A review of patient data raises the question: Is it time for a formal update of the diagnosis and treatment guidelines for Parkinson's disease?
TORONTO—More than one-quarter of patients diagnosed with Parkinson’s disease are not treated with medications in the first year after the initial diagnosis, according to research presented at the 62nd Annual Meeting of the American Academy of Neurology. This was one of the findings from an analysis of nationwide patterns of diagnosis and treatment in patients who were recently diagnosed with Parkinson’s disease conducted by Maureen J. Lage, PhD, of HealthMetrics Outcome Research, Groton, Connecticut, and colleagues at Teva Neuroscience Inc, Kansas City, Missouri.
The researchers used two HIPAA-compliant databases—one from a private commercial insurer and the other from Medicare—to compile demographic information on 25,444 patients who were diagnosed with Parkinson’s disease between January 2004 and June 2008. All participants also had continuous insurance coverage from the six months prior to diagnosis to one year after diagnosis, comprising the 18-month period each subject was followed. The investigators pointed out that “this analysis serves to update the current literature,” after a previous analysis, published in 2009, included data from 1999 to 2001.
“The study examines ‘real world’ practice patterns associated with a diagnosis of Parkinson’s disease,” Dr. Lage told Neurology Reviews. “As such, it allows for how actual use compares to treatment guidelines for the disease. Physicians can compare treatment of Parkinson’s disease in a relatively large sample to their practice patterns, as well as gain some understanding of some common therapy regimens for the disease.”
Trends in Treatment and Diagnosis
The patients’ mean diagnosis age was 75, and the majority of patients were male (55%). Diagnosis was highest among those living in the north central (39%) and southern (31%) regions of the United States.
During the study period, 28% of patients were not treated with a Parkinson’s disease medication, while 36% received such medication in the six months prior to the index date. Of those who received medication, half were given a prescription prior to diagnosis, while 39% were given the medication after their initial diagnosis.
Of the subjects who filled a prescription, 75% were initially prescribed either carbidopa/levodopa or carbidopa/levodopa/entacapone. In those who received medication for the entire 18-month period, 14% switched therapies. The most common switches were from carbidopa/levodopa to a dopamine agonist (23%) or from a dopamine agonist to carbidopa/levodopa (20%).
More than 20% of subjects used more than one class of medications simultaneously, with the most common being a combination of a dopamine agonist and carbidopa/levodopa. In addition, patients with Parkinson’s disease were also commonly prescribed an antidepressant (45%), antipsychotic (17%), and/or anxiolytic (16%).
Is an Update Warranted?
“As Parkinson’s disease treatment algorithms and therapeutic options are being continuously updated by the neurology community, this study provides a current view of nationwide Parkinson’s disease diagnosis and treatment patterns. These findings may suggest a need for a formal update of Parkinson’s disease treatment guidelines,” Dr. Lage said. “This type of analysis also continues to highlight the ongoing educational need for the target community of healthcare practitioners and payers regarding updated Parkinson’s disease guidelines, including recommendations for timing and selection of appropriate initial Parkinson’s disease therapy.”
—Rebecca K. Abma