-analyses were performed, and subgroup analyses explored the effectiveness of specific interventions. Device-based interventions demonstrated superior efficacy over pharmacological therapies, with a pooled effect size (Cohen's d) of 1.12 (95% confidence interval (CI): 0.94-1.29) for motor symptom control and quality of life improvements. Subgroup analyses showed DBS and levodopa-carbidopa intestinal gel to be particularly effective, with levodopa-carbidopa intestinal gel showing a Cohen's d of 1.25 (95% CI: 0.91-1.58). Device-based therapies also reduced medication dosages and associated motor complications. Sensitivity analyses confirmed the robustness of these findings, and no significant publication bias was detected. However, gaps remain in understanding the long-term outcomes and cost-effectiveness of these interventions. Device-based interventions, especially DBS and levodopa-carbidopa intestinal gel, offer superior symptom control and quality of life improvements compared to traditional pharmacological therapies in advanced PD. These findings support the integration of device-based therapies into personalized treatment strategies. Further research is needed to explore long-term outcomes and establish standardized guidelines for their implementation in clinical practice.