Advanced Parkinson's disease treatment patterns in Italy: results from a multicenter observational study.
Advanced Parkinson's disease treatment patterns in Italy: results from a multicenter observational study.
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Original abstract
BACKGROUND AND OBJECTIVES: Substitution therapy with oral levodopa is the primary treatment of Parkinson's disease (PD). However, long-term levodopa use is associated with fluctuations in response and dyskinesia. These complications severely affect the patient quality of life. Fluctuation management in long-standing PD is poorly documented. The Parkinson's Disease Fluctuations treatment Pathway (PD-FPA) study was an Italian multicenter, observational study designed to describe how fluctuations are treated in patients with advanced disease. PATIENTS AND METHODS: Between July 2018 and December 2020, ten centres enrolled consecutive patients aged ≥18 years who had been diagnosed with PD 10-15 years before enrollment and had been experiencing fluctuations for at least 2 years before enrollment. Data on patient characteristics, PD stage, fluctuations, and treatments were collected at enrollment (T0) and prospectively at 6 months (T1) and 12 months (T2). Data were also collected retrospectively, at 1 and 2 years before T0. RESULTS: At T0, patients (n = 296, 60.1% male, mean age 68 years) had Hoehn and Yahr disease stage 2-3 and 47% had comorbidities (29.8% cardiovascular disease). PD stage and other PD assessment scores were overall stable during the entire 3-year observation period. Over 3 years, the use of dopamine agonists progressively decreased (51% of patients at T2), the use of monoamine oxidase-B inhibitors was stable (63%), while the use of catechol-O-methyltransferase inhibitors progressively increased (42%). Safinamide and opicapone showed the biggest increase in use over the 3-year observation period. Treatment changes were mostly prompted by fluctuations and were reported in about 50% of patients at T0 and 30% at T1 and T2. CONCLUSION: Maintenance of stable disease in patients with long-standing PD and fluctuations is feasible with non-invasive treatments. Accurate treatment adjustments and individualized strategies with new-generation add-on drugs may be of key importance.