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. 2022 May;39(5):2009-2024.
doi: 10.1007/s12325-022-02072-x. Epub 2022 Mar 5.

Long-Term Persistence and Monotherapy with Device-Aided Therapies: A Retrospective Analysis of an Israeli Cohort of Patients with Advanced Parkinson's Disease

Avner Thaler  1   2   3 , Yael Barer  4 , Ruth Gross  5 , Raanan Cohen  5 , Lars Bergmann  6 , Yash J Jalundhwala  6 , Nir Giladi  7   8   9 , Gabriel Chodick  4   10 , Varda Shalev  4 , Tanya Gurevich  7   8   9
Affiliations

Long-Term Persistence and Monotherapy with Device-Aided Therapies: A Retrospective Analysis of an Israeli Cohort of Patients with Advanced Parkinson's Disease

Avner Thaler et al. Adv Ther. 2022 May.

Abstract

Introduction: Patients with advanced Parkinson's disease (PD) may require device-aided therapies (DAT) for adequate symptom control. However, long-term, real-world efficacy and safety data are limited. This study aims to describe real-world, long-term treatment persistence for patients with PD treated with levodopa-carbidopa intestinal gel (LCIG). The study also aims to describe patient profiles, treatment discontinuation rates, co-medication patterns, monotherapy rates, and rates of healthcare visits and their associated costs for patients receiving all forms of DAT (deep brain stimulation [DBS], continuous subcutaneous apomorphine infusion [CSAI], or LCIG).

Methods: In this retrospective analysis of the Israeli Maccabi Healthcare Services database, adult patients with PD were analyzed in three cohorts, based on DAT (DBS, CSAI, or LCIG). The primary endpoint was LCIG treatment persistence 12 months after initiation.

Results: This analysis included 161 DAT-treated patients (LCIG, n = 62; DBS, n = 76; CSAI, n = 23). Among those who discontinued, the mean time to discontinuation was 86.4 months for LCIG and 42.4 months for CSAI (p = 0.046). Twelve months after initiation, 14.3% LCIG, 10.7% DBS, and 5.9% CSAI patients were not receiving any additional anti-parkinsonian therapy. At the last recorded visit, 28.6% LCIG, 13.3% DBS, and 5.9% CSAI patients received DAT as monotherapy. During the first 12 months after initiation, 45.2% LCIG, 65.2% CSAI, and 1.3% DBS patients had no reported hospitalization days. Annual healthcare visit costs decreased following LCIG initiation (US$9491 vs. $8146) and increased following DBS ($4113 vs. $7677) and CSAI ($6378 vs. $8277).

Conclusion: DAT are well maintained in patients with advanced PD. These retrospective data suggest that patients receiving LCIG may have higher long-term persistence rates compared with patients receiving CSAI. A subgroup of patients was treated with DAT as monotherapy without additional oral anti-parkinsonian therapy, with LCIG showing the highest rates.

Keywords: Apomorphine; Deep brain stimulation; Levodopa infusion; Monotherapy; Parkinson’s disease; Treatment persistence.

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Figures

Fig. 1
Fig. 1
Reasons for exclusion. aPatients were excluded for not having a diagnosis of PD. The diagnoses of these patients were not recorded in this study. CSAI continuous subcutaneous apomorphine infusion, DAT device-aided therapy, DBS deep brain stimulation, LCIG levodopa-carbidopa intestinal gel, PD Parkinson’s disease
Fig. 2
Fig. 2
Time to discontinuation of DAT. p values were calculated using the log-rank test. CSAI continuous subcutaneous apomorphine infusion, DAT device-aided therapy, LCIG levodopa-carbidopa intestinal gel. aMean months of follow-up are shown as median not reached in LCIG group. p value was calculated using log-rank test
Fig. 3
Fig. 3
Treatments for Parkinson’s disease given in addition to DAT over time. CR controlled-release, CSAI continuous subcutaneous apomorphine infusion, DAT device-aided therapy, DBS deep brain stimulation, LCIG levodopa-carbidopa intestinal gel, PD Parkinson’s disease. aZero added PD medications represents monotherapy. bPatients with DAT monotherapy and only CR formulations of levodopa as additional oral co-medication. cNumber of added PD medications refers to those given in addition to DAT in the 6 months before baseline, 90 days before and 90 days after the 12-month timepoint, and 6 months before final DAT. Levodopa may be included in the number of added PD medications. p values were calculated using chi-square test
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References

    1. Antonini A, Chaudhuri KR, Martinez-Martin P, Odin P. Oral and infusion levodopa-based strategies for managing motor complications in patients with Parkinson's disease. CNS Drugs. 2010;24(2):119–129. doi: 10.2165/11310940-000000000-00000. - DOI - PubMed
    1. Chaudhuri KR, Schapira AH. Non-motor symptoms of Parkinson's disease: dopaminergic pathophysiology and treatment. Lancet Neurol. 2009;8(5):464–474. doi: 10.1016/S1474-4422(09)70068-7. - DOI - PubMed
    1. Odin P, Ray Chaudhuri K, Slevin JT, Volkmann J, Dietrichs E, Martinez-Martin P, et al. Collective physician perspectives on non-oral medication approaches for the management of clinically relevant unresolved issues in Parkinson's disease: Consensus from an international survey and discussion program. Parkinsonism Relat Disord. 2015;21(10):1133–1144. doi: 10.1016/j.parkreldis.2015.07.020. - DOI - PubMed
    1. Fox SH, Katzenschlager R, Lim SY, Barton B, de Bie RMA, Seppi K, et al. International Parkinson and Movement Disorder Society evidence-based medicine review: update on treatments for the motor symptoms of Parkinson's disease. Mov Disord. 2018;33(8):1248–1266. doi: 10.1002/mds.27372. - DOI - PubMed
    1. DeMaagd G, Philip A. Parkinson's disease and its management: part 3: Nondopaminergic and nonpharmacological treatment options. P T. 2015;40(10):668–679. - PMC - PubMed

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