Treatment stability comparison among different ADD-ON therapies in fluctuating Parkinson's disease patients: the role of clinical and demographic factors.
Treatment stability comparison among different ADD-ON therapies in fluctuating Parkinson's disease patients: the role of clinical and demographic factors.
Where did the research take place?
The study site has not been established. Author addresses may differ from where the research occurred.
Rome, IT · Author affiliation
Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Via di Grottarossa, 1035, Rome, 00189, Italy. domiziana.rinaldi@uniroma1.it.Location evidence
Turin, IT · Author affiliation
Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.Location evidence
Grenoble, FR · Author affiliation
AGEIS, Université Grenoble Alpes, Grenoble, 38000, France.Location evidence
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Original abstract
IntroductionMotor fluctuations represent a major challenge in Parkinson's disease (PD) management. To address them, ADD-ON therapies with monoamine oxidase type B (MAO-B) and catechol-O-methyl transferase (COMT) inhibitors are used to enhance and prolong dopaminergic effects of levodopa, thereby improving motor fluctuations. Despite widespread use, real-life comparative data remain limited.MethodsWe performed a retrospective, longitudinal study including PD patients referred to two Italian tertiary movement disorder centers. Patients with motor fluctuations requiring ADD-ON therapy (selegiline [SL], rasagiline [RS], safinamide [SF], or opicapone [OP]) and ≥ 12 months of follow-up were included. The primary outcome was treatment stability, defined as months without significant therapy modifications or ADD-ON discontinuation. Secondary outcomes included levodopa dosage changes, initiation of other antiparkinsonian therapies, and ADD-ON discontinuation rates. Cox regression models and Kaplan-Meier survival analyses evaluated the influence of ADD-ON type and clinical-demographic variables on treatment stability.ResultsWe analyzed 169 patients (SL = 20; RS = 26; SF = 78; OP = 45). Groups differed in age at ADD-ON initiation (p = 0.020; RS > OP), disease duration (p = 0.002; OP > RS and SF), and baseline levodopa equivalent daily dose (p = 0.003; SF and OP > RS). No significant differences in treatment stability were found between groups (p = 0.29). SF group showed higher levodopa increases (p = 0.02) and initiation of new therapies (p = 0.02). ADD-ON discontinuation occurred in 23.1% of patients, mainly due to AEs (16.6%). Cox regression showed no significant predictors of treatment stability.ConclusionsAll ADD-ON therapies showed comparable treatment stability and tolerability. No statistically significant sex-related differences were observed, although a trend toward more frequent therapy modifications was found in female patients.